The Do’s and Don’ts of Medicine

On Sunday I stumbled on something that made me stop and think through a few issues about American medical care. I have long been a believer in universal healthcare and yes, I consider getting the best healthcare available to all citizens (and even others in our country who are not citizens) to be one of those inalienable human rights that the U.S. Constitution states as unalienable. If a human being can do something to help or medically save another human from misery or a life-threatening problem, they should do it. Obviously there are always circumstances, like those nasty ethical conundrums where you have to choose between this life or that life, but that is why I say “can do”, since I recognize that sometimes one can do nothing or too little. Otherwise, as Nike would say…just do it.

I also recall during my college days that becoming a doctor was a goal for many young people, sometimes for caring reasons and probably more often for economic/prestige reasons. Being a doctor was a very lucrative gig. What we know about universal healthcare is that it tends to make being a doctor a less lucrative gig. The most economically-driven sorts probably go in different directions today, but medical schools are still inundated with applications and have no shortage of good applicants. Women now dominate medical school enrollment in the United States, representing a historic transformation from an almost entirely male field to one where women are the clear majority. For the sixth year in a row, women made up the majority of applicants, matriculants, and total enrollment. In 2024-25, women comprised 56.8% of applicants, 55.1% of matriculants, and 54.9% of total enrollment. Women comprised the majority of enrolled U.S. medical students for the first time, according to 2019 data released by the AAMC (Association of American Medical Colleges). The proportion of women students has been rising over recent years, from 46.9% in 2015 to 49.5% in 2018. In 2019, women comprise 50.5% of all medical school students. According to data published in The Wall Street Journal recently, women make up nearly six in 10 students enrolled in college. So, the fact that medical schools are now accepting more women than men mirrors trends at the undergraduate level. Today, 47% of US women aged 25-34 years have a bachelor’s degree compared with 37% of men.

The history of women in medicine is a compelling story of breaking barriers, overcoming discrimination, and gradually transforming a male-dominated field into one where women now represent the majority of medical students. Records from Ancient Egypt note women physicians such as Meit Ptah who lived around 2700 BCE. The real trailblazer in 1849 was Elizabeth Blackwell, who became the first woman in the United States to be granted an MD degree. The primary barriers in women obtaining a truly complete medical education was the struggle to obtain clinical training and internships. Since the medical traditionalists could not prevent the classroom training of female students, they tried to prevent them from receiving their license to practice. And after graduating, many women found they were banned from internships, residencies, and medical societies – and they began opening their own hospitals and clinics. The number of women in medical schools tripled between 1970 and 1975. Nearly half of new medical school students were women as the 21st century began. According to the American Medical Association, women now make up 36 percent of America’s physician workforce, compared to just 6 percent in 1950. Some female physicians say their patients and families often assume they are nurses.

The downside of this is that the productivity of our medical professional pipeline suffers from this shift. As politically incorrect as that sounds, the research reveals significant differences in career duration and patterns between female and male physicians, with women consistently having shorter professional careers across multiple dimensions. Female physicians retire 4.1 years earlier than their male counterparts. Female physicians are also more likely to report higher levels of depression and burnout than male physicians – possibly because they often shoulder a great burden in terms of childcare and housework at home. They get better grades and may well be better doctors on overage, but for every med school slot they take, they work 35% less time than men over their working lives. According to the University of Michigan’s Intern Health Study, almost 40% of women physicians scale back their medical practice, or leave the profession altogether, early in their careers. The primary reason? Family. Female physicians had higher attrition rates than their male counterparts across every career stage. Lack of support and higher degrees of burnout may well play as crucial a role as work-family issues.

That means our medical professional pipeline school productivity has worsened through this demographic trend. The bottom line is that after being virtually excluded from medicine for centuries, women now comprise 55% of medical school students and have been the majority for eight consecutive years. Now our society needs to address the gap that is creating.

That’s where the issue of the DO versus MD issue comes into play. DO (Doctor of Osteopathic Medicine) and MD (Doctor of Medicine) are both medical degrees that lead to becoming a fully licensed physician in the United States, but they represent different approaches to medical education and practice. Where MD programs have not grow to keep pace with medical demand, 17 new DO programs have started just in the last five years. Both DOs and MDs complete four years of medical school, followed by residency training in their chosen specialty. They can prescribe medications, perform surgery, and practice in all medical specialties. Both must pass licensing exams and meet the same requirements for medical licensure. DOs follow osteopathic principles that emphasize the body’s ability to heal itself and do Manipulative Treatment (OMT), which involves hands-on techniques to diagnose and treat musculoskeletal problems. They take a more holistic approach, considering the whole person rather than just symptoms, Many DOs and MDs practice very similarly once they complete their training. Some DOs regularly use OMT in their practice, while others rarely do. Both can specialize in any medical field and are equally qualified to provide medical care.

DOs have become increasingly prevalent in medicine today, representing a significant and growing portion of the physician workforce in the United States. Over the past 150 years, the osteopathic medical profession has grown exponentially and today represents approximately 11% of all physicians and 28% of all medical students in the U.S.. The number of osteopathic physicians in the U.S. has increased by more than 70% in the past decade alone. More prospective physicians than ever before are choosing to become DOs, with nearly 40,000 medical students attending 42 colleges of osteopathic medicine across 67 campuses. Nearly 70% of DOs in active practice today are under age 45. The number of female osteopathic physicians is also on the rise, accounting for 45% of all DOs in active practice…a 25% greater penetration than among MDs…for good reasons…

Women are well suited to medicine and the rigorous intellectual training needed.

But women are less productive over their careers than men, requiring more medical training by the system overall.

That gap seems like it’s getting filled by the Osteopathy field and will be more and more, with more and more women, who may well prefer the means and methods of the DO versus the MD.