Salary Insights: DO vs MD - What Every Medical Student Should Know

The Untold Truth About Salary Differences Between DOs and MDs

The DO vs MD discussion often centers on one pressing question for premeds and medical students: Will my degree affect how much I earn as a physician?

Both DOs (Doctors of Osteopathic Medicine) and MDs (Doctors of Medicine) are fully licensed physicians in the United States with the same legal scope of practice. They can prescribe medications, perform surgery, enter any specialty, and lead healthcare teams. Yet salary surveys consistently show an average income gap between the two groups.

This difference, however, is less about the letters after your name and more about a complex interplay of factors: specialty choice, residency competitiveness, location, practice type, and even personal career goals.

This guide breaks down the real drivers behind physician salaries, clarifies myths about osteopathic medicine and income, and gives practical advice on how to think about salary differences if you’re deciding between DO vs MD.

---

DO vs MD: Training, Philosophy, and How They Relate to Income

To understand salary differences, you first need a clear picture of what distinguishes DO vs MD training—and what doesn’t.

Training and Education: More Similar Than Different

MD (Allopathic Medicine)

• Traditional pathway in the U.S. and globally recognized.
• Focuses on diagnosing and treating disease, often described as “disease-centered.”
• Curriculum emphasizes biomedical sciences, clinical skills, and evidence-based medicine.

DO (Osteopathic Medicine)

• Equally rigorous four-year medical education leading to full physician licensure.
• Includes all core biomedical and clinical training that MD programs provide.
• Adds a distinctive osteopathic philosophy:
  • Emphasis on the whole person (mind, body, spirit)
  • Focus on preventative care and functional health
  • Training in Osteopathic Manipulative Treatment (OMT)—hands-on techniques to diagnose and treat musculoskeletal dysfunction.

From a salary perspective, the extra osteopathic components (like OMT) do not inherently reduce or increase income. What they may influence, however, is the type of practice settings and specialties DOs gravitate toward, which in turn affects earnings.

Residency Matching: A Major Lever on Future Salary

Residency training is where salary trajectories begin to diverge, not because one degree is “inferior,” but because of differences in specialty distribution and competitiveness.

Historically:

• MD graduates matched at higher rates into some of the most competitive and highest-paying specialties, such as dermatology, orthopedic surgery, plastic surgery, and certain subspecialties.
• DO graduates were more heavily represented in primary care programs (family medicine, internal medicine, pediatrics), which generally pay less.

With the single accreditation system under the ACGME (completed in 2020), DO and MD graduates now apply through the same residency match system. DOs are increasingly represented in a wider array of residencies, including competitive specialties. However, long-standing patterns and institutional preferences still play some role in who gets which spots.

Scope of Practice: Equal on Paper, Different in Practice

Legally and clinically:

• Both DOs and MDs can practice medicine and surgery in all 50 states and U.S. territories.
• Both can become attendings, partners, department chairs, program directors, and hospital leaders.

In real-world practice:

• A larger proportion of DOs work in primary care, especially family medicine and rural medicine.
• A larger proportion of MDs enter subspecialties and procedural fields that have higher mean salaries.

This difference in specialty distribution is one of the primary reasons behind the salary gap—not that DOs are automatically paid less for the same job.

---

Physician Salary Overview: Big-Picture Trends for DOs and MDs

Average Physician Salaries: What Recent Data Shows

Surveys such as the Medscape Physician Compensation Report 2024 and similar sources provide a useful snapshot of physician salaries across the U.S. While exact numbers vary by source and methodology, the general pattern is consistent:

• Average MD salary: Around $400,000 annually
• Average DO salary: Around $350,000 annually

This roughly $50,000 difference is meaningful—but you should interpret it carefully:

• It is an average across all specialties and locations.
• It reflects who is in which specialty, not a formal pay cut for DOs.
• When DOs and MDs practice in the same specialty, same region, same setting, compensation is usually comparable.

Why Averages Can Be Misleading

Imagine two groups of 100 physicians:

• Group A (mostly MDs) with a higher proportion of orthopedic surgeons, dermatologists, and cardiologists.
• Group B (mostly DOs) with a higher proportion of family physicians, pediatricians, and general internists.

Even if each specialty pays the same to DO vs MD, the average salary in Group A will be higher simply because it has more high-earning specialists.

This is exactly what happens in many compensation surveys: specialty mix drives the difference far more than the degree itself.

---

Key Factors That Drive Salary Differences Between DOs and MDs

1. Specialty Choice: The Single Biggest Determinant

Specialty choice is by far the largest driver of lifetime earning potential in medical careers—for both DOs and MDs.

Approximate ranges (using broad national averages):

• Primary Care (Family Med, General Internal Med, Pediatrics):
  Usually $250,000–$350,000 annually.
• Hospital-Based or Cognitive Specialties (Neurology, Psychiatry, Endocrinology):
  Often $280,000–$400,000+ depending on region and practice type.
• Procedural and Surgical Specialties (Orthopedic Surgery, Cardiology, Derm, Radiology, Anesthesia):
  Commonly $450,000–$700,000+, with some surpassing that in high-volume practices.

Historically:

• DOs have been overrepresented in primary care, which drags down the average DO salary.
• MDs have been overrepresented in subspecialties and surgical fields, raising the group’s average.

However, this trend is shifting:

• More DOs are matching into specialties like anesthesiology, emergency medicine, PM&R, radiology, and even more competitive fields.
• As this happens, the DO vs MD salary gap is likely to narrow over time.

2. Geographic Location: Where You Practice Matters

Location significantly impacts physician salaries—often more than degree type.

• Rural or underserved regions

  • Frequently offer higher base salaries and signing bonuses to attract physicians.
  • Loan repayment incentives and retention bonuses are common.
  • Cost of living may be lower, translating into higher real purchasing power.

• Urban centers and coastal cities (e.g., NYC, San Francisco, Boston)

  • May have higher nominal salaries, but often extreme costs of living.
  • Intense competition among physicians can restrain salary growth.

Regional variations also matter:

• The Midwest and South often post the highest physician salaries.
• The Northeast and West Coast may offer prestige and academic opportunities, but often with relatively lower salary-to-cost-of-living ratios.

Both DOs and MDs are subject to these trends; your ZIP code often matters more than your degree.

3. Experience and Career Stage

Like most professions, physician salaries grow with experience:

• Residents and Fellows

  • DO and MD trainees generally receive similar stipends at the same institution and PGY level.
  • Degree type does not affect residency salary.

• Early-career Attendings (0–5 years)

  • Compensation is heavily influenced by initial contracts—base salary, productivity incentives (RVUs), sign-on bonuses, and partnership tracks.
  • DO vs MD rarely matters if you’re in the same role and specialty; negotiation skills and contract terms matter more.

• Mid- and Late-career Physicians (10+ years)

  • Income may increase via partnership, ownership stake, expanded procedures, leadership roles, or side ventures (consulting, speaking, real estate, etc.).
  • Again, specialty choice and practice structure overshadow degree type.

4. Type of Practice and Employer

Physician salaries are also shaped by how and where you practice:

Private Practice

• Potential for higher upside, especially in:
  • Procedure-heavy specialties (orthopedics, GI, cardiology, dermatology)
  • High-demand markets
• Income may include:
  • Base salary
  • Profit-sharing or ownership distributions
  • Ancillary income (imaging centers, surgery centers, etc.)
• More financial risk and business responsibility.

DOs and MDs in the same practice are generally compensated based on productivity and partnership terms, not degree.

Employed or Hospital-Based Positions

• Common in:
  • Large health systems
  • Academic centers
  • Community hospitals
• Typically offer:
  • Stable salary
  • RVU-based bonuses
  • Benefits (health insurance, retirement, CME, malpractice coverage)
• Often less variation by degree, as institutional salary scales focus on specialty, seniority, and productivity.

Academic Medicine

• MDs are still more common in academic roles, but DOs hold faculty positions across the country.
• Academic salaries:
  • Often lower than private practice, but with added benefits such as job stability, research time, and teaching.
  • Degree rarely affects academic pay for the same role and rank.

---

Comparing Salaries by Specialty: DO vs MD Numbers

To visualize how salary differences appear within specialties, consider the following (hypothetical but realistic) averages:

Specialty	Average Salary for MDs	Average Salary for DOs
Family Medicine	$250,000	$230,000
Internal Medicine	$290,000	$275,000
Pediatrics	$280,000	$265,000
Orthopedic Surgery	$600,000	$550,000
Neurology	$380,000	$360,000
Psychiatry	$300,000	$290,000
General Surgery	$500,000	$480,000

A few key takeaways:

• Within each specialty, the difference is modest, often in the range of $10,000–$50,000.
• These gaps may reflect:
  • Geographic distribution (e.g., more DOs working in lower-paying regions)
  • Practice type (e.g., more DOs in salaried vs partner roles)
  • Years of experience (if DOs in a specialty are, on average, younger in that field)

Crucially: There is no universal pay scale that pays DOs less than MDs for the same job. When you see differences, they almost always stem from context, not the degree itself.

---

Real-World Example: How Career Choices Outweigh Degree Type

Consider two fictional—but realistic—physicians who graduated in the same year.

Case Study: Dr. Smith (MD) vs. Dr. Johnson (DO)

• Dr. Smith, MD

  • Specialty: Orthopedic Surgery
  • Practice: Large private group in a major metropolitan area
  • Compensation: $600,000+ annually, plus productivity bonuses and potential partnership profits
  • Lifestyle: High procedure volume, long hours, high financial rewards

• Dr. Johnson, DO

  • Specialty: Family Medicine
  • Practice: Community health center serving underserved populations
  • Compensation: $250,000 annually, plus loan repayment and strong benefits
  • Lifestyle: More predictable hours, strong continuity of care, high sense of mission and community impact

If you simply compared “MD vs DO salary,” you might claim the degree explains a $350,000 difference. In reality, the gap is driven by:

• Specialty (orthopedics vs primary care)
• Practice setting (private group vs community clinic)
• Geography and patient population
• Personal priorities (income vs mission, schedule, family time)

If Dr. Johnson had chosen orthopedic surgery as a DO and matched into a similar job as Dr. Smith, their incomes would likely be much closer.

---

Practical Advice: Choosing Between DO vs MD with Salary in Mind

If you’re a premed or early medical student wondering how to navigate DO vs MD and medical careers intelligently, here’s how to frame your decision.

1. Start with Your Likely Specialty Interests

Be honest with yourself:

• Are you drawn to procedural/surgical fields and okay with longer training and intense competition?
• Or are you more interested in primary care, continuity of care, and holistic medicine?

If you’re strongly aiming for a very competitive specialty (like dermatology or neurosurgery), an MD route may currently offer slightly broader access at some institutions. However:

• Many DOs still successfully match into these fields each year.
• Your board scores, clinical performance, research, and letters will matter far more than the degree alone.

2. Understand That Degree Is Only One Variable

For long-term salary and satisfaction, these have much greater impact than DO vs MD:

• Specialty
• Practice type (academic vs private vs employed)
• Region and market demand
• Your skills in negotiation and career management
• Willingness to work extra hours, take call, perform procedures, or take on leadership roles

If you prioritize geographic flexibility and a particular type of academic name recognition (especially internationally), MD may provide a somewhat smoother path. If you resonate strongly with the osteopathic philosophy and envision primary care or holistic practice, DO may feel more aligned.

3. Prepare Early for Competitiveness (Regardless of Degree)

If higher physician salaries and access to competitive specialties are important to you:

• Maximize academic performance

  • Excel in preclinical courses and clinical rotations.
  • Aim for strong scores on licensing exams.

• Get involved in research

  • Especially important for academic or competitive specialties.
  • Seek mentors who are well-placed in your specialty of interest.

• Network and seek mentorship

  • Shadow physicians in your target specialty (both DO and MD).
  • Attend specialty meetings, join interest groups, and build relationships.

• Develop business and negotiation skills

  • Take time to learn about physician contracts, RVUs, and practice management.
  • Consider electives or reading in healthcare finance and practice management.

4. Think Beyond Salary Alone

Salary is important, especially with the high cost of medical education and student loans. But lifetime career satisfaction also depends on:

• Day-to-day work you enjoy
• Work-life balance
• Family and personal goals
• Ability to practice in settings and locations you care about
• Feeling aligned with your professional identity (osteopathic vs allopathic philosophy)

For many physicians, an extra $30,000–$70,000 per year in income may not outweigh choosing a specialty or setting they genuinely love.

---

Frequently Asked Questions (FAQ) About DO vs MD Salary Differences

Q1: Why do MDs appear to earn more than DOs on average?

Most large compensation surveys show higher average salaries for MDs, but this is largely because:

• MDs are more represented in higher-paying specialties like orthopedic surgery, dermatology, radiology, and certain subspecialties.
• DOs historically have been more concentrated in primary care, which generally pays less.

When DOs and MDs practice in the same specialty, region, and practice type, their compensation is usually very similar. There is no formal policy or pay scale that mandates lower salaries for DOs.

---

Q2: Are DOs at a disadvantage for high-paying specialties and top residency programs?

The landscape is evolving:

• Historically, some competitive residencies and academic programs favored MD applicants, partly due to familiarity and institutional tradition.
• With the unified ACGME accreditation system and increasing visibility of osteopathic medicine, many programs now consider strong DO and MD applicants on similar footing.

However:

• Some very competitive fields (like integrated plastic surgery or dermatology) may still be more challenging to enter as a DO, especially at certain legacy institutions.
• Strong board scores, research productivity, clinical performance, and networking can offset many of these barriers.

In short: DOs may face slightly more friction in some high-paying specialties, but many still succeed at the highest levels.

---

Q3: Will being a DO limit my salary potential if I choose a high-paying specialty?

Not inherently. If you:

• Match into a high-paying specialty (e.g., anesthesiology, radiology, orthopedics, cardiology), and
• Join a similar type of practice in a comparable region as an MD colleague,

then your earning potential can be very similar. Comp plans are typically structured by:

• Specialty
• Productivity (wRVUs, procedures, patient volume)
• Seniority and partnership status

Degree type (DO vs MD) rarely appears in the compensation formula.

---

Q4: Should I let salary be the main deciding factor between DO and MD?

Using salary as your only deciding factor is risky. Consider instead:

• Your alignment with osteopathic vs allopathic philosophy
• Your likely specialty goals and how competitive they are
• Learning environment, culture, and geographic preferences of individual schools
• Long-term career satisfaction, not just numeric income

It’s reasonable to factor in physician salaries and salary differences, but remember that:

• Specialty and practice choices will profoundly shape your income.
• A satisfied, well-supported family physician may feel far richer in life than a burned-out, highly paid specialist.

---

Q5: Can DOs reach leadership roles, academic positions, and top-tier incomes?

Yes. DOs occupy roles as:

• Department chairs
• Program directors
• CMOs and CEOs of health systems
• Academic faculty and researchers
• High-earning private practice partners in surgical and subspecialty fields

The key drivers are competence, performance, relationships, and experience. The DO vs MD letters may influence first impressions in some environments, but they do not cap your ceiling.

---

Ultimately, the “untold truth” about salary differences between DOs and MDs is this: your degree influences your path less than your specialty, performance, and choices do. If you understand these factors early and align them with your goals, you can build a rewarding medical career—financially, professionally, and personally—whether you become a DO or an MD.