GeneralORIGINAL ARTICLE

DO (under) representation in US guideline development: an investigation of guideline authors from 2021–2023

Alfred B. Amendolara, MS; Steven Salazar, BSN; Tiffany Nguyen, BS; Porter Fife, BS; Blake Harris, BS; Alessandra M. Rivera, MS; Kennedy Madrid, BS; Yvannia Gray, BA; and Stephen Stacey, DO
Notes and Affiliations
Notes and Affiliations

Received: September 5, 2024

Accepted: February 26, 2025

Published: March 19, 2025

  • Alfred B. Amendolara, MS, 

    578278
    Noorda College of Osteopathic Medicine
    , Provo, UT, USA

  • Steven Salazar, BSN, 

    Department of Clinical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Tiffany Nguyen, BS, 

    Department of Biomedical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Porter Fife, BS, 

    Department of Biomedical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Blake Harris, BS, 

    Department of Biomedical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Alessandra M. Rivera, MS, 

    Department of Biomedical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Kennedy Madrid, BS, 

    Department of Biomedical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Yvannia Gray, BA, 

    Department of Biomedical Science, Noorda College of Osteopathic Medicine, Provo, UT, USA

  • Stephen Stacey, DO, 

    Director of Osteopathic Education, May Clinic La Crosse Family Medicine Residency, Mayo Clinic, La Crosse, WI, USA

Abstract

Context: Research and scholarship are core drivers of medicine in the modern era. Evidence-based practice continues to replace expert opinion and long-held practice beliefs. Involvement in the development and writing of these guidelines is critical for Doctors of Osteopathic Medicine (DOs) to maintain a seat at the academic table. According to the American Osteopathic Association (AOA), 11 % of practicing physicians in the US are DOs. This number is growing, as nearly 25 % of current medical students attend an osteopathic medical school. Without involvement in guideline development, DOs risk giving up control of their own practice of medicine.

Objectives: To quantify the contribution of DOs to the body of literature guiding practice, author information was extracted from all US-based guidelines published in the years 2021, 2022, and 2023 listed in the Emergency Care Research Institute (ECRI) Guidelines Trust database.

Methods: Authors of US-based guidelines listed in the ECRI Trust database from the years 2021–2023 were counted and categorized into one of three groups based on terminal degree: MD holders, DO holders, and Other-degree holders. Authors whose degrees could not be identified were counted as “Unidentifiable.” Additional data including sponsoring organization, organization type, and specialty were collected.

Results: A total of 674 guidelines were published by US organizations in 2021, 2022, and 2023, with 604 reporting author information. A total of 9,376 authors were counted. Of that, 7,253 held an MD (77 %), 110 held a DO (1.2 %), and 1,848 held another terminal degree (19.7 %); meanwhile, 1.66 % of counted authors did not have an identifiable degree. A total of 604 guidelines published by US organizations were identified. Of these, 88 (14.6 %) contained at least one DO author in their author list. Sixty-two unique specialties were identified, along with 130 unique sponsoring organizations. Of those specialties, 28 (44.4 %) had at least one DO author of at least one guideline. Of 130 sponsoring organizations, 44 (33.8 %) developed at least one guideline with at least one DO author. No osteopathic sponsoring organizations were identified.

Conclusions: Based on these results, we conclude that DOs are underrepresented in the development of guidelines.

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