Relatively few osteopathic physicians (DOs) practice in the deep central southern geographic region as compared to other parts of the United States.To assess the potential effects of underrepresentation on the perception of osteopathic medicine among allopathic physicians (MDs) in this geographic region.A 20-item, Likert scale survey was designed to evaluate participant perceptions of the osteopathic medical profession. The instrument was mailed to 468 MDs who reside and practice in the deep central southern region of the United States.One hundred seven individuals completed the survey for a response rate of 22.9%. Although the majority of respondents (71 [66.3%]) recognized the distinctiveness of the osteopathic medical profession, they were not necessarily able to articulate these differences clearly through their responses to other survey items. In addition, survey participants expressed was a belief that residency training programs accredited by the Accreditation Council for Graduate Medical Education were more beneficial to osteopathic medical graduates than those approved by the American Osteopathic Association (94 [87.8%]). Finally, there was a perception that research efforts supporting "the scientific basis of osteopathic medicine" were inadequate (53 [49.5%]). The one demographic factor that had a statistically significant (P<.001) positive impact on perceptions of osteopathic medicine among these MDs was previous contact with DOs.Underrepresentation of DOs in the deep central southern region of the United States appears to have an impact on the perception of osteopathic medicine among MDs insofar as direct or indirect contact with osteopathic physicians led to improved perceptions among this cohort.