TCOM: MD Degree Study Group Assessment (First Report)

[saxman]

Dr. Russo,

Thank you for posting the link to this editorial.

After carefully reading the article three times, I was left with the following impressions:

1. The article is very well-written.
2. Prominent Texans discriminate for medical doctors and against doctors of osteopathic medicine. Why?
3. The profession of modern osteopathic medicine as symbolized by the D.O. degree, and the archaic expression "osteopath" is not correctly understood by most Texans including residents of the Dallas-Fort Worth metroplex where there is arguably the best school of osteopathic medicine in the America. Why?
4. The author eloquently defends TCOM and the osteopathic medical profession, but the editorial leaves the reader asking the following questions:

a.) If TCOM educates highly qualified students to become clinicians, medical scientists, or leaders in the health care industry analogous to graduates of other Texas medical schools, how can Texas justify and afford the existence of two independently governed physician professions that essentially perform the same functions for the general public?

b.) How can the two professions be considered separate or parallel if D.O. graduates can complete ABMS accredited post-graduate specialty training, obtain ABMS specialty and subspecialty board certification, occupy the same scope of practice and privileges niche in hospitals and large health care institutions, and be subject to the same laws, rules, and regulations of medical practice as established by the federal and state government?

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[drusso]

Dr. Russo,

Thank you for posting the link to this editorial.

After carefully reading the article three times, I was left with the following impressions:

1. The article is very well-written.
2. Prominent Texans discriminate for medical doctors and against doctors of osteopathic medicine. Why?
3. The profession of modern osteopathic medicine as symbolized by the D.O. degree, and the archaic expression "osteopath" is not correctly understood by most Texans including residents of the Dallas-Fort Worth metroplex where there is arguably the best school of osteopathic medicine in the America. Why?
4. The author eloquently defends TCOM and the osteopathic medical profession, but the editorial leaves the reader asking the following questions:

a.) If TCOM educates highly qualified students to become clinicians, medical scientists, or leaders in the health care industry analogous to graduates of other Texas medical schools, how can Texas justify and afford the existence of two independently governed physician professions that essentially perform the same functions for the general public?

b.) How can the two professions be considered separate or parallel if D.O. graduates can complete ABMS accredited post-graduate specialty training, obtain ABMS specialty and subspecialty board certification, occupy the same scope of practice and privileges niche in hospitals and large health care institutions, and be subject to the same laws, rules, and regulations of medical practice as established by the federal and state government?

2) I don't know. There are also prominent Fort Worthians who discriminate *for* DO's. I never experienced discrimination while in Texas, but maybe people said things behind my back.

3) Lack of adequate PR I presume.

4a/b) These questions go to the heart of the "Paradox of Osteopathy." The best explanations I've encountered have to do with understanding osteopathic medicine as both a profession and a social movement. There are more detailed explanations, but basically all social movements go through similar developmental phases as they mature.

Osteopathic medicine is now in the phase of its development where it is internally struggling with its values regarding "assimilation" versus "distinctiveness." How "liberal" or "conservative" you are about your osteopathic views dictates, to a large degree, where you land on the osteopathic political spectrum of "assimilation" versus "distinctiveness."

Other explanations distinguish between "analagous" and "homologous" concepts/ideas. Bats, birds, and insect all use wings for flight, but the evolution and structure of those wings are radically different. So too, both DO and MD degrees qualify practitioners for the unrestricted practice of medicine, but both degrees came out of separate histories and evolutionary pathways.

Practically, I think that UNTHSC could support both programs.

 

[RetinaTazer]

Dr. Russo,

Thank you for posting the link to this editorial.

After carefully reading the article three times, I was left with the following impressions:

1. The article is very well-written.
2. Prominent Texans discriminate for medical doctors and against doctors of osteopathic medicine. Why?
3. The profession of modern osteopathic medicine as symbolized by the D.O. degree, and the archaic expression "osteopath" is not correctly understood by most Texans including residents of the Dallas-Fort Worth metroplex where there is arguably the best school of osteopathic medicine in the America. Why?
4. The author eloquently defends TCOM and the osteopathic medical profession, but the editorial leaves the reader asking the following questions:

a.) If TCOM educates highly qualified students to become clinicians, medical scientists, or leaders in the health care industry analogous to graduates of other Texas medical schools, how can Texas justify and afford the existence of two independently governed physician professions that essentially perform the same functions for the general public?

b.) How can the two professions be considered separate or parallel if D.O. graduates can complete ABMS accredited post-graduate specialty training, obtain ABMS specialty and subspecialty board certification, occupy the same scope of practice and privileges niche in hospitals and large health care institutions, and be subject to the same laws, rules, and regulations of medical practice as established by the federal and state government?

A) Texas Medical Board is the only entity to regulate the practice of physicians MDs or DOs in Texas.

B) Diversity is important in medicine as the art of medicine is extremely important in the pratice of medicine.

Why texas taxpayers have to foot the bill (20 million/ year) to replicate a parallel structure of an existing and successful medical school?

 

[RetinaTazer]

http://www.star-telegram.com/225/story/1761460.html

 

[drusso]

http://blogs.do-online.org/media/2/20100223-DR_2-23-10_RansomArticle.pdf

 

[RetinaTazer]

Dear TCOM alums and my DO fellows:

First, I would like to apologize to you all for taking the liberty to write to you about the issue that would affect the future of TCOM and our osteopathic profession. UNT Health Science Center leaderships have been planning to start up an allopathic medical school on campus for the past two years. The stated reasons for supporting of such a plan include the prestige of an MD school, potential of increase in research funding and clinical rotation sites.

Like on any issues, there are members in the same family who support, those who oppose, and those remain neutral.

The supporters of the idea of an MD school along side with TCOM may think the status of TCOM would be enhanced because it would demonstrate the parity of the two schools. Also, they think that there is no difference between the training of MD and DO except for the component of OMT, whose efficacy is still questionable as we are in the age of evidence-based medicine. Like all DOs have experienced the lack of public recognition of the DO degree title, the supporters think they should deserve better, the prestige of a MD title after all the long years of hard work, the training in ACGME programs and a huge student loan debt. Their wishful thinking that TCOM and MD school sharing the same campus is a step forward in a possible potential of the merger of the two professions.

The misconception that osteopathic profession is going to fade away into the past has been proven wrong with the historical merger of the two professions, which took place in California in 1962. The Californian merger actually strengthened the profession and the newly MDs experienced discriminations from their MD colleagues. Osteopathic medicine has enjoyed the exponential growth over the past three decades. Today, 20% of medical students are DO students, and 60,000 DOs are actively practicing, i.e., representing 7% of physician work force. In 10 years, 25% of medical students are DO students and there will be 100,000 DOs practicing, i.e., representing 10% of physician work force. The DO title will become a household brand very soon.

I recognize that DO schools still have a lot to do to perfect the integration of the osteopathic philosophy and practice in our training curriculum for us to appreciate the holistic approach in the patient care. However, the practice of medicine is a blend of an art and science. I believe DOs approach patients from a different perspective in a subtle way.

Those who remain neutral on the issue because the issue does not affect them directly as they have other things to worry with their busy practices and the impending cut in the medicare physician fee.

I would like to share my thoughts why I am supporting the cause of protecting the osteopathic heritage of UNTHSC. I am ethnically Vietnamese and grew up part of my childhood in France. I came to the USA at the age 19. English is my third
language and is still a broken English in three. Osteopathic profession has given me the opportunity to become a vitreo-retinal surgeon and neuro-ophthalmologist even though I had set out to become a holistic and integrative physician. I graduated from TCOM in 2002 and went on for trainings across the country until 2009. I am only in my first year of practice in a multi-specialty group of 3 other MD ophthalmologists and 6 optometrists.

I support the preservation of osteopathic entity of UNTHSC because Texas law says so. TCOM has been a success story as it has been ranked among the top 50 medical schools for primary care for the past 9 years and the students have achieved the highest average scores in COMLEX step 1, 2 and 3 for the past few years in a row. I want that current and future TCOM students receive the best training opportunity. The push for an MD school has been disruptive in the education of the current TCOM students as there has been a large exodus of basic science and clinical faculty.



I oppose to the establishment of an MD school at UNTHSC because:

• It negates the fact that TCOM is a full-fledged medical school.
• It is purely discriminatory against DOs and implies that DOs are second-class physicians or do not have the full potential to become specialists or researchers.
• It is a travesty to waste millions of tax-payers’ dollars to pay for a parallel administrative structure of the two schools with the same purpose of educating future physicians.
• The process of starting-up a new MD school may take 10 years, while expansion of TCOM can help to alleviate the looming physician shortage.
• There are two new MD schools in Texas, one El Paso and Brownsville, and more are being planned in Austin and Amarillo. Therefore, we need to increase the number of DO graduates if we want make DO a household brand sooner. Furthermore, recent study of “medical social mission” published in the Annals of Medicine placed TCOM at the top of list of all the medical schools in Texas. TCOM model fulfills its mission of responding to the medical care needs of the state.
• The addition of a pharmacy school would have enhanced the stature of UNTHSC, which developed a plan to start a pharmacy school in 2004. However, this has been relegated to the UNT Dallas campus.

I do recognize there are disagreements among a number of DOs with some of the AOA policies. I am urging you to put aside our disagreements and let’s help the TCOM students to get the best possible clinical rotation sites. If the UNTHSC leaderships think they can change a state law prohibiting UNTHSC from granting MD degree, we can join our efforts to mandate JPS, a local county hospital, to be affiliated with the only medical school in the county.

I am urging you to show your support of our alma mater by contributing financial donations to the TOMA/TCOM Task Force. We need to defeat the plan at the next legislature session opening in January 2011. Please contact your local representatives to support TCOM issue.

In conclusion, osteopathic medicine has survived the past two centuries and is here to stay forever. This profession has given us the opportunity to achieve our professional goals. Let’s be proud of our heritage and start upholding the Osteopathic Oath. Let’s end with paraphrase from president John F Kennedy’s a famous quote: “Ask not what your profession can do for you, ask what you can do for your profession.”

Osteopathic Physicians:"Treating the people, not just the symptoms!"​

"To find health should be the object of the doctor. Anyone can find disease."​

 

[ShadyMedicine]

August 19, 2010

Students, Faculty, Staff and Alumni:

The University of North Texas System Board of Regents today voted to approve a proposal to develop a new MD degree program at the UNT Health Science Center at Fort Worth (UNTHSC). The MD program will be housed in an independent fifth school in addition to the Texas College of Osteopathic Medicine, Graduate School of Biomedical Sciences, School of Public Health, and School of Health Professions.

Approval comes upon completion of pre-approval requirements that the Board of Regents directed UNTHSC leadership to accomplish at the Regents’ November 2009 meeting. The requirements were to secure all necessary start-up funding from the community, establish a business plan for the new school, ensure commitments to secure a strong future for all existing programs, and confirm relationships with area hospitals for student rotations and graduate training.

The following summarizes the proposal and what our Board has approved:

The Need: Texas has requested the expansion of medical education training to meet current and projected physician shortages. In response, UNTHSC has already grown its existing medical class at TCOM from 115 in the Class of 2005 to 220 in the Class of 2014. Our challenge is to ensure TCOM continues to be a leader in the education of family and rural practitioners without having entering medical class sizes exceed best practices for a quality education. Our recently constructed facilities are designed to handle larger medical classes and we are committed to expanding in order to provide more doctors of all types.

The Proposal: UNTHSC proposes to add a fifth school to its campus that will offer the MD degree. We propose to enroll not more than 100 MD students in fiscal year 2014 after accreditation and planning are complete. We have committed to build upon and support the continued development and success of the other four existing colleges. Our long-term goal is to strengthen our existing schools while adding programs that benefit the State and provide new educational opportunities for future students.


Cost and Local Donations: Over the past two years, UNTHSC has conducted extensive fiscal and academic planning to determine how our existing infrastructure could support two separately accredited medical programs at one location. With this unique sharing opportunity, the comprehensive business and academic plan estimates the start-up costs for starting the new MD program will total $21.5 million. Our Board of Regents gave us the challenge to raise these funds privately and we are very proud that we have successfully obtained firm and credible local pledges of financial support of $25 million to cover the initial incremental and all start-up costs. Beginning in five years, the only cost to the State of Texas will be the usual and appropriate costs associated with additional Texas medical students. This innovative private-public proposal is particularly of interest in difficult financial times as it will benefit the state by allowing the local community to provide all start-up costs for the new medical school.


Benefit: UNTHSC wants to enable as many of its graduates as possible to remain in Texas for their medical practice. Fort Worth area hospitals have indicated an enthusiasm for partnering with UNTHSC to bring both MD and DO students and faculty onto their hospital campuses for undergraduate medical education. This will allow hospitals to expand their resource commitments to graduate medical education, which is the area that will help attract and keep the most new doctors in Texas. We have written clinical education partnership agreements (as well as financial pledges) from Texas Health Resources, Tarrant County Hospital District, Baylor Health System, HCA North Texas/Plaza Medical Center, and Cook Children’s Health System.


Next steps: Years ago, language was adopted in the UNTHSC authorizing statute preventing the issuance of an MD degree by the UNT System in Fort Worth. This is the only medical school in Texas with a degree restriction of any kind. We intend to ask the Texas Legislature to remove this restriction and authorize the formation of an MD degree-granting medical school at UNTHSC. We will then work with the Liaison Committee on Medical Education (LCME) to earn full accreditation of the new program.

The Fort Worth community views this opportunity as a logical progression building on the UNTHSC’s 40-year history of innovation, growth and success. The community has demonstrated tremendous commitment, which now allows us to bring this proposal forward with no incremental start-up cost to the state.

We believe this is a “win-win” for Texas, for Fort Worth, for UNTHSC, for TCOM, and for our future students and doctors who will serve our state.

Sincerely,


C. Dan Smith
Chairman, UNT System Board of Regents

Lee Jackson
Chancellor, UNT System

Scott B. Ransom, DO, MBA, MPH
President, UNT Health Science Center

 

[RetinaTazer]

DeLengocky: North Texas needs more residency slots, not M.D. classes

Posted Monday, Oct. 11, 2010
By Tayson DeLengocky
Special to the Star-Telegram
When the Texas Legislature convenes in January, it might act on a proposal from the University of North Texas Health Science Center (UNTHSC) to establish another medical school -- an allopathic or MD-granting school tentatively called UNTMD -- on its Fort Worth campus.
The UNTMD proposal claims a start-up cost of $21.5 million, which will be covered by community pledges of $25 million. This cost estimate is far below those of other planned or recently established medical schools in Texas.
The Paul Foster School of Medicine in El Paso, which admitted its first class of 40 students in 2009, cost $150 million. UT Southwestern and the Seton Family of Hospitals plan to invest $1.5 billion to establish a medical school and medical center in Austin.
The Texas Higher Education Coordinating Board estimates funding to establish a medical school in South Texas could reach $99 million. The 2009 Legislature approved the school but will not fund the program until after 2015.
The low cost estimate of the UNTMD plan raises questions about its credibility and the vision and nature of UNTMD. In 2004, UNT Health Science Center did a business study for a school of pharmacy. The total start-up cost for a program with a graduating class of 60 students was about $23 million. Is it realistic to expect that six years later the start-up cost of a medical school with a class size of 100 students will be less expensive?
A closer analysis of the UNTMD business plan shows deliberate omissions. It did not include the cost of renovating 22,000 square feet of building space that will be reserved for the MD school. According to the UNTHSC's Legislative Appropriation Request for fiscal year 2012-13, UNTHSC is asking, rather surprisingly, for $90 million for a new building of 150,000 square feet, which coincides with the minimum space required for a small medical school. Why isn't this cost reflected in the business plan?
Furthermore, the business plan does not detail administrative costs; UNTMD at UNTHSC would increase administrative costs beyond their present levels.
The culture of growth in UNTHSC's administrative ranks is striking. In 2007, UNTHSC's student enrollment was 1,153. In addition to the president, there were nine vice presidents, seven associate vice presidents, one assistant vice president and 11 associate deans, for a total of 29 leadership positions. By 2010, with a student enrollment of 1,587, the numbers had risen by 11 positions. As of 2010, in addition to the president, there were 17 vice presidents, five associate vice presidents, four deans and 15 associate and assistant deans, or 42 leadership positions. These do not include the department chairs and service directors.
At an Aug. 23 town-hall meeting, UNTHSC President Scott Ransom presented the future UNTMD curriculum as building "on the success achieved at TCOM by adopting a similar, although not identical, educational delivery model, teaching style and curriculum, subject to meeting all the requirements for curriculum content for an MD program."
UNTMD will share a single corps of clinical and basic science faculty members. Basically, UNTMD would be a duplication of TCOM except for the different title degree. UNTMD's curriculum will offer less than the TCOM curriculum by eliminating the emphasis on the neuro-musculoskeletal component of medical education.
Establishing UNTMD will make UNTHSC a medical school of one body with two heads (the two administrative structures) and make UNTHSC the largest medical school in Texas with 330 students per class. Does this make any sense in business and academic terms?
The addition of 400 MD students definitely will benefit Fort Worth by infusing $1.7 billion into the local economy over the next 10 years. But increasing the student enrollment at UNTHSC would have the same impact, as it has a $600 million annual economic impact on the local community with a current enrollment of 1,500 students.
Research has shown that the availability of graduate medical education placements -- residency slots and not slots in medical school -- is the limiting factor in addressing a physician shortage. Using the pledges of $25 million to develop 125 additional residency slots represents a better, more cost-effective strategy for responding to the projected physician shortages in Tarrant County. Resources should be invested in a successful program, TCOM, rather than a costly, unnecessary duplication of it.
Establishing an MD degree at the UNTHSC would amount to converting one superior medical school program into two mediocre programs.
Dr. Tayson DeLengocky, a 2002 alum of the Texas College of Osteopathic Medicine, practices vitreo-retinal surgery and neuro-ophthalmology in Peoria, Ill., and is a member of the American Osteopathic Association's Council of New Physicians In Practice.
Looking for comments?

 

[fourthst]

FWIW, the president of the Texas Medical Board is a D.O. - so I'm not sure about discrimination against D.O.'s in Texas...
http://www.tmb.state.tx.us/boards/mbbios.php

 

[mrwesticles]

Integration is truly going to be a first step. If MDs are educated alongside DOs, it shows that there is an equivalency in the most essential knowledge with bonus osteopathic manipulation training. If anything, an MD in training would be interested in what DO training had to offer.