Chapman points need serious evaluation

[hfiso]

Evidence-based medicine is what we pride ourselves on as clinicians, right? Can anyone show me some real evidence of chapman points? If not, it's 2023 and we can move on. We, as DOs, continue to shoot ourselves in the foot by sticking to these osteopathic principles.

If we clean up some of the made up jargon, we could move a lot further in the future of the MD/DO debacle. What will it take to get chapman points out of medical education all together? They can have their place in a OMM residency, but otherwise shouldn't be taught as if it is fact.

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[GoSpursGo]

To sum up the conclusion of many other threads on this subject (and similar subjects): good luck.

As a brief aside, there is a significant difference between something being "evidence-based" and "standard of care." Plenty of things that are taught in medical school don't actually have any clear literature support for their practice, but continue to be practiced in the absence of evidence refuting their use. For one example, until recently aspirin was used routinely for heart disease (and colon cancer) prevention across wide swaths of adults. These recommendations were finally changed in 2022 when relatively new randomized clinical trials were able to show that the benefits may not outweigh the risks unless a patient has specific risk factors: USPSTF Recommendation: Aspirin Use to Prevent Cardiovascular Disease . These trials were able to be conducted because they were of great interest, the cost of running these trials was very low (basically any patient can buy aspirin over the counter for negligible cost), and the practitioners could easily have "clinical equipoise" (i.e. believe that it is equally likely that treatment with aspirin or not would be beneficial, thus making it ethical to randomize patients). It still took a tremendous amount of work to change the standard of care.

Bringing this back to your question, I think it should quickly become apparent why these OMM principles are unlikely to be removed from osteopathic education any time soon--you're almost certainly never going to see a RCT that is going to address the question of chapman points to "disprove" their use. Frankly, with relatively few physicians using chapman points and thus relatively few patients being impacted, there would be little interest in conducting such a trial. And further, the physicians who DO use chapman points in clinical practice likely lack clinical equipoise (cynically, they may even feel incentivized NOT to participate in a trial that challenges the practice in standard of care). So in the absence of such new RCT data you are unlikely to see the teaching in school change.

TLDR: you're not going to change anyone's mind on the standard of care without clear evidence refuting the use, so OMM is likely to remain part of the price of admission to DO schools.

 

[DrZoidbergDO]

you mean i can't feel your prostate through your IT band???

 

[hfiso]

To sum up the conclusion of many other threads on this subject (and similar subjects): good luck.

As a brief aside, there is a significant difference between something being "evidence-based" and "standard of care." Plenty of things that are taught in medical school don't actually have any clear literature support for their practice, but continue to be practiced in the absence of evidence refuting their use. For one example, until recently aspirin was used routinely for heart disease (and colon cancer) prevention across wide swaths of adults. These recommendations were finally changed in 2022 when relatively new randomized clinical trials were able to show that the benefits may not outweigh the risks unless a patient has specific risk factors: USPSTF Recommendation: Aspirin Use to Prevent Cardiovascular Disease . These trials were able to be conducted because they were of great interest, the cost of running these trials was very low (basically any patient can buy aspirin over the counter for negligible cost), and the practitioners could easily have "clinical equipoise" (i.e. believe that it is equally likely that treatment with aspirin or not would be beneficial, thus making it ethical to randomize patients). It still took a tremendous amount of work to change the standard of care.

Bringing this back to your question, I think it should quickly become apparent why these OMM principles are unlikely to be removed from osteopathic education any time soon--you're almost certainly never going to see a RCT that is going to address the question of chapman points to "disprove" their use. Frankly, with relatively few physicians using chapman points and thus relatively few patients being impacted, there would be little interest in conducting such a trial. And further, the physicians who DO use chapman points in clinical practice likely lack clinical equipoise (cynically, they may even feel incentivized NOT to participate in a trial that challenges the practice in standard of care). So in the absence of such new RCT data you are unlikely to see the teaching in school change.

TLDR: you're not going to change anyone's mind on the standard of care without clear evidence refuting the use, so OMM is likely to remain part of the price of admission to DO schools.

Thanks for your input. I do agree with you, but that doesn't mean we can't reduce the time spent educating future doctors on irrelevant material. There is so much unchecked material in osteopathy. No one cares to question anything.

Dr. Zink's compensatory pattern of fascial diaphragms ?? why do all OMM docs just act like these things are facts.

My point is that OMM can stay in DO programs, but there needs to be a serious revision on some of the ancient stuff made up by one person.

 

[GoSpursGo]

Thanks for your input. I do agree with you, but that doesn't mean we can't reduce the time spent educating future doctors on irrelevant material. There is so much unchecked material in osteopathy. No one cares to question anything.

Dr. Zink's compensatory pattern of fascial diaphragms ?? why do all OMM docs just act like these things are facts.

My point is that OMM can stay in DO programs, but there needs to be a serious revision on some of the ancient stuff made up by one person.

I don't disagree with you. I'm merely answering your question about "what it will take" to change what is taught in school, and explaining why I don't think anyone (other than annoyed medical students) is clamoring to do actually do it.

 

[DOVinciRobot]

As long as the AOA/NBOME/COCA have power and a steady revenue stream lining their pockets from pre-meds eager to be taken advantage of none of these things will change.

The DO leadership organizations have zero interest in furthering the profession, and this is very clear to anyone who pays attention to their actions.

 

[MateoGM416]

As long as the AOA/NBOME/COCA have power and a steady revenue stream lining their pockets from pre-meds eager to be taken advantage of none of these things will change.

The DO leadership organizations have zero interest in furthering the profession, and this is very clear to anyone who pays attention to their actions.

I think younger generations of DO's are less likely to believe and propagate such things. As DO's become a larger share of physicians in the workforce in the future I think there will also eventually be more external scrutiny towards some of these techniques.

 

[Goro]

I think younger generations of DO's are less likely to believe and propagate such things. As DO's become a larger share of physicians in the workforce in the future I think there will also eventually be more external scrutiny towards some of these techniques.

Exactly! Once your generation takes over osteopathic medical education, the DO World will join the 21st century.

 

[AlbinoHawk DO]

Evidence-based medicine is what we pride ourselves on as clinicians, right? Can anyone show me some real evidence of chapman points? If not, it's 2023 and we can move on. We, as DOs, continue to shoot ourselves in the foot by sticking to these osteopathic principles.

If we clean up some of the made up jargon, we could move a lot further in the future of the MD/DO debacle. What will it take to get chapman points out of medical education all together? They can have their place in a OMM residency, but otherwise shouldn't be taught as if it is fact.

MD/DO debate is not one that matters or will be fixed. You can clean up OMM as much as you want, but as long as the letters MD and DO are distinct, not everyone will be welcoming. You just need to accept you're a DO and move on with your life

Cleaning up OMM is an old topic. I've heard these same things for 10 years. I've heard from older people that they've had people advocating for this for over 25 years. The "true believers" or those that profit from the distinction of degree are at the helm. There's no motivation to change anything. Like everyone else, you will graduate and move on with your life and shoving the bad memories of this in to the depths of your brain. Life will go on

Sorry for sounding defeatist and cynical, but this has been the way for decades. Nothing will change unless something big forces it to change like they did with the residency merger

 

[GoSpursGo]

MD/DO debate is not one that matters or will be fixed. You can clean up OMM as much as you want, but as long as the letters MD and DO are distinct, not everyone will be welcoming. You just need to accept you're a DO and move on with your life

Cleaning up OMM is an old topic. I've heard these same things for 10 years. I've heard from older people that they've had people advocating for this for over 25 years. The "true believers" or those that profit from the distinction of degree are at the helm. There's no motivation to change anything. Like everyone else, you will graduate and move on with your life and shoving the bad memories of this in to the depths of your brain. Life will go on

Sorry for sounding defeatist and cynical, but this has been the way for decades. Nothing will change unless something big forces it to change like they did with the residency merger

Exactly. True believers are exactly that—they truly believe that OMM principles are part of the standard of care for a DO, or outright have a vested financial interest in perpetuating that standard. So to them, the burden of proof is on DISPROVING that it should be the standard, not on them to prove it works. Further, it is almost always the true believers who care enough to work their way into leadership positions, whereas the jaded people are usually content to focus clinically.

If you actually care about this, then when you are an attending YOU should apply for a leadership position. Not “somebody should,” but actually make it a priority yourself, because this is a thankless campaign. Until attendings make it clear they care what is being taught, and honestly probably generate data challenging the efficacy of OMM, nothing is likely to change

 

[Osminog]

The problem isn’t just Chapman’s points. Most of OMM isn’t real. It primarily works via the placebo effect and the release of endorphins through human touch. The diagnostic methodology and physiological principles of OMM aren’t grounded in logic or evidence.

I remain hopeful that Chapman’s points and craniosacral therapy will be removed from DO schools’ mandatory curricula, followed by the rest of OMM. Ultimately, the DO degree must be abolished, along with DO-specific organizations, licensure bodies, and board exams; osteopathic medical schools must be converted into MD-granting institutions and finally held to MD standards.

 

[MateoGM416]

osteopathic medical schools must be converted into MD-granting institutions and finally held to MD standards.

What standards do you mean? Having a hospital attached and more research?

 

[Darrow O'Lykos]

Exactly! Once your generation takes over osteopathic medical education, the DO World will join the 21st century.

The catch-22 though is that sadly, the vast majority have zero interest in stepping into those roles to bring forth the necessary change. Those that do have an interest in those roles, in my opinion, are disproportionately composed of true-believers.

The problem isn’t just Chapman’s points. Most of OMM isn’t real. It primarily works via the placebo effect and the release of endorphins through human touch. The diagnostic methodology and physiological principles of OMM aren’t grounded in logic or evidence.

I remain hopeful that Chapman’s points and craniosacral therapy will be removed from DO schools’ mandatory curricula, followed by the rest of OMM. Ultimately, the DO degree must be abolished, along with DO-specific organizations, licensure bodies, and board exams; osteopathic medical schools must be converted into MD-granting institutions and finally held to MD standards.

Ceterum censeo Carthaginem esse delendam.

 

[Osminog]

What standards do you mean? Having a hospital attached and more research?

LCME accreditation standards.

"Having a hospital attached" isn't an LCME accreditation standard. There are fully accredited MD schools without their own university hospitals.

 

[MateoGM416]

LCME accreditation standards.

"Having a hospital attached" isn't an LCME accreditation standard. There are fully accredited MD schools without their own university hospitals.

Ok then which standards are those that DO schools not meet besides research? I'm not trying to argue I'm genuinely asking

 

[Drrrrrr. Celty]

The problem isn’t just Chapman’s points. Most of OMM isn’t real. It primarily works via the placebo effect and the release of endorphins through human touch. The diagnostic methodology and physiological principles of OMM aren’t grounded in logic or evidence.

I remain hopeful that Chapman’s points and craniosacral therapy will be removed from DO schools’ mandatory curricula, followed by the rest of OMM. Ultimately, the DO degree must be abolished, along with DO-specific organizations, licensure bodies, and board exams; osteopathic medical schools must be converted into MD-granting institutions and finally held to MD standards.

I think there's a sincerely cute belief that medicine is a lot more evidence based or that we have land mark studies which clear cut denote effect and at low patient sizes. This isn't really the case.

A lot of medicine is still throwing darts in the dark, require >10000 pt years to produce minimal effect, or are minimally better than placebo. I'm in fellowship and you could easily have a room of your attendings disagree with each other entirely on even what the national guideline standard of care is for basic diseases.

OMM fundamentally is low risk, low reward. No one is getting addicted to it. No one is getting AKIs from it. And if it helps then great. I'm sure there might be some underlying thing to some of it. But no one's going to look for it. And I honestly don't care because half of research when written by people not packing a large grant ends up being utterly crap, and the other half is illegible scientifically.

Certainly I think there should be a merger of the professions. I don't think Osteopathic medicine has a character of distinction anymore. That being said I think we do have to admit that DO schools are pumping American Grads into the US healthcare market. And I will say this non-pejoratively, they're putting out people who are more interested in clinical work and practice than physician-scientist, academic, research tracks.

 

[DO2015CA]

I think there's a sincerely cute belief that medicine is a lot more evidence based or that we have land mark studies which clear cut denote effect and at low patient sizes. This isn't really the case.

A lot of medicine is still throwing darts in the dark, require >10000 pt years to produce minimal effect, or are minimally better than placebo. I'm in fellowship and you could easily have a room of your attendings disagree with each other entirely on even what the national guideline standard of care is for basic diseases.

OMM fundamentally is low risk, low reward. No one is getting addicted to it. No one is getting AKIs from it. And if it helps then great. I'm sure there might be some underlying thing to some of it. But no one's going to look for it. And I honestly don't care because half of research when written by people not packing a large grant ends up being utterly crap, and the other half is illegible scientifically.

Certainly I think there should be a merger of the professions. I don't think Osteopathic medicine has a character of distinction anymore. That being said I think we do have to admit that DO schools are pumping American Grads into the US healthcare market. And I will say this non-pejoratively, they're putting out people who are more interested in clinical work and practice than physician-scientist, academic, research tracks.

And importantly, are putting out competent physicians.

It’s funny as I am in fellowship too. Every single day, I discover more and more gray zones that my specialty operates. which I assume mine is not unique in that aspect.

 

[Rapsidy]

Exactly! Once your generation takes over osteopathic medical education, the DO World will join the 21st century.

Just gonna drop this gem that Dr. Carmody just released on his YouTube channel.

 

[EDThoracotomy]

Just gonna drop this gem that Dr. Carmody just released on his YouTube channel.

The twitter feed of this video and Dr. Broder's interaction is the perfect example of why the AOA/NBOME and DO leadership are tone deaf and do not care about DO students. The feed is on 2.19 and 2.9. He doubles down with no evidence that DOs want the NBOME.

 

[MateoGM416]

The twitter feed of this video and Dr. Broder's interaction is the perfect example of why the AOA/NBOME and DO leadership are tone deaf and do not care about DO students. The feed is on 2.19 and 2.9. He doubles down with no evidence that DOs want the NBOME.

To be fair it is pretty existential for them. If there is no COMLEX then why do we need NBOME leadership at all

 

[AlbinoHawk DO]

The problem isn’t just Chapman’s points. Most of OMM isn’t real. It primarily works via the placebo effect and the release of endorphins through human touch. The diagnostic methodology and physiological principles of OMM aren’t grounded in logic or evidence.

I remain hopeful that Chapman’s points and craniosacral therapy will be removed from DO schools’ mandatory curricula, followed by the rest of OMM. Ultimately, the DO degree must be abolished, along with DO-specific organizations, licensure bodies, and board exams; osteopathic medical schools must be converted into MD-granting institutions and finally held to MD standards.

It sounds to me like you really want to be an MD. It's understandable. Nobody wants to feel like the "other," but you will also go through clinicals, residency, fellowship (maybe) and eventual practice. You'll learn there's really no issue outside of premeds. You'll also learn that being an MD is not all its cracked up to be because "oh, you went to Wayne State? Well, that's cute. I went to University of Virginia."

Medicine is not as clear cut where we have perfect studies for everything. Hell, even with well established studies we don't have anything for the average patient where we can say with certainty that taking 8 different medicines at the same time is good. We just discarded last year the hypothesis that depression is linked to low serotonin levels. This is not to say there aren't points of OMM (such as craniosacral and chapman's) that are beyond credulity and should be removed. However, there's a lot of OMM in a gray area that are practices nearly identical (techniques) to physical therapy. I don't expect OMM to disappear anytime soon, but it could be de-emphasized from curriculum and be driven more toward the field's training primarily taking place in residency or fellowship

Lastly, you shouldn't celebrate the idea of abolishing DO-specific organizations and licensures. We need competition in medicine. The idea that the NBME will own everything means that we will be subject to their whims when it comes to CME and costs. Celebrating any monopoly comes from a place of ignorance

 

[Darrow O'Lykos]

We need competition in medicine. The idea that the NBME will own everything means that we will be subject to their whims when it comes to CME and costs. Celebrating any monopoly comes from a place of ignorance

If you're worried about competition, NBOME has a stranglehold monopoly on licensing DO students. If you truly support competition, then support resolution S-20-30 from SOIMA which would give students the choice of which licensing series to take. That's what true competition looks like.

 

[AlbinoHawk DO]

If you're worried about competition, NBOME has a stranglehold monopoly on licensing DO students. If you truly support competition, then support resolution S-20-30 from SOIMA which would give students the choice of which licensing series to take. That's what true competition looks like.

I'm okay with that. If you want to become licensed under USMLE, go ahead. You'll probably need to create some type of OMM supplement if you want the resolution to be taken seriously. I would suggest that the 3rd year osteopathic shelf-exam serves this purpose

 

[DO2015CA]

It sounds to me like you really want to be an MD. It's understandable. Nobody wants to feel like the "other," but you will also go through clinicals, residency, fellowship (maybe) and eventual practice. You'll learn there's really no issue outside of premeds. You'll also learn that being an MD is not all its cracked up to be because "oh, you went to Wayne State? Well, that's cute. I went to University of Virginia."

Medicine is not as clear cut where we have perfect studies for everything. Hell, even with well established studies we don't have anything for the average patient where we can say with certainty that taking 8 different medicines at the same time is good. We just discarded last year the hypothesis that depression is linked to low serotonin levels. This is not to say there aren't points of OMM (such as craniosacral and chapman's) that are beyond credulity and should be removed. However, there's a lot of OMM in a gray area that are practices nearly identical (techniques) to physical therapy. I don't expect OMM to disappear anytime soon, but it could be de-emphasized from curriculum and be driven more toward the field's training primarily taking place in residency or fellowship

Lastly, you shouldn't celebrate the idea of abolishing DO-specific organizations and licensures. We need competition in medicine. The idea that the NBME will own everything means that we will be subject to their whims when it comes to CME and costs. Celebrating any monopoly comes from a place of ignorance

Like everything in this world, competition is good!

 

[Osminog]

It sounds to me like you really want to be an MD. It's understandable. Nobody wants to feel like the "other," but you will also go through clinicals, residency, fellowship (maybe) and eventual practice. You'll learn there's really no issue outside of premeds. You'll also learn that being an MD is not all its cracked up to be because "oh, you went to Wayne State? Well, that's cute. I went to University of Virginia."

Medicine is not as clear cut where we have perfect studies for everything. Hell, even with well established studies we don't have anything for the average patient where we can say with certainty that taking 8 different medicines at the same time is good. We just discarded last year the hypothesis that depression is linked to low serotonin levels. This is not to say there aren't points of OMM (such as craniosacral and chapman's) that are beyond credulity and should be removed. However, there's a lot of OMM in a gray area that are practices nearly identical (techniques) to physical therapy. I don't expect OMM to disappear anytime soon, but it could be de-emphasized from curriculum and be driven more toward the field's training primarily taking place in residency or fellowship

Lastly, you shouldn't celebrate the idea of abolishing DO-specific organizations and licensures. We need competition in medicine. The idea that the NBME will own everything means that we will be subject to their whims when it comes to CME and costs. Celebrating any monopoly comes from a place of ignorance

It's not about "really wanting to be an MD." It's about quality of education, and it's about uniformity of curricular standards. Osteopathic medical schools, on the whole, offer vastly inferior clinical education in comparison to their MD counterparts. Many DO schools (including "top" ones) send their students to complete a majority of their core clerkships at small outpatient private practices. These students lack basic inpatient exposure prior to their fourth-year audition rotations and residency training. Osteopathic medical schools also include pseudoscientific nonsense in their pre-clinical curricula; alternative medicine of any kind should not be at the center of a medical school's curriculum.

OMM doesn't have to disappear. It can be taught alongside chiropractic, homeopathy, acupuncture, and other alternative medicine modalities at alternative medicine programs. It should just be excluded from the curricula of academic institutions that educate future physicians.

"We need competition in medicine." Can we be serious here? There's no real competition between the MD path and the DO path. Osteopathic medicine is just an off-brand backup plan for medical school applicants with low GPAs and MCAT scores. Every DO organization is a cheap knock-off of its corresponding MD organization. COCA is a trash version of the LCME; the NBOME is a trash version of the NBME; and the AOA is a trash version of the AMA. The notion that the NBOME is keeping the NBME in check and preventing a monopoly is beyond laughable.

 

[EDThoracotomy]

To be fair it is pretty existential for them. If there is no COMLEX then why do we need NBOME leadership at all

That is the point. We don't. The NBOME should bo dissolved or merge with the NBME. Complex is a garbage exam. NBME does everything better than the NBOME and gives the same end result.

Of course Gimple and the NBOME will claim it is essential for DOs but the only thing it is essential for is to line their pockets.

 

[AlbinoHawk DO]

It's not about "really wanting to be an MD." It's about quality of education, and it's about uniformity of curricular standards. Osteopathic medical schools, on the whole, offer vastly inferior clinical education in comparison to their MD counterparts. Many DO schools (including "top" ones) send their students to complete a majority of their core clerkships at small outpatient private practices. These students lack basic inpatient exposure prior to their fourth-year audition rotations and residency training. Osteopathic medical schools also include pseudoscientific nonsense in their pre-clinical curricula; alternative medicine of any kind should not be at the center of a medical school's curriculum.

OMM doesn't have to disappear. It can be taught alongside chiropractic, homeopathy, acupuncture, and other alternative medicine modalities at alternative medicine programs. It should just be excluded from the curricula of academic institutions that educate future physicians.

"We need competition in medicine." Can we be serious here? There's no real competition between the MD path and the DO path. Osteopathic medicine is just an off-brand backup plan for medical school applicants with low GPAs and MCAT scores. Every DO organization is a cheap knock-off of its corresponding MD organization. COCA is a trash version of the LCME; the NBOME is a trash version of the NBME; and the AOA is a trash version of the AMA. The notion that the NBOME is keeping the NBME in check and preventing a monopoly is beyond laughable.

If you have a problem with clinical education, you can advocate for COCA standards to be more stringent. It doesn't necessarily have to be an adoption of LCME standards even though I'm not against adoption of LCME standards

Osteopathy is part of medicine. It's not part of acupuncture or homeopathy, so there's no way you'll convince American DOs to divorce themselves from their physician training as it defeats what the original intent of the degree is

While DO organizations do not keep NBME in check based on size, you're once again advocating in favor of a monopoly to no benefit for you or anyone. As of now, I can walk into any hospital in the US and use osteopathic board accreditation, while other accrediting bodies, such as ABPS, are not taken everywhere. The same goes for faculty positions where I can use my AOA board certification if I want, but other than NBME, no other board certification allows you to be faculty. These 2 alone are a very strong head-start for a model of competition. Other DO organizations and societies are there for people that want to be a part of it. Simply put, if you don't want to be a part of them, don't be. Nobody is forcing you to be. This is not like the old days where you completed a DO residency and were bound to AOA board certification. The idea that you just want it gone for others because you're embarrassed of your degree (are you even a DO?) it ludicrous

I mean this as kindly as possible if you're a DO student, but I would strongly suggest you find a way to get over the fact that you aren't and won't be an MD. You need to address your inner inadequacies that make you feel you don't measure up because you're not defined by a degree name and no amount of wishful thinking will erase OMM and convert you into an MD

 

[MateoGM416]

The idea that you just want it gone for others because you're embarrassed of your degree (are you even a DO?) it ludicrous

I mean this as kindly as possible if you're a DO student, but I would strongly suggest you find a way to get over the fact that you aren't and won't be an MD. You need to address your inner inadequacies that make you feel you don't measure up because you're not defined by a degree name and no amount of wishful thinking will erase OMM and convert you into an MD

You love building this strawman about being insecure about being a DO and then accuse the people who don't agree with you as having that insecurity. If anyone is insecure about being a DO, it's the DO's who can't publicly admit there are fundamental flaws in some osteopathic principles that need to be addressed

 

[DO2015CA]

It's not about "really wanting to be an MD." It's about quality of education, and it's about uniformity of curricular standards. Osteopathic medical schools, on the whole, offer vastly inferior clinical education in comparison to their MD counterparts. Many DO schools (including "top" ones) send their students to complete a majority of their core clerkships at small outpatient private practices. These students lack basic inpatient exposure prior to their fourth-year audition rotations and residency training. Osteopathic medical schools also include pseudoscientific nonsense in their pre-clinical curricula; alternative medicine of any kind should not be at the center of a medical school's curriculum.

OMM doesn't have to disappear. It can be taught alongside chiropractic, homeopathy, acupuncture, and other alternative medicine modalities at alternative medicine programs. It should just be excluded from the curricula of academic institutions that educate future physicians.

"We need competition in medicine." Can we be serious here? There's no real competition between the MD path and the DO path. Osteopathic medicine is just an off-brand backup plan for medical school applicants with low GPAs and MCAT scores. Every DO organization is a cheap knock-off of its corresponding MD organization. COCA is a trash version of the LCME; the NBOME is a trash version of the NBME; and the AOA is a trash version of the AMA. The notion that the NBOME is keeping the NBME in check and preventing a monopoly is beyond laughable.

Last paragraph

It has nothing to do with being as powerful. The competition comes in where you can say eff you to one and take another. It keeps them in check. With AOA opening up BC to MDs, this is a very good thing. Maybe enough cross over that we have realistic competition eventually.

You only need to be BC, realistically it doesn’t matter which in order to bill.

I took both DO and MD boards. DO boards cost $1750. MD were $2200. With a monopoly, then who knows where costs will be. As for the people that ask me why I took MD if I feel they’re equivalent is because my fellowship specialty doesn’t have a sub-board for DOs. If I leave fellowship then I would continue on with my DO primary board simply because it’s cheaper and I value competition

You love building this strawman about being insecure about being a DO and then accuse the people who don't agree with you as having that insecurity. If anyone is insecure about being a DO, it's the DO's who can't publicly admit there are fundamental flaws in some osteopathic principles that need to be addressed

Albino and I don’t always see eye-to-eye these days but he’s right here. You can advocate for increasing standards up to LCME without trying to completely trashcan the DO degree. As someone in a large academic university program, no one has ever questioned my credentials (at least to my face lol). It seems only DO students rotating through even seem to care enough to bring up that my badge says DO.

 

[MateoGM416]

Albino and I don’t always see eye-to-eye these days but he’s right here. You can advocate for increasing standards up to LCME without trying to completely trashcan the DO degree. As someone in a large academic university program, no one has ever questioned my credentials (at least to my face lol). It seems only DO students rotating through even seem to care enough to bring up that my badge says DO.

The guy he's replying to's opinion is definitely extreme, and I don't think the DO degree should be trashed. It's just very silly to pretend to know how secure or insecure someone is about the type of doctor they are from how they feel about some things they were taught in school.

I grew up in the South being taught in school that the Civil War was fought for state's rights and not slavery at all, that climate change was still being debated amongst scientists, and that creationism was a defensible alternative to the big bang theory. Just because I know those things are wrong doesn't mean I'm insecure about the overall quality of the education I received.

 

[Neopolymath]

This problem will persist even as the old guard literally die. Morbid, I know. It's a safe-haven for politically driven people that wouldn't have a chance in MD orgs to become the enemy/bureaucratic bloat. It's a place for true-believers, of which there are still an alarming amount graduating. It's a place people try to get rich the parasitic way.

And most importantly, as a competent DO who excelled in spite of these organizations, I have little free time. I'm doing a lot of stuff. With my little free time, am I going to go to some weirdo DO only thing and deal with the headache and futility and increased irritation or am I going to go to my state medical society meeting to work toward protecting our profession from midlevels, government casualty, and insurance companies?

The reason this persists is ultimately that nearly all of the people who should be at these meetings as normal/pragmatic DOs have better things to do. The opportunity cost is too great when I can simply ignore it and never give a dime to any of them. Spending time on this painfully slowly sinking ship is a sunk cost fallacy by definition.

This whole process works and it's probably the least bad way to train physicians. The hours are not as bad and the job is not as bad as many people dramatically state. That said, many people make terrible decisions and sacrifices in this training pathway due to sometimes subconscious and sometimes outright pressure. These people missed time they will never get back for things they didn't need to do.

At the end of the day, going to an AOA event isn't going to pay me more or get me more days off. It isn't going to give me more time with my family instead of doing paperwork. It isn't going to create competition that means I do less MOC (BS) and less paperwork. It sure as hell isn't going to make me a better physician. So, no, the DO world will still be what it is because competent people are moving on with their lives and not becoming martyrs for a system that should be burned down ultimately.

Palliation is for people not organizations.

 

[Neopolymath]

The guy he's replying to's opinion is definitely extreme, and I don't think the DO degree should be trashed. It's just very silly to pretend to know how secure or insecure someone is about the type of doctor they are from how they feel about some things they were taught in school.

I grew up in the South being taught in school that the Civil War was fought for state's rights and not slavery at all, that climate change was still being debated amongst scientists, and that creationism was a defensible alternative to the big bang theory. Just because I know those things are wrong doesn't mean I'm insecure about the overall quality of the education I received.

This board has always had a small, vocal minority of people who think that acknowledging the bloat/pointlessness (backed by a history of doing scant positive) of many aspects of DO culture means that you are insecure or self-hating.

How can I argue against the bloat in American healthcare but then also tolerate what the DO world is? It's untenable as it stands.

 

[DO2015CA]

The guy he's replying to's opinion is definitely extreme, and I don't think the DO degree should be trashed. It's just very silly to pretend to know how secure or insecure someone is about the type of doctor they are from how they feel about some things they were taught in school.

I grew up in the South being taught in school that the Civil War was fought for state's rights and not slavery at all, that climate change was still being debated amongst scientists, and that creationism was a defensible alternative to the big bang theory. Just because I know those things are wrong doesn't mean I'm insecure about the overall quality of the education I received.

Other than using hot ticket examples because it will polarize a reader when your point is actually pretty good

 

[sylvanthus]

Learn it, memorize it, regurgitate it for tests, become an attending and move on and never look back.

 

[AlbinoHawk DO]

You love building this strawman about being insecure about being a DO and then accuse the people who don't agree with you as having that insecurity. If anyone is insecure about being a DO, it's the DO's who can't publicly admit there are fundamental flaws in some osteopathic principles that need to be addressed

Except for the fact that i have over and over again acknowledged the shortcomings and need for change. Talk about strawman arguments

Fact is the person I'm responding to is saying that anything OMM needs to be banished, all DO organizations closed and everything converted to MD. It doesn't get more clear than that when it comes to a deep resentment and desire to be an MD

 

[AlbinoHawk DO]

This board has always had a small, vocal minority of people who think that acknowledging the bloat/pointlessness (backed by a history of doing scant positive) of many aspects of DO culture means that you are insecure or self-hating.

How can I argue against the bloat in American healthcare but then also tolerate what the DO world is? It's untenable as it stands.

It's fine to want to get rid of bloat or make the system better. As i mentioned previously, people should have the option to take steps instead and be licensed this way

It's also okay to say there are aspects of OMM that should be scrapped. After all, i hated OMM and did poorly on these sections, but i also realize not all of it is trash, and nobody forces me to practice it. The same goes for osteopathic organizations and board certification. You don't have to join or take them if you don't want to, but why do you think you need to erase it for everyone else?

Truth is many people went DO because they couldn't get MD and still wish there was a way to turn MD so they dedicate all their time to trying to erase DO so they can claim just a little more that yet are MDs

So it's fine if you want to refine things, but if your position is "destroy osteopathy and turn me into an MD," yeah, it's insecurity. Otherwise you'd just be moving on with your life

 

[Osminog]

If you have a problem with clinical education, you can advocate for COCA standards to be more stringent. It doesn't necessarily have to be an adoption of LCME standards even though I'm not against adoption of LCME standards

Osteopathy is part of medicine. It's not part of acupuncture or homeopathy, so there's no way you'll convince American DOs to divorce themselves from their physician training as it defeats what the original intent of the degree is

While DO organizations do not keep NBME in check based on size, you're once again advocating in favor of a monopoly to no benefit for you or anyone. As of now, I can walk into any hospital in the US and use osteopathic board accreditation, while other accrediting bodies, such as ABPS, are not taken everywhere. The same goes for faculty positions where I can use my AOA board certification if I want, but other than NBME, no other board certification allows you to be faculty. These 2 alone are a very strong head-start for a model of competition. Other DO organizations and societies are there for people that want to be a part of it. Simply put, if you don't want to be a part of them, don't be. Nobody is forcing you to be. This is not like the old days where you completed a DO residency and were bound to AOA board certification. The idea that you just want it gone for others because you're embarrassed of your degree (are you even a DO?) it ludicrous

I mean this as kindly as possible if you're a DO student, but I would strongly suggest you find a way to get over the fact that you aren't and won't be an MD. You need to address your inner inadequacies that make you feel you don't measure up because you're not defined by a degree name and no amount of wishful thinking will erase OMM and convert you into an MD

It would be easier to eliminate COCA than to try to convince COCA to be more like the LCME. And if you think that’s impractical, please remember that individuals on SDN used to argue back in the day that merging the ACGME and AOA residency systems was impractical. Progress is being made. People are gradually realizing that the MD-DO divide is completely artificial and unnecessary.

Osteopathy is not “a part of medicine.” It’s alternative medicine. Only in the US is it shoved into medical curricula. It is in the same category as homeopathy, chiropractic, and acupuncture. The term “osteopathic medicine” is an oxymoron; what is really taught at DO schools is “medicine, plus osteopathy.”

DO organizations have no anti-monopoly function. In MD circles, they are completely ignored or deemed irrelevant. They have no sway beyond making DOs’ lives more difficult. I’m glad that your AOA board certification makes you eligible for faculty positions, just like allopathic board certification would; it’s a shame that most departments at ivory tower institutions seldom, if ever, consider DOs for those kinds of positions.

I’m not sure why you think all the psychoanalyzing is necessary. It’s an uninspired form of ad hominem that doesn’t contribute to the discussion at all. As much as I love the idea of rehashing the “self-hating DO” trope in every other SDN thread, I’d rather talk about the immense benefits of abolishing osteopathic medicine.

 

[Osminog]

So it's fine if you want to refine things, but if your position is "destroy osteopathy and turn me into an MD," yeah, it's insecurity. Otherwise you'd just be moving on with your life

This misrepresents my point. I am not looking to “destroy osteopathy.” Osteopathy will continue to exist, alongside many other forms of bodywork healing practices. I just believe in the separation of medicine from alternative medicine modalities.

Also, I don’t care so much about the letters after your name. In the 1960s, the DO and MD degrees were merged in the state of California. For a $65 fee (around $600 today), DOs could obtain the right to call themselves MDs. 86% of the DOs in California took advantage of that opportunity. Perhaps you would’ve been one of the people within the 14% who preferred to not be MDs. Good for you. My primary focus is not on degree titles but rather on the future of medical education—more specifically, the quality of medical education and the uniformity of standards across institutions. Changing DO schools to MD degree-granting institutions is not an end in itself; rather, it would simply be a probable byproduct of creating uniform standards and eliminating pseudoscience from their curricula.

 

[Niwrad]

IMO, from what I can see, eventually there will be something that will act as closure between MD/DO divide. It's a matter of when not if.

What form that takes, hard to say.

Some possibilities

- the dental route, where both degrees exist but are equivalent in all but name
- the California route, where DO is converted to MD
- COMLEX becomes de facto equivalent to USMLE
- Zombies eat everyone

 

[DO2015CA]

IMO, from what I can see, eventually there will be something that will act as closure between MD/DO divide. It's a matter of when not if.

What form that takes, hard to say.

Some possibilities

- the dental route, where both degrees exist but are equivalent in all but name
- the California route, where DO is converted to MD
- COMLEX becomes de facto equivalent to USMLE
- Zombies eat everyone

As long as the zombies can feel my CRI while eating my brains then I choose this option

 

[Goro]

This problem will persist even as the old guard literally die. Morbid, I know. It's a safe-haven for politically driven people that wouldn't have a chance in MD orgs to become the enemy/bureaucratic bloat. It's a place for true-believers, of which there are still an alarming amount graduating. It's a place people try to get rich the parasitic way.

Honestly, Neo, I don't know about this. I've seen a real change in mindsets of DOs in our OMM/OMT Dept over the past 20 years. The True Believer/Cult of Still mindset seems to be on life support these days, if it's not actually dead.

The shift has been more to a believe that Osteopathy itself is, well, helpful.

And most importantly, as a competent DO who excelled in spite of these organizations, I have little free time. I'm doing a lot of stuff. With my little free time, am I going to go to some weirdo DO only thing and deal with the headache and futility and increased irritation or am I going to go to my state medical society meeting to work toward protecting our profession from midlevels, government casualty, and insurance companies?

The reason this persists is ultimately that nearly all of the people who should be at these meetings as normal/pragmatic DOs have better things to do. The opportunity cost is too great when I can simply ignore it and never give a dime to any of them. Spending time on this painfully slowly sinking ship is a sunk cost fallacy by definition.

It's important to avoid the sin of solipsism. In understand where you're coming from, but that's you. There are people out there who take a strong interest in their profession. Why do doctors become Faculty, even if it's only an adjunct position? For free library and email privileges and a small stipend? Nope, it's because they enjoy teaching.

Why do people take leadership roles in thier organization? While some might be on power trips, others have a definite stake in thier chosen profession.

So, I actually have some hope that your generation will accomplish something good. But as you surely know, there are tons ho people who love to complain, but refuse to life a finger to be part of the solution, even when the complaints are valid. Coping mechanism, I suppose. Excuse are easy, though, finding solutions are harder.

I know that the changes you all seek will come after I retire. I do hope that they can come while I'm still alive.

In the meantime, you students can at least lobby your sympathetic DO faculty to try to get into positions of power, and work for change. Don't just say "something needs to go", give the solutions. That way. when they go tot he AOA Convocation, or the annual meeting, they network and perhaps, just perhaps, get the ball rolling.

 

[Goro]

Also, I don’t care so much about the letters after your name. In the 1960s, the DO and MD degrees were merged in the state of California. For a $65 fee (around $600 today), DOs could obtain the right to call themselves MDs. 86% of the DOs in California took advantage of that opportunity.

I don't know how many of you have heard the full backstory on this, I have, and it was a fascinating and almost admiral display of ruthlessness on the part of the CAMA.

As Omsi points out, they almost destroyed the DO in CA. But they overreached into restraint of trade territory.

 

[AlbinoHawk DO]

It would be easier to eliminate COCA than to try to convince COCA to be more like the LCME. And if you think that’s impractical, please remember that individuals on SDN used to argue back in the day that merging the ACGME and AOA residency systems was impractical. Progress is being made. People are gradually realizing that the MD-DO divide is completely artificial and unnecessary.

Osteopathy is not “a part of medicine.” It’s alternative medicine. Only in the US is it shoved into medical curricula. It is in the same category as homeopathy, chiropractic, and acupuncture. The term “osteopathic medicine” is an oxymoron; what is really taught at DO schools is “medicine, plus osteopathy.”

DO organizations have no anti-monopoly function. In MD circles, they are completely ignored or deemed irrelevant. They have no sway beyond making DOs’ lives more difficult. I’m glad that your AOA board certification makes you eligible for faculty positions, just like allopathic board certification would; it’s a shame that most departments at ivory tower institutions seldom, if ever, consider DOs for those kinds of positions.

I’m not sure why you think all the psychoanalyzing is necessary. It’s an uninspired form of ad hominem that doesn’t contribute to the discussion at all. As much as I love the idea of rehashing the “self-hating DO” trope in every other SDN thread, I’d rather talk about the immense benefits of abolishing osteopathic medicine.

So you think it's easier to destroy the entire accreditation body for DO schools and be taken over by LCME while also converting all degrees into MD? Come on, give me a break. So far one of your complaints has been that you have clinical rotations at private clinics. I personally rotated with a neurologist who was core faculty for USC and the USC students would rotate at his clinic, so I would doubt LCME will save you here, but lets entertain for one second that you could change that. You think it's easier to pass a resolution with COCA for all rotations to be required to be held at a residency sponsoring institution or do you think it would be easier to convince all schools and COCA to disappear for LCME to take over?

Please explicitly state what aspects of LCME accreditation you need to be implemented. Please don't try to weasel by saying everything. Lets analyze all your points and see if there is benefit or if it's easier to implement these things through COCA than to advocate to destroy COCA and have an LCME takeover

DO organizations do help in anti-monopoly function. Both DO2015CA and I have explained to you how they do. Just because you don't like them doesn't mean they don't serve this function. I don't think any ivory tower would accept you if you got your fantasy MD from AT Still University, so I don't see the point you're trying to make. Let me guess, the school should also change its name because AT Still was a pseudoscientist?

Even putting the validity of osteopathic treatments aside, osteopathy is part of medicine by way of historical roots. The entire term "Osteopathic Medicine," which you claim is an oxymoron (it isn't), was created to appease those that wanted the medicine part to be stated explicitly. The entire field was created so that you practiced osteopathy, which happened to include the training of being a physician in the conventional sense. You simply will never convince American DOs to abandon a core tenant of being a physician in order to learn osteopathy because you, in your medical student infinite wisdom, thinks it's just alternative medicine, regardless if it is or not

Again, all your complaints boil down to "I want to be an MD." If you want to be an MD so badly, there are different routes to it. You're not here advocating for students. You're advocating for the degree you want. You can't convince me or anyone reasonable that your statements "Osteopathic Medicine is an oxymoron, DO organizations serve no function, OMM needs to be eliminated from medicine entirely, and have LCME take over COCA" that they mean "I don't care about the letters. I care about students."

This misrepresents my point. I am not looking to “destroy osteopathy.” Osteopathy will continue to exist, alongside many other forms of bodywork healing practices. I just believe in the separation of medicine from alternative medicine modalities.

Also, I don’t care so much about the letters after your name. In the 1960s, the DO and MD degrees were merged in the state of California. For a $65 fee (around $600 today), DOs could obtain the right to call themselves MDs. 86% of the DOs in California took advantage of that opportunity. Perhaps you would’ve been one of the people within the 14% who preferred to not be MDs. Good for you. My primary focus is not on degree titles but rather on the future of medical education—more specifically, the quality of medical education and the uniformity of standards across institutions. Changing DO schools to MD degree-granting institutions is not an end in itself; rather, it would simply be a probable byproduct of creating uniform standards and eliminating pseudoscience from their curricula.

Osteopathy is medicine. You're exactly looking to destroy osteopathy because you want to divorce it from its core roots. If you're truly this dissatisfied with it, you should look into going into an MD-granting institution

Your primary focus is clear from your statements even if you try to deny it and pretend it's about the students. It's almost as laughable as the Jerry Falwell statement of "love the sinner and not the sin" when it comes to homosexuality

 

[AlbinoHawk DO]

IMO, from what I can see, eventually there will be something that will act as closure between MD/DO divide. It's a matter of when not if.

What form that takes, hard to say.

Some possibilities

- the dental route, where both degrees exist but are equivalent in all but name
- the California route, where DO is converted to MD
- COMLEX becomes de facto equivalent to USMLE
- Zombies eat everyone

In the ideal world we would all have a single-accrediting body that goes beyond current LCME where we particularly ban institutions from having mid-levels interfere with training of medical students (e.g., taking procedures or being alongside during rotations). We should ideally have everyone take the same step exams. Schools should be able to choose to offer osteopathy training in addition for those interested and continue to have a residency for NMM; it would appease those that want it to continue to exist, appease those that don't want to take it, and make sure those that go into it are doing it because they actually want to be there. The degree would be an MD, but if you take the osteopathy elective, you can get a "diplomate in osteopathy" and use the letters DO in addition. Finally, we wouldn't have single societies or only one licensing board

But the ideal world doesn't exist. The best case scenario we can bring COCA standards up. COMLEX will be replaced by USMLE + an OMM exam in-house. We could eliminate OMM practices such as craniosacral and chapman from the general curriculum with less hours spend on learning OMM overall. We would also get a match where US applicants apply and match first without revealing their degree or institution granting it

 

[deleted721365]

The further one goes in their medical training the more they realize how “evidence-based medicine” is often times a bunch of bull**** (Brian Carmody has a great podcast on this topic). Not only that, but it’s been the catalyst to cookie cutter, algorithms that are the backbone to the rise of mid levels. With more training comes the understanding that lots of what we do is more gray (ie being a doctor and applying your training) than black and white (ie being a mindless robot mid level and just following an algorithm).

That being said, I do not like omm either but it’s just low hanging fruit for med students to pick at. Lots of **** we do either has no evidence or bad evidence at that.

 

[Mad Jack]

It's funny, everyone rails on about evidence-based medicine until you reach practice and find there's nothing but anecdotes and correlation guiding much of what we're doing at the advanced attending level. And then the problem becomes when evidence finally does come out, it is viewed as gospel, even if flaws are clearly apparent. A good example of this is ARDSNet demonstrating superior outcomes of 6 mL/kg when compared to 12 mL/kg being used to justify all patients being on low-volume ventilation when the study just skipped the more commonly utilized 8-10 mL/kg. The study basically demonstrated that volumes lower than are typical in ventilating patients are superior to volumes that are higher than typical, but what about, you know, typical volumes? Would 8 or 10 have outperformed 6? Are we killing people because we took low-volume ventilation as gospel when the only comparator was a volume that most people would wince at the barotrauma potential of?

Don't let the OMM stuff get to you. If it upsets you that much, why did you choose to go to a DO school? You knew what you were in for, a lot of weirdness that will never be scientifically explored because there is no desire and no funding. Getting upset about it is just a waste of time that will distract far more from your life than the couple of hours you're in OMM lab each week. After third year you'll never deal with it again, so just chill, it'll be fine and you'll look back on this in 5 years or so and be like wow, how was I so upset about something so inconsequential to the rest of my life.

 

[DO2015CA]

It's funny, everyone rails on about evidence-based medicine until you reach practice and find there's nothing but anecdotes and correlation guiding much of what we're doing at the advanced attending level. And then the problem becomes when evidence finally does come out, it is viewed as gospel, even if flaws are clearly apparent. A good example of this is ARDSNet demonstrating superior outcomes of 6 mL/kg when compared to 12 mL/kg being used to justify all patients being on low-volume ventilation when the study just skipped the more commonly utilized 8-10 mL/kg. The study basically demonstrated that volumes lower than are typical in ventilating patients are superior to volumes that are higher than typical, but what about, you know, typical volumes? Would 8 or 10 have outperformed 6? Are we killing people because we took low-volume ventilation as gospel when the only comparator was a volume that most people would wince at the barotrauma potential of?

Don't let the OMM stuff get to you. If it upsets you that much, why did you choose to go to a DO school? You knew what you were in for, a lot of weirdness that will never be scientifically explored because there is no desire and no funding. Getting upset about it is just a waste of time that will distract far more from your life than the couple of hours you're in OMM lab each week. After third year you'll never deal with it again, so just chill, it'll be fine and you'll look back on this in 5 years or so and be like wow, how was I so upset about something so inconsequential to the rest of my life.

Agreed in 5 years it will all be a distant memory.

 

[Drrrrrr. Celty]

It's funny, everyone rails on about evidence-based medicine until you reach practice and find there's nothing but anecdotes and correlation guiding much of what we're doing at the advanced attending level. And then the problem becomes when evidence finally does come out, it is viewed as gospel, even if flaws are clearly apparent. A good example of this is ARDSNet demonstrating superior outcomes of 6 mL/kg when compared to 12 mL/kg being used to justify all patients being on low-volume ventilation when the study just skipped the more commonly utilized 8-10 mL/kg. The study basically demonstrated that volumes lower than are typical in ventilating patients are superior to volumes that are higher than typical, but what about, you know, typical volumes? Would 8 or 10 have outperformed 6? Are we killing people because we took low-volume ventilation as gospel when the only comparator was a volume that most people would wince at the barotrauma potential of?

Don't let the OMM stuff get to you. If it upsets you that much, why did you choose to go to a DO school? You knew what you were in for, a lot of weirdness that will never be scientifically explored because there is no desire and no funding. Getting upset about it is just a waste of time that will distract far more from your life than the couple of hours you're in OMM lab each week. After third year you'll never deal with it again, so just chill, it'll be fine and you'll look back on this in 5 years or so and be like wow, how was I so upset about something so inconsequential to the rest of my life.

Tbh the covid pandemic made me lose a lot of interest in pulm and icu research. When it came down to things, we changed our perspectives on a lot of things. Permissive hypoxia, bipap till exhaustion, high flow o2, etc overnight because we were backed up against a wall. Now we practice a whole different type of medicine from what I did my first year of residency. Now I frequently walk into ICUs for consults are see ppl being okay with O2s in the 85s and maps in the 60s.