DO discrimination? Is it overblown?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

doctorE2010

Member
10+ Year Member
5+ Year Member
15+ Year Member
Joined
Oct 23, 2005
Messages
135
Reaction score
0
I've heard of people discriminating against DO's, and I'm sure that there are uneducated people who do not understand the degree/profession. I just wanted to get insight from people who are either attending DO programs or have graduated...is this "discrimination" a constant battle or are people making a bigger deal out of it than it really is? It seems to me like any descimination comes mostly from the uneducated public and not within the medical community, but I'd like to hear from people with first hand experience since I'm relatively new to learning about osteopathic medicine.

Members don't see this ad.
 
doctorE2010 said:
I've heard of people discriminating against DO's, and I'm sure that there are uneducated people who do not understand the degree/profession. I just wanted to get insight from people who are either attending DO programs or have graduated...is this "discrimination" a constant battle or are people making a bigger deal out of it than it really is? It seems to me like any descimination comes mostly from the uneducated public and not within the medical community, but I'd like to hear from people with first hand experience since I'm relatively new to learning about osteopathic medicine.

The majority of DO discrimination is among uninformed premeds.
 
OSUdoc08 said:
The majority of DO discrimination is among uninformed premeds.

I concur
 
Members don't see this ad :)
yes, many of the haters are insecure premeds who aren't afraid to talk **** on an anonymous forum.
 
The biggest place I've seen discrimination is at A-hole medical schools like University of Maryland that only allow visiting students in on elective rotations if they come from ACGME Accredited schools. By definition osteopathic schools can not obtain this Accreditation and therefore can not rotate there.

Our AOA rep told us there were some other schools that did that and the AOA sucessfully sued them, aparently the UMD giant is too big to tackle.

Otherwise not too bad if you don't mind some major badgering during allo residency interviews and such... and unless you don't care about getting a quality education you'll probably be applying to at least a few allo residency programs because good osteo programs are few and far between these days. Be prepped for the "pressure interviews" because they will happen (not always but definitely will)...

$.02
 
You guys want to hear something funny. 9 times out of ten when I hear somebody disputing the qualifications of a DO its in places like this forum. Amazing! Why do we have to be our biggest problem?
 
That's kind of what I figured...seems like the bias is mostly due to ignorance.
 
H0mersimps0n said:
.

Otherwise not too bad if you don't mind some major badgering during allo residency interviews and such... and unless you don't care about getting a quality education you'll probably be applying to at least a few allo residency programs because good osteo programs are few and far between these days. Be prepped for the "pressure interviews" because they will happen (not always but definitely will)...

$.02

Not sure what you mean about "pressure interviews". I have gone on 17 interviews all at allo residency programs in ob/gyn. The only place I received any flack about being a DO was by a DO interviewing me. Ironically I received a "we are ranking you highly" letter, though I am not ranking that program. Otherwise, I have had a really positive experience. Granted the most of my interviews are on the East Coast. The West Coast I have heard is not as friendly to us. But no personal experience myself.
 
H0mersimps0n said:
Otherwise not too bad if you don't mind some major badgering during allo residency interviews and such... and unless you don't care about getting a quality education you'll probably be applying to at least a few allo residency programs because good osteo programs are few and far between these days. Be prepped for the "pressure interviews" because they will happen (not always but definitely will)...

I've interviewed at numerous allopathic residency programs and not one time have I had a pressure interview or been hassled in any way about being from an osteopathic program. Lots of allopaths are fascinated by it. I've checked each program out further by talking to DO faculty and residents there, and they have confirmed that there is no problem. Obviously I can speak only for those programs that I have interviewed at, but my classmates in similar situations also report no problems with it. The allopaths are coming around for the most part, so I think that outright discrimination is not common anymore.
 
I worked for a few years in a psychiatric residency program. My boss was the program director for the psychiatry rsidency program. It is an allopathic program. Basically, not only does he treat DO applicants the same as all other applicants, he even favors them a bit (probably because DO principles are great for psychiatry). At this hospital in particular, an allopathic hospital, they are very DO friendly. In the ER especially, it is crawling with DO residents.
 
doctorE2010 said:
I've heard of people discriminating against DO's, and I'm sure that there are uneducated people who do not understand the degree/profession. I just wanted to get insight from people who are either attending DO programs or have graduated...is this "discrimination" a constant battle or are people making a bigger deal out of it than it really is? It seems to me like any descimination comes mostly from the uneducated public and not within the medical community, but I'd like to hear from people with first hand experience since I'm relatively new to learning about osteopathic medicine.

As has been stated previously most of this discrimination comes from type/insecure premeds who get much of their value from the initials behind their names. In the real world there i very little of this. I worked in an ER where MDs and DOs worked side by side. There was no difference either in the way patients or docs treated ecah other. People just want you to be competent and caring.
 
Members don't see this ad :)
doctorE2010 said:
I've heard of people discriminating against DO's, and I'm sure that there are uneducated people who do not understand the degree/profession. I just wanted to get insight from people who are either attending DO programs or have graduated...is this "discrimination" a constant battle or are people making a bigger deal out of it than it really is? It seems to me like any descimination comes mostly from the uneducated public and not within the medical community, but I'd like to hear from people with first hand experience since I'm relatively new to learning about osteopathic medicine.

As has been stated previously most of this discrimination comes from type A/insecure premeds who get much of their value from the initials behind their names. In the real world there i very little of this. I worked in an ER where MDs and DOs worked side by side. There was no difference either in the way patients or docs treated ecah other. People just want you to be competent and caring.
 
In my opinion this is all that you need to know:

1. There will always be plenty of anecdotal evidence out there to support whatever side you want to hear/argue for and/or against.

2. For every person that has something negative to say about DO's, there are plenty more people who just simply want a good doctor who knows his/her $hit (MD or DO), and a decent amount of people who will seek you out because they prefer DO's for a variety of reasons.

Take my opinion for what its worth...this is just how I view things...
 
I have never felt any discrimination from other students, residents or attendings. In fact, most of the reception I get is quite positive...especially after they learn that I am an OMM Fellow and can treat them. 🙂

I have been on several rotations with students from other medical schools (there are 5 in Philadelphia) who not only asked me to treat them, but also asked about things that they can do for their patients as well.

I think that the way you conduct yourself either as student, resident or attending will be the standard by which you are judged and not the degree you possess.

And I also agree that the most I hear about "discrimination" is when I log on to SDN.
 
Thanks guys for your honest replies! Earlier in the week I was wrestling with some self-doubt about the implications of having a DO instead of MD behind my name...now I'm really excited about being a DO. One of the major reasons is that I'm really excited about learning OMM...at first I was skeptical but I'm starting to think that it's a great alternative to the over-medication of much of the US population. I also no longer feel like I'm "settling" and am really happy with my decision to pursue osteopathic medicine. I'm thinking of going to see an Osteopathic doctor for my next exam (even though she's 45 minutes away) just to get a first hand opinion. Again, thanks for the input!
 
doctorE2010 said:
Thanks guys for your honest replies! Earlier in the week I was wrestling with some self-doubt about the implications of having a DO instead of MD behind my name...now I'm really excited about being a DO. One of the major reasons is that I'm really excited about learning OMM...at first I was skeptical but I'm starting to think that it's a great alternative to the over-medication of much of the US population. I also no longer feel like I'm "settling" and am really happy with my decision to pursue osteopathic medicine. I'm thinking of going to see an Osteopathic doctor for my next exam (even though she's 45 minutes away) just to get a first hand opinion. Again, thanks for the input!

Good for you! But just FYI-you can learn OMM as an MD, too.

my .02- DOs are just as respected. But what really earns respect is being competent, not the two letters behind your name.
 
yposhelley said:
my .02- DOs are just as respected. But what really earns respect is being competent, not the two letters behind your name.
Exactly!!! 😀 👍

Nice to have you back on the forums Shelley!
 
subtle1epiphany said:
Exactly!!! 😀 👍

Nice to have you back on the forums Shelley!



All of the DO's I've talked with about this say that the whole discrimination thing is way overblown. It doesn't happen 99.9% of the time. That being said you always have 1 idiot in the bunch...
peace-B
 
my friend interviewed at highly competitive ER programs in NY, PA and one in MA (not saying which) and those were high pressure and in one of the programs he was told that he was going to be the first DO to be considered for their program. Big programs and a bunch of questions about DO's... He's very competitive overall (which is how he got these interviews) so there was no academic pressure questions...

I was just making sure no one reading this thought they were going to march into any University program in the country they want and not expect some questions about wtf a DO is, why they their their medicine is better than MD, why they went to a DO school and not an MD school and even if they applied to any MD schools. I'd be mega surprised to get those questions from small/community hospitals and even SOME universities.

It may be rare but you're foolish if you think it never happens/aren't prepared for it.

I'm interested in radiology and my undergrad University has a med school (also where I'm from) that I want to be considered at. I had to meet with the director of clinical education and research face to face to explain to him what a DO was and the differences etc. before he even considered me for doing a rotation there.

So thats three University programs I can think of off the top of my head.
 
If you're an alpha male/female with confidence and a take em by the balls attitude, you'll be just fine as a DO.

Sure, in areas with few practicing DO's, you may need to explain it more (can't fault people for simply not knowing. it's not exactly a normal passtime to spend 4 hours a day on SDN! 😀 ).
 
H0mersimps0n said:
\I had to meet with the director of clinical education and research face to face to explain to him what a DO was and the differences etc. before he even considered me for doing a rotation there.


If a director of clinical education and research does not know what a D.O. is, then we have serious problems. I very seriously doubt that an allopathic physician, in any part of the country, would not know what a D.O. is. In fact, I know a lot of MDs in the Norwestern US, (where there are no Osteopathic medical schools ) that I will be doing rotations with that are well aware of my training and background, yet do have have any D.O. colleagues in their practice.

I could see explaining it to a pt or even an aspiring premed, but to another physician? No way...
 
SquidDoc said:
If a director of clinical education and research does not know what a D.O. is, then we have serious problems. I very seriously doubt that an allopathic physician, in any part of the country, would not know what a D.O. is. In fact, I know a lot of MDs in the Norwestern US, (where there are no Osteopathic medical schools ) that I will be doing rotations with that are well aware of my training and background, yet do have have any D.O. colleagues in their practice.

I could see explaining it to a pt or even an aspiring premed, but to another physician? No way...

Believe me I wasn't all that pleased I had to spent a vacation day to meet with him. Fortunately I had my alpha male, testicle-squeezing ability to get me through it- lol 😀

sad but true...
 
I think the answer to your question is largely based on two important factors: location and specialty.

From my travels as a fourth year over the past few months I have noticed that striking differences in the perceptions of DO's exist depending on where I was geographically. It seems that the midwest is very friendly and open, however, I wish the same could be said about certain parts of the northeast such as Boston. Unfortunately, a lot of the PDs at big Boston programs are still pretty old skewl and not as accepting to DO's. I realize there will be those that write in saying the opposite, however, from recently completing an elective in neurology at a very well respected, ivy, 'H'ard core program I can tell you that DO discrimination does still exist among administrators. For the most part I think that the younger and up-and-coming generation of physicans will be much more accepting and any discriminiation will very almost non-existant in the future.

Another example is of a classmate of mine who applied several months ago to do an elective at a smaller, southern low-tier program only to get a rejection flat out stating that the reason she was rejected was because she was a DO student. I don't even know if this is legal but just further illustrates the point that discrimination is still out there there but it appears to be sparse.
 
Careofme said:
I think the answer to your question is largely based on two important factors: location and specialty.

From my travels as a fourth year over the past few months I have noticed that striking differences in the perceptions of DO's exist depending on where I was geographically. It seems that the midwest is very friendly and open, however, I wish the same could be said about certain parts of the northeast such as Boston. Unfortunately, a lot of the PDs at big Boston programs are still pretty old skewl and not as accepting to DO's. I realize there will be those that write in saying the opposite, however, from recently completing an elective in neurology at a very well respected, ivy, 'H'ard core program I can tell you that DO discrimination does still exist among administrators. For the most part I think that the younger and up-and-coming generation of physicans will be much more accepting and any discriminiation will very almost non-existant in the future.

Another example is of a classmate of mine who applied several months ago to do an elective at a smaller, southern low-tier program only to get a rejection flat out stating that the reason she was rejected was because she was a DO student. I don't even know if this is legal but just further illustrates the point that discrimination is still out there there but it appears to be sparse.

I definately agree with your sentiments in regards to increasing acceptance as our generation replaces the old-timers; but I would recommend that your friend take some legal action against the program that wouldn't allow her to rotate at the hospital because of being an osteopathic med student. I definately don't think that's legal. DO/MD are both considered medical doctors in the US and so student's institutional affiliations shouldn't be the determining factor on a rotating application.
 
uacharya said:
I definately agree with your sentiments in regards to increasing acceptance as our generation replaces the old-timers; but I would recommend that your friend take some legal action against the program that wouldn't allow her to rotate at the hospital because of being an osteopathic med student. I definately don't think that's legal. DO/MD are both considered medical doctors in the US and so student's institutional affiliations shouldn't be the determining factor on a rotating application.


There have been various cases where MD programs have been sued successfully by DO students for similar reasons. so... SUE SUE SUE! 😍
 
I actually urged her to call the AOA and talk to someone there about it. Does anyone know who within the AOA would be the best to deal with this issue? The funny thing is that I think this whole issue angers/frustrates me more than her! Anyway, I dont think that a program should get away with this especially when ACGME=AOA (legally at least). Any other suggestions? Thanks.
 
I actually urged her to call the AOA and talk to someone there about it. Does anyone know who within the AOA would be the best to deal with this issue?

The funny thing is that I think this whole issue angers/frustrates me more than her! Anyway, I dont think that a program should get away with this especially when ACGME=AOA (legally at least). Any other suggestions?
Thanks.
 
Careofme said:
I actually urged her to call the AOA and talk to someone there about it. Does anyone know who within the AOA would be the best to deal with this issue?

The funny thing is that I think this whole issue angers/frustrates me more than her! Anyway, I dont think that a program should get away with this especially when ACGME=AOA (legally at least). Any other suggestions?
Thanks.

I would recommend that you contact Dr. Crosby, JD of the AOA who acts an executive legal advisor for the association. I happend to peruse the online blog that was mentioned earlier in this forum and there is a blog entry in regards to a similar situation in which UPMC was sued on a similar basis. Fortunately, the decision favored D.Os and now UPMC gladly accepts D.O students to rotate! =o) Anyways, here's the link. The article is titled "Educational Victories For Osteopathic Physicians" and can be found in the January 2005 section of the Education page. http://www.do-online.osteotech.org/blog/index.php?blogid=4&archive=2005-01&catid=16

I can understand your frustration but hang in there! I got accepted at a prominant allopathic externship for medical students between my 1st and 2nd year and attendings (all MDs) said that I performed better than most of their residents (all MDs as well). Although this could've just been an attempt to inflate the old ego, I'm hoping a bit of sincerity made its way through =oP. But this just goes to show you, the whole "D.O stigma" is definately overblown than it actually is.
 
Careofme said:
I actually urged her to call the AOA and talk to someone there about it. Does anyone know who within the AOA would be the best to deal with this issue?

The funny thing is that I think this whole issue angers/frustrates me more than her! Anyway, I dont think that a program should get away with this especially when ACGME=AOA (legally at least). Any other suggestions?
Thanks.

I would recommend that you contact Dr. Crosby, JD of the AOA who acts an executive legal advisor for the association. I happend to peruse the online blog that was mentioned earlier in this forum and there is a blog entry in regards to a similar situation in which UPMC was sued on a similar basis. Fortunately, the decision favored D.Os and now UPMC gladly accepts D.O students to rotate! =o) Anyways, here's the link. The article is titled "Educational Victories For Osteopathic Physicians" and can be found in the January 2005 section of the Education page. http://www.do-online.osteotech.org/blog/index.php?blogid=4&archive=2005-01&catid=16

I can understand your frustration but hang in there! I got accepted at a prominant allopathic externship for medical students between my 1st and 2nd year and attendings (all MDs) said that I performed better than most of their residents (all MDs as well). Although this could've just been an attempt to inflate the old ego, I'm hoping a bit of sincerity made its way through =oP. But this just goes to show you, the whole "D.O stigma" is definately a manifistation of ignorant undergrads that don't know the difference between penicillins and cephlasporins. (No offense to any undergrads reading this post; we were all there at one time as well)
 
I currently work at a hospital and there are DOs and MDs everywhere, with no difference. Actually, the doc most people think is the best anestesiology is a DO. However, I was recently shadowing a DO who said, "Being a DO is like choosing to be a person of color during the civil rights movement." While I think that is a bit extreme, she did have some examples of discrimination she had faced, but it all examples were over 10 years old.
 
uacharya said:
I would recommend that you contact Dr. Crosby, JD of the AOA who acts an executive legal advisor for the association. I happend to peruse the online blog that was mentioned earlier in this forum and there is a blog entry in regards to a similar situation in which UPMC was sued on a similar basis. Fortunately, the decision favored D.Os and now UPMC gladly accepts D.O students to rotate! =o) Anyways, here's the link. The article is titled "Educational Victories For Osteopathic Physicians" and can be found in the January 2005 section of the Education page. http://www.do-online.osteotech.org/blog/index.php?blogid=4&archive=2005-01&catid=16

I can understand your frustration but hang in there! I got accepted at a prominant allopathic externship for medical students between my 1st and 2nd year and attendings (all MDs) said that I performed better than most of their residents (all MDs as well). Although this could've just been an attempt to inflate the old ego, I'm hoping a bit of sincerity made its way through =oP. But this just goes to show you, the whole "D.O stigma" is definately a manifistation of ignorant undergrads that don't know the difference between penicillins and cephlasporins. (No offense to any undergrads reading this post; we were all there at one time as well)



That's what I am talkin' 'bout...sue sue sue!
 
BrettBatchelor said:
I'll pass that message along to your patients.

Please do, gotta make sure I get to use my future combined DO/JD degree 😍
 
BrettBatchelor said:
Haha. Nice.


I tried...

BASHFUL
 
Dotsero said:
As has been stated previously most of this discrimination comes from type/insecure premeds who get much of their value from the initials behind their names. In the real world there i very little of this. I worked in an ER where MDs and DOs worked side by side. There was no difference either in the way patients or docs treated ecah other. People just want you to be competent and caring.

Yes, it is kinda pitiful in a sense that a person honestly feels that initials behind one's name is the true value of his or her self-worth. It rises the question if he or she is mature enough to be entering a medical doctor profession. I also believe that if a person thinks DOs or MDs are inferior one to another, he or she probably needs more healthcare experience then be applying to medical school.
 
OSUdoc08 said:
The majority of DO discrimination is among uninformed premeds.

I could not disagree more. Just take a stroll over to the anesthesiology forum for some perspective - and anesthesia is supposedly a "DO friendly" specialty.

Discrimination in securing allopthic residencies is very common and widespread.

In the private practice world it is less common. However, there are still plenty of hospitals and physician groups that will not credential/hire DOs. And this occurs in all cities, even ones with DO schools in them. Tulsa is a good example.
 
uacharya said:
I definately agree with your sentiments in regards to increasing acceptance as our generation replaces the old-timers; but I would recommend that your friend take some legal action against the program that wouldn't allow her to rotate at the hospital because of being an osteopathic med student. I definately don't think that's legal. DO/MD are both considered medical doctors in the US and so student's institutional affiliations shouldn't be the determining factor on a rotating application.

It is not illegal. There are still some schools that will not accept DO students for visiting rotations. U. of Iowa is an example, although I heard they might finally be changing this policy.
 
Dotsero said:
As has been stated previously most of this discrimination comes from type A/insecure premeds who get much of their value from the initials behind their names. In the real world there i very little of this. I worked in an ER where MDs and DOs worked side by side. There was no difference either in the way patients or docs treated ecah other. People just want you to be competent and caring.

Incorrect.
 
It never ceases to suprise me...there is soooo much more DO discrimination on sdn than anywhere I have seen.

As far as Urology goes, I talked with the PD at a major allopathic University hospital (sat next to him on the plane) and he said that any DO applicant would be compared on even ground with the MD candidates. He even asked me to consider doing a 4th year rotation with him, so I doubt that there is any real discrimination there. What we hear is not always the truth of the matter. Times are changing.

Direwolf- Are you a COMP student/grad? I used to live in Rancho/Fontana area...
 
DireWolf said:
It is not illegal. There are still some schools that will not accept DO students for visiting rotations. U. of Iowa is an example, although I heard they might finally be changing this policy.

Where did you hear this? I don't know any different, but Iowa is a pretty DO friendly state (life time resident here). If you have first hand knowledge of this I would really love to hear it b/c it was one of the places I intended to apply for residency w/ USMLE scores. Please let me know. Thanks
 
krayj36 said:
Where did you hear this? I don't know any different, but Iowa is a pretty DO friendly state (life time resident here). If you have first hand knowledge of this I would really love to hear it b/c it was one of the places I intended to apply for residency w/ USMLE scores. Please let me know. Thanks

I applied for an elective rotation there last year. They called me on the phone and told me to read their website concerning visiting students. It explicitly states that students must be from LCME-accredited medical schools to rotate there. I was told my application would not even be considered. Dr. Doan, moderator of the ophthalmology forum and a former U. of Iowa resident confirmed this policy for me and posted in the ophtho forum.

I have heard rumors that they are considering changing this. I would call the curriculum/registrar office at U. of Iowa to confirm.

And yes, this all occurs even though Iowa has a DO school and there are a decent number of DOs in some of U of Iowa's residency programs.
 
DireWolf said:
It is not illegal. There are still some schools that will not accept DO students for visiting rotations. U. of Iowa is an example, although I heard they might finally be changing this policy.


Of course it is. The AOA has continually succeeded at gaining rotation rights, hospital medical staff privileges, and restitution for damages from institutions who have unlawfully discriminated against DOs based solely on the nature of their training. Contact the AOA litigation committee and lay a hand for future DO generations. If we don't speak up and make our rights be respected unlawfull discrimination will surely continue.
 
Please add University of Maryland to that list. I tried to rotate there, contacted tons of people only to discover the Dean of the University hides behind the same rule mentioned by DIREWOLF: no visiting meds from non-LCGME accreditted schools...

so, if/while someone is at it they can add UMD to their class action lawsuit list or whatever that'd be fantastic.

Thanks
 
As a DO who has applied to allopathic rads, I can tell you without hesitation that discrimination does exist, although it is subtle and overt at most places. Many of my rotations as a MS were at allopathic programs and they were oblivious to DO's in many cases due to very little previous exposure.

Oddly enough, once I did well and outperformed many of the "top" MD's the most flak I caught was from the other MS's who felt threatened. During my intern year there were 10 DO's and 17 MD's in the program and oddly enough the DO's/MD thing was really only a problem for the 1st year MD's who felt insecure about themselves.

I am now working in the USAF as a Primary care doc, when I arrived I was the first DO they had had in years out of 7 docs. They didn't really "say" anything derogatory to me, but after being there 6-8 months and they figured out I actually knew I was a competent doc, several of them said to me over a beer "wow, we didn't know DO's actually were comparable to "us" (MD's)."

When I told them I was applying to Radiology, they snickered and sneered b/c even in the military, radiology is very competative. Well, now I'm heading off to radiology this summer in San Antonio as 1 of 2 DO's of 24 residents. I can't wait to break down this ridiculous barrier.

My spin is, a DO or an MD can be good or bad. I like being able to show other physicians whom are unfamiliar with DO's due to lack of exposure that we are "not inferior" because of our training. Many of you in FP probably won't experience much of this type of discrimination, but if you are applying for ER/OB/Surgery/Rads/Gas-- you will likely notice this occurs.

Moral is- if you work/study hard, you can get into most programs. Study hard for the boards and if you are applying to a very competative field (allopathic) and you take the USMLE and score well, you have a shot.
 
I was looking at University of Minnesota's website, and they stated that they only allow LCME-approved students to rotate there, too. I guess it's not the norm, but it's not super uncommon. What I'm failing to get is how it's illegal unless there's some statute specifically dealing with this type of discrimination. As a rule, you can't discriminate on the basis of age, race, religion, etc., but everyhing else is fair game.
 
exlawgrrl said:
I was looking at University of Minnesota's website, and they stated that they only allow LCME-approved students to rotate there, too. I guess it's not the norm, but it's not super uncommon. What I'm failing to get is how it's illegal unless there's some statute specifically dealing with this type of discrimination. As a rule, you can't discriminate on the basis of age, race, religion, etc., but everyhing else is fair game.

Basically, alot of the funding for residency comes from the government, the government says the degrees are equal. That is the general basis for the lawsuits. There is more too it but that is the basics
 
Just to help some of the MS3s out who are applying for away rotations, UPitt starting allowing DO students to rotate last year. Most departments at Vandy still use the LCME rule, which is listed on their website, but a couple of them (anesthesiology for example) will allow DO students to rotate there.
 
Top