DO/MD merger? what do you think?

[bones]

There has been a little talk recently about what it would be like if the osteopathic world merged with allopathic medicine.

NOTE: this is a THEORETICAL exercise. I'm just curious what you think. chances are, you'll never see the change- but I wanted to explore some of the principles involved.

a few points to consider-

1) AT Still chose to award DO's rather than MD's to his students for a good reason. His students treated their patients using methods and approaches that were totally alien to the MD world at the time. Now, MD's and DO's are probably more alike than different.
So, does it make sense to have two different professions who's practice rights, legal rules, and training are so similar? would it be enough to have schools that specialized in what we now consider osteopathic philosophy and practice, while awarding the MD degree?

2) MD stands for doctor. everyone accepts this. DO? well, some know what it stands for and many don't. We'll likely be explaining what we are for the rest of our lives, when we could just have it in our degree. Osteopathic Medicine is something of a misnomer now anyway- our practice is far broader than the name would indicate.

3)OMM is a difficult specialty that takes many years to get good at, perhaps something would be lost if a merger occurred. Would schools with an osteopathic concentration be able to maintain a full osteopathic faculty? In surgery, it is easy since this is a high-pay high - prestige career that is removed from primary care. To make OMM purely a residency would remove it from the training of all of those that could use it in their primary care careers, as well as cripple would be specialists- forcing them into residencies close in length to that of surgeons and likely not offering equal pay (assuming we see insurance coverage changes- OMM docs now make bank?but that is another post). It seems to me that OMM needs to be taught in undergraduate medical education, as it is now. Should it be an elective? would there be enough support for a full faculty if it was an elective? perhaps it could be a substantial area for clinical rotations for those from various schools that were interested- thus avoiding some of these issues.

4) Those that wish to be MD's but have difficulty in the admissions process sometimes take advantage of the generally lower numerical entrance requirements in DO schools (albeit minor) and thus the applicant pool each year contains a certain percentage of would-be doctors that have little or passing interest in the 'osteopathic philosophy' or OMM. This ends up creating a schism of sorts, between the osteopaths who use OMM and love the philosophy taught at DO schools- and end up holding AOA positions etc. and then the rest who feel jilted every time the profession tightens its belt, changes a policy to distinguish DO?s from MD's or tries to increase OMM hours in the curriculum.
-Not only are these issues difficult politically, but some MD's regard DO's as inferior specifically because of this schism. Many people they know were forced into the DO profession for want of adequate numbers to be admitted to MD schools- so they assume that all DO's have similar motivation for entering the profession- and thus it is somehow inferior in their eyes to the MD degree. All such thoughts would be abolished as soon as MD?s were awarded to all and the only people who studied OMM were those who seriously wanted to use it in their practice.

5) boards. should they really be different? sure we are generally taught to approach patients a little differently than most MD's, but is this currently reflected in the COMLEX? do we really need all of COMLEX to account for our OMM class?

6) RESEARCH RESEARCH RESEARCH. Think about it. If there was a merger, what would the chances be of MD?s getting funding to see how effective OMM is (relative to what DO?s get now)?

7) A poorly executed merger was attempted in California a while back, with disastrous results. Anyone with a detailed history of this, mitigating factors and the like- lets hear it! I am very curious as to why this happened and what went wrong.

Don?t misunderstand, I am very interested in OMM myself- I may even specialize in it. I am not entirely sure how I would answer these questions, and I wanted to get these thoughts out there and hear what others had to say.
All viewpoints are welcome. Don?t hold back your crazy ideas, but please refrain from the sweeping generalizations and personal attacks that cause so much annoyance in the other threads.

best wishes,
-bones
KCOM '05

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[Mr. happy clown guy]

I think the editorial in the April JAOA discussing Osteopathic and Allopathic Unity being the only way to preserve Osteopathic Uniqueness is a great example of the need for somewhat of a "merger".

 

[CADO2B]

Hey it happened in CA in the 60s and 70s, I don't see why I couldn't happen again either here or elsewhere. Get a good lawyer though, because it'll be an uphill battle. <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" /> <img border="0" title="" alt="[Eek!]" src="eek.gif" />

 

[Mr. happy clown guy]

?

Our own survival with its distinct identity has alot to do with the unity with the allopathic medical world. We have been isolationist for far too long. We have had the "oh poor me" attitude...the "everybody picks on us" attitude for far too long.

 

[Amra]

What would the upside be? Continuity of name? It is a safe bet all your patients will call you "Doctor" and couldn't for the life of them differeniate between DO and MD.

Sure, its was tried in Cali... one of historical "big mistakes" of the AMA... proved beyond of shadow of a doubt that DO=MD. Can you say "Ooppss..." Wonder what genius came up with that one... completely disproved all of the AMA allegations..

I don't think there is much AMA-pushed anti-DO movements except for individual prejudice (and they're just showing their ignorance). The new enemies: Tort reform (at least here in Pa), HMOs, PAs and NPs (the ones that cut into the physician revenue).

Just my $0.02.

-A

 

[Ice Man]

It would be a good idea. It would be good for DO's, good for MD's, and good for patients.

 

[Dr. Nick]

I think something quite obvious is being neglected in this discussion.

What will MDs gain with such a merger?

Any thoughts?

 

[oceandocDO]

Maybe award an MDo and an MDa? I doubt the MDs would ever agree with it. If the two schools did merge, I can assure you the osteopathic route would be the more competitive one to get into. Why? Simply because DO training is a more thorough education. MDs who apply to allopathic school are not applying there because they "agree with the allopathic philosophy more than the DO philosophy" (what is the MD philosophy anyway?). MD students are applying MD because of those very letters. If the semantic distinction is evaporated, the best students will naturally want the training that affords them the most comprehensive learning available: the DO education. While OMM may have it's ups and downs, DOs still, I can guarantee you, know more anatomy and musculoskeletal function than an MD student. Walk up to an MD student and ask how many articulations are on a rib. 2/3 wouldnt know. 3/3 DO students would. OMM is, after all, a melting of the finest aspects of physical therapy and chiropractic, both of which took their professions from the foundations of OMM. Hence my next point, related to the above poster:
•••quote:•••I think something quite obvious is being neglected in this discussion.

What will MDs gain with such a merger?
••••Money. MDs will send their patients to a physical therapist in a heartbeat, but they would never send their patient for OMM. Never. Why? If an MD could perform the OMM, they could keep the patient in house and BILL for it..... ahh,...billable. (Here's where MDs will suddenly listen to what I'm saying.) Yes, contrary to most people opinions, OMM is very billable to insurance and the like. I even know some OMM professors at NYCOM that dont accept insurance at all and make WELL into the mid-six figures a year for taking nothing but cash and doing nothing but OMM. There is a patient population out there that will pay ANYTHING for these treatments if they work, which most do. 1/4 of Americans suffer from some type lower back pain sometime in their life. That's 70 million patient visits a year right there.

All in all, DOs will continue to merge with the MDs in all aspects of care and society. The older DO crowd who went DO because of a strict belief system is finally starting to retire and the newer generation sees much less of a distiction. The AOA has to get itself together and start marketing better. Right now they're clueless. But, I hear they did hire the ad agency that does the "Got milk" campaign, so hopefully that arena will see improvement.

As to the California merger of the 60's, to my knowledge, it wasnt a voluntary thing. The medical board in CA basically started revoking DO residencies by the dozens. They told any DO to send in $60 and they would receive an MD degree. Some did, and have it to this day. Basically the AMA was getting a bit scared of the competition. This is where the whole "Quack" thing started I think. A few die-hard DOs saved the profession though out there and fought for the residency slots and slowly (over 20+ years), the profession came back. The west, however, is still the least infiltrated sector of the DO map. With the new schools out there it will change, but not soon enough IMO. This very ordeal 30+ years ago is one of the things that soured the older population of DOs today. Hence, many of them still have that "poor me" attitude as isolationists. I think it's important to remember our history, but let's not keep reliving it.

 

[Qafas]

I, for one, believe that things are fine just the way they are. The only disadvantage in becoming a DO as opposed to an MD would be discrimination against the Osteopathic profession. Granted that there was a time when such discrimination was prevalent and widespread. But, times have changed; look around you ? DOs and MDs are practicing side by side without any real problems. If there is any prejudice still lingering against DOs, it is in the minds of individuals and is not a general, system-wide problem.
From what I have learned thus far, I think that the quality and availability of some osteopathic residencies leaves something to be desired, and that DOs have a tough time getting into many allopathic residencies, even if their performances are on par with those of MD applicants to the same programs. But, that is hardly a reason for doing away with a hundred years of tradition and history. Perhaps the licensing exams should be merged, so that everyone takes just the USMLE and all DOs can be gauged on the same scale as all MDs. But, I don?t see that happening, at least not any time soon. For one, there would be no way to test DOs on OMT if the exams were made identical.
I?ve also heard the argument that people in general are not aware of the Osteopathic profession. That certainly is a legitimate concern. But, it is better solved by raising the awareness of the public about our profession rather than by converting or merging it with another. I agree that the differences in osteopathic and allopathic medicine have faded away over the years in many respects. However, there still remain some very fundamental and important distinctions between the two, and they are worth preserving.
Just my opinion!

 

[Dr. Nick]

Hey OceandocDO,

You're not a new member, are you?

Cheers,
Dr. Nick

 

[jhug]

•••quote:••• If osteopathic medical schools start awarding a MD as opposed to a DO, anyone who obtained a score less then 27 on the MCAT and was admitted to a DO school should thank God that they applied in time. (Not that it is impossible to get into a MD school with a score less then 27, but it is much harder.) ••••I usually don't pick specifics out but this made me laugh.... my brother didn't even take the mcat and he was accepted to an MD program in the bahamas. If it was all about the acronyms you can get the MD title with a pathetic mcat-- if one at all.

I personally think that MSU is a type and shadow of things to come. MD/DO schools-- both indipendant, yet totally equal

 

[Jersey Girl]

Subatomic, you need to get over yourself! The MCAT is not all there is in an application to med school. Where a 1 day standardized test is week, many other things may be extremely strong. DO's have a whole person philosophy clinically, and while going through the application process to DO schools, I noticed they had a whole person philosophy when reviewing applicants as well. I have seen people who I know on a personal level get into MD schools because they have a 34 on their MCAT. Yet there GPA is week, they are not well rounded, and do not have any EC's. You made the remark that DO school MCAT averages are slightly lower. More like a 27 instead of a 29 or 30. Well, there are lots of MD schools with the same MCAT averages. MCAT averages which are even lower than that. Howard, Meharry, and Moorehouse to name a few. Look into Nevada, and Georgia as well. These schools award an MD. They are only a couple MD schools with MCAT averages which are more like a 27. And to be truthful, is a 27 really that significantly different from a 29 or a 30? It seems so minor and foolish to focus on such a small difference. There are 125 MD schools in the country, and only 19 DO schools. It seems like every body always compares MCAT averages of the most competative MD schools to DO schools. Which isn't representative of the whole, and isn't really right to do. Lastly, I am sure that not every body that went to college did outstanding on their SAT. I know lots of people who did poorly on their SAT and became outstanding students of science, and researchers. Just like the SAT is one indicator of college success, the MCAT is only one indicator of Med school success.

 

[jhug]

grammatical correction-- in my haste i goofed-- i meant totally indEpendent, yet totally equal

 

[GoForIt]

I am not in favor of the MD/DO merger. Over 100 years ago AT Still started the DO philosophy. 100 years later, I still see the need to maintain the DO philosophy.

oceandocDO posted May 20, 2002 03:02 AM
•••quote:••• Maybe award an MDo and an MDa? ••••Let's face it. AOA will not award MDo and AMA will not award MDa. Similarly, AOA will not award MD+ and AMA will fight it even if AOA wants to do it. I think D.O. is very appropriate. It distinguishes from the other MD folks. Furthermore, it tells everyone that you are US trained and passed the three rigorous COMLEX exams; you are not a FMG; and that you are recognized by the USA government as MD equal.

If you think that the D.O. letters after your name makes you perceived as less qualified than M.D. and that having the same two letters from DO schools would solve the problem, think again. I am not sure that Harvard MD would consider Howard MD as equal, so why would Johns Hopkins MD consider KCOM MD as equal?

jhug posted May 20, 2002 10:41 AM
•••quote:•••I personally think that MSU is a type and shadow of things to come. MD/DO schools-- both indipendant, yet totally equal ••••This is really the ultimate solution, but probably won't happen in the next 100 years. Currently only 6 of the 19 are public osteo med schools. I do not know how soon/realistic that each public med school will have both MD and DO programs. A public osteo med school will retain top students in the state as well as increasing the general population's awareness of osteo medicine.

I think to make D.O. medicine continue to prosper, more quality osteo resident programs are needed. I applaud COMP for increasing the number (four times more) as well as improving the quality of its affiliate resident programs in the past few years.

MD outnumbers DO. This is a fact and it will not change. But if all DOs unite behind the DO philosophy, DO will be the distinctive medicines. MD/DO merger will only make DO distinct.

 

[RockandRolldoc]

I agree... I do not think that DO's and MD's should merge. I like the DO and MD identities and the two only benefit medicine and wellness in society. What I do think is necessary is for the AOA to get their heads out of their Rectums and get the word out there. Let the country know that there are two types of doctors... let them know that manipulation can be very efficacious in treating many common ailments without drugs. Let them know about the more humane and compassionate whole-body approach to medicine.
If they do merge something... I believe it should be Comlex and USMLE. I actually heard a few people talking about it at NYCOM when I interviewed there a couple months ago. They would be the same exam.. and the DO's would take one extra section on manipulation. This makes sense because it levels the playing field for residencies a little more. It also makes sense because even though both exams are comparable...it truly standardizes licensing for all physicians in the US.

 

[Ice Man]

You all are forgetting that the AMA is very cool with DO's.... THEY DON'T HAVE TO BE. What the DO's that I know say are that the AOA is the hold up. The AMA would love to have DO's become MD's they get more money and more federal funding to put in residency programs. The AMA working with the NBME tried to work out a deal afew years back with the AOA to get the NBME to add a 50 question section to the USMLE and eliminate the COMLEX, well it didn't work.

 

[Dr. Nick]

JerseyGirl,

"It seems like every body always compares MCAT averages of the most competative MD schools to DO schools. Which isn't representative of the whole, and isn't really right to do. "

No, everybody compares allopathic averages to osteopathic averages. This is entirely appropriate.

I would say that your suggestion of comparing Osteopathic averages to lower-tier MD schools "isn't representative of the whole, and isn't really right to do."

 

[Dr. Nick]

•••quote:•••Originally posted by jhug:
•I usually don't pick specifics out but this made me laugh.... my brother didn't even take the mcat and he was accepted to an MD program in the bahamas. If it was all about the acronyms you can get the MD title with a pathetic mcat-- if one at all.

I personally think that MSU is a type and shadow of things to come. MD/DO schools-- both indipendant, yet totally equal•••••2 Points:

#1 - Foreign medical schools are an entirely different beast altogether. I wouldn't so easily dismiss people's MCAT scores as "pathetic". I know some pretty bright people that attend foreign medical schools.

#2 - It seems incredibly wasteful to run parallel DO/MD programs nationwide. In this day and age of cost cutbacks and financial pressures I think that this is unrealistic.

 

[migraineboy]

I am totally in agreement with the concept of eliminating the COMLEX. It would be easy to tack on an OMM/OMT subsection to the USMLE for osteopathic students. I also believe that, unless that AOA can improve the quality of AOA-approved residencies, these residency programs should be eliminated. The osteopathic community has worked so hard to maintain its distinction from the allopathic world, however I feel that they have somewhat sacrificed the quality of education they offer the students in order to maintain this distinction. Maybe we could focus our training on being "better" instead of being "different". Just a thought....

 

[osteodoc13]

I have to take exception with oceandocDO's characterization of the California merger. It was actually completely voluntary, and instigated by DOs who were fed up with being treated as second class citizens. What the MDs gained was getting rid of competitors who had, historically, simply provided better care.

The plans for the merger actually began in the 1930s, a time when DOs in California led the nation in terms of numbers, length and scope of education, and prestige. But they were still outcasts in the medical community, unable to gain privileges at community hospitals, and generally looked down upon. At the time, they owned a small hospital on the County-USC campus, and they were given every 10th patient. When they would publish their annual M&M reports, the patients treated osteopathically would do much better than those treated allopathically. In fact, the DOs training in OB had to go to the MD hospital to get more experience in complicated births, because those treated osteopathiclly were rarely complicated. In the late 1930s the MDs decided to limit the number of patients given to the DO hospital, and stopped publishing data altogether.

The merger finally occured in the 1960s through a ballot initiative which removed the state board's ability to license new DOs and to renew licenses. Current DOs could, however, send in a check and recieve an MD degree through the mail. The new MDs were still belittled, though. They were called "little MDs," but they were finally equal in the eyes of the law. At the low point, there were &lt;100 DOs in the state.

Finally in the 1970s the Supreme Court of California overturned the proposition on the grounds that it violated DOs civil right to practice their medicine.

The ironic thing is that the merger was used by DOs in other states to show that their training was equivalent, and thus should be given full practice rights. Thus the MDs lost not only the merger, but their claim of superiority over DOs.

What the DOs lost was time and energy which could have been spent on Osteopathic research. At the time, California was a hotbed of research, with many PhDs combining with DOs to try to prove scientifically what they were feeling with their hands.

We don't need another merger because, as Dr. Nick has pointed out in other threads, his attendings are practicing osteopathic philosophy, albeit without using OMM.

 

[Qafas]

•••quote:••• Points that I made that were obviously not clear:
I originally stated that the MCAT is not indicative of the quality of the student or physician.
Restated: MCAT scores do not matter. They cannot not be used to determine what kind of doctor a person will become. I even believe they cannot be used to determine what kind of student a person will be while in school. But admissions committees do not see it that way. They like having numbers that they can use to eliminate candidates from the applicant pool. If significantly more students with high MCAT scores start applying to osteopathic schools, as much as I would like to believe differently, I think osteopathic medical school admission committees will develop the same number tunnel vision that many allopathic schools have. This would unfortunately eliminate the highly qualified candidates who have MCAT scores less then 27. ••••Hi SubAtomic,
I don?t find your argument against the MCATs convincing at all. I could make the same argument the other way around; that is to say that if there were no MCATs, some people who score really low and clearly don?t have the aptitude to handle med school would be able to slip past the admissions committees. You say that MCATs are no indication of what kind of doctor (or even med student) one is going to be. Let me ask you this ? what is?? There is NO one thing that can foretell what kind of doctor one will make. For that matter, not even a collection of attributes will concretely and unequivocally indicate that. That presents quite a challenge, and the only way to solve it is to have standards against which all applicants must be measured. It follows logically then that the more competitive the applicant pool, the higher the standards are going to be. Let us not forget that med schools are not sitting around waiting to hand out charity admissions. If you want it bad enough, you will have to measure up to your peers.
The argument you make is flawed because I could just as easily say the same thing about grades. I did not have stellar grades as an undergrad. But, is that necessarily an indication of what kind of doctor I will be? No, right? Well, why should admissions committees bother with grades then. Why not just base it all on clinical experience that one has racked up? Because just as soon as you make that argument, you?ll have hundreds of applicants who don?t have much in the way of experience arguing that THAT is no indication of what kind of doctor one is going to make either.
That is why the only acceptable solution is to take a look at all of one?s attributes in one glance. If the MCATs are low, you better hope that you shine in other areas. If you don?t, then you have more work ahead of yourself; I had to enroll in a special Master?s program to prove that I could handle the rigors of med school despite my poor grades. That, along with strong MCATs has gotten me into the class of 2006.
As for people who aren?t really interested in Osteopathic medicine but apply to Osteo schools simply because they cannot get into allopathic schools ? I see nothing wrong in that. An interest in osteopathy is a relative issue; that is to say that it is not something tangible that you can wrap up in a bundle and take with you to the interview. If an uninterested student is better qualified than an interested one, he or she still has every right to compete for that seat. After all, an interest in osteopathy, in and of itself, is no guarantee that one will make a good DO. And the end goal of all applicants is to be physicians. But, for the sake of the profession and the uninterested student, one would hope that that student will have respect for the profession and the community of which he or she has chosen to become a part.

 

[Dr. Nick]

Osteodoc,

"What the MDs gained was getting rid of competitors who had, historically, simply provided better care."

-What's the evidence for the above statement?

"The plans for the merger actually began in the 1930s, a time when DOs in California led the nation in terms of numbers, length and scope of education, and prestige. But they were still outcasts in the medical community, unable to gain privileges at community hospitals, and generally looked down upon."

-How, exactly, did the Osteopaths "lead the nation" in numbers, and length and scope of training? If this is true, i'd enjoy reading some evidence.

- How did the Osteopaths, "lead the nation in...prestige" yet at the same time live as, "outcasts in the medical community, unable to gain privileges at community hospitals, and generally looked down upon" This is so confusing.

"We don't need another merger because, as Dr. Nick has pointed out in other threads, his attendings are practicing osteopathic philosophy, albeit without using OMM."

Not sure I follow your logic on this one, Osteodoc. If we are "practicing osteopathic philosophy albeit without OMM" as you claim - wouldn't that be evidence for a merger? If you think we are so similar why not merge?

Also, I think your claim that we are "practicing Osteopathic philosophy" is not really true either. We are Allopaths, not Osteopaths. I don't think Osteopathy owns all holistic approaches to medicine.

 

[jrich15]

It wasn't that DO's in California led the nation....in regards to both MD's and DO's, but only in regards to DO's. The education of the DO's in California at the time was superior to the majority of the other Osteopathic Schools at the time. Dr. Nick, if you are interested in this and have the time you should check out the book authored by Norman Geitz titled "The D.O.'s:Osteopathic Medicine in America". Norman Geitz was a professor of medical sociology at one of the Chicago medical schools (allopathic) and is now at Ohio State U. college of osteopathic medicine. He is very fair in his judgement of osteopathic medicine in general. In stating that he is fair, I mean that he is critical when it is deserving, but is not biased. As far as what will MD's gain by the merger, I would research the AMA's stance on this. They have been very promerger since the 1930's. It may even suprise you that the AMA absorbed the homeopaths back in the early 20th century. Check out that book it is very good. Just my opinion.

 

[drusso]

I think that Osteodoc has it essentially correct...

The Gevitz book is a very good history of osteopathic medicine's early development, but ends in the late 1970's. Another good reference is, "Osteopathic Medicine: A Reformation in Progress" available through Amzaon.Com--it provides more current references.

<a href="http://www.amazon.com/exec/obidos/ASIN/0443079919/qid=1021993808/sr=8-1/ref=sr_8_1/102-5480350-9320159" target="_blank">http://www.amazon.com/exec/obidos/ASIN/0443079919/qid=1021993808/sr=8-1/ref=sr_8_1/102-5480350-9320159</a>

Also, I have an electronic (PDF) copy of a history student's doctoral dissertation on the recent history of osteopathic medicine titled "An examination of the status of osteopathic medicine from 1960-2000." A very engaging and insightful analysis of osteopathic medicine's recent development. E-mail me privately if you would like a copy (it is free for downloading from UMI too)

I think that understanding the osteopathic profession's history is crucial and some thing that most students neglect to study. As the old saw goes, "Those who don't understand history are doomed to repeat it."

 

[osteodoc13]

Thanks to jrich for preempting my reply to Dr. Nick. I meant that the California DOs led the nation of DO's.

In terms of better results, read the rest of my post regarding the statistics put out my the two county hospitals. Also, consider the results of the Spanish influenza epidemic of the early 1900s. DOs, working just with manipulation, had success rates in the 80% range, compared with 30% range for MDs using allopathic medicine.

When I said we don't need a merger, I meant that DOs don't need to blend into the AMA, because MDs are becoming more osteopathic every day. We should retain our identity and wait for the rest of the medical community to come to us.

 

[dkwyler94]

As far as the merger, I would be very much for it. I am a student at a DO school now. I knew almost nothing about DOs before coming here, I had only once met one. I simply liked the school. Since coming here I have come to believe the most significant differences between DOs and MDs is historical and political. I also hear far more negative comments about MDs from DOs than I ever heard from MDs about DOs.

I think the AMA and MDs in general would have no problem with the two fields merging. In many ways they all ready have as most DOs do AMA approved residencies and DOs are welcome to be members of the AMA(I am). The AOA will fight it of course.

As I frequently express to people when I discuss this, there are differences. There are also differences between a molecular biologist and a college english professor, but both are PhDs. Their differences are much greater than that between MDs and DOs.

The difference between the professions is in the underlying philosophy-not really in the practice. The schools can talk about them all they want, but if an individual does not incorporate it into their own philosophy of how to practice medicine, it will not affect how they practice. These personal philosophies will be there regardless of the initials after the name.

In the end, Osteopaths and Allopaths all practice medicine. They are both medical doctors. This is what MD is all about.

I also think the last difference in the practice of the two, OMM, will disappear as more research is done in the area. It either works and everyone who practices medicine should recognize and use its benefits(personally or by referral), or it doesn't work and it should be left to the history books.

(Note:There is an interesting editorial along these lines in the Nov. 4th 1998 issue of the NEJM if I remember correctly.)
KCOM-2005

 

[jhug]

•••quote:••• the most significant differences between DOs and MDs is historical and political ••••Totally true-- minus the omm.

•••quote:••• I also hear far more negative comments about MDs from DOs than I ever heard from MDs about DOs.
••••Also, totally true. Most of the MD's i've asked are taken back by the question of what they think of DO's. The usual response is-- can you do your job?? and with a confident yes we are on our way. In many ways we shoot ourselves in the foot with the comments of being more, trained more/better, better philosophies. In the end it is WHO you are not WHAT you are that will make you a great doctor. If you want to be a holistic, caring, compitent, patien- oriented physician the only one who will make you so is YOU, not so much the institution you attend.

 

[Dr JPH]

•••quote:•••In the end it is WHO you are not WHAT you are that will make you a great doctor. If you want to be a holistic, caring, compitent, patien- oriented physician the only one who will make you so is YOU, not so much the institution you attend. ••••Smartest thing anyone has said in this topic so far.

 

[Dr. Nick]

dkwyler94,

That was a nice post.

I would only add that I don't think OMM will be either totally tossed out or totally accepted with further study. I suspect that a few useful techniques will show efficacy and will be kept (likely in management of axial pain) and some of the more bizarre stuff might fall out of favor (perhaps, cranial).

Cheers

 

[luckymed]

Is there a link to the info regarding the MD/DO merger? thans

 

[osteodoc13]

I've gotten my information from spending time both with people who were around at the time, like Dr. Frymann and Dr. Ethan Allen, and from one of our faculty who is extensively researching the history, Dr. Michael Seffinger.

The best I could offer is to contact the school and see if Dr. Seffinger has anything in writing yet.

 

[Jersey Girl]

Dr. Nick,
In reply to what you said earlier to me. You have to keep in mind that there are only 19 osteo schools and 125+ allo schools. So even if you are comparing "osteo averages", to "allo averages", the difference in the sample size between both types of schools makes drawing definate conclusions from these stats difficult.

 

[Jersey Girl]

One more thing. To really draw a conclusion about MCAT averages in the osteo and allo world, 19 Allo schools in the US would have to be chosen RANDOMLY, and compared to the 19 Osteo schools MCAT averages. It would be interesting to see if any statistics have been calculated in this manner.

 

[John DO]

You make a good point by bringing up the AMA's acceptance of other transient doctorate-level medical professions, such as homeopathy. I have always wondered how the MD title is considered so stedfast and elite when all throughout our country's history the medical establishment has been so free as to award this degree to those professionals whom the medical establishment considered "quacks."

In addition, how can we hold this degree in such unequivacal high regard when ANYONE with a doctorate-level degree (such as Optometrists, Podiatrists, Chiropractors, and, yes, even Osteopaths-haha) can purchase an MD from the University of Antigua for $19,450? Albeit not formally recognized in the United States, if one were to pass the FMG exam, they are as much an MD, fully licensed as such, as the Harvard grad. Does anyone know where a limited-practice physician, as mentioned before, can purchase a DO?

I do not intend this post to imply that MDs are inferior. Quite the contrary, the point should be taken that we are EQUAL schools of medicine, both with Achilles' heels, so members of each should spend less time attacking one another and more time learning from each other.

 

[BrooklynDO]

In my thoroughly humble opinion, a DO/MD mergeer is possible in the future, maybe when we (class of 06) or so are the people "in charge". Having come from a program that is a BS/DO and people had to go elsewhere to med school b/c of poor performance on the mcat (they are getting MD degrees now) I think many more people will be more willing to recognize that an MD is good, but a DO is better, simply because any given DO has more options in choosing treatment. The points made about money and OMT are billable, and as for difficulty of med schools, its very simple, DO's took a hard courseload and added courses without adding time.

 

[Bigdaddy]

I think Dr. Nick simply enjoys reading his own posts.

 

[apgar7]

I wouldn't mind a merger of the osteopathic and allopathic associations. I think it would be good to have a unified head with two different states, so to speak. But this doesn't mean I'd want us to have the same degree titles. I would want the osteopathic schools to continue to graduate students who receive a DO degree and allopathic schools to graduate students who receive an MD degree. Why? I feel that the DO degree says something different about the way I approach medicine. It says that I have different (perhaps enhanced) training in musculoskeletal problems. It says that I take an interest in the psychosocial dimensions of people's health. Now, this does not mean that an MD cannot do these things, but it is not implied in his/her title the way it is implied in the DO title. In short, I only hope that the DO title stays alive (and of course those DO schools that teach OMM) and not necessarily the AOA as an individual orgnaization.

 

[Elena]

How about an MDO title? It would illustrate the difference, but at the same time make it more clear that a DO is a physician.

 

[JmE]

I would not be in favor of a merger as I think it is important to have the two pathways seperate and somewhat independent. I think it works to the benefit of both that they remain seperate.

Some of my opinion comes from the history and some comes from my experiences in preparing for and applying to medical school.

Probably my biggest fear regarding a merger is that there would be one less independent pathway for a dedicated and able person to realize their potential.

-JmE-

 

[apgar7]

•••quote:•••Originally posted by Jersey Girl:
•How about an MDO title? It would illustrate the difference, but at the same time make it more clear that a DO is a physician.•••••I actually don't mind this idea if it could work. But I didn't mention it because there are a couple problems with it. First, if osteopaths took on the MDO title, then allopaths could either keep their title as MD or change it to MDA. I don't think they would change their title to MDA because there would be an education phase for the public to learn what MDA means. . .and I don't think allopaths would want to mess up their already well known title of MD. Secondly, if allopaths stayed on the easy path and kept the MD title while osteopaths adopted MDO, I don't think that would change the current state of things too much. The population could still potentially wonder "what the hell is an MDO? are they the same as MDs? are they REAL doctors?" and so on. In my mind it seems just as easy to keep the DO title. Most people don't even know DO's exist, and if they see a DO with a white coat and stethoscope they usually automatically assume you are a doctor like the rest of the doctors out there.

 

[jimdo]

We must be VERY careful not to imply that one is BETTER than the other. I think I read that remark a few posts back and it would be very counterproductive. We must remember that we are the MINORITY of physicians, and cannot expect the overwhelmong majority of physicians to change their degree or even practice guidlines simply to appease us. If you look at the numbers game, the DO world is so small as to be insignificant (harsh but true) in political decision making by the MD world. Plus they have the recognized history and established name. Would you change degree if you were in their shoes?? I wouldnt.
I have one more point, and you are all going to jump on me for this one. WE WILL NEVER BE EQUAL TO THE MD. Wait a minute......before you react, let me qualify my statement. IM THE EYES OF SOCIETY, we will never be equal simply because they view DOCTOR = MD, and have been spoonfed this for all their lives. Now in terms of practice, ability, strengths and weaknesses, intelligence and aptitude, we are absolutely 100% equal to them. Fact of the matter though is that we will NEVER be equal to them in perception by the public and perhaps within some areas of healthcare. There are simply too few of us compared to the overwhelming number of MD, too shady of a history (esp in the eyes of the public), and too much of an establishment in place for a perceived equality by the lay person to exist. Now..that doesnt mean that we cant educate, inform, treat, practice etc., but we will never be able to overcome this common perception in America and across the world. The sooner we realize this and use it to our advantage, the better off and more successful the DO world will be. As it stands now, I find it common in the DO world to be butting horns with the MD establishment all of the time, especially those that are extremely pro-OMT. We simply are not a big enough goat to be able to lock horns with the MD antelope. Bad analogy, but I think you get my point.
So why try?? Why even bother?? Well.. I believe our role needs to be one in which we strive to carve a niche in the medical world based off of our philosophy and emphasis. But to believe that we can change the MDs to practicing the way we do is naivete. This is why I believe it to be so counterproductive to suggest that osteopathic medicine is "better" than allopathic. We can encourage them to pick up areas of our emphasis as we pick up areas of theirs, but we simply dont have the muscle to change an establishment.
Osteopathic medicine will NEVER be perceived as better by the public because they have grown up with the MD system and the average American does not like change. Now one definitely should have pride in our profession, I am not suggesting otherwise. But the sooner we learn to practice within the MD system without complaining, moaning and trying to change it to suit our agenda, the better off the MD world and we will be. However, our agenda can be eased into play and we can have some success in getting it across. I believe though frankly, that the sooner we begin de-emphasizing the differences between the two professions (as we are all guilty) the more successful we as DOs will become in our agenda.

 

[jimdo]

One further point. I ask you all to read my comments as one who is proud to be a DO. I am simply trying to inject a little reality into our conversation. Many of you seem quite idealistic and I think that it is great, but at the same time we must face the situation for what it truly is and not get overwhelmed in orur zeal. We CAN make a difference, but we cannot change the system to fit our needs. Rather, we can work within the system to accomplish smaller, more tangible goals.

 

[Future GI Guy]

An Allopathic View:

While I don't mean to be mean, I have a particular view on this topic that may sound it (to American trained FMG's).

Frankly, as a future allopath trained in Missouri, I would fully support the change and merger of DO's and MD's. I think it would end confusion for a patient population that isn't very educated as to the subtle differences between the two degrees.

It's quite obvious that America does not train enough physicians for herself. That said, I think it's also quite obvious that physicians from American Allopathic Schools and Osteopathic schools are both trained well and have an equal level of skill. (view the USNEWS rankings of Primary Care Schools and you'll see how many osteopath schools fair against allopath schools: they do quite well)

The problem that Osteopaths face, I think, is in the name. It's all about confusion. I mean, if a patient wants to get a new pair of glasses, do they go to a DO or an OD, and what's the difference? Of course, we all know the difference here, but I actually heard a patient say she thought DO's gave out glasses.

It's confusing, and there's no need for it to be that way.

Program directors in allopathic residencies also try to shore up their deficiencies by only accepting candidates who are M.D.'s. You can promote an "all-M.D." residency and people don't HAVE to know that half of the residents are American trained FMG's, and probably trained on a tropical island somewhere.

A merger and change of the degree (from DO to MD) would dramatically improve health care around the country. It would do so in at least 2 ways:

1. Strengthen Residencies: with American trained Osteopaths, you get a real physician who brings no language barrier to the table. You know that he or she has been taught from the latest journals and has been trained well in medical school. Change the degree, and allopathic residencies will bring in the former DO's willingly and gleefully. This will open up more pathology for DO students and will also help Allopathic residencies recruit the truly most qualified candidates.

2. It will strengthen Osteopathic education: there is little doubt that some Osteopathic Medical Schools have had trouble forming hospital affiliations because of the old M.D. vs D.O. conflict. With this roadblock removed, it would probably open up much more clinical opportunities for D.O. students to train closer to their medical school. (i.e. Kirksville students would no longer have to travel to Michigan or Florida for third year clerkships).

Now the downside for Osteopaths may be the loss of OMM, which, as someone mentioned earlier in the thread, is viewed as "quackery" not only be a lot of patients, but also by a lot of Osteopathic students themselves. I think OMM would probably dissolve in the decade following the merger, unless real retrospective studies could support it's clinical value.

Another downside may be the loss of Osteopathic residencies. With a merger like this, more Osteopathic students will choose traditional allopathic institutions based on reputation and the diversity of pathology at those institutions. Osteopathic residencies may have trouble filling, and unless they too changed their focus from D.O. to M.D., they'd have a hard time finding enough recruits.

Anyway, I've written a lot junk that no one else will read, but I just thought a different viewpoint might be of value.

Merge baby merge.

 

[drusso]

But if I wanted to be an MD, then I would have gone to an MD school. I wanted to be a DO. I like OMM and think that it's useful in certain circumstances. I've faced no problems in the world being a DO. When people ask what a DO is I say "an osteopathic doctor", when they ask what is that I usually say, "an MD with added training manipulative medicine---kind of like chiropractic or physical therapy." That usually clears things up right away. I think that my views actually reflect the majority of DO students and recent graduates and not a vocal minority who didn't get into a MD school.

So, what's in a merger for me?

 

[jimdo]

I think GI GUY makes some valid points. However, I believe he may be mistaken regarding training opportunities. MANY DOs train at allopathic institutuins, in fact my residency will be at an MD hospital. Furthermore, I have found no program as of yet that do not accept DOs for training. Also, I am certain that residency directors view DOs as a far better candidate than any FMG and have been told so directly by many. I have not found any discrimination yet and I am smack in the middle of residency application.

 

[Forensic Chick]

Hey guys,

Here's my idea:

MD's are looked at universally as medical doctors - as they should be. When a DO is mentioned -- it is rare to find someone who actually knows what a DO is let along what they actually do. Since, in practices, there is pretty much no difference (ie: MD's and DO's can do the same things like surgery, Rx, etc) -- the degree awarded in Osteopathic medicine should be M.D.O. -- Medical Doctors in Osteopathy. This way DO's will receive the recognition they deserve yet will still be distinct from the MD community... What do you think?

 

[Future GI Guy]

Drusso,
Well, I'm not sure what a merge would do for you.

What I am sure about is that it would help a lot of patients understand the simularities of function and ability between M.D.'s and D.O.'s. And doesn't it really come down to patient comfort?

I also believe that you are the exception, rather than the rule, when it comes to "choosing" a DO versus an MD school. I have a lot of friends at Kirksville and UHS who applied on the second go-round, who maybe didn't have a stellar application but so desperately wanted to be a physician. Though I realize this doesn't speak for everyone--I know it speaks for a lot of osteopathic students.

In my view, what it really comes down to is how much you partied during your undergraduate years, and that has nothing to do with abilities.

Why not integrate the dozen or so Osteopathic schools into the meshwork of allopathic schools? It would produce approximately 2,000 more M.D.'s a year and eliminate patient confusion with the name. Maintain the tradition of OMM if you want. Practice it, if you believe in it's healing properties. I have no problem with that.

As to allopathic residencies acceptiong DO students. You're right, they do so already. In truth, they get more money for DO's trained in this country than for M.D.'s trained in another, so it makes economic sense. That said, there are some 60 year old program directors out there (and they may be few and far between) who still believe in an all-M.D. school. If you look at some of the more "uppety" residencies, you'll see that they stuff a few Foreign Medical Graduates (from genuinely wonderful schools like Tokyo and Moscow) to fill the gap they have in their rank order list.

It does still happen. I assure you. Though I will concede, it's happening less.

In summary, I believe a merger would benefit the american patient population more than it would benefit any MD or DO, and that's all I really care about.

 

[JmE]

•••quote:•••Originally posted by drusso:
•But if I wanted to be an MD, then I would have gone to an MD school. I wanted to be a DO. •••••I 100% agree with this. If I wanted to be an MD, I would not have withdrawn my applications from MD schools when I got accepted at my first choice DO school.

(to the thread):

I wanted DO, not MD. I don't think I would ever be for a merger.

-JmE-

 

[JmE]

•••quote:•••Originally posted by Future GI Guy:
•
In summary, I believe a merger would benefit the american patient population more than it would benefit any MD or DO, and that's all I really care about.•••••I think keeping a seperate pathway through which individuals can go into practice will benefit society more in the long run. I really believe that if a merger were to happen, we would eventually see another "bend" on medical practice take it's place in providing an alternative pathway.

I do not think it is wise as a profession nor for the patients to have all domestic physicians rely on one pathway under one organization.

I think about how many very good DO s that would not have been in practice today if the California merger had spread.

All said IMHO.

-JmE-

 

[drusso]

•••quote:•••Originally posted by Future GI Guy:
•Drusso,
Well, I'm not sure what a merge would do for you.

--snip--

It would produce approximately 2,000 more M.D.'s a year and eliminate patient confusion with the name.

In summary, I believe a merger would benefit the american patient population more than it would benefit any MD or DO, and that's all I really care about.•••••But, what patient confusion? When I walk into a room to see a patient and introduce myself as Dr. Russo no one balks, points and laughs, runs away, or insults me. I'm the only D.O. in my transitional year this year and no one is confused. One colleague did ask, "So, what's the difference between an MD and DO...I know you guys are doctors, but why is the degree different?" I explained the historical differences and and why A.T. Still chose a different degree for the graduates of his medical school and that seemed to clear things up.

When I write orders, I sign them David Russo, DO and nurses don't call me and accuse me of impersonating a doctor. They just follow my orders. One nurse did comment, "Oh, you're a D.O.! Boy, I need you to fix my neck later."

So, this confusion things is really blown out of proportion. Within medical circles most people know that D.O.'s are doctors. Most patients don't ask, probably don't care, and when they do ask, they don't react negatively. I know no D.O.'s who are starving due to lack of patients.

So, again, what *EXACTLY* will a merger accomplish?