DOs going into specialty care?

[MacGyver]

Isnt the trend of DOs increasingly choosing specialties over primary care somewhat disturbing to the philosophy of DO?

After all, surgery, optho, derm, rads, etc tend to contradict the low invasive philosophy of DO doesnt it?

Isnt the attractiveness of DO programs diminished when half its graduates will have nothing to do with primary care?

There is a good argument to be made taht DO in a primary care scope trains its doctors to do stuff that MDs are not trained to do. But isnt this no longer the case when you have MD vs DO in radiology/derm/surgery/etc?

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[shindog]

Originally posted by MacGyver
Isnt the trend of DOs increasingly choosing specialties over primary care somewhat disturbing to the philosophy of DO?

After all, surgery, optho, derm, rads, etc tend to contradict the low invasive philosophy of DO doesnt it?

Isnt the attractiveness of DO programs diminished when half its graduates will have nothing to do with primary care?

There is a good argument to be made taht DO in a primary care scope trains its doctors to do stuff that MDs are not trained to do. But isnt this no longer the case when you have MD vs DO in radiology/derm/surgery/etc?

That depends on why a student chooses a D.O. school. I chose my school because I thought it was the best school I got accepted to (including three MD acceptances). Therefore, the trend is positive for me, since I plan on specializing.

If a student chooses D.O. based solely on OMT training and primary care, then this could be viewed as a negative.

I agree that OMT has little or no place in many specialties. You will hear some die-hard, hardcore people on this board try to argue otherwise, but the evidence just isn't there yet to support it. All of the D.O.s I've talked to outside of primary care see no use for OMT except at home with family and friends.

 

[drusso]

The profession needs osteopathic specialists to train osteopathic generalists. We need DO cardiologists, pulmonologists, rheumatologists, etc who have training and understanding of OMT (even if they don't use it themselves) who can guide the education of DO generalists.

--David

 

[oceandocDO]

MacGyver...

I totally disagree with your statement. There's NOTHING better than a specialist with a firm appreciation and training in primary care. I think this is one of the major problems in medicine these days, it's so damn subspecialized that your surgeon for the ring finger on the left hand doesnt appreciate and/or know what the surgeon for the ring finger on the right hand does. If you ever find a surgeon, radiologist, or dermatologist who knows medicine and primary care well, stick with him/her, because most of them immediately delete that knowledge as soon as they pick up the scalpel/xray/magnifying glass.

Speaking of which, OMT is a tool, not a foundation, and even if you never use it in practice, its training affords you several hundred extra hours of education in anatomy, biomechanics, physiology, palpation, etc. It will make a radiologist a better diagnostician because of the detailed anatomical training it mandates. It will offer a dermatologist another tool in better palpation for deeper lying pathology. It will offer a surgeon presurgical palpatory skill as well as a post-surgical treatment modaltities..... post-op Ileus, for example.

The osteopathic philosophy says nothing about primary care, it urges one to see the body as more than the sum of it's parts, which is the tenent that much of modern medicine fails to appreciate. It encourages "Generalist first, specialist second", but that doesnt necessairly mean you stop at generalist.

 

[CoolDOguy]

To underestimate the power of touch is to overestimate our knowledge of human biology.

 

[BrooklynDO]

I have to agree with Ocean (go NYCOM )
although most DOs were historically generalists, and are taught to think of the whole patient, it doesnt mean that specialization is in any way contrary to the philosophy.
"If you ever find a surgeon, radiologist, or dermatologist who knows medicine and primary care well, stick with him/her, because most of them immediately delete that knowledge as soon as they pick up the scalpel/xray/magnifying glass. "--- sad but true, and sometimes understandable...
i read a DO students account of a surg rotation where he? basically was able to impress the attending with his knowledge of path/anatomy ...mostly this was because out of all the other students examining a particular patient, he was able to palpate the patient during an exam, and felt where the tumor? (i dont remember the specifics sorry) was.... so yea, omt/omm is a great tool, since you cant really use a scalpel with anesthesia much can ya?

 

[Careofme]

It is important to remember that Osteopathy does NOT just mean OMT/OMM but includes much more. Many people seem to miss this point. Yes, it is a clinical tool but also a philosophy and can be used in every specialty out there from Internal to Surgery.

care

 

[hosskp1]

WE have plenty of DO's who choose to go into primary care. We need DO's in the specialties. I think that as an osteopathic graduate I have the right to pick any damn specialty I want without being seen as a traitor to AT Still. If we are to be seen as equals to MD's then we have to be willing to accept it when we decide to train like them. I think this is an irrelevant point today considering my school convinced me to attend by not stressing primary care the way other schools did. It is my life and I have to live it- I can't stand primary care and no one can make me do it- I feel no guilt about betraying AT Still.

 

[Vince]

good point drusso

 

[dr_almondjoy_do]

I would have to agree with Drusso and OceanDoc. And I also have a true story that ties it all together...

I was recently treated at my Primary Care physician's office for allergies. She's an MD. I have never had problems with her, and I like the way she treats her patients. I continue to go to her.

One day, she had a resident with her that I just found to be so much more approachable. The minute he walked into the room, he was hands-on with me. Normally, she'd stay about 3 ft. away from me until it was time to get near for vital signs.

He even went over some things I could do on my own to treat my sinuses so that I wouldn't be so dependent on antibiotics and flonaze. And b/c I was a NYCOM student, he went over some lymphatic treatments with me that he learned at PCOM.

Any other visit I've had before that included pill after pill. I used to go to her every time the climate changed. Since this last visit, I have been really well with the climate and my allergies.

I was never able to make a clear distinction on the methods of practice between MD and DO specialists until that day.

That third year resident turned out to be a PCOM graduate. He plans on being a nephrologist. I'm sure he will do fine as a specialist based on his approach with me that day.

 

[PACtoDOC]

I agree with everyone accept MacGyver, as usual. I am convinced that MacGyver is a plant from the trial lawyers of America sent here to infiltrate and cause "hate and despair" among all medical providers. I have never read a useful post by MacGyver, as they are all inflammatory in nature.

But, I must admit that I must have yet to be exposed to the Osteopathic philosophy except for OMM. Maybe it will come later in my schooling; probably 2nd year I guess.

 

[JHawk623]

quick question......if DOs and MDs are on a level playing field and DOs are supposedly the equal of MDs.....then why the distinction. Why isn't there just one medical degree....don't you think it can be confusing for the public? If DOs can do everything an MD can do and want to be seen as equal then why two different schools?

 

[skypilot]

Different philosophy espoused by AT Still back in the horse and buggy days when MDs were still prescribing mercury and antibiotics didn't exist.

However there is no significant difference in the training just a difference in the philosophy. That is why you will find DOs and MDs working and training together everywhere you go.

My personal opinion, if someone goes to an osteopathic school and takes the USMLE and does an allopathic residency, they should be able to hold themselves out as an MD. (or a DO if they prefer).

If an MD gets training in OMT and passes the Comlex they should be able to hold themselves out as a DO.

 

[goooooober]

Booooooooooooooooooooo, Booooooooooooooooooooooooo
Boooooooooooooooooooo, Boooooooooooooooooooooooooooo

 

[dctrben]

I would like to add my 2 cents.

My wife recently gave birth to our first child (a girl). The OB that we went to worked in concert with an MD. Bear in mind that this is Kirksville, so the MD is a rarety. Anywho, the DO and the MD would see my wife, depending on when her appointment was. I tagged along when my class schedule allowed and let me tell you, the difference is like night and day. The MD is excellent and knows his stuff inside and out. The DO was equally knowledgeable, but his level of care was so much better (in our opinion) for one big reason: he was one of the most personable people I have ever met. He would come in and put and on my wife and look into her eyes when he asked how she was doing. Fortunately the DO was on call when my wife went into labor and I honestly think he made all the difference in the labor and the recovery. He was not afraid to use his palpatory skills to get what he needed to done.

My wife recently was able to help out her sister with the birth of her first child and it was all only MDs where they live. She said the difference was amazing and definately preferred her experience over what her sister went through. The hard part will be to find a DO for our other kids 😉

This is not to say that all MDs are not personable (there are plenty out there that are) and not to say that all DOs are. However, if you were to generalize DOs are not 'afraid' to touch their patients. It just comes down to really the healing power of touch.

Personally, I think that the main difference today between MDs and DOs is their respective histories. Yes, the philosophies are starting to mesh and there are many DOs that are specializing. The fact remains that a DO is trained to care for the human body, and to paraphrase A.T. Still: A doctor's job is to find health, anyone can find disease. It is really just another way of approaching the same task.

Will the two ever become one? Not in our lifetimes, there are too many people that uphold the profession and honor its roots (in both fields).

I guess that was a bit more the 2 cents 😀 😀

Ben

 

[skypilot]

The reasons you gave are some of the reasons a lot of OB patients are choosing to see Nurse Midwives instead of Obstetricians. Individual hands on care. Not such a rush to cut or medicate.

 

[dr_almondjoy_do]

😍 😍

 

[hosskp1]

Happens all the time- and in reverse as well.

I think you ran into personalities. I think you just happened to like the DO because his personality meshed with your. The MD may not have worked as well for you due to persoanlity.

I have seen this situation before, but I have also seen it where the DO was the more malignant doctor. and the MD was more personable.

Doctors need to judged by their actions and words, not whether they are a DO or an MD.

Originally posted by dctrben
I would like to add my 2 cents.

My wife recently gave birth to our first child (a girl). The OB that we went to worked in concert with an MD. Bear in mind that this is Kirksville, so the MD is a rarety. Anywho, the DO and the MD would see my wife, depending on when her appointment was. I tagged along when my class schedule allowed and let me tell you, the difference is like night and day. The MD is excellent and knows his stuff inside and out. The DO was equally knowledgeable, but his level of care was so much better (in our opinion) for one big reason: he was one of the most personable people I have ever met. He would come in and put and on my wife and look into her eyes when he asked how she was doing. Fortunately the DO was on call when my wife went into labor and I honestly think he made all the difference in the labor and the recovery. He was not afraid to use his palpatory skills to get what he needed to done.

My wife recently was able to help out her sister with the birth of her first child and it was all only MDs where they live. She said the difference was amazing and definately preferred her experience over what her sister went through. The hard part will be to find a DO for our other kids 😉

This is not to say that all MDs are not personable (there are plenty out there that are) and not to say that all DOs are. However, if you were to generalize DOs are not 'afraid' to touch their patients. It just comes down to really the healing power of touch.

Personally, I think that the main difference today between MDs and DOs is their respective histories. Yes, the philosophies are starting to mesh and there are many DOs that are specializing. The fact remains that a DO is trained to care for the human body, and to paraphrase A.T. Still: A doctor's job is to find health, anyone can find disease. It is really just another way of approaching the same task.

Will the two ever become one? Not in our lifetimes, there are too many people that uphold the profession and honor its roots (in both fields).

I guess that was a bit more the 2 cents 😀 😀

Ben

 

[cookypuss3]

1. Yes, those of us taking USMLE and doing an allopathic residency should be awarded that damn M.D... Or how about a nice dual degree, D.O./M.D.? I like that best.

2. I think that even those people who don't buy into OMT and generally poo poo the entire D.O. philosophy will benefit from D.O. training. The integrated view on medicine and treatment is fabulous... and I know how to apply it.. whereas lots of M.D.s are simply problem-focused, scalpel-wielding machines. You don't think patients can tell the difference? Someone was describing the differences in encounters between an MD and a DO, for her allergies I think, and that was such a great example!

3. Finally, D.O. students going into their 3rd and 4th years will have a huge advantage over their M.D. counterparts for this reason: from the 1st week of our education we are hands on, touching people, honing observational and palpatory skills in OMT. We all know that those skills just take time, right? So by the time we reach clinicals, we have two years on the schmos from the state school who don't even know how to touch a person.

Therefore, my conclusion is such: even though I am going into the most non-D.O. oriented specialty you can think of, D.O.s rock!!

 

[PACtoDOC]

Sorry Puss
But I think you are generalizing MD students. MD schools have changed a lot in the last 10 years. Many of them offer excellent clinical med courses that last the entire first year or two. Many get to see patients earlier than they used to, and hence, I do not think it is fair to say that MD students are at a disadvantage over us as DO students. I think we are all rather equally prepared, but I think we have an advantage when it comes to treating and disgnosing musculoskeletal problems.

 

[TMarkus]

Isnt the trend of DOs increasingly choosing specialties over primary care somewhat disturbing to the philosophy of DO?

There is a trend catching on here. Many of our new DO students are finding that the allopathic door is not being opened to them. These students are average MD candidates, but often strong DO candidates. They are motivated to become physicians yet the MD schools are shutting them out because of grades, scores, backgrounds, etc. Osteopathic schools are not as anal about the numbers. They are holistic right down to how they choose candidates for school. "Is this person well rounded and motivated to become a physician?"

That said these student get in because they want to practice medicine. Originally, I think the DO was attractive because of its philosophy and application to primary care. What we are seeing now is two fold.

1) More individuals are finding value in this philosophy, and are therefore attracted to it.
2) More individuals are using the DO angle as a way into the profession.

The Osteopath was originally sought after for a variety of reasons, but s/he was shut out of the military. The AMA shut out DO's early on as well, so the entire population of DO's were marginalized. This trend has reversed in the last couple of decades, and will continue to do so in the coming decades. Which means that we will begin to see DO's practicing everywhere, in every specialty. In a couple more decades the line between MD and DO will be blurred significantly. As the others have said, this is a good thing.

What may be disturbing is that across the board we are running out of primary care physicians. Many states have implemented conditional loan programs to attract students into the primary care field. This is a nationwide health care issue not an MD/DO one.

 

[pafbdoc]

cookypuss...

1. Yes, those of us taking USMLE and doing an allopathic residency should be awarded that damn M.D... Or how about a nice dual degree, D.O./M.D.? I like that best.

Sorry folks, this will never happen, nor should it. Residency and licensing exams have nothing to do with degree title. On your ideology, maybe nurse practitioners and PA's can take the COMLEX or USMLE and get a D.O. or an MD? I bet many of them would pass the thing. Or maybe MDs can take the COMLEX and get a D.O.? Board exams are mostly for legal reasons, only in the last decade or so have they become such a measuring stick for placement and "competency".

Honestly, if you're not proud to be a D.O., head to the Caribbean. IMO, you should wear the D.O. because it says you're a doctor who can offer a bit more to his/her patients than the dime-a-dozen docs out there now, even if you're not going into a specialty that can use OMM everyday. Like you said, it's the slight difference in training modalities that set the schools apart. Even a radiologist or pathologist will benefit from OMM with the extra detailed anatomy training it offers.

That said, I agree with points 2 and 3 above. good luck.

 

[DO_messenger]

man... id be so happy to be a DO... i guess it would be nice to be an MD, but i would MUCH rather be a DO...

 

[doctorperez]

I do not understand the complication... DOs are equal in what MDs can do. Due to training differences, MDs do not know how to do somethings DOs can. Most DOs maintain different medical philosophies. Nothing stated previously, IMHO, prevents MDs or DOs from specializing.



_________________________

 

[skypilot]

Originally posted by pafbdoc
cookypuss...

Residency and licensing exams have nothing to do with degree title

If you train in Australia your degree is an MBBS. But when you come to the US and take the USMLE and do an allopathic residency you can call yourself an MD.

Originally posted by pafbdoc
cookypuss...

On your ideology, maybe nurse practitioners and PA's can take the COMLEX or USMLE and get a D.O. or an MD?
That said, I agree with points 2 and 3 above. good luck.

Sure after 4 years of med school and at 3 years of residency any PA or Nurse practitioner could take the USMLE and call themselves an MD. 😉

 

[drusso]

Originally posted by skypilot
If you train in Australia your degree is an MBBS. But when you come to the US and take the USMLE and do an allopathic residency you can call yourself an MD.Sure after 4 years of med school and at 3 years of residency any PA or Nurse practitioner could take the USMLE and call themselves an MD. 😉

Actually, one's degree does not change. Think about it. You were awarded a MBBS degree in Australia---it's a piece of paper on the wall. You mean to tell me that you take the USMLE and the paper on the wall undergoes some magical change? The reason why DOs are DOs is because we are fundamentally taught (and licensed to practice and authorized to get reimbursed for) a service that MDs do not routinely provide---OMT.

You can think of US allopathic and osteopathic medical training as HOMOLOGOUS meaning, "corresponding in position, value, structure, or function," US allopathic and Australian allopathic training is EQUIVALENT meaning, "capable of being put into a one-to-one relationship." That's a distinction that I'm comfortable with.

 

[skypilot]

Originally posted by drusso
Actually, one's degree does not change.

This is my point. The guy is an MBBS, doesn't even have a graduate degree, and is allowed to advertise as an MD if they so desire. Any DO who passes the the USMLE and does an allopathic residency should be allowed the same privilege if they so desire. I think in some states this is actually permitted.

 

[drusso]

Originally posted by skypilot
This is my point. The guy is an MBBS, doesn't even have a graduate degree, and is allowed to advertise as an MD if they so desire. Any DO who passes the the USMLE and does an allopathic residency should be allowed the same privilege if they so desire. I think in some states this is actually permitted.

That's because the MBBS and the US MD are equivalent degrees. So are the US MD and the Caribbean MD. The US MD and the US DO are homologous degrees. Regardless, the US MD and US DO are licensed to practice medicine equivalently so it becomes a moot point. DO's have unique training that MDs don't and the general public is entitled to know this information vis-a-vis who is a DO and who is not. Also, how would the general public know that DOs are DOs if DOs changed their degrees after doing an allopathic residency. Some people specifically seek out DOs because of their musculoskeletal training, approach to patient care, or prior positive experiences with DOs. Why cut yourself off from these people?

 

[skypilot]

Originally posted by drusso
Some people specifically seek out DOs because of their musculoskeletal training, approach to patient care, or prior positive experiences with DOs. Why cut yourself off from these people?

Yeah I guess I agree! I just get annoyed when people say "What's a D.O.?"

 

[TMarkus]

Try not to get discouraged, and look at it as an opportunity to teach. If you are not familiar with a particular title wouldn't you ask what it meant? If you get defensive about the question you run the risk of alienating. Instead, teach, instruct, illuminate. Help everyone to understand what being a DO is about. Give them knowledge, and empower them to pass it on.