DOs Residency Merger with ACGME

[jw3600]

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I think there's three kinds of DO students:

1- Wanted to be a DO, hard-core DO
2- Wanted to be an MD but will do whatever it takes to be a physician
3- Doesn't give a damn, just wants to be a physician

The 2s tend to split along two lines- the ones that have the massive chip on their shoulder and come off as MD-wannabes, and the ones that go super hardcore DO to overcompensate because they feel like they "owe the profession something for giving them a chance." Both types make me lol, as I'm a #3 myself- idgaf what degree I have, and I objectively honestly believe there is no reason for there to be 2 separate degrees. It's just kind of stupid.

You could fall into 3 but with the qualifier "I wanted to be an orthopedic surgeon." It's not something I am personally set on but without the merger I had a legitimate shot. Now, I pretty much have none (assuming the merger works out that way I believe it will work out- this is mainly speculation). This is mainly why I am anti-"merger"/hostile takeover.

 

[Mad Jack]

You could fall into 3 but with the qualifier "I wanted to be an orthopedic surgeon." It's not something I am personally set on but without the merger I had a legitimate shot. Now, I pretty much have none (assuming the merger works out that way I believe it will work out- this is mainly speculation). This is mainly why I am anti-"merger"/hostile takeover.

The merger sucks for the minority, not gonna lie. But the majority of people, it benefits. Look at how much of each class goes into IM- if even half of those specialize, that's more people than every uro, ortho, ophtho, and derm match at a given school combined. So it really benefits more people than it harms, but it does tend to harm those interested in surgery and derm.

I guess I'm all for it because idgaf about surgery or derm lol, it does nothing but benefit me.

 

[GUH]

The AMA doesn't accredit medical schools or residencies, nor do they represent all of medicine.

They exert significant power within the LCME and ACGME. They don't exert significant power within COCA or the AOA.

 

[Mad Jack]

Hey, literally everyone on the forum or this thread, I'd love your input: how many of you think that the DO degree existing as a separate entity because of OMM is a good thing, and how many think we should merge and be done with it? Maybe I'll start a poll later.

 

[Postictal Raiden]

I am very happy with the merger. As Madjack said, it's a small sacrifice (a hundred or so of ultra competitive specialties) for a greater gain (not having to worry about training at a program with questionable standards).

 

[22031 Alum]

Yeah, I want to be a physician. And if my degree is changed to an MD I'll take it and still be grateful to be in an awesome career. But it would be nice to be able to retain the degree and professional affiliation that I sought out when applying to school and leave the door open for those behind me, just like an MD would most likely prefer the same for his degree. On a lesser note, I also think it's healthy that the AMA doesn't represent all of medicine in the United States.

You've yet to give a concrete reason for why it'd be nice to retain that separate degree title. Especially since, as @SLC aptly pointed out, it comes with baggage that can be detrimental to some with the title. History? Honoring those who've gone before? Is that worth a negative effect on those to come? I realize that I have the luxury of not worrying about my degree "disappearing" but like I said, if I still get to do what I'm doing the trappings are totally irrelevant.

I also think you're vastly overestimating the power/role of the AMA, but that's a separate topic.

 

[GUH]

Hey, literally everyone on the forum or this thread, I'd love your input: how many of you think that the DO degree existing as a separate entity because of OMM is a good thing, and how many think we should merge and be done with it? Maybe I'll start a poll later.

Are you going to filter out MDs from DOs?

 

[Mad Jack]

Are you going to filter out MDs from DOs?

Are you encouraging discrimination? 😉

 

[jw3600]

The merger sucks for the minority, not gonna lie. But the majority of people, it benefits. Look at how much of each class goes into IM- if even half of those specialize, that's more people than every uro, ortho, ophtho, and derm match at a given school combined. So it really benefits more people than it harms, but it does tend to harm those interested in surgery and derm.

I guess I'm all for it because idgaf about surgery or derm lol, it does nothing but benefit me.

I think I have mentioned this to you in another thread. Merger is good for the profession, bad for me.

 

[GUH]

You've yet to give a concrete reason for why it'd be nice to retain that separate degree title. Especially since, as @SLC aptly pointed out, it comes with baggage that can be detrimental to some with the title. History? Honoring those who've gone before? Is that worth a negative effect on those to come?

I also think you're vastly overestimating the power/role of the AMA, but that's a separate topic.

Historical differences, sure
Sticking with awarding a degree which we earned rather than one which we didn't earn
The fact that some patients seek out DOs
The fact that some people want to become DOs and there are already medical schools for those who don't
The absence of evidence that the existence of DOs harms patients
The allopathic profession's history of treating DOs as inferiors, even after agreeing to a merger

 

[GUH]

Are you encouraging discrimination? 😉

Are you saying that treating MDs and DOs differently is discrimination? 😉

 

[Mad Jack]

Historical differences, sure
Sticking with awarding a degree which we earned rather than one which we didn't earn
The fact that some patients seek out DOs
The fact that some people want to become DOs and there are already medical schools for those who don't
The absence of evidence that the existence of DOs harms patients
The allopathic profession's history of treating DOs as inferiors, even after agreeing to a merger

The absence of evidence is not the evidence of absence.

 

[Mad Jack]

Are you saying that treating MDs and DOs differently is discrimination? 😉

You're asking me to discriminate with my answers based on degree, so yeah, I'd say that is.

 

[GUH]

The absence of evidence is not the evidence of absence.

In the absence of evidence, the null hypothesis stands.

 

[Mad Jack]

In the absence of evidence, the null hypothesis stands.

The null hypothesis represents the commonly accepted view of something, not nothing at all. Given that MD education is widely viewed as superior to DO education, the onus is on DOs to prove they are equal and not the other way around. So you are saying that my hypothesis stands, thanks.

 

[GUH]

Given that MD education is widely viewed as superior to DO education, the onus is on DOs to prove they are equal and not the other way around.

EDIT: Licensing laws in all 50 states have clearly established that it is assumed that DOs are not inferior.

 

[Mad Jack]

EDIT: Licensing laws in all 50 states have clearly established that it is assumed that DOs are not inferior.

What politicians decide has little relation to what the truth is. From a scientific perspective, your claim would be nonsense.

The world (not just the USA, but the WORLD) has one largely accepted common standard of what medicine is. We are the ones that deviate from that standard, so we must disprove the null hypothesis, not the other way around.

 

[kenjixshadow]

Hey, literally everyone on the forum or this thread, I'd love your input: how many of you think that the DO degree existing as a separate entity because of OMM is a good thing, and how many think we should merge and be done with it? Maybe I'll start a poll later.

If only AOA has the balls to start a poll like this, they would see an overwhelm for the majorities are in favor of the merge. Is it possible that we can come up with a voting system for this? If not, I can see the next generation of DOs to start something like this.

 

[GUH]

What politicians decide has little relation to what the truth is. From a scientific perspective, your claim would be nonsense.

The world (not just the USA, but the WORLD) has one largely accepted common standard of what medicine is. We are the ones that deviate from that standard, so we must disprove the null hypothesis, not the other way around.

From a "scientific" perspective, DOs have been treating patients, training, conducting medical research, and sitting on licensing boards for decades successfully alongside MDs.

Are we really having this discussion? Your assertion that there is no consensus is silly. Nowhere in the US is it assumed that DOs are inferior physicians, except among a minority of backwards MDs and maybe among a self-loathing few on SDN. The world's opinion is irrelevant here. They don't even award MDs in a lot of countries anyways and have very little experience with osteopathic physicians. Some places in the world believe that photographs trap souls but we don't use that nonsense to establish a "scientific" consensus.

 

[Mad Jack]

From a "scientific" perspective, DOs have been treating patients, training, conducting medical research, and sitting on licensing boards for decades successfully alongside MDs.

Are we really having this discussion? Your assertion that there is no consensus is silly. Nowhere in the US is it assumed that DOs are inferior physicians, except among a minority of backwards MDs and maybe among a self-loathing few on SDN.

I'm talking globally. I'm talking the mainstream scientific community. The US does not represent the mainstream of scientific consensus, silly.

 

[22031 Alum]

Historical differences, sure
Sticking with awarding a degree which we earned rather than one which we didn't earn
The fact that some patients seek out DOs
The fact that some people want to become DOs and there are already medical schools for those who don't
The absence of evidence that the existence of DOs harms patients
The allopathic profession's history of treating DOs as inferiors, even after agreeing to a merger

So it's mostly just history/emotion for you. That's fine, but if there ever were a serious push, clinging to those in the absence of concrete benefit rarely works out well. Especially since there is evidence of negative effects.

Also, your last point seems to be implying that it's surprising the AOA is still in the inferior role despite the merger. That was the whole point of the merger. It wasn't an expression of good will, it was an assertion of power.

 

[GUH]

I'm talking globally. I'm talking the mainstream scientific community. The US does not represent the mainstream of scientific consensus, silly.

The US is the only country with extensive experience with osteopathic physicians, and the only country which trains them.

 

[GUH]

So it's mostly just history/emotion for you. That's fine, but if there ever were a serious push, clinging to those in the absence of concrete benefit rarely works out well. Especially since there is evidence of negative effects.

Also, your last point seems to be implying that it's surprising the AOA is still in the inferior role despite the merger. That was the whole point of the merger. It wasn't an expression of good will, it was an assertion of power.

What is the evidence of negative effects?
And why would the fact that the GME takeover was forced upon us be a reason to believe that it's good for us?

 

[Mad Jack]

The US is the only country with extensive experience with osteopathic physicians, and the only country which trains them.

And that means exactly what so far as science is concerned? Nothing. It means we have an alternative to the null, that the rest of the world has yet to test.

And as to DOs having just as good of outcomes, I'll have to dig up a study that was being passed around the other day. It was a look at factors that predisposed towards malpractice claims, and one of the major factors was being a DO rather than an MD.

 

[GUH]

And that means exactly what so far as science is concerned? Nothing. It means we have an alternative to the null, that the rest of the world has yet to test.

And as to DOs having just as good of outcomes, I'll have to dig up a study that was being passed around the other day. It was a look at factors that predisposed towards malpractice claims, and one of the major factors was being a DO rather than an MD.

You can think that there is some sort of scientific consensus of DO inferiority, but there isn't.

I'd love to see that study, not that it would even prove your assertion.

 

[22031 Alum]

What is the evidence of negative effects?
And why would the fact that the GME takeover was forced upon us be a reason to believe that it's good for us?

Evidence of negative effects? Don't conflate what I'm talking about with the sidetrack y'all have gotten into about negative patient outcomes. I mean professional negatives. You could ask @Mad Jack about that- I think he could tell you about some programs he'd like to go to but won't get the chance.

One degree with one accreditation process wouldn't help him with that, but it might help someone who comes along later. Similarly, the GME takeover might not help him personally but could raise overall training standards for future med school graduates. Does either of those things seem bad to you, if you think about the long term?

 

[Siggy]

The merger sucks for the minority, not gonna lie. But the majority of people, it benefits. Look at how much of each class goes into IM- if even half of those specialize, that's more people than every uro, ortho, ophtho, and derm match at a given school combined. So it really benefits more people than it harms, but it does tend to harm those interested in surgery and derm.

I guess I'm all for it because idgaf about surgery or derm lol, it does nothing but benefit me.

The assumption being that fellowship PDs ignore the DO and the residencies that were AOA prior to the merger.

It's kinda of like Obama Care in some instances. Sure, you got an insurance plan through the exchange... but that doesn't mean you can find a physician who's willing to take it. Sure, you're now from an ACGME residency, but that doesn't mean that a fellowship PD has to take you.

 

[Mad Jack]

You can think that there is some sort of scientific consensus of DO inferiority, but there isn't.

I'd love to see that study, not that it would even prove your assertion.

http://www.ncbi.nlm.nih.gov/pubmed/15146773

"Characteristics of disciplined physicians and predictors of disciplinary action for all violations and by type of violation were the main outcome descriptors. Years in practice, black physicians, and osteopathic graduates were positive predictors for disciplinary action. In contrast, female physicians, international medical graduates, and Hispanic and Asian physicians were less likely to receive disciplinary action compared with male, US allopathic, and white physicians, respectively."

I've got some evidence, now where is yours?

 

[jw3600]

You can think that there is some sort of scientific consensus of DO inferiority, but there isn't.

I'd love to see that study, not that it would even prove your assertion.

Dude. You go to osteopathic school right? They have taught you cranial, yes? Do you really need any more evidence that most of the original concepts of the OSTEOPATHIC (aka all disease comes from bone) medicine is ****ing nonsense?

 

[GUH]

Evidence of negative effects? Don't conflate what I'm talking about with the sidetrack y'all have gotten into about negative patient outcomes. I mean professional negatives. You could ask @Mad Jack about that- I think he could tell you about some programs he'd like to go to but won't get the chance.

Makes sense. Although I think the problem there lies more with the GME programs themselves than the quality of osteopathic medical education.

One degree with one accreditation process wouldn't help him with that, but it might help someone who comes along later. Similarly, the GME takeover might not help him personally but could raise overall training standards for future med school graduates. Does either of those things seem bad to you, if you think about the long term?

Raising training standards is great, especially if there is a demonstrable benefit to physicians or patients. I don't believe that the only way to do it is by throwing in the towel and putting ourselves out of existence.

 

[Mad Jack]

The assumption being that fellowship PDs ignore the DO and the residencies that were AOA prior to the merger.

It's kinda of like Obama Care in some instances. Sure, you got an insurance plan through the exchange... but that doesn't mean you can find a physician who's willing to take it. Sure, you're now from an ACGME residency, but that doesn't mean that a fellowship PD has to take you.

If all of the programs are ACGME (by the time my class is matching, they all will be) the only difference will be community versus university programs. Most PDs of fellowship programs care more about where you did your residency than anything else, your DO doesn't a whole hell of a lot compared to whether you did your rotations at a university versus community versus large university-affiliated community hospital. My school's OPTI actually has a few decent-sized hospitals that have matched pretty well into ACGME fellowships in the past, so keeping those doors open is pretty damn nice.

 

[GUH]

Dude. You go to osteopathic school right? They have taught you cranial, yes? Do you really need any more evidence that most of the original concepts of the OSTEOPATHIC (aka all disease comes from bone) medicine is ****ing nonsense?

Cranial is a relatively recent development and of course I'm skeptical, even after doing an OMM rotation with a fair amount of cranial and meeting patients who swear that it's the only thing that helps. But not all of OMM is cranial.

 

[22031 Alum]

Makes sense. Although I think the problem there lies more with the GME programs themselves than the quality of osteopathic medical education.

Raising training standards is great, especially if there is a demonstrable benefit to physicians or patients. I don't believe that the only way to do it is by throwing in the towel and putting ourselves out of existence.

Bolded makes it clear you've gotten your identity tied up in the DO letters more than you'd like to admit. Nothing about being a physician would cease to exist. Don't lose sight of that.

 

[Siggy]

The fact that some patients seek out DOs

Often those aren't the type of patients you want in your practice...

 

[GUH]

http://www.ncbi.nlm.nih.gov/pubmed/15146773

"Characteristics of disciplined physicians and predictors of disciplinary action for all violations and by type of violation were the main outcome descriptors. Years in practice, black physicians, and osteopathic graduates were positive predictors for disciplinary action. In contrast, female physicians, international medical graduates, and Hispanic and Asian physicians were less likely to receive disciplinary action compared with male, US allopathic, and white physicians, respectively."

I've got some evidence, now where is yours?

One study does not prove a consensus. But out of curiosity, do you have the actual study? All I can see is an abstract which doesn't have any of the statistical information. Maybe it was a good study, but maybe it wasn't and it's hard to tell from just the abstract.

 

[Siggy]

The world (not just the USA, but the WORLD) has one largely accepted common standard of what medicine is. We are the ones that deviate from that standard, so we must disprove the null hypothesis, not the other way around.

The world? Like all of those countries that treat the medical degree as a 6 year undergraduate degree instead of a 4 year graduate degree?

 

[GUH]

Often those aren't the type of patients you want in your practice...

haha yeah I've seen a few ...interesting... ones who prefer DOs.
But I've also met some who were truly mishandled by other physicians in the past and now prefer DOs. Maybe it's not fair for them to make that judgment, but it is nice to work with someone who trusts your credentials rather than doubts them.

 

[Mad Jack]

The world? Like all of those countries that treat the medical degree as a 6 year undergraduate degree instead of a 4 year graduate degree?

Only four years of those degrees are medicine, the first two are undergraduate level sciences. Regardless, they teach medicine in the same manner and model as we do (if not in the same time frame) in our MD programs. A difference in length is not the same as a difference in ideology and method.

 

[Mad Jack]

One study does not prove a consensus. But out of curiosity, do you have the actual study? All I can see is an abstract which doesn't have any of the statistical information. Maybe it was a good study, but maybe it wasn't and it's hard to tell from just the abstract.

If you've got a library service at your school it should be easy enough to pull up from the data provided in the abstract. The actual study is copyrighted and can only be accessed if you've got a paid journal service.

 

[Siggy]

Only four years of those degrees are medicine, the first two are undergraduate level sciences. Regardless, they teach medicine in the same manner and model as we do (if not in the same time frame) in our MD programs. A difference in length is not the same as a difference in ideology and method.

...and yet outside of 1 rotation (my school required an OMM rotation) and 4 hours a week, DO schools use the same ideology and method. Do I need to find the study showing that only a minority of DO physicians actually use any OMM, and a tiny minority incorporate a significant amount of OMM into their day to day practice?

 

[Mad Jack]

Also, you have provided zero studies in your defense, so I'm still ahead in that department.

 

[GUH]

Bolded makes it clear you've gotten your identity tied up in the DO letters more than you'd like to admit. Nothing about being a physician would cease to exist. Don't lose sight of that.

It was brought up on a previous thread but during the California merger, DOs who became "MD"s were prohibited from advertising osteopathic manipulation among their services. That kind of imposition would be a strain on some DOs, and sets a poor precedent of telling doctors how to practice. As I said on that thread, there would likely be less resistance to a merger if there were assurances that OMM would not be eliminated or discouraged.

 

[Mad Jack]

...and yet outside of 1 rotation (my school required an OMM rotation) and 4 hours a week, DO schools use the same ideology and method. Do I need to find the study showing that only a minority of DO physicians actually use any OMM, and a tiny minority incorporate a significant amount of OMM into their day to day practice?

Hence my whole point in this thread- the DO degree has no substantive difference and thus should not exist as a separate entity, as it only does harm to those that carry it compared to their MD counterparts and also enables lower educational and rotation site standards (further hurting DO students for no reason).

 

[Siggy]

Hence my whole point in this thread- the DO degree has no substantive difference and thus should not exist as a separate entity, as it only does harm to those that carry it compared to their MD counterparts and also enables lower educational and rotation site standards (further hurting DO students for no reason).

Which I agree with. Personally, I think within the next 20-30 years we'll see the end of osteopathic medicine with a complete merger. I don't know if current DOs would get back door MDs, but minting new DOs will cease and the current ones will slowly phase themselves out as they retire.

 

[GUH]

lower ... rotation site standards

I think we've had this discussion in the past but rotation site standards are not particularly tight for LCME-accredited schools.

 

[Mad Jack]

It was brought up on a previous thread but during the California merger, DOs who became "MD"s were prohibited from advertising osteopathic manipulation among their services. That kind of imposition would be a strain on some DOs, and sets a poor precedent of telling doctors how to practice. As I said on that thread, there would likely be less resistance to a merger if there were assurances that OMM would not be eliminated or discouraged.

OMM wouldn't be. I already addressed that you'd have to be brain damaged to think that why they put that particular ban in place then would happen today. Nowadays CAM is all the rage, we've got MDs doing OMM fellowships, etc. The AMA doesn't ban a physician from advertising any practice unless it us unsafe and proven to be so, for the most part. MDs do everything from acupuncture to hormonal therapy and you think they'll go out of their way to specifically ban OMM in 2016?

 

[GUH]

Also, you have provided zero studies in your defense, so I'm still ahead in that department.

You can believe that there is a "scientific consensus" that DOs are inferior physicians. I disagree in spite of the one single solitary study you were able to dig up.

 

[Mad Jack]

I think we've had this discussion in the past but rotation site standards are not particularly tight for LCME-accredited schools.

[citation needed]

I'll show you the relevant paragraphs from the COCA and LCME tomorrow.

 

[22031 Alum]

It was brought up on a previous thread but during the California merger, DOs who became "MD"s were prohibited from advertising osteopathic manipulation among their services. That kind of imposition would be a strain on some DOs. As I said on that thread, there would likely be less resistance to a merger if there were assurances that OMM would not be eliminated or discouraged.

The California "merger" (degree switch) from 50 years ago? I really wouldn't get too worried about things happening the same way now.

I am concerned that you say it'd be important to have assurances that OMM wouldn't be discouraged. That's not how things work. Modalities are encouraged or discouraged based on evidence, not promises. Once the consistent, rigorous evidence starts to roll in, OMM will stand on its merits. As a proponent of the modality that should excite you.

 

[Mad Jack]

You can believe that there is a "scientific consensus" that DOs are inferior physicians. I disagree in spite of the one single solitary study you were able to dig up.

I said nothing of the sort. I said that MD education is the global standard. To dispute that, one must find evidence to the contrary. I've found evidence, but not to the contrary.