Is it pride, or is there really a significant difference?

[MTY]

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enough debates and confusion bout the MD and DO, but i do have one question for DO docs out there. Can DO docs ref. themselves as medical doctors?

as i was having a conversation with my friend,who is currently a MD at ucsf. he said with all qualifications being equal, and to prevent any misconception and confusion for the patients and general public, we should assimilate both profession. Perhaps change those initials to MD/O (for ostepathic) and MD/A (for allopathic). this way, DO docs shouldn't hesitate upon the legitimay of whether they are being considered as medical doctors.

i have to honestly say that more and more outstanding DO's have been accepted to many top specialty programs. e.g. i personally know a DO melanoma fellow at ucsf. I feel there should no longer be any discrimination or bias between these two professions. still, to avoid the confusion and to educate the public (which is the hardest part!),i say both the AOA and AMA should drop their pride and do it for the benefit of the public. regarless what your philosophy is, whether is allopathic or osteopathic, your mission is to help people, and you're always a medical doctor. what do you guys think?

 

[WishUponAStar]

Hiya,

I like it. Without taking away the individuality of the D.O. it makes it easier for the general public to accept and understand. A doctor is a doctor is a doctor.

W.U.A.S.

 

[Mango]

I'm not sure about the "medical doctor" title question, but I am sure of one thing. The AMA will fight any attempt to change the title MD. I would be willing to say that I am 100% sure that they will never change the title MD to MD/A. The AMA is an historically conservative bunch, and they also take a lot of pride in the history of the profession. Part of that history is the title Medical Doctor.

Actually, I don't even think the AMA has accepted the term "Allopathic." From what I've been told, that term was coined only to differentiate MD's from others, such as DO's.

I'm not saying that there shouldn't be a change, just that I wouldn't count on it any time soon.

 

[drusso]

The AMA does use the term "allopathic" in description of MD and DO physicians and their respective training:
http://www.ama-assn.org/aps/physcred.html

"The Liaison Committee on Medical Education (LCME), an agency cosponsored by the American Medical Association and Association of American Medical Colleges, with participation from the Canadian Medical Association for schools in Canada, accredits educational programs in allopathic schools of medicine in the United States and Canada. Allopathic schools of medicine grant a doctor of medicine (MD) degree."

"The American Osteopathic Association (AOA) Bureau of Professional Education accredits 16 colleges of osteopathic medicine in the United States that grant a doctor of osteopathy or (DO) degree. Before entering an osteopathic college, students complete four years of preprofessional education in an accredited college or university. A doctor of osteopathy (DO) degree requires four academic years of study, two years devoted to didactic instruction in the biomedical sciences and clinical medicine and two years devoted to clinical work in community hospitals, major medical centers, and physician?s offices. Students rotate through urban and rural settings, experiencing all major areas of medicine.

Osteopathic principles and practices are integrated throughout the four-year curriculum. Students learn to use osteopathic techniques for diagnosis and treatment of disease, as well as for disease prevention. The curriculum emphasizes the relationship of body systems and holistic patient care."

The merging of the two professions was attempted in the 1960's in CA with poor results. The bottom line is that the majority of DO's like being DO's (even more so lately since DO's have become rather trendy among the health-conscious and well-to-do Birkenstock crowd) and like their degree just fine. Also, with the explosion of health-related information available to patients, many more patients are specifically seeking out DO's to be their primary care doctors or for specialized musculoskeletal care. Changing the degree would hinder patients in effectively locating DO's.

As for whether or not there is "really" a difference between MDs and DOs---My observation is that there are osteopathically-minded MDs and allopathically-minded DOs out there. The degrees reflect not differences in the science of medicine but differences in the "art" of its practice. It's the person that makes the doctor not the type of degree.

Finally, it's just a historical curiousity that mainstream medicine evolved along two lines in the U.S.A. It spawned a whole movement in health care with DOs around the world. Chiropractic is an osteopathic off-shoot. PTs, OTs, and others use many manual medicine techniques that have their roots in osteopathy. I think it should be viewed as something kind of cool and not something to be changed.

 

[prolixless]

Originally posted by MTY:
enough debates and confusion bout the MD and DO, but i do have one question for DO docs out there. Can DO docs ref. themselves as medical doctors?

as i was having a conversation with my friend,who is currently a MD at ucsf. he said with all qualifications being equal, and to prevent any misconception and confusion for the patients and general public, we should assimilate both profession. Perhaps change those initials to MD/O (for ostepathic) and MD/A (for allopathic). this way, DO docs shouldn't hesitate upon the legitimay of whether they are being considered as medical doctors.

i have to honestly say that more and more outstanding DO's have been accepted to many top specialty programs. e.g. i personally know a DO melanoma fellow at ucsf. I feel there should no longer be any discrimination or bias between these two professions. still, to avoid the confusion and to educate the public (which is the hardest part!),i say both the AOA and AMA should drop their pride and do it for the benefit of the public. regarless what your philosophy is, whether is allopathic or osteopathic, your mission is to help people, and you're always a medical doctor. what do you guys think?

I think the answer to your question depends on how DO's intend the term 'medical doctor' to the people they are talking to. If DO's are secretly trying to imply 'Doctor of Medicine' when they say "Hi Mrs. Doe. I'm the medical doctor who will be treating you today" then they certainly ought not refer to themselves as a 'medical doctor.' If, on the other hand, DO's are simply trying to imply by the term 'medical doctor' that they are doctors who are trained in the practice of medicine and surgery--i.e., they can diagnose disease, prescribe medications and perform invasive procedures--then it is legitimate for them to use the term. What we see here is that the term 'medical doctor' doesn't automatically mean MD, although people tend to think it does because they think MD's are the only type of complete physician. We can say with certainty, however, that Doctor of Medicine means MD and Doctor of Osteopathy means DO. The moral of the story here is that sometimes the context calls for physicians to refer to themselves according to their degree (either MD or DO), sometimes it calls for them to refer to themselves as medical doctors, and sometimes "I'm a doctor" works just fine. Also, by no means am I trying to lessen the significance of the term "osteopath" or "osteopathic physician." But more often than not it will be impractical for these kinds of physicians to refer to themselves as so, due to the multitude of blank looks on people's faces when they hear "osteopath" or "osteopathic physician." I think most osteopathic physicians don't want to start out their conversations with their patients by having to explain what an osteopath is. I think they would rather treat their patients first and explain the osteopathic philosophy second or as the topic casually arises.

 

[OldManDave]

To address you first query, yes...a DO can refer to him/herself as a "medical doctor", or say, "I am a doctor" cause there is no legally differentiable difference.

As for your suggestion on changing nomenclature to clarify and ease public perception...I support it 100% I think it is an excellent idea. The training rec'd in both program types is equivalent (some better than others & others not quite as awesome) or both degrees would not still have full-medical practice rights.

Furthermore, both program types have instilled a more "people friendly" emphasis to their (again, some more than others) curricula, which had classically been associated with only DO schools.

However, I think you will find even more resistance from the AOA than from the AMA. The AOA tends to be a self-selective and rather crusty old crew who tends to "cling to the past". Most all of the younger Docs, both DOs and MDs, that I have worked with could care less what the initials behing their sig is...it's all about patient care.

But, we will most likely have to await the "changing of the guard" in both the AMA and AOA before anything so radical as a change in nomencalture occurs...we wouldn't want to precipitate a world crisis would we? Like the choice b/t two sets of letters are really all that big of a deal?????



------------------
David W. Kelley, MS-2
'Old Man Dave'
KCOM, Class of '03

Nothing Risked, Nothing Gained!!

 

[MTY]

Originally posted by OldManDave:
To address you first query, yes...a DO can refer to him/herself as a "medical doctor", or say, "I am a doctor" cause there is no legally differentiable difference.

As for your suggestion on changing nomenclature to clarify and ease public perception...I support it 100% I think it is an excellent idea. The training rec'd in both program types is equivalent (some better than others & others not quite as awesome) or both degrees would not still have full-medical practice rights.

Furthermore, both program types have instilled a more "people friendly" emphasis to their (again, some more than others) curricula, which had classically been associated with only DO schools.

However, I think you will find even more resistance from the AOA than from the AMA. The AOA tends to be a self-selective and rather crusty old crew who tends to "cling to the past". Most all of the younger Docs, both DOs and MDs, that I have worked with could care less what the initials behing their sig is...it's all about patient care.

But, we will most likely have to await the "changing of the guard" in both the AMA and AOA before anything so radical as a change in nomencalture occurs...we wouldn't want to precipitate a world crisis would we? Like the choice b/t two sets of letters are really all that big of a deal?????

thanks guys for your feedbacks. i just feel that we should do it for the public's sake, not because of strong philosophical differences from one to another.

majority of the general public are already confused about types of physicians to seek pertaining to their treatment, why bother to confuse them with the physician's philosophy?
we dont' see FMG MD have to explain to their patients about their foreign training. as matter fact, one of the FMG MD was trained in both herbal medicine and western medicine during his med schools years. i don't him has to explain his philosophical perspective before patient consultation.

i guess my point is, with all factors equal, training equal, why bother to have differnt letters behind their names to confuse the patients? i am sure DO physicians dont' want patients questioning his/her ability because they see something that they're not familiar, or referring them as bone doctors. DO are just as competitive as MD, and able to perform in every medical field. so why do they need to be 'differernt' from rest of the medical doctors?

 

[Stephen Ewen]

In all states there is a law allowing MB BS, MB ChB etc., etc. IMGs to write themselves as MDs.

As I understand it, and I have not personally looked into the details to verify this, some DOs in Texas long ago sued under this law to be able to write themselves as MDs in Texas.

Again, this is hearsay--well, I know one Texas D.O. who did this.

But at any rate, please verify this info before fully accepting it.

Personally, I like the idea for patients' sake to standardize a medical degree. It can and would avoid some needless confusion and even worry. Though I think the AOA has done a great job at producing material to educate the public, there remains yet a huge chunk of people that still ask, "What is a D.O.?"

But to counter what I just said, some patients might feel slighted if their MD turned out to all along be a DO...which might open a can of worms in medical malpractice.

Overall, for reasons related to the long-term, I think it is very, very important for American medicine to maintain these two "branches" of medicine, despite any difficulties there may be.

 

[ADRIANSHOE]

As old man dave said, its about timing, politics and the changing of the guard. with state licensure boards highly diverse (some states have combined boards, others "separate but equal") the changing of the guard has to be coordinated strategically over 50 separate fronts, if not simultaneously then sequentially. This war of simplicity and efficiency must be fought on a timetable that recognizes the history of both the AMA and the AOA.
but having said that, there is no reason why in a society that requires efficiency of thought and action that a critical field of licensure ie medicine would have two separate routes and separate governing bodies. If we grant that it is a governmental right to license health practioners then it is obvious that this licensure should be efficient and address certain minimum standards across the board. Additional practice rights such as manipulation or open heart surgery would be governed by less inclusive specialty boards.
The savings inherent with such an efficient set up might allow the other 49 states to follow california's lead and offer FREE medical education to all its admitted students. THIS SINGLE ACT would free up physicians from such a staggering load of debt that they would have more bargaining power to resist the sirens call of the HMO sharks. There are about 80,000 medical students enrolled at any one time in america at a cost of about 1.6 billion dollars in tuition and fees. This is about the cost of one destroyer. another way of saying this is this is about 1% of the yearly budget surplus projected by the US government for the next ten years.
Simply put, if the government would put 1% of its surplus in a savings fund for the next ten years, medical student tuition could be PERPETUALLY funded from the interest by the year 2010. Unfortunately common sense regarding combining medicine into a single licensure and eliminating student debt is often simply to easy a concept to grasp.

 

[turtleboard]

While well-written, I fail to see how merging the two professions would eliminate excess costs and help finance the education of, as you say, 80,000 medical students (I think the actual number is a little less, around 65,000). Not all states have separate osteopathic and allopathic governing boards -- in fact I believe most have combined boards with both MDs and DOs participating!

Tim W. of N.Y.C.

 

[ADRIANSHOE]

tim, you are right, the savings wouldnt provide funds for complete medical student savings in year one.

But, one body is definitely a better start toward efficiency and i doubt anyone would argue that it would save money through reduction of certain duplicated processes.
As I said in the lead paragraph, this is a longterm strategic problem. while cutting
the cost of administration may only save 10 million or so a year in duplication and salary (I am just throwing out a number), that money compounds each year similarly to an IRA and as an IRA would grow to massive proportions within a 20 year time frame so would a fund which is generated from money already being spent however shunted into an education fund rather than being thrown away on duplication as is being done now.
sorry I was wildly vague originally, but sometimes its nice to see what kind of response a general broadbrush idea generates.
Often people seem more concerned with the MINOR problem of the duality of MD vs DO and miss the more overwhelming crisis of todays student: DEBT. So thought I'd combine the two and see what happened.

 

[turtleboard]

Student debt for most med students is pretty manageable. I don't think it's such a crisis that a total revamp of the financial aid system is in order. Then again what the heck do I know? Last year I spent 1/4 what my friends at a certain med school on Long Island in Old Westbury were spending.

Oh well...

Is BU Med still the most expensive professional school in the country? I heard several years ago that that dubious honor was NYU Dental's.

Tim W. of N.Y.C.

 

[rt66doc]

"DO" has worked fine for me over the last 30-plus years. Whenever someone asks "What's a DO", I tell them. Duh.

Don't worry about it, you've got bigger fish to fry.

Cheers,
Tom
PCOM '66

[This message has been edited by rt66doc (edited 02-04-2001).]

 

[ADRIANSHOE]

Tim, my debt will be around 190,000 by the time i finish residency in two more years...my debt isn't atypical...many people join the military or join the nhs who wouldnt otherwise...this makes for a lot of problems...its easy to say "oh, well, thats the choice they made" but the truth is they felt forced into that choice...there are very few people in the general population who can even comprehend how a debt in excess of 100,000 locks you into a set of choices..the flip side of that is of course we knew going in so we have in essence accepted this..........but, lets consider that first job out of residency, would there be a difference in what people did in these first initial career choices if they were not saddled with a minimum payment of 900 to 1800 a month (depending on how you structure your loans).
Would people be more civic minded and less business minded if they were not faced with this debt load? would they accept less financially rewarding but more personally rewarding choices? would the longevity of both physician's careers and their lifes be changed? would their quality of life be changed? Would the HMOs be able to use one doctor against another if there were not a new crop of heavily indebted physicians entering the workforce each year?
30 years ago, I might completely agree with you that the debt is a manageable sidenote to another wise rewarding career, however I am not sure it now is that clearly true.
There is an inevitable conflict of interest in asking a physician to A: provide caring concerned and patient directed care
and B: generate sufficient income to pay your loans. The presence of these loans tips this ethical balance of business/patient care into what i see as a negative tilt. We sent an 11 billion dollar space mission into orbit today. If you crunch the numbers on that using either 65 or 80000 students, you will see that ONE shuttle mission to a marginally usefull space station (my personal bias, i am willing to admit i am wrong if the station generates modest scientific gains) is equivalent to the cost of funding a SAVINGS account which would perpetually fund ALL american medical students for the rest of history....what is ONE less space shuttle mission compared to PERPETUALLY unencumbered physicians with one less stressor upon them.
We cannot ignore the DAILY ethical paradoxes that we students, interns and physicians are placed within. These paradoxes will not magically disappear with free medical student funding, however if the abusive programs which exist out there (and we all know they exist) felt the students could walk away from them anytime they felt like it, we would probably see some reduction in the daily abuses that occur. Thanks for your thoughts, your making me work at this...i appreciate that.

 

[ADRIANSHOE]

just an added note:

a syllogism:

a. Stress shortens peoples lives tremendously
b. large debt causes large stress to most people (check the reasons people commit suicide)
c: therefore large debt shortens lives tremendously.