Is the DO degree relevant anymore?

[DO2015CA]

Gross. Another 1200? No thanks.


It's called satire....


A lot more do than people think... and for the countries that don't if you are there with an organization such as Doctors Without Borders then you have full rights anyway... Honestly the international thing is a non-issue for 99% of DO grads.

Lol that’s what I thought. Spend another 1200 on top of this ridiculously expensive.

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[JSReed]

My big issue with the DO degree is that many countries still don't recognize it. It's a big issue with people at my school interested in international medicine

Speaking from experience, depends on context. You'll have some issues in Iceland, doubt you'll have as many in Malawi. If you're going to the countries that really need the clinicians, they're not going to care too much about MD/DO/MBBS.

 

[mudpilesMD]

Overall there is no reason that the credentials shouldn't be the same in the current healthcare climate. A chapman's point at the 12th rib has never been used to diagnose appendicitis. Nor has one in the 2nd intercoastal space been used to diagnose an MI even when an EKG was negative. It has a useless utility in today's medicine whether it is true or not. I'm not even saying to throw it out altogether if they wanted to keep it for historical purposes but there is no reason our very degree should be called something that greater than 95% of us will never practice or use.

 

[mudpilesMD]

Lol that’s what I thought. Spend another 1200 on top of this ridiculously expensive.

$1200 is a drop in the bucket when tuition is >$60k a year. The benefits to me are clear. Aside from placing you on an even playing field for fellowships, you'll never have to deal with the bull**** that is the AOA ever again.

 

[AnatomyGrey12]

$1200 is a drop in the bucket when tuition is >$60k a year. The benefits to me are clear. Aside from placing you on an even playing field for fellowships, you'll never have to deal with the bull**** that is the AOA ever again.

The merger actually gets rid of a lot of what you are saying. Now that everyone is graduating from an ACGME accredited residency unless you go to a program that has osteopathic recognition (very few do, it's really easy to avoid this) you don't have to deal with OMM or the AOA ever again.

 

[mudpilesMD]

It does but it doesn't at the same time. Subspecialization is the only way to maintain job security and avoid midlevel creep in many fields (IM, PEDs, Gas, etc) this makes fellowships more competitive with each passing year. Having step 3 allows you to be on the same playing field. It is slowly but surely being looked at more and more for fellowship consideration while it used to be a BS exam.
I know a few people who went back during residency to take Step 2 CS just so they can sit for Step 3. But it really depends on what you're going into.

And you'll have to study OMM for level 3 after being in residency for 1-2 years and finally thinking you've escaped it.

 

[AnatomyGrey12]

It does but it doesn't at the same time. Subspecialization is the only way to maintain job security and avoid midlevel creep in many fields (IM, PEDs, Gas, etc) this makes fellowships more competitive with each passing year. Having step 3 allows you to be on the same playing field. It is slowly but surely being looked at more and more for fellowship consideration while it used to be a BS exam.
I know a few people who went back during residency to take Step 2 CS just so they can sit for Step 3. But it really depends on what you're going into.

And you'll have to study OMM for level 3 after being in residency for 1-2 years and finally thinking you've escaped it.

I know lots of people going into fellowships, some of them very competitive. None of them had Step 3. Maybe specific programs want Step 3 (more of a way of saying no DOs), but no one needs Step 3 to match any fellowship.

Telling people to take Step 3 is asinine.

 

[mudpilesMD]

I know lots of people going into fellowships, some of them very competitive. None of them had Step 3. Maybe specific programs want Step 3 (more of a way of saying no DOs), but no one needs Step 3 to match any fellowship.

Telling people to take Step 3 is asinine.

I'm not telling anyone to do anything. Perhaps you misunderstood, but I'm explaining my perspective.
The fellowship match that exists today won't be the same one in 5-6 years when you're ready for it.

I'm not saying that CS opens doors but it's hard to know because so little DOs take it.
Have a look at this survey and see how many PDs (mostly in more competitive specialties) say CS is a considerable factor. The very same PDs will respond that they couldn't care less about PE. Regardless of the reasons why these are the stone cold facts.

https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf

 

[AnatomyGrey12]

I'm not telling anyone to do anything. Perhaps you misunderstood, but I'm explaining my perspective.
The fellowship match that exists today won't be the same one in 5-6 years when you're ready for it.

I'm not saying that CS opens doors but it's hard to know because so little DOs take it.
Have a look at this survey and see how many PDs (mostly in more competitive specialties) say CS is a considerable factor. The very same PDs will respond that they couldn't care less about PE. Regardless of the reasons why these are the stone cold facts.

https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf

But they aren't stone cold facts.... what is actually a fact is that DOs have been matching well into fellowships without taking CS.... like matching really, really well... so....

 

[DO2015CA]

I need the data showing fellowships are looking at step 3 before I’d think about taking step 3

 

[CuriousGeorgeTA19]

I think the main problem with the DO degree is the name grossly misrepresents the training we receive. We didn’t learn bone medicine. We learned medicine and received a few hours per week of manual medicine training the first two years of medical school. That’s it. We should be Doctors of Medicine with Osteopathic distinction (MD-O) or something in that vain.

One of the best things we can do to preserve “Osteopathic Medicine” is change the degree name to something more marketable. As it stands, American DOs will always have a hard time marketing themselves nationally and internationally, because the name makes no logical sense.

This.

 

[DO2015CA]

This.

Not this.

The only way I can agree with changing a degree for marketability is for all physicians to be MD in order to fight midlevel dr not doctors.

 

[IsWhat]

Not this.

The only way I can agree with changing a degree for marketability is for all physicians to be MD in order to fight midlevel dr not doctors.

There will never be a degree change at the undergraduate medical education level - that’s a stupid battle to fight. The GME merger, however, opens up possibilities for residencies and states to grant DOs an MD and/or MD-O, etc. in the name of equal training. Other countries do this type of thing (India being one of them) so it is not unheard of.

Physician Assistants will soon be Physician Associates, and rightfully so. The new name actually represents how they function in our healthcare system. Why should we be afraid to have a degree that represents our training? It’s called progress. The whole, “you should have studied harder and gotten into an MD program” argument is not good enough anymore. We go through the same exact training only to pop out the end with a degree that represents us as bone doctors. We aren’t, and we haven’t been for 60 years.

I’m not saying I want to completely disregard the OMT training we receive, hence the Osteopathic distinction. But, to continue propagating a degree that disregards 99% of your training in the name of “history” is absolutely ridiculous. We are getting our clocks cleaned by mid-levels, so whatever reason you need to get on board with a post-residency degree change, fine.

 

[DO2015CA]

There will never be a degree change at the undergraduate medical education level - that’s a stupid battle to fight. The GME merger, however, opens up possibilities for residencies and states to grant DOs an MD and/or MD-O, etc. in the name of equal training. Other countries do this type of thing (India being one of them) so it is not unheard of.

Physician Assistants will soon be Physician Associates, and rightfully so. The new name actually represents how they function in our healthcare system. Why should we be afraid to have a degree that represents our training? It’s called progress. The whole, “you should have studied harder and gotten into an MD program” argument is not good enough anymore. We go through the same exact training only to pop out the end with a degree that represents us as bone doctors. We aren’t, and we haven’t been for 60 years.

I’m not saying I want to completely disregard the OMT training we receive, hence the Osteopathic distinction. But, to continue propagating a degree that disregards 99% of your training in the name of “history” is absolutely ridiculous. We are getting our clocks cleaned by mid-levels, so whatever reason you need to get on board with a post-residency degree change, fine.

But what’s the point? We are full fledge doctors. Changing the initials you can use to the public does nothing but cater to the doctors inferiority complex. It will not change the residencies open to you, it won’t increase the jobs that are open to you, it won’t change how you practice, etc. What is actual point other than trying to decrease an inferiority complex

 

[hallowmann]

MDs have been actively working to become the sole Physician title for years - and now with the GME merger it wouldn’t surprise me if there became some kind of pathway to an MD for DOs. Maybe something similar to India where you graduate from medical school with an MBBS and receive an MD after specialty/residency training. This would effectively erase the DO degree in a relatively palatable way and removes undergraduate medical education from the equation.

That's not really how that works. Its the medical board that determines whether an individual can advertise as an MD, despite having different credentials. MBBS grads don't suddenly become MDs or receive an MD. They have and will always have an MBBS. They get licensure from the state medical boards and in some states for simplicity the boards have ruled that you can advertise yourself as an MD despite having a foreign equivalent degree. Your degree didn't change and you weren't suddenly gifted with an MD, you just have the ability to advertise yourself as an MD.

DO medical boards in turn govern how DOs can advertise, and DOs are required to advertise as DOs per the AOA and virtually all DO state boards (almost half are covered under the general medical board, but others have independent bodies that handle licensure).

Wasn't there a push to change the title from DO to MDO? I think there was some pretty intense push back from the AOA too.

This has literally happened numerous times, almost every 10-20 yrs since the advent of the DO degree (first time was ~1913 by one of the former ASO presidents)... Its a bit sad that I know that...

...And honestly, if I bust my ass, Work hard, take 2 set of board exams, and get through DO school and match, I certainly won't want my DO letters switched to MD especially knowing that no MD schools wanted me as a student. It's like trying to divorce someone that stayed by your side through all the bad times to marry your long lost crush who has never even noticed you all those years before everything started working for you.

10/10 for analogy.

If DO students would start taking Step 2 CS (we already take Step 1 and Step 2 CK) then we would qualify to sit for Step 3. You DO NOT need level 3 to obtain licensure. You need one complete set of exams (even if you have a DO degree) whether that be level 1, 2 and 3 or Step 1,2, and 3. I confirmed this with the FSMB. There are only like 4-6 states, I can't recall which, that would not allow you to do this. But if this became mainstream that would change fast.

The point would be that if no one was taking level 3 that would be a massive loss to the AOA financially ($875 x 4,000 test takers each year on average). Additionally, it would destroy the utility of their licensure exams overall and prompt faster change. Because FSMB oversees licensure there is no way they can ever force anyone to take step 3.

Personally, I took Step 2 CS. It cost me an extra $1200 but I don't need to see OMM again, pay AOA dues once I graduate, or sit for another poorly written test. Also, it's very helpful when applying for fellowships which across the board is becoming more competitive.

You're asking DO students to pay an extra $1200 to take an extra exam in medical school when they already don't have money and it would in turn likely limit interviews/apps they submit in the match and would absolutely limit the states they can be licensed in (but hey its only 10% of the US) just to stick it to the AOA.

Very few fellowships actually care about Step 3. The vast majority care about ability to be licensed (i.e. you completed a series of licensing exams and your state can license you) and a handful care that you performed well on the last exam in the series (whether that's Step 3 or Level 3). Fellowships are built on connections. You do research in the field, you attend meetings, you network. That's the best way to increase your fellowship chances. Taking Step 3 will do so only marginally, and you'll still need to do all the other stuff to really match well.

My big issue with the DO degree is that many countries still don't recognize it. It's a big issue with people at my school interested in international medicine

A lot of countries (like a 1/3 of them if not more by now) completely recognize the US DO degree. Many don't officially recognize it because very few (if any) DOs have applied for medical practice rights in those countries, and as a result decisions are made on a case by case basis for DOs. There are a handful of countries that are "OMM only" countries due to the presence of non-medical DO degrees, but I will say that I've heard of people appealing to boards, and this is sometimes bypassed.

Its really not a big issue with people interested in international medicine. Working with aid organizations in virtually every country only requires that you be licensed to practice in your country of origin, meaning a DO can practice medicine in a lot of countries, even "OMM only" ones if they are under the umbrella of an aid organization.

Many countries also restrict US DOs due to the lack of guarantee that DOs are ACGME trained (an internationally recognized standard). This is resolved with the merger, and I will say just in the last 5-6 years, multiple countries that did not recognize the US DO degree as a medical degree have since changed their policies (most notably all of Canada and Australia are both in this category).

Its also not the degree ("MD") that is recognized, its the LCME accreditation of the degree-granting institution that differentiates degrees. We would not only need to change the degree, the LCME would have to accredit all DO schools, meaning an MD-O option wouldn't really fix the international issue.

You may be wondering why I'm saying all this. Its because this is something that I really considered when starting medical school, because it was (at the time) an issue for me, but with the changes and after learning more about the process, it simply isn't any more.

...Honestly the international thing is a non-issue for 99% of DO grads.

Probably more like 99.5%. We're talking pretty much only people who have dual-citizenship in countries that do not recognize the US DO degree. And in all honesty, those people should have just gone to that other country for med school if they wanted the ability to practice there.

It does but it doesn't at the same time. Subspecialization is the only way to maintain job security and avoid midlevel creep in many fields (IM, PEDs, Gas, etc) this makes fellowships more competitive with each passing year. Having step 3 allows you to be on the same playing field. It is slowly but surely being looked at more and more for fellowship consideration while it used to be a BS exam...

Subspecialization doesn't avoid midlevel creep, it just delays it. Plenty of subspecialties already have a heavy presence of NPs and PAs in tertiary centers. Subspecialization in certain fields can even limit your job security, for example many Pediatric subspecialists would not be able to sustain volume to effectively practice outside of large institutions/Children's hospitals.

Subspecialize because you like the specialty, not because you feel you "have to." If that's the only way you can set yourself apart from an NP and PA with less than half your training, something else is wrong.

...I know a few people who went back during residency to take Step 2 CS just so they can sit for Step 3. But it really depends on what you're going into.

And you'll have to study OMM for level 3 after being in residency for 1-2 years and finally thinking you've escaped it.

My Level 3 OMM studying involved watching a couple YouTube videos, scanning through the Savarese chapter on cranial, and reviewing a PPT from MS2 that we had before our OMM shelf for a grand total of maybe 2-3 hrs of prep. Still did much better on Level 3 than any other COMLEX. If you do intern year right, there is a lot of truth to that "2 months, 2 weeks, and a #2 pencil" saying.

 

[IsWhat]

That's not really how that works. Its the medical board that determines whether an individual can advertise as an MD, despite having different credentials. MBBS grads don't suddenly become MDs or receive an MD. They have and will always have an MBBS. They get licensure from the state medical boards and in some states for simplicity the boards have ruled that you can advertise yourself as an MD despite having a foreign equivalent degree. Your degree didn't change and you weren't suddenly gifted with an MD, you just have the ability to advertise yourself as an MD.

DO medical boards in turn govern how DOs can advertise, and DOs are required to advertise as DOs per the AOA and virtually all DO state boards (almost half are covered under the general medical board, but others have independent bodies that handle licensure).

I’m not actually talking about an MBBS advertising themselves as an MD in the United States. In India you graduate from medical school with an MBBS and can practice as a general physician. If you decide to do a residency and specialize then you are granted an MD afterwards. This is why you see some IMGs from India are an MBBS and some are an MD. If you see an Indian MD here in the US then they had residency training in India AND residency training here. I just did a rotation with a bunch of IMGs and learned about this.

 

[fldoctorgirl]

We had a 4th year panel post-match and one of the people who had matched ob/gyn actually brought up this Step 2 CS so you can take Step 3 thing. She said she had been advised by several people that some ob/gyn fellowships were requiring Step 3, and that she should consider sitting for Step 2 CS. She said she planned on looking into it more with her new program director. Again, anecdotal, and I wouldn't advocate for telling people to sit for another exam in their 3rd year of medical school so they can maybe apply for a fellowship when they don't even know what they want to do yet.

A chapman's point at the 12th rib has never been used to diagnose appendicitis

You mean that story our OMM professor told us about his surgeon friend who took every positive Chapman's point straight to the OR for an appy even if they had no other symptoms, and they always ended up having appendicitis wasn't true???? Damn. There goes my whole belief system.

 

[hallowmann]

I’m not actually talking about an MBBS advertising themselves as an MD in the United States. In India you graduate from medical school with an MBBS and can practice as a general physician. If you decide to do a residency and specialize then you are granted an MD afterwards. This is why you see some IMGs from India are an MBBS and some are an MD. If you see an Indian MD here in the US then they had residency training in India AND residency training here. I just did a rotation with a bunch of IMGs and learned about this.

MD degrees in British system countries are further advanced degrees. Usually it involves a good amount of research as well, not just residency training. The MD degree there is considered essentially a Ph.D. of medicine, were as the MBBS, MBChB, etc. are bachelor level degrees. While I'm not sure specifically about India, I know that the MD training in other British system countries is a more involved than just residency as we know it.

 

[IsWhat]

MD degrees in British system countries are further advanced degrees. Usually it involves a good amount of research as well, not just residency training. The MD degree there is considered essentially a Ph.D. of medicine, were as the MBBS, MBChB, etc. are bachelor level degrees. While I'm not sure specifically about India, I know that the MD training in other British system countries is a more involved than just residency as we know it.

I’m not sure where you are going with this.

All I know is MDs have tried in the past to get rid of the DO degree (California 1960s) and it really wasn’t that hard for them to do it. With the residency merger it will be even easier to argue for a unified degree post residency. It won’t take much lobbying to get politicians to sign off on this. It is a logical conclusion to what is a fairly convoluted system of physician training in the United States.

American DOs should get in front of this and offer a degree change post residency that is a representation of what we are. American DOs can’t advertise as DOs in many countries, because the DOs in said countries (ie. Australia) do not believe we receive enough OMT training to call ourselves DOs - and they are right, we don’t. We are MDs with a smidge of OMT training. If we don’t get in front of this and offer a post residency degree (like an MD-O) that advertises the osteopathic portion of our training, then the DO degree is going to go bye bye completely.

 

[Osminog]

I wonder how much more competitive admission into osteopathic medical schools would become if they started awarding MD degrees. Based on my experience, there are a lot of prestige-oriented people with decent stats who would rather abandon the medicine track (or study in the Caribbean) than have “DO” after their names.

If reputable osteopathic schools in desirable locations, like PCOM, CCOM, Western, Touro-CA, etc., were to start offering MD degrees, I’m guessing their MCAT averages would soar to 510 or higher.

In a sense, by awarding DO degrees instead of MD degrees, osteopathic schools create a pool of applicants whose academic qualifications aren’t great but who are humble and passionate enough to forgo the prestige of an MD in order to become a physician.

 

[AnatomyGrey12]

I wonder how much more competitive admission into osteopathic medical schools would become if they started awarding MD degrees. Based on my experience, there are a lot of prestige-oriented people with decent stats who would rather abandon the medicine track (or study in the Caribbean) than have “DO” after their names.

If reputable osteopathic schools in desirable locations, like PCOM, CCOM, Western, Touro-CA, etc., were to start offering MD degrees, I’m guessing their MCAT averages would soar to 510 or higher.

In a sense, by awarding DO degrees instead of MD degrees, osteopathic schools create a pool of applicants whose academic qualifications aren’t great but who are humble and passionate enough to forgo the prestige of an MD in order to become a physician.

The only way they can legally offer the MD degree is by getting LCME accreditation.

 

[mudpilesMD]

You're asking DO students to pay an extra $1200 to take an extra exam in medical school when they already don't have money and it would in turn likely limit interviews/apps they submit in the match and would absolutely limit the states they can be licensed in (but hey its only 10% of the US) just to stick it to the AOA.

I honestly don't think that $1200 is a lot of money in the grand scheme of things and most likely won't impact the number of applications people can submit. I'm not really sure how you can immediately jump to that conclusion. As per my original post, I suggested that if it becomes more prevalent for DOs to take CS those 3-4 states would change over their regulations. The current limitations on DOs in those states are not out of spite but rather because no one has challenged them. Again, this is simply a suggestion for DOs looking to escape the AOAs grasp and maybe make themselves more competitive for fellowships.

Very few fellowships actually care about Step 3. The vast majority care about ability to be licensed (i.e. you completed a series of licensing exams and your state can license you) and a handful care that you performed well on the last exam in the series (whether that's Step 3 or Level 3). Fellowships are built on connections. You do research in the field, you attend meetings, you network. That's the best way to increase your fellowship chances. Taking Step 3 will do so only marginally, and you'll still need to do all the other stuff to really match well.

Again, this is changing. I'm not saying its happening overnight but it is rapidly changing. There were 2,018 residency spots added in the 2019 match maintaining the match rate at about 95-96% for US grads (https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/03/2019-Match-by-the-Numbers.pdf). At the same time, fellowships have gotten more and more competitive each year with fewer seats available per a graduate https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/02/Results-and-Data-SMS-2019.pdf (page 13, table 3). This is because less (if any) fellowships are added per year. Yes, networking and everything else you mention is most important. But all else considered equal they'll go with the guy with Step 3 score in hand.
The facts are in the numbers. Although this is an older PD survey it is the only one available. It clearly shows what PDs care about. http://www.nrmp.org/wp-content/uploads/2017/02/2016-PD-Survey-Report-SMS.pdf


Subspecialization doesn't avoid midlevel creep, it just delays it. Plenty of subspecialties already have a heavy presence of NPs and PAs in tertiary centers. Subspecialization in certain fields can even limit your job security, for example many Pediatric subspecialists would not be able to sustain volume to effectively practice outside of large institutions/Children's hospitals.

Delaying it, avoiding it. Same thing. Delaying it until you can have enough job security that you won't have to worried about being replaced by someone who can practice the same medicine (under supervision) for cheaper. If you don't understand this then you truly have a poor grasp on the state of healthcare in urban environments. Yes, mid-levels are in subspecialized fields but they're significantly more limited to what they can do in those fields. Yes, some specialties may ultimately be a disservice with regard to volume but that is a minority. Usually, people pursuing those positions are truly passionate about that field and willing to take a pay cut and restricted to academic centers. Most other physicians would like to start looking at a paycheck and paying back their loans.

Subspecialize because you like the specialty, not because you feel you "have to." If that's the only way you can set yourself apart from an NP and PA with less than half your training, something else is wrong.

Right, because hospital administrators and insurance companies really care about what you as individuals can do to "set yourself aside". No, they don't. They care about the bottom line. And if you're physician who can be replaced by a cheaper health care worker you won't be on it.

 

[AnatomyGrey12]

But all else considered equal they'll go with the guy with Step 3 score in hand.
The facts are in the numbers.

You have provided zero facts to support this claim when there are hundreds to 1000+ DOs that match fellowships every single year without Step 3.

Again, this is simply a suggestion for DOs looking to escape the AOAs grasp and maybe make themselves more competitive for fellowships

Again, most residencies aren't getting osteopathic recognition. DO grads from here on out won't have to ever deal with the AOA again if they don't want to. The AOA knows this and is terrified of it, hence why they have launched their huge advertising campaign to try and get residency grads to choose AOA board certification.

You have yet to provide a single scrap of evidence that Step 3 makes anyone more competitive for fellowships. My school has residencies in just about every specialty and they have placed residents in competitive fellowships in literally just about every single one from ortho/ENT down to IM and peds.

 

[hallowmann]

I’m not sure where you are going with this.

All I know is MDs have tried in the past to get rid of the DO degree (California 1960s) and it really wasn’t that hard for them to do it. With the residency merger it will be even easier to argue for a unified degree post residency. It won’t take much lobbying to get politicians to sign off on this. It is a logical conclusion to what is a fairly convoluted system of physician training in the United States.

American DOs should get in front of this and offer a degree change post residency that is a representation of what we are. American DOs can’t advertise as DOs in many countries, because the DOs in said countries (ie. Australia) do not believe we receive enough OMT training to call ourselves DOs - and they are right, we don’t. We are MDs with a smidge of OMT training. If we don’t get in front of this and offer a post residency degree (like an MD-O) that advertises the osteopathic portion of our training, then the DO degree is going to go bye bye completely.

I wasn't going anywhere, I was just relaying information about the British system MD degree.

This is not a revolutionary topic. This has been tried numerous times in the past. The issue isn't getting laws passed or state governments, its rather state medical boards. The problem is that boards and bodies and even the judiciary usually go with what the national organizations (i.e. the AOA) say. There was a lawsuit a few years back in New York, where physicians tried to argue that they too should be able to advertise themselves as MD the way that licensed foreign graduates can. They lost, and the AOA code of ethics (section 8) was cited as the reason.

In the US, people don't get degrees from residency training, they get certifications. DOs are already getting the same board certifications that MDs get from ACGME residencies and board exams. The school is where your degree comes from, and as such the only way to really change the degree is by changing the charter of the school and in turn getting LCME accredited. The reason it worked in CA in the 1960s is because COA and CMA were working very closely for years to eliminate the division. It basically requires that the overarching osteopathic organization (i.e. the AOA) be behind such a measure. The way it worked in the COA was in part because high members in the COA reached high positions in the AOA as well, and even then despite COA being the largest delegation, others in the AOA opposed it vehemently basically kicked COA out. The only way to really make this happen is to get the AOA behind it, which means as others have mentioned lots of non-"true believers" getting to high positions in the organization.

Its been tried a lot, and its failed a lot. Personally I think the idea of a "new degree" doesn't make any sense, because it doesn't fix any problems with the DO degree. The only reasonable alternative would to be something like a separate degree or certification that is awarded in addition to the MD degree by osteopathic schools.

In any case, it doesn't really matter. Seriously, it really doesn't. This barely comes up in actual practice. People don't care. Personally, I could care less if the degrees merge, I only agree for simplicity's sake (the 2 degrees are not sufficiently different to justify their existence). It need not really happen, and it could easily go the way of DMD and DDS.

I honestly don't think that $1200 is a lot of money in the grand scheme of things and most likely won't impact the number of applications people can submit. I'm not really sure how you can immediately jump to that conclusion. As per my original post, I suggested that if it becomes more prevalent for DOs to take CS those 3-4 states would change over their regulations. The current limitations on DOs in those states are not out of spite but rather because no one has challenged them. Again, this is simply a suggestion for DOs looking to escape the AOAs grasp and maybe make themselves more competitive for fellowships.

Again, this is changing. I'm not saying its happening overnight but it is rapidly changing. There were 2,018 residency spots added in the 2019 match maintaining the match rate at about 95-96% for US grads (https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/03/2019-Match-by-the-Numbers.pdf). At the same time, fellowships have gotten more and more competitive each year with fewer seats available per a graduate https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/02/Results-and-Data-SMS-2019.pdf (page 13, table 3). This is because less (if any) fellowships are added per year. Yes, networking and everything else you mention is most important. But all else considered equal they'll go with the guy with Step 3 score in hand.
The facts are in the numbers. Although this is an older PD survey it is the only one available. It clearly shows what PDs care about. http://www.nrmp.org/wp-content/uploads/2017/02/2016-PD-Survey-Report-SMS.pdf

Delaying it, avoiding it. Same thing. Delaying it until you can have enough job security that you won't have to worried about being replaced by someone who can practice the same medicine (under supervision) for cheaper. If you don't understand this then you truly have a poor grasp on the state of healthcare in urban environments. Yes, mid-levels are in subspecialized fields but they're significantly more limited to what they can do in those fields. Yes, some specialties may ultimately be a disservice with regard to volume but that is a minority. Usually, people pursuing those positions are truly passionate about that field and willing to take a pay cut and restricted to academic centers. Most other physicians would like to start looking at a paycheck and paying back their loans.

Right, because hospital administrators and insurance companies really care about what you as individuals can do to "set yourself aside". No, they don't. They care about the bottom line. And if you're physician who can be replaced by a cheaper health care worker you won't be on it.

1. It actually does affect how people apply to residencies. $1200 at a time when COA is not all that more than the 3 other years, but you have an additional cost in the thousands. People I know who wanted to apply broadly had to borrow money or take out private loans to cover applications. $1200 buys a lot of apps.

2. You're making a lot of assumptions about how states would respond. I wouldn't do that. Even though osteopathic internships are being eliminated, 2 state osteopathic boards are still requiring "AOA equivalent" internships for licensure. Those 4-5 states are holdouts for a reason, and its likely because of some "true believers" in high places.

3. Did you look at that PD survey? The majority of programs care that you passed Step/Level 3. A handful care about specific score cutoffs, but this tells you nothing of whether those same programs that care about a Step 3 score cutoff don't also care about a Level 3 score. All this survey gives you is that its a factor among all the factors in an app. It honestly says nothing about whether or not taking Step 3 vs. Level 3 gives you an edge. They even combine them when they talk about the percentage of programs/mean importance of "USMLE Step 3/COMLEX Level 3 score".

4. Delaying vs. Avoiding. My mistake, I interpreted your statement when you said avoiding something as being a path for physicians in general, not just a way for you/your classmates to kick the can to the next few classes of docs. Subspecializing doesn't fix the problem of midlevel creep.

5. You clearly didn't understand what I meant by setting yourself apart. You can pretend as much as you like that you can get to a point of specialization to maintain job security, but the only true way to be secure is to be versatile and able to adapt, which has direct fiscal effects. You don't get that from subspecialization. That's my point. Recognize what all those years of studying, being placed in different environments, and training has done for you and capitalize on that. Don't sell yourself short, you're a doctor for a reason.

Also don't forget that you are the reason those administrators have paychecks. You bring in the money.

 

[PhillyDoc24]

Ok, I'm serious about this so please post your ideas about how to get this moving. For now, I've thought of the following:

1. Get as many people to become a member of the AOA. It's free if you're a student!

2. Make a website where current DOs (students, residents, fellows, and doctors) can sign a petition. I can create this.

3. Once we get a decent number of signatures, start pushing the issue at the AOA.

This is just a general idea but I think we would have to ask LCME for advice. I don't really know what's required to make the switch. If we get info from LCME about how to do it, then the AOA can't blow smoke up everyone's *** about how they can't do it.

CuriousGeorge, I would like to talk to you about this. There is momentum with this topic. How do we have a private conversation?