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MBBS = MD = DO?
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That's the beauty of this approach. The AOA has nothing to do with it. Just as organizations who award MBBS have nothing to do with states allowing MBBS to use MD.
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The AOA however does have more political power than do foreign MBBS-granting institutions. They would surely oppose it.
I'm still unconvinced on changing the degree name. I don't care much for OMM or for some of the AOA's policies, but I'm working hard to earn a DO degree and I'll wear it with pride.
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I understand. I worked very hard for my degree as well. For me it is simply a practical preference due to private practice. MD is more beneficial here unless you are doing an OMM private practice. I don't do OMM or anything particularly "Osteopathic".
I am proud to be a Physician as well. Be proud, by all means. That said, I do hope for uniformity and again, for practical reasons, it would be great to have the option.
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Agreed. Plus, even if the AOA didn't explicitly spell out that something like this is a violation of their "Code of Ethics", which they do, it would be more up to the state osteopathic medical boards whether this could fly. I know that my state osteopathic medical board has repeatedly stated that it is a violation of licensure agreement (or something like that) for a DO to advertise themselves as anything other than a DO.
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I agree with Osteotastic,
Yes, the DO leadership is resistant to allowing us to use anything other but the DO title but the simple fact is that the title does close doors and does hurt us. Its time the DO populace get some balls, stop burying our heads in the sand and actually stand up to the douche bag cronies that are protecting their own power by not actually representing us.
As much as some sdners like to rail for keeping the DO, if today the change to MD were offered to practicing DOs, the majority would take it hands down. I also agree with those who say MDO would be an improvement, it would, though allowing a DO to do the same as an MBBS and use the MD title would be a more simple solution allowing only those that wanted to to do it.
Yes, the DO leadership is resistant to allowing us to use anything other but the DO title but the simple fact is that the title does close doors and does hurt us. Its time the DO populace get some balls, stop burying our heads in the sand and actually stand up to the douche bag cronies that are protecting their own power by not actually representing us.
As much as some sdners like to rail for keeping the DO, if today the change to MD were offered to practicing DOs, the majority would take it hands down. I also agree with those who say MDO would be an improvement, it would, though allowing a DO to do the same as an MBBS and use the MD title would be a more simple solution allowing only those that wanted to to do it.
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Wouldn't a simple internet search let patients know where people went to school, did residency, etc...?
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if this actually happened, DO school applications would probably skyrocket overnight...
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Lol, as much as I hate to admit it, that is probably true. Kind of like how if podiatry were a surgical subspecialty for MD/DO rather than its own degree, it would be insanely popular. It would be the new ENT.
If a patient doesn't want to see me because I'm a DO, it's their loss. Most patients care far less about "qualifications" and "outcomes" than they do about "quality of cafeteria food" and "bedside manner." Ask any patient to describe a major surgery, and you know what they'll talk about most? The food, the things the doctors said, the way the nurses and techs treated them, and how nice their room was. This isn't to say that DOs provide inferior care, but rather that physician pedigree is often the last thing on the mind of patients when they're seeking care. More often than not, what they want to know is what friends, family, and members of their community have to say about a given physician, not where they went to school.
Hell, I used to be kind of "yeah, I'm going to med school. I decided to go to a DO school" and kind of worry about having to explain things to people and whatnot, but I've gotten more positive than negative responses, so I'm very open about the DO thing and would never change my title. Most positive feedback is along the lines of "my PCP/cardiologist/son's pediatrician/whatever is a DO and they're so nice! DOs are great and I think you've picked an awesome path to being a physician!" People care about what gets them in the feels- the bedside manner, sitting and talking with them at eye level, having a good sense of humor, giving them hope- more than they care about what degree is hanging on your wall.
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I wasn't referring to quality of care.
Do You believe a patient who looked up their doctor's credentials after seeing MD on a lab coat coat, office, business card, pajamas, etc... would feel deceived?
In the case of an MBBS, no. In the case of a DO, yes.
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I guess thats kind of the elephant in the room here.
Well I'm pointing it out. In the US, we've got two types of medical education. You can't just run around saying you went to one type of school when you attended the other. MBBS and all of the variations thereof are the foreign equivalents of an MD degree and only differ in their lettering due to the nomenclature preferences of their respective countries' educational systems. The DO degree is a different degree for more reasons than just historical ones.
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OK Jack,
Certainly with such a statement you would not mind specifying exactly how these educations are "different" and exactly what you mean by "types". You see, my mind responds much more favorably to logic and reason than non-specific statements. Are you able to formulate a logical argument that backs such statements and would you mind enumerating the reasons that are "more than just historical" that these degrees are different? I would truly just love to hear it.
Also, what is your current status? What is meant by "non-student?"
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I'm a DO student.
The "more than historical" difference is on several levels. We have different accrediting bodies that require different things of our schools. A DO school is not an MD school because it likely is not up to LCME standards, even were said school to apply, as most DO schools could not meet the non-tuition funding requirements, the research requirements, or the teaching hospital requirements required by the LCME. There is a not insubstantial amount of our education dedicated to the practice of OMM, which makes our education different than our MD counterparts, even if we choose not to use it one day in practice.
It's not that DO education is inferior, it is just substantially different. We generally do not have large attached teaching hospitals, we do not have the crazy amount of full-time researchers the LCME requires (I believe it is 70, but I could be wrong), and we devote hundreds of hours to studying OMM over the course of our education. We are required to take a different licensing exam (in addition to the USMLE if we so choose) that has a different focus to its questions and additional questions about OMM to boot.
It's like saying wine and sherry are the same thing. They are very similar, but there is a substantial enough difference that to say that they are the same is disingenuous. The both do the job, certainly, but they are not the same product and they do not make it to the shelf by the same process.
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Do medical schools in Austrailia, Saudi Arabia, or India that grant the MBBS that equates to thr MD degree meet LCME standards? (Rhetorical)
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What you have done is answered the question "what is different about LCME and COCA"
Schools that award the MBBS are non-LCME as are offshore MD schools.
This does not address the question of how the education is actually different. The "not insubstantial" time devoted to OMM that you mention comes out to a total of ~3% of my total med school hours (all 4 years). Yet my degree is designated 100 to this fraction of my education.
On top of that, my 3rd and 4th year training was from all MDs and included zero OMM. I then went to an ACGME Residency with zero OMM. And I now practice indistinguishably from my colleagues again with zero OMM.
Not only this but with the merger of residency programs ahead, COCA is set to be crushed and it is only a matter of time until the pressure will extend to DO schools to put up or get out.
The AOA which may face extinction in the coming years, is not going to look out for our options and future. We must do that. We must have our options secured before the ship sinks not after.
-excerpt from letter written to the board of Deans from Norman Gevitz PhD.
“If unification and one common standard are desirable for the osteopathic medical profession and in the public interest with respect to graduate medical education, what compelling and rational reason is there for the AOA and/or AACOM to NOT join with LCME in one unified undergraduate medical education accreditation system with one common standard?”
"there is no doubt that going forward, growing and enormous pressure will be placed by organized allopathic medicine to have osteopathic medical schools adhere to the same accreditation standards as a prerequisite for allowing newly graduated DOs into ACGME programs—not withstanding AOA and AACOM membership on the ACGME Board.
Your Board’s response to the question has to be more than the non-answer “We have no plans to consider joining the LCME.” If you and your deans cannot fashion a compelling and rational argument against joining the LCME, then the vote of the Board of Deans to support a unified GME program under the auspices of ACGME will inevitably lead to osteopathic medical schools having to meet LCME standards. This will result in each of the schools having to make new and substantial financial commitments. If schools cannot find the necessary resources to make changes needed to comply with LCME standards and expectations, they will, without question, close. And if our colleges close there will be fewer DO graduates each year to compete with MD graduates for scarce residency positions."
"It would be illusory to expect that LCME would establish a different standard for osteopathic medical schools from that to which currently LCME-accredited community-based medical schools must adhere. When homeopathic and eclectic medical schools agreed to become accredited by the AMA in the first decade of the 20th century, no special accommodation was made for their schools. In 1905, there were no less than 24 homeopathic and eclectic medical colleges. In 1935, the number of such schools shrunk to a mere 3. In that latter year, the two surviving homeopathic medical colleges were required to drop all mention of “homeopathy” in their self-descriptions and remove any semblance of homeopathy from the required medical school curriculum. In 1939, the last surviving eclectic medical school closed its doors forever. To not know allopathic accreditation history may prove disastrous for currently existing osteopathic medical schools."
If we are not careful to advocate for our equivalence, as would be effectively done by establishing the ability to be designated MD as do other non lcme physicians, it is not inconceivable that your degree designation could hold much less value in the future.
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The difference between the two is the difference in accrediting standards. DO students have less access to research, less access to high-acuity patients, less access to specialist rotations, and less access to faculty and staff due to substantially higher student:full time faculty ratios. We learn the same things, certainly, but our education is lacking in much of the opportunity that is provided by LCME accredited schools. DO schools are a different experience than MD schools, have different accrediting bodies, and DOs must take a different accrediting exam to gain their license. That seems like enough to merit our having a different set of letters sitting past our name.
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Interesting piece by Gevitz. I do wonder whether or how DO schools would hypothetically meet LCME standards. Basically, would the requirements for diverse funding, large numbers of full time faculty, and sizeable research infrastructure be so financially cumbersome that most schools would close?
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I always thought it was odd that if you went to school in Iowa or Ireland or Israel and wanted to practice in the US you have to take the USMLE
BUT, if you by chance went to 1 of the 30 DO schools in the US, you could just take a different exam. You would think that the public would want all doc's to have passed the same licensing exam...
Most would, yes. They literally do not have the resources, particularly the free-standing DO schools like LECOM and Touro.
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LECOM is enough of a money maker that it could easily join forces with a real health system (one particular one comes to mind) to "diversify" it's funding, much like TCMC had to do following its LCME probation. I don't know a ton about Touro's clinical affiliates, but if they were required to, I wouldn't be surprised of they could do so as well. That said, both and virtually all COMs would fight tooth and nail to stop something like that because it will be costly.
That said, I find Gevitz's slippery slope arguments weak at best. Even if we're to assume the LCME wanted to take over the accreditation of COMs, why couldn't the LCME establish differing rules for two different degrees? State medical boards do it with licensing of DOs vs. MDs.
His whole purpose in writing that letter was to scare people into thinking that the merger will change "everything" and destroy the DO profession as a whole, of course it's going to be filled with exaggerating statements and the idea that all schools would close (just as it pushed the idea that huge amounts of AOA programs would close).
The truth is that if the schools had to adhere to LCME standards, almost all would. They'd hate it, they'd have to spend money and make changes, but most would.
Also, don't forget that there's a large spectrum of MD schools out there. They're not all JHU, and some already get 30-40% of their funding from tuition.
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http://www.aacom.org/docs/default-source/data-and-trends/fy2011-RevandExpbyCOM.pdf?sfvrsn=6
here is financial data for DO schools if you or anyone is interested.
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Agreed,
It would be in our best interest to advocate for the ability to use the MD title as the other non-lcme Physicians. As for those who argue that our degrees are so "different". This sounds like one of those fluff pamphlets with no actual meaning that the AOA prints out telling people we are "different kinds of doctors". What a bunch of BS. We study the exact same curriculum other than the small minority of forced OMM that people roll their eyes through, we are eligible to sit for the same board exams, we go side by side through the same residency programs and practice indistinguishably in the hospitals. It is actually the most similar of the educational and professional paths out there.
Also, just because lcme schools may have requirements to have a certain number researchers on staff and be involved in active research does not mean that the medical students are actually required to be actively involved in research. Most I know never did or were peripherally involved to a very minor extend just to get their names down the list on a publication. Significant involvement in research as a Physician is what an MD PhD is for. This normally does not affect the actual medical school curriculum.
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Thanks! I've been searching for something like this for MD schools too. All I can base my info on is that article from 2010 (I think) that surveyed MD schools about funding.
This is very true. All it does is make it easier for MDs to get pre-clinical research experience/opportunities than DOs, which might slightly pad the CVs of the MDs that wouldn't go out of their way to do it. In terms of the actual medical education the research/researching faculty really don't make a big difference.
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In 1983, a group of DO's tried to sue in the state of NY in response to the State of NY Board of Regents conferring the MD degree upon foreign graduates. The DO's lost, and the court wrote:
"Here, in pursuit of its legitimate interests in regulating the practice of medicine, the State of New York has demonstrated a rational interest in maintaining a distinction between physicians whose education has included substantial training in the manipulative theories and practices of osteopathy and those whose medical education has not included such training"
Additionally, the court wrote
"With respect to foreign medical graduates and "Fifth Pathway" physicians licensed to practice in New York, it appears that there are no foreign osteopathic schools and no foreign schools that grant the D.O. degree. Foreign medical graduates and trainees, therefore, whatever the quality of their training may be, are not instructed generally in the principles of osteopathy."
Fast forward now to whenever the merger is finally in place and there is some "DO training" available to anyone seeking to enter traditionally osteopathic training programs -- would this weaken the court's original argument seeing that now these foreign grads are indeed receiving "osteopathic" training prior to beginning their residency training where they will be able to use the MD degree (as opposed to some other foreign equivalent). Certainly not a lawyer, just curious.
The actual case is here: http://www.leagle.com/decision/19831365561FSupp804_11260
"Here, in pursuit of its legitimate interests in regulating the practice of medicine, the State of New York has demonstrated a rational interest in maintaining a distinction between physicians whose education has included substantial training in the manipulative theories and practices of osteopathy and those whose medical education has not included such training"
Additionally, the court wrote
"With respect to foreign medical graduates and "Fifth Pathway" physicians licensed to practice in New York, it appears that there are no foreign osteopathic schools and no foreign schools that grant the D.O. degree. Foreign medical graduates and trainees, therefore, whatever the quality of their training may be, are not instructed generally in the principles of osteopathy."
Fast forward now to whenever the merger is finally in place and there is some "DO training" available to anyone seeking to enter traditionally osteopathic training programs -- would this weaken the court's original argument seeing that now these foreign grads are indeed receiving "osteopathic" training prior to beginning their residency training where they will be able to use the MD degree (as opposed to some other foreign equivalent). Certainly not a lawyer, just curious.
The actual case is here: http://www.leagle.com/decision/19831365561FSupp804_11260
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FMG's might be eligible for pre-residency "osteopathic training", but the "training" will still not have been a part of the education that led to their medical degree. The court seems to maintain that there is a significant enough difference in the educational requirements that lead to the DO vs FMG medical degree that separate titles are necessary.
By "medical education", the court seems to only imply medical school and not the entire continuum of undergraduate to graduate medical education.
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This is because the LCME believes that the mission of medical schools is not just to train physicians, but to forward the practice of medicine scientifically.
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His jusy occured to me, but I wouldn't be at all surprised, though, if MD schools... both LCME and Caribbean, start hiring DO faculty to teach OMM electives for students interested in pursuing Osteopathic-focused GME. That, then might be weaken that judges argument.
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Wouldn't removing OMT from curricula have the same effect?
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Yeah, but that's unlikely to happen any time soon. On the other hand, with the merger, the AOA focused residencies would require some OMM training for MDs to match, so its very possible for what NurWollen said to happen in the not too distant future.
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Precisely. For whatever reason, AOA/COCA simply do not seem to value this idea. New schools pop up claiming to be "teaching centered" and altruistically "rural/underserved primary care focused". Meanwhile, administrators snicker and line their pockets with easy federal student loan dollars behind the scenes.
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but the key word might be "electives". Even if a number of FMG's took OMM electives, it still may not be construed as being "generally instructed" (or, required) in FMG's medical school education.
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Yeah, that's true, it's hard to say how it would play out.
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No more tardigrade???? Sad, man.
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I know a few years ago the AOA passed a resolution at the House of Delegates meeting reaffirming the DO designation. Does anyone know if there was any polling data of practicing DO's or students/residents/fellows that showed what percent favored keeping the DO and what percent would have liked to have used the MD designation that was presented prior to passage of the resolution?
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Based on what I've heard, it was either 2:1 or 3:1 in favor of keeping the DO degree. Around the same time, a group of DO students had proposed to SOMA to submit a request to the AOA about looking into (not to change, just to research the idea of) changing the degree to "MD, DO" (where DO meant Diploma of Osteopathy or something). The proposal was overwhelmingly rejected at the SOMA meeting.
If I recall correctly, @DocEspana had a bit more info about this.
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Yea. It was crushed in SOMA 3-4 years ago. Overwhelming rejection.
A poll gets made here every year aaking opinions on it. Probably seen four of them. First three ended up with 30-35% in favor of change and the rest against. The most recent one (might even be this thread idk where im posting right now) was a touch dsifferent. It was up for about a month and was 65-35, with the usual 35% for change and everyone else against it. maybe 1-2 votes had been cast in the last week of the poll, effecively it was over as nearly everyone who posts or haunts this forum had already voted in te first week, let alone the first month. Then in the span of 24 hours round-about 30 votes were placed all for "MD DO". And suddenly it was 55-45 in favor. Then the original author declared victory and no one voted on the poll again. It was.... suspicious. Thats about all I can say about it.
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While that may be the majority opinion, I think @Fergison2 makes a fairly compelling point. A majority of DO's would likely accept the MD title if it was offered. Actions speak louder than opinions...
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theyd also accept three gold buillions. But some things arent going to be freely offered when there is a proprietary organization with a monopoly on the term within the country.
If we're talking realistic, not magical fairy that taps degrees and makes new letters appear? The overwhelming majority would REJECT any attempt to turn DO degrees into MDs by nearly every method thought up short of magic. Actual history has shown that, which is actually irrefuteable, unlike your extremely refutable hypothetical claim. Give MDs instead of DOs? Rejected numerous time in the 70s-80s. Give MD degrees through the licensing boards so DOs can use whichever they want? The California debacle still scars people. MD-DO? Soundly defeated by the only group in the AOA that would even muster 35% support for that ridiculous idea. Join with the LCME and just become one body.... actually... that is a possiblity. But the AOA itself needs to buy in as that would require liquidating the AOA and if the repeated near-derailments of the GME merger is any sign, the AOA will never ever ever give up their office jobs. Also a good number of DO schools would close as, unlike AOA residencies, some AOA medical schools would have a hard time hitting some of the obscure (and non-negotiable) requirements placed on MD schools for how they have to structure their education.
What you overlook is that anything that changes the degree, MASSIVELY devalues it. 65% of people know that and admit it. 35% know that and are sticking their fingetrs in their ears and screaming over the resounding objections of others.
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anyone remember this thread from a disgruntled CA-3 a few years ago?
http://forums.studentdoctor.net/threads/do-degree-change-any-updates.862759/
@DocEspana I adjusted my wording.
http://forums.studentdoctor.net/threads/do-degree-change-any-updates.862759/
@DocEspana I adjusted my wording.
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So, a majority opposing attempting any method to be optionally granted MD's-- while a majority willingly accepting MD's if this was somehow (though unlikely) done-- I guess my point was that I find that hypocritical.
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My point was I don't think a majority would on your hypothetical situation, but neither of us have any evidence on it. "common sense" often doesn't predict complex decisions well. But my doubt is no better justified than your belief . So... Shrug
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The bolded is the stupidest **** I have ever heard. Stop drinking the kool-aid. The same way it didn't matter if the professor teaching me in undergrad was curing XYZ disease, it has no bearing on how well education that is taught is or if its on par. We take the same or similar boards, and the MBBS people are not at the same standard as us and neither is the caribbean, yet they all still use MD.
sub·stan·tial
səbˈstan(t)SHəl/
1. concerning the essentials of something.
"there was substantial agreement on changing policies"
That OMM factors so heavily into many DO curriculums is one example of how a DO curriculum has a substantial (as in, not insignificant and essential difference) in how DOs are educated as compared to their MD counterparts. There is also the matter of teaching facilities and hospitals- the expectations required by LCME standards lead to MDs having a substantial difference in the quality of their clinical rotations and thus the education received. Our MD counterparts have a substantially higher level of access to research opportunities and support. Most DO schools would never qualify to be LCME member schools because they are lacking in things that are substantial enough to make our education not meet the uniform standards of LCME accreditation. That alone should be reason enough for you to see that we have a difference in education in regard to MD training, even when OMM is out of the picture. But then you throw in the focus of many schools, such as mine, where OMM is a significant part of the curriculum (most students at my school have to sink as much time into OMM and anatomy as they do into all other subjects combined, an experience that makes the focus of our education very, very different from the experience of an MD student) and you get an educational experience that is essentially very different from what someone at an MD school would have.
It isn't a matter of inferiority, it's just that we are different. Think about it like car companies. Ford sells inferior models of their product overseas. But if you were to bring one of those to America and it were to pass the safety inspections required for it to be on the road, ultimately you'd still be driving a Ford. We're not Fords. We're Chevys. We came out of a different design process and a different plant. Sure, the ultimate product is very similar, but no matter what we do, we can't call ourselves Fords, because we aren't. It isn't a quality difference, it isn't a price difference, it isn't discrimination, it just is what it is. We aren't the same thing, legally or by lineage, any more than a Protestant is a Catholic or a Ford is a Chevy or a Coke is a Pepsi.
