The old MD vs. DO argument rears its ugly head

[jll66]

Some fellow 3rd year osteopathic students and I were discussing the DO vs. MD issue (again) the other day, and we'd like to know what other medical students think of the following:

What if we just award ALL medical students the MD degree and then anyone interested in osteopathy could take elective courses in it during medical school, and then do a residency in osteopathy. (I know many of you will say that there is NO WAY the AOA will ever allow such a thing, but hey, people laughed at Elizabeth Cady Stanton when she suggested that women had a right to vote! Keep reading.) That way you really get only the students who genuinely want to become osteopaths, and you eliminate the problem of the MD wannabe's who won't use OMM in their practices anyway. (I admit I'm not a huge fan of OMM, but I do think some of it works, and I think many of my classmates are great at it, and I think they should use it because they love it!)

It's very harmful to the field of osteopathy that MOST practicing DO's (I've heard > 70%!!) do NOT use any OMM in their practices at all. That must puzzle their patients! And it is probably annoying to prospective patients when they seek an osteopath, but find out they do no manipulation. That sends a pretty loud message, don't you think? I have met numerous DO's who tell their patients that there really is no longer any difference b/w MD and DO. There's such a huge identity crisis in osteopathy! It's pathetic and embarassing.
Do I think the AOA's Unity Campaign will help? As a former marketing manager, my hunch is... NOT! Osteopathy will be accepted by the public when, and ONLY when everyone who studies it believes in it, uses it, and is proud of it, and when its efficacy is proven by RESEARCH. The AOA just doesn't get it.

We were told thousands of times in school that DO is not just MD + OMM, but I beg to differ! As far as the philosphy of practicing medicine, there are plenty of MD's out there who are holistic and compassionate, and conversely there are thousands of DO's out there who are NOT!!! These traits cannot be taught in medical school (and it certainly wasn't even attempted at my school!). Being compassionate, and treating the patient as a whole person comes from one's individual personality, their upbringing, their values, and their sense of why they want to be physicians.

Having 2 different sets of boards and separate residencies makes the whole mess even more complicated. Medical students should choose the residency that will give them the best training in their selected field. The AOA should support that. We all know how much work, stress, and money we put into our medical training; why shouldn't we strive for the absolute best we can be?

I have volumes more to say on this issue, as I'm sure many of you do, but I'll stop here, and perhaps we can get a dialogue going.

I'm VERY interested in your opinions!!

p.s. PLEASE don't get on my case about accepting an acceptance from an osteopathic school if I really wanted allopathic...I was much more positive about osteopathy when I started medical school, and have only become more and more bitter as I've seen it from the inside. Thank you.

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[njdevil]

As far as using OMM. One of my professors told us that he spoke to the person that wrote that 70-80% of DOs don't use manipulation. When asked how he got that number...he said that it sounded good. My Professor also said that a recent survey with real numbers says that about 85% of DOs use OMM in some capacity.

------------------
Adam

KCOM '03

 

[Karl]

You may find two articles in the Nov. 4th issue of NEJM interesting. One is a clinical study of Osteopathy vs. Traditional (allopathic) treatment of back pain, the other is an editorial that discusses topics related to those discussed above.

I'm an MS2 at an osteopathic school and, although I have only limited experience with actual clinical medicine, I tend to agree with the above post in that a physician can have a holistic and patient-focused attitude regardless of the letters that follow his/her name. I feel that osteopathy is very beneficial in some circumstances but is probably not the all encompassing healing power that it is sometimes touted to be.
I also feel that any physician should have the opportunity to learn osteopathic techniques if he/she has an interest and feels that it may benefit his/her patients. There is at least one M.D. who is recieving training (I think informal) at my school, he is a physical medicine/rehab specialist.
I don't have a problem with merging the two professions and making OMM a training option for all but it does worry me that further research into osteopathy and the ideas of structure/function relationships and the body's innate healing capacity might be steam-rolled by the allopathic machine. Of course, I also believe that all good doctors are aware of these principles, not just DOs.

I do want to say that although my feelings about Osteopathy have been modified since I started my osteopathic training, I still plan to make use of it and I'm extremely happy with the overall education that I'm getting at my institution.


[This message has been edited by Karl (edited 11-04-1999).]

 

[Test Boy]

I think one of the problems with D.O.s not using OMM is either because they don't have enough training or not enough talent. Let's face it, to be really good at it you need to practice all the time or be naturally good at it. With the heavy courseload they throw at you in the 1st and 2nd year, it becomes very hard to learn and fully absorb the OMM techniques and be good at it. I guess too many D.O.s are not confident enough to use it more often.

 

[njdevil]

Dear all osteopathic medical students and premeds,

I thought a lot about this since my last quick response. The points on this forum are at least thought worthy. But it all falls apart once you consider the California Merger. The AOA is too skeptical
(and powerful for that matter) for any unity to come about where the DO degree is elimnated.

In the 60's the California Osteopathic Association agreed with a merger. We lost 2000 DOs and a DO school. Meanwhile these new MDs were labeled little mds. The specialists were no longer certified and the referels from MDs to goto DOs was unscene. Also DOs lost hospital priveleges.

In a way this gave osteopthic medicine its legitimacy because they were recgonized as equivalents but it was also a downfall in that the MDs made the DOs practictally useless.

I was given this speach by a physician who lived through it during Founders day, the story is also told in Norm Gevitz Book.

The bottom line is that the AMA doesn't want competition and removal the osteopathic medical schools may unify medicine but it will also eliminate osteopathic medicine completely (how many years do you think the AMA would let the specialty exist) and basically hurt practicing DOs. It is too dangerous even if the attitude has changed recently. Remember, the AMA is a self-serving organization.

Just a thought.

PS: I know we are all busy with school but Greg and Dave, I hope you hear your ideas on this topic.

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Adam

KCOM '03

 

[OldManDave]

Your thoughts/commentary have definitely piqued my interests...let me ponder my own thooughts for a while so that I can reciprocate with an adequate reply...

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'Old Man Dave'
KCOM, Class of '03

 

[turtleboard]

I've been involved with a lot of the premed/med school chats for a while, and I've always been a pretty informed guy on topics dealing with osteopathic physicians and the like (ask Gregory Gulick or David Russo). But lately what I've been noticing is that a lot of anti-MD sentiment brews on osteopathic boards, almost as much as anti-DO sentiment stirs on premed forums.

Your assertion, Adam, that the AMA is a self-serving organization is correct in that the AMA serves the interests of physicians, whether they're MD or DO. This came about, as you mentioned, in the aftermath of the California merger, but with recent articles in publications such as American Medical News (1994 articles on DOs), and the more recent NEJM article, I think allopathic medicine has adequately embraced osteopathic medicine.

You further assert that should the two professions merge, the AMA would not allow MD-degree osteopathic physicians to exist for too long a time for fear of competition. That's a pretty big leap!

My point is that allopathic medicine is not your profession's enemy, yet you seem to stand by those beliefs. I sincerely hope the rest of the osteopathic profession isn't as paranoid -- there's really no reason for it. The old battle scars between the DOs and MDs SHOULD be long gone by now. It's time for both professions to move on and move forward since BOTH will always be around.


Tim of New York City.
(yes, if you haven't guessed by now, an MD medical student)

[This message has been edited by turtleboard (edited 11-06-1999).]

[This message has been edited by turtleboard (edited 11-06-1999).]

 

[drusso]

Tim (of New York City) makes some good points. DO's and MD's need to work more closely with one another and put aside petty self-interests. This has been the trend over the last 30 years and I can't think of a reason why it would reverse itself. Still, among old DO's there really is residual hostility and, unfortunately, this hostility gets passed on to younger DO students.

One can understand the basis of their ill-will toward MD's. Many old DO's can tell stories about being frozen out of MD-hospital contracts, being harrassed by frivolous lawsuits filed by county and state medical societies, being victims of character assassination, having patients stolen from them when sent for consultations, and on and on...all because they attended a DO school instead of a MD school.

Moreover, I think that the AMA and AOA by DEFINITION are self-serving bureacracies...so what's new? A large portion of both organization's political activity is directed at maintaining certain monopolies and turfs. Still, a point that has been raised numerous times here and on other forums is that MD's and DO's are political allies in the larger scheme of things: Both earnestly fight managed care and government's attempts to interfere with the doctor-patient relationship. Last year Nancy Dickey, MD, former president of AMA, visited UNTHSC/TCOM and spoke about the convergence of medicine and public health and returned for a residency fair later in the year to promote a family medicine residency program in her area. Would that have happened 50 years ago??

Informed premeds, medical students, and physicians know that osteopathic and allopathic medicine are equivalent professions that happened to evolve, initially, down slightly different paths. Since DO's are the minority profession, it will always be incumbent upon us to demonstrate that what we do is valuable and effective. I think that the last paragraph of the NEJM editorial really hits the nail on the head and echoes what Norman Gevitz (one of osteopathic medicine most recognized historians and proponents) has been saying for years:

"At the end of the century, osteopathy continues its uneasy dance with allopathy, but only one partner is really paying attention. The resurgence in the numbers of osteopaths should not mask the precarious position of osteopathy. At its birth, osteopathy was a radical concept, rejecting much of what allopathic medicine claimed was new and useful. Today, osteopathic medicine has moved close to the mainstream -- close enough that in general it is no longer considered alternative medicine. The long-term survival of osteopathic medicine will depend on its ability to define itself as distinct from and yet still equivalent to allopathic medicine. That argument may best be articulated not in theoretical terms, but by demonstrating treatment outcomes. The paradox is this: if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic -- that is, based on osteopathic manipulation or other techniques -- why should its use be limited to osteopaths?"

FYI: I participated as a table trainer at a recent CME on OMT and noticed 6 MD's signed up along with 30 DO's--20% of the participants (or, 4 times the proportion of DO's that comprise the general physician population). DO's should use this emerging interest by MD's in OMT to fulfill what AT Still originally intended when he founded osteopathy in the late 1800's: To reform medicine and add to the physician's armamentarium a non-pharmacologic treatment modality for helping patients. Remember, he never intended to create a parallel profession! Had the good old boys in Kansas not laughed him out Baker University when he first lectured about his ideas, but instead offered him some small little laboratory in the corner of some building, none of this would be happening.

------------------
David Russo, MS3
UNTHSC/TCOM
Research Fellow, Department of Osteopathic Manipulative Medicine


[This message has been edited by drusso (edited 11-06-1999).]

 

[njdevil]

I believe my history lesson has been misconstrued. I don't carry any bitterness or resentment towards allopathic medicine. I have no prejudice against MDs.

My point is that merging has been attempted. It was a disaster to the osteopathic profession. Going to school in where osteopthic medicine was founded, we hear constantly about our distincitiveness.

My second point is a reattempt is risky. The AMA made the merging sound very appealing the first time and it turned out to not be in the best interest of osteopathic medicine. So, my note was only pointing out our history.

It was once said that those who ignore their past ignore their future.

 

[DanReidman]

I too attend an Osteopathic Med School where they stress the uniqueness of our philosophy and subsequent approach to the patient. I have done a decent amount of preceptorship and rotations and have a personal history in the health care professions and I can say that outside of the mothership of my school I have seen zero, absolutely zero difference in the approach to a patient.
This little idea that we are different must be allowed to die it's long overdue death. Perhaps when the field of oseopathy began it was different. The medical practices at that point might have focused on the ailment rather than the patient, but that is no longer.
Our approach is not different it is universal. Neuro-Endicrinology has put to rest this Descartian idea that we are a brain with a body. After that was shown we lost our uniqueness.
As for the manipulation. It is good and worthy of practice, but I am not convinced that we can hang our hat on it solely to define our profession. Without it we are left naked and just plain old medical students and physicians. This may be terrorizing to the old guard that has waged the battle for years, but I have no interest in a fight, I came to learn medical science and practice it, thus I find it comforting.
We must remove ourselves from this us versus them mentality. We are not a religion and I have no interest in acting like the ones who have adopted such a separitist and divisive attitude.
It's time we grow up. The AMA is not the evil empire. We are not the good guys. Let's just practice good medicine and stop trying to define ourselves like adolescents in a personality crisis.

 

[Deb]

To jll66

If you feel that strongly about this issue then maybe you should try to transfer to
an allopathic school. Believe it or not, some of us actually use OMT and want to be
known as DOs'. Personally, I like the idea of having a little something extra to offer
patients. Also, I'd guess the number of DOs who don't use OMT is much lower than you
stated. Where did you get that number (>70%)? Many, if not most of our family medicine
docs routinely use OMT and the patients love it! In addition to FM, I've personally
seen it used in Peds, OB/GYN, and even the ER. I'm sorry your experiences haven't been
as positive, but if you really wanted to, I'm sure you could find at least a few DOs in
your area that use OMT. Finally, while it's true that much more work must be done to
prove the efficacy of our methods, isn't it up to us to pursue that research? Please
don't be offended, but if you don't plan to be part of the solution then at least try
not to be part of the problem.

Turtleboard,

I think you'll find that most of the paranoia in this and other med student forums is a
reflection of the immaturity/insecurity of some of the posters and not representative of
the Osteopathic profession as a whole.

Deb
UHS-COM 2001

 

[turtleboard]

The CMA/COA merger of the 1960s was a different time. Osteopathic medicine was still seen by organized allopathic medicine (the AMA) as the enemy, according to Gevitz, so merger at that time would have been -- and indeed proved to be -- risky.

In today's world of medicine, I don't see a shread of bitterness between the two professions (DO vs. MD debates on med/premed student forums on the internet do not count), so I don't think merger would be as risky. BUT I neither believe there would nor should be a merger between MDs and DOs. The osteopathic profession continually proves that its existence improves healthcare in America, whether through OMT and the DO healthcare philosophy or through tapping the underserved populations that have traditionally been neglected by MDs. Moreover a merger between osteopathic medicine and allopathic medicine cannot happen because, and correct me if I'm wrong, the AOA still wants to be left out of the AMA House of Delegates. From what I remember the AMA invited the AOA to send DOs to its House of Delegates meetings, and the AOA firmly rejected their invitation. Organized osteopathic medicine -- formed of men and women of the "old guard" -- seems to still hurt (though they're not bitter as evidenced by the lack of an anti-MD campaign) from the 1960s fight.

You learn from your past, you don't live in it.

Tim of New York City.

[This message has been edited by turtleboard (edited 11-06-1999).]

 

[turtleboard]

Deb,

That's true. I've never met a DO who hated MDs. It's only on the net, under the cover of anonymity, do certain people like to go off on DOs or MDs.

Tim of New York City.

 

[DanReidman]

The attitude steeped in bitterness has not reached a contra-MD campaign on a gross level. Rather it remains secluded within the walls of osteopathic medical schools spread from clinician to student bodies in the form of off the cuff comments which try to glorify our approach while demonizing the MDs.
We have all heard this and I hope that others have shared my shame by association in these childish attemts to make ourselves look better by degrading others.
It is this background din that we are weaned on that I speak of and it is carried by us into our practices. It is no way to walk with dignity as we try to uncover solutions to help our patients.
The recent NEJM editorial indeed says it best, we have no more enemy, the fight has ended, I only hope that our elders along with the recent generations of DO graduates can let go of these fixations and simply define their practice by excellence, not as DOs or MDs but as doctors.

 

[Mayqswet]

I appreciate the informative discussion going on here and would like to add another perspecitve. As a hospital employee in NC for nearly 8 years, I had never heard of a DO until I began to research the profession last Sept. Now that I have been accepted to 2 DO schools for next year, I have asked several MDs and RNs about their perception of DOs. Most of the RNs have never heard of a DO and I get a mixed response from MDs. About 30% of them say that they're not sure about the curriculum, but they feel that DOs are just fine and would have not problem working with them. Most of them say that they have known quality people who were DOs and smilingly congratulate me. About 40% the MDs feel the same, but have not come into contact with a DO or they don't really know much at all about osteopathic medicine. About 20% have are somewhat accepting, but "warn" against going with the DO route because of status issues. Lastly, around 10% of them wrinkle their face like a kid trying brussles sprouts for the first time. They have either met a person they didn't like who happened to be a DO or their only knowledge is 2nd or 3rd hand negative information and they don't know much about "vodoo" osteopathic medicine.

My point to all of this is that there is still much misunderstanding and mistrust by MDs in areas where there are few DOs or no DO schools. Heck, out of the 100 or so people I have told about getting into medical school, only 5 or 6 have had a good idea what a DO is. I believe the NEJM article and the unity campaign will at least give people something to go on.

Is the majority of the posturing b/w DO vs MD in the pre-med arena? Yes. But I think it's because that's the time in doctor's careers where they are trying to figure out what they want to be when they grow up. Is it the only place it exists. No.

I for one, plan on using OMM in my practice, even if I get into one of my in state MD schools and go that route. I've seen it work. In fact, I was at a primary care conference yesterday at the hospital and watched an MD do some simple manipulation techniques to help a sports related injury. OMM works and DO schools have kicked butt in improving their curriculums in the past 30 years. After much reading, asking, and doing a class-by-class comparision of the curriculums, the main difference I see between the in state MD schools we have in NC (UNC & East Carolina Univ) and DO schools is $90,000 difference in tuition over 4 years (granted, there is a little attitude at UNC). The more people know about osteopathic medicine and OMM, the more it will be accepted across the board. Whether there should be merger, I don't know. But I do know that prejudice does exist and from what I have seen on the MD side, it is mainly due to lack of knowledge.

------------------
Phillip
Class of 2004 (somewhere)
Happiness isn't having what you want, it is wanting what you have.
The early bird may get the worm, but the second mouse gets the cheese.



[This message has been edited by Mayqswet (edited 11-06-1999).]

 

[turtleboard]

So does anyone know if MDs can get OMT training? If so, how?

I remember reading in an article in American Medical News several years back about an MD doing an OMM residency at KCOM. I thought AOA residencies were open only to DOs. Anyway, is there a way to do OMM without going through an entire residency for it? Like CME classes or something?

Tim of New York City.

 

[Mayqswet]

I've heard that MSUCOM has a very good program/course/workshop for MDs to learn OMM. Old man Dave said he'll teach me if I end up going the MD route. I already told him to come up with a price

------------------
Phillip
Class of 2004 (somewhere)
Happiness isn't having what you want, it is wanting what you have.
The early bird may get the worm, but the second mouse gets the cheese.

 

[drusso]

Yes, MD's can indeed get training OMT. CME programs at MSU-COM, SFIMMS, and other places are open to MD's and DO's.

http://www.wenet.net/~sfimms/
http://www.com.msu.edu/cme/

However, as you can see, it can be quite expensive to do on a post-graduate basis. And, for every day away from your busy practice you lose $$. Moreover, some MD's (and even DO's) have problems getting reimbursed by insurance companies because they are not board certified in OMM. While board certified OMM specialists perhaps ought be compensated a little more than DO generalists for OMT, ostensibly because their evaluation and management activities are "more cognitively complex", the insurance industry's argument than physicians MUST be board certified in OMM in order to do it competently and be entitled to compensation is rediculous.

Welcome to medicine...

[This message has been edited by drusso (edited 11-07-1999).]

[This message has been edited by drusso (edited 11-07-1999).]

 

[MSUCOM2003]

Hello,


Merging Osteo and Allo med would be an incredibly short-sighted action with serious consequences. One of the great things about this country, that really does not exist anywhere else in the world, is the concept of checks and balances. If a federal judge had not come down on Bill Gates recently, we'd all end up working for Microsoft someday. The point is, many people before us sacrificed their lives (literally and figuratively), to allow us to study and practice medicine outside of the "traditional" path. Osteopathic medicine is, at least in theory, on par with Allopathic Med. Let us not waste our time trying to merge the two professions, and instead focus on securing funding, conducting research and increasing awareness that in America people do have a choice in professional medical care.


Sudhir

 

[wallawalla]

Two comments:

#1--A.T. Still was an M.D. Many other students/graduates would like to enjoy what that means in the medical community at large.

#2--If you gave today's D.O. medical students (and MANY past graduates)a choice if they wanted to have an M.D. or D.O. degree issued to them upon graduation, 95% would choose the M.D. degree, because the fact is the majority of students would have chosen the M.D. route had they been accepted to an allopathic medical school. If, on the otherhand, you gave the students the choice of a D.O. or an M.D.+ D.O.-certificate (to designate that they went to a school that honored the teachings of A.T. Still, et. al.), the percentage of those choosing the M.D. + D.O. certificate would jump to about 99%.

I am not saying what side of the fence I stand on. I'm just stating the obvious.

 

[Deb]

To Wallawalla,

Where did you get your stats? If you have an opinion, feel free state it,
but please don't use "percentages" unless you can back them up with REAL
surveys.

Deb UHSCOM-2001

 

[turtleboard]

Wallawalla,

Since when would a simple degree, like M.D., make you feel any different if you were a D.O.? I always thought that it was the nature of being a doctor -- a physician -- that made all of us want to get into medicine in the first place. It's like saying a B.S. is better than a B.A.

Heck, I'd have sooner thought money to be second, but never JUST to be an M.D.

I doubt being an M.D. over a D.O. would confer any special recognition from the community-at-large. The TRUTH is most people don't even know (and the ones who do find out, don't even really care).

If you're in osteopathic school, it's a shame that you took a spot from someone who really wants to be a DO, or perhaps just wants to be a doctor but doesn't give a hoot as to whether he signs his name M.D. or D.O.


Tim of New York City.