United We Stand, Divided We Fail as a Profession

The University Of North Texas Health Science Center (UNTHSC) is a state sponsored-institution with the legislative stipulation that the president of UNTHSC be a D.O. The state recognizes that UNTHSC is first and foremost an osteopathic entity even though it is comprised of Texas College of Osteopathic Medicine (TCOM), the Department of Physician Assistant Studies, the Graduate School of Biomedical Sciences, the School of Public Health and the School of Health Professions.

TCOM

TCOM has been an exemplary model in its contributions to the care of Texas citizens. It has been among the top 50 medical schools for primary care medicine since 2002 by U.S. News & World Report and in the Top 20 medical schools for Hispanics in 2005 and 2007 by Hispanic Business Magazine. 65 percent of its graduates specializing in primary care and 34 percent serving in small towns of fewer than 25,000 people.
Furthermore, TCOM students are as qualified as any allopathic medical students. The admitting class of 2013 has an average MCAT scores and GPAs of 29.2 and 3.63, respectively. These numbers place TCOM students equal or better than 32 other allopathic schools in the nation. Also, they earned the highest scores on Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Step1 and 2 over the past two years, and ranked 2nd quartile on US Medical Licensure Examination (USMLE).


TCOM has tried to integrate fully into the local medical community by having a majority of M.D.s serving on the faculty and having M.D.s chairing the Departments of Orthopedics and Pediatrics. TCOM students are rotating at some local hospitals under M.D. tutelages. TCOM students have demonstrated their potentials and quality that the chair of Orthopedics at JPS and UNTHSC, Dr. Lichtman, introduced resolution-302 “Recognition of Osteopathic Education and Training” to the House of Delegates of American Medical Association to call for mutual recognition of education, training and board certification systems.

UNTHSC’ s medical school has been approved to increase its class size from 175 to 250 students by the Texas Higher Education Coordinating Board in response to the shortfall of primary care physicians. UNTHSC president Ransom has recently established an MD study group to evaluate the feasibility of adding an MD school in hope of forming new affiliations with local hospitals for undergraduate and postdoctoral training opportunity. The local hospitals will only launch GME programs accredited from the Accreditation Council for Graduate Medical Education (ACGME) and partnered with a Liaison Committee on Medical Education (LCME) accredited medical school. For instance, Cook Children Medical Center preferred to form an affiliation with Texas A&M Medical School, which is 2 hours away, even though Dr. Bowman is the chairman of the hospital’s Leukemia and Lymphoma department and also chairs the TCOM’s department of Pediatrics.

The local hospitals’ demand of establishing ACGME residency programs may be understandable, but the request of a LCME-accredited medical school is blatantly discriminatory and prejudicial towards osteopathic community because D.O.s are qualified physicians and have something extra to offer compared to 25% of physicians are international medical graduates (IMGs), who did not graduate from any LCME-accredited medical school.

A potential threat of an M.D. school to be established in the region is very remote because it took about 15 years for the State of Texas to approve and fund a new medical school in El Paso because it costs about $100 million. A quest for a medical school to be established in South Texas since 1997 has still to wait until 2015 to be able to apply for state funding. Therefore, a creation of an M.D. school at UNTHSC would take another 15-20 years unless it is to be created at the expense of TCOM’s resources.

It is a moral imperative that University of North Texas System and medical educators, and local and state leaders, should take a stand against prejudice towards a state-sponsored medical school, TCOM.- not coerce D.O.s to change their titles to M.D. in exchange for educational opportunity.

UNTHSC should focus its energy and money to garner political support from the state and local governments to mandate the local county hospital, John Peter Smith, to form official affiliation with its only state medical school in Tarrant County. This quest for political support is attainable because it has a high moral ground and it saves the state millions of dollars from duplicating a parallel medical school serving the same purpose. Retrospectively, D.O.s in Los Angeles were able to obtain from the Los Angeles County Boards of Supervisors to establish a formal osteopathic training at the county hospital, known as Unit 2, in 1923 during which, osteopathic medicine was ostracized by allopathic medicine. As osteopathic medicine has achieved parity with allopathic medicine, along with TCOM’s outstanding records, it should be easy for UNTHSC leaders to achieve formal affiliation with John Peter Smith (JPS) for training opportunity for TCOM students and graduates.

Furthermore, UNTHSC should invest its resources in partnerships and starting-up costs with local hospitals to create new GME programs, which can be dually accredited by ACGME and AOA. It should be emphasized that ACGME programs are not required to be affiliated with a LCME-accredited medical school. Local hospitals will benefit a lot from new GME programs because osteopathic graduates provide high quality and affordable care and bring GME funding from Medicare to the hospitals.

Instead of creating division and evoking emotion among osteopathic profession and the lengthy time of 15 to 20 years to start of a M.D. school unless it intends to drain resources from TCOM, UNTHSC leaders should abort the plan of adding an M.D. school because a small size MD school will not take the health science center to the national level more efficiently. In the current health care trend of a growing public demand for holistic and integrative medicine, a stronger TCOM has the unique opportunity to be a leader in the field and can thus take the institution to the national level faster.

I am TCOM graduate of class 2002. I served my rotating internship and fellowship in neuro-ophthalmology in Michigan , followed by are residency in ophthalmology in N.Y. Currently, I am completing a fellowship in Vitreo-Retinal Surgery and will join a private practice in Illinois and will serve on the faculty of University of Illinois School of Medicine. I know that a large number of TCOM graduates have established their practices in the Dallas-Fort Worth Metroplex or in all over the state of Texas and they are willing to give help TCOM as our long history of osteopathic volunteering can attest it for. Some have expressed interests in starting ENT or ophthalmology residency programs.

In the worse case scenario that there are not enough clinical positions to accommodate the class size increase, TCOM can always rely on the profession to make accommodations for students to do clerkships temporarily outside of the state until more clinical training opportunities become available in Texas. It should be emphasized there is no state requirement that medical students have to do their clerkships within the state of Texas. Furthermore, 38% of M.D. graduates choose to serve residency outside of Texas. Therefore, the stake-holders that UNTHSC/TCOM is obligated to are the citizens of Texas and the U.S.A..
In summary, United We Stand, Divided We Fail as a Profession. I implore UNTHSC leaders to take pride in that they are training qualified and different kind physicians. As a premier osteopathic institution, UNTHSC has a moral obligation to promote the osteopathic principles and practices and make the profession grow because American public deserve a true system of health care instead of a system of fixing diseases.