Open Letter to UNTHSC Educators: Take a stand against discrimination!

Dear my former TCOM/UNTHSC professors and faculty members:

First, I would like to apologize to you all for taking the liberty to write to you about the issue that would affect the future of TCOM and UNTHSC. UNT Health Science Center leaderships have been planning to start up an allopathic medical school on campus for the past two years. The stated reasons for supporting of such a plan include the prestige of an MD school, potential of increase in research funding and clinical rotation sites.

I would like to extend my deep gratitude to you all for having been doing a great job of teaching us despite the limited resources at the early days. You have been instrumental to the success of TCOM, its graduates and students. TCOM has been ranked among the top 50 medical schools for primary care for the past 9 years and the students have achieved the highest average scores in COMLEX step 1, 2 and 3 for the past few years in a row. Recently, TCOM was placed at the top over all the medical schools in Texas according to the study of “medical social mission” published in the Annals of Medicine. You are actually helping to train physicians of the future responding to the health care needs of the state of Texas.

The supporters of the idea of an MD school along side with TCOM may think the status of UNTHSC would be enhanced because of the prestige of the MD school, a well-known brand.

• Some may perceive DO students are less qualified than MD students because of the differences in GPA and MCAT scores of those DO students and MD students. According to AACOM and AAMC data, the 2008 entering DO students have a mean total MCAT score of 26.19 and a mean overall GPA of 3.46 versus the MD students have a mean total MCAT score of 30.9 and a mean overall GPA of 3.66. It should be noted that there have been a few newly opened DO schools, which may have contributed to the lower scores.
• Let’s look at these numbers, according to AAMC aggregated data 2007-2009 (see the attached table) 34.5% of MD students, i.e., 19,107 MD students have MCAT scores from 5 to 29. TCOM students have an average MCAT score of 29.2 and GPA of 3.63 in 2009. These numbers placed TCOM students equal or better than 32 other allopathic medical schools.

The supporters misperceive that MDs do research. Physicians mostly prefer to be clinicians. Statistically, only 25 % of MD/PhD graduates actually perform research in their career.

Also, there is a misperception that there is no difference between the training of MD and DO except for the component of OMT, whose efficacy is still questionable as we are in the age of evidence-based medicine. I recognize that DO schools still have a lot to do to perfect the integration of the osteopathic

philosophy and practices in our training curriculum for us to appreciate the holistic approach in the patient care. The practice of medicine is a blend of art and science. I believe DOs approach patients from a different perspective in a subtle way. I can attest to you as a specialist that 5 retina specialists will treat the same patient with the same condition differently and none of them is wrong in their approach.

Is osteopathic medicine and philosophy still relevant?

First, there has been a growing public interest in complementary and alternative medicine (CAM) recent years. According to data reported in 2007 by the National Institutes of Health’s National Center for Complementary and Alternative Medicine, 38% of adults and 12% of children in the United States used some form of CAM that year. According to the National Center for Statistics’ 2007, Americans spent $33.9 billion out-of-pocket on CAM, of which $11.9 billion were spent on an estimated 354.2 million visits to CAM practitioners.

• Most allopathic medical schools have responded to this public interest by offering some elective instructions in CAM. Even a tentative proposal of core competencies in integrative medicine in undergraduate medical curriculum in allopathic schools was advanced in hope of instilling graduating physicians with the values, knowledge, attitudes and skills to improve the physician-patient communication.
• D.O.s are better positioned to respond to this public interest thanks to its long tradition of a holistic and preventive philosophy to patient care.

Second, musculoskeletal conditions and injuries are among the most common reasons for visits to physicians in the United States. They accounted for more than 131 million patient visits in 1995 and cost $215 billion annually. According to the National Center for Health Statistics in 2003 and 2004, 21% of individuals aged 18 to 44, 59% of those aged 45 to 54 years, and 98% of those aged 55 to 64 years reported limitation of activity due to musculoskeletal conditions. According to a 1999 survey of the Steering Committee on Collaboration among Physician Providers Involved in Musculoskeletal Care, the percentages M.D.s who felt adequately prepared to physically assess problems of low back pain and foot pain were, respectively, 31% and 10%. By contrast, the percentages of D.O.s who felt adequately prepared to assess low back pain and hand problems were, respectively, 84% and 41%. Thus, osteopathic training appears to be at the forefront of addressing major healthcare issues and fulfilling public demands for patient-focused care.

Third, osteopathic medicine has enjoyed the exponential growth over the past three decades. Today, 20% of medical students are DO students, and 60,000 DOs are actively practicing, i.e., representing 7% of physician work force. In 10 years, 25% of medical students are DO students and there will be 100,000 DOs practicing, i.e., representing 10% of physician work force. The DO title will become a household brand very soon.

I would like to share my thoughts why I am supporting the cause of protecting the osteopathic heritage of UNTHSC. I am ethnically Vietnamese and grew up part of my childhood in France. I came to the USA at the age 19. English is my third language and still broken in three. Osteopathic profession has given me the opportunity to become a vitreo-retinal surgeon and neuro-ophthalmologist even though I had set out to become a holistic and integrative physician. I graduated from TCOM in 2002 and went on for trainings under the tutelage of both DOs and MDs across the country until 2009. I am only in my second year of practice in a multi-specialty group of 3 other MD ophthalmologists and 6 optometrists. I also serve as a clinical assistant professor of surgery at University of Illinois College of Medicine.

I support the preservation of osteopathic entity of UNTHSC because Texas law says so. That is why the UNTHSC president has been a DO.

I oppose to the establishment of an MD school at UNTHSC because:

• It negates the fact that TCOM is a full-fledged medical school and thus negates your contribution to educating physicians.
• It is purely discriminatory against DOs and implies that DOs are second-class physicians or do not have the full potential to become specialists or researchers.
• It is a travesty to waste millions of tax-payers’ dollars to pay for a parallel administrative structure of the two schools with the same purpose of educating future physicians.  
• The process of starting-up a new MD school may take 10 years and its exorbitant cost, while expansion of TCOM can help to alleviate the looming physician shortage.
• Offering an M.D. degree at the UNTHSC would be converting one superior medical school program into two mediocre programs.
• There are two new MD schools in Texas, one El Paso and Brownsville, and more are being planned in Austin and Amarillo. Therefore, the people of Texas does need a robust TCOM, the only DO school, because the people deserve diversity and quality in ways of approaching to patient care.
• The addition of a pharmacy school would have enhanced the stature of UNTHSC, which developed a plan to start a pharmacy school in 2004. However, this has been relegated to the UNT Dallas campus.

Some of you have been part of the amazing journey of this 40 year-old osteopathic institution. You have been instrumental to the growth of UNTHSC, which is currently the premier osteopathic institution in the nation, at the least. I believe UNTHSC will grow more to reach its full potential and not be limited because of its osteopathic identity. UNTHSC is well-known and respected by 60,000 DO physicians and others. Would a small UNT MD school get the same reputation? Do we want to be the same like the rest of the pack or be as good and unique?

I am appealing to all of you as educators to take the stand against the prejudice and discriminations against your DO students. I am asking you for your support to protect this fine institution that you are part of. Your moral and financial support is greatly needed. Please contribute to the TOMA/TCOM advocacy fund and send letters of support to your local legislators. You can find the information how to help at the Texas Osteopathic Medical Association website.

It will be used to politically mandate JPS to be formally affiliated with UNTHSC and advocate the pledge money for the new school to fund the new residency slots with other local hospitals. These above goals can be accomplished if the UNTHSC leaderships think they can change a state law prohibiting UNTHSC from granting MD degree.

Again, I thank you for having taught me well at TCOM.