Dr. Scott Stoll's reasons for opposing the MD option at UNTHSC

The following  letter dated January 5th, 2009 by Scott Stoll, DO, PhD.

This letter is intended to provide my input regarding the possibility of an MD degree option at UNTHSC.  As I understand it, you are Chair of the Study Group charged with collecting input regarding this issue and that all UNTHSC faculty and other interested parties have been directed by President Ransom to provide you with input into this important decision making process.  As I provide this input to you, I also will provide similar input to the TCOM Interim Dean, the UNTHSC Provost, the UNTHSC President, the UNT System Board of Regents, and the UNT System Chancellor.

As you know, I have a relatively long history of involvement at UNTHSC, in this community, and with both the MD and DO professions.  Having been accepted at both MD and DO medical schools, I chose to matriculate at TCOM in 1985.  From 1985-1992, I completed a DO degree from TCOM, a PhD in Physiology from UNT, and a Family Medicine Internship at OMCT in Fort Worth.  During these years, I also served UNTHSC as an employee sequentially as a Student Tutor, Teaching Assistant, Predoctoral Fellow, and Research Assistant.  I sat for and passed both the DO NBOME and the MD FLEX national medical licensing examinations.  I completed an ACGME (MD) accredited PM&R residency that I personally had to make ACOGME (DO) accredited.  I chose to make a career at UNTHSC and have been employed as a full time faculty member in the medical school with adjunct appointment in the graduate school since 1995.  I have served as a Department Chairman for over 10 years; I was the founding Executive Director for the national Osteopathic Research Center at UNTHSC; and I am Co-Director of the Physical Medicine Institute.  I have been Principal Investigator for over $6 million in competitive grant awards at UNTHSC and have been a Co-Investigator or key collaborator for several million dollars more.  I have served for over 10 years on the Board of Directors for UNTHSC-TCOM and UNTHSC clinical practice plan (UNTHealth) as well as for the Easter Seals Society of North Texas.  Throughout this time, I have maintained active clinical practice on campus and at local hospitals including the JPS Health Network.  I am currently a Tenured Professor and my wife Myra and I are preparing our three sons for college and adult life in our west Fort Worth home.  I say these things not to brag, but only to illustrate my deep love for and commitment toward this community and this institution.  Further, I want to highlight the fact that I am familiar with what it takes to train medical students, conduct research, practice medicine and raise funds – and have done so arm-in-arm with MD physicians every step of the way.

With this longwinded introduction out of the way, I wish to state unequivocally, that it is wrong to offer an MD degree at UNTHSC.  It is wrong:  1) because it is unnecessary; 2) because it is harmful to TCOM and our community; 3) because it institutionalizes professional discrimination and prejudice; and 4) because of the manner in which the decision making process is being conducted.

Offering an MD degree at UNTHSC is wrong because it is unnecessary.  Of the nine medical schools in Texas, only one trains osteopathic physicians.  By almost any measure, TCOM is the top osteopathic medical school in the nation and by many measures; it is superior to most allopathic medical schools.  This is particularly true in the medical training of physicians committed to primary care which is most needed by the state of Texas and the nation.  A fundamental assumption in this decision making process is that UNTHSC is committed to a medical school class size of a maximum of 250 students in each training year.  This number will not increase or decrease with the addition of an MD degree.  Therefore, the addition of an MD degree is unnecessary to UNTHSC’s commitment to help provide Texas with the physicians that it so desperately needs.  TCOM has seen phenomenal growth in faculty and class size without an MD option and will be able to continue this growth trajectory best with focus maintained on its premier DO product.

Offering an MD degree at UNTHSC is wrong because it is harmful to TCOM and our community.  Developing and implementing an MD degree program at UNTHSC will require resources including space, faculty time, and additional administrators (MD dean and dean’s office support at the least).  Perhaps most importantly, the focus of the top UNTHSC leadership will be diverted to this new task of creating an MD program instead of maintaining focus on enhancing the DO program.  There will be no new resources available from the state of Texas or the clinical practice plan (UNTHealth) to support this new program.  Therefore, unless there are substantial novel philanthropic gifts directed to the MD program, all of these resources will be taken from existing programs on UNTHSC campus.  TCOM will be the primary school from which these resources will be taken and this will result in compromises in the DO degree program.  I have seen this time and again as new programs are developed on campus. 

Our local community as well as the state of Texas will be harmed by decreasing the DO class size from its current target of 250 students per year.  Osteopathic physicians are unique and contribute in a unique fashion to healthcare options available to Texans.  The majority of DO graduates practice primary care medicine whereas a significant minority of MD graduates practice primary care.  This is in part because from the first day of medical school, DO students are instructed in the importance of treating the whole person instead of the reductionist view of the body as a compilation of specialty related parts.  Integrated throughout the DO curriculum, but especially emphasized in the two years of classes and required clinical clerkship in osteopathic manipulative medicine, is the concept that optimal health comes from all of the body’s systems working together.  A rational medical treatment plan, we are taught and come to know as true, is based on aligning the body’s systems to work together to prevent and cure disease.  An understanding of this truism encourages a large percentage of DOs to pursue primary care medicine because of the satisfaction that comes from making a real and longstanding difference in the health of our patients.  Of course, this underlying wisdom also provides a foundation from which a number of DOs develop into some of our nation’s greatest medical specialists.  Diversion of attention and resources away from the DO program in order to create another MD degree will hurt Texas and our local community by reducing the availability of access to DOs as an important and unique healthcare option.

It is wrong to offer an MD degree at UNTHSC because it institutionalizes professional discrimination and prejudice.  President Ransom has indicated that the primary reasons for considering an MD option at UNTHSC include the possibility that TCOM’s current challenges with local access to medical student clinical training opportunities, graduate medical education (residency training) opportunities, research funding, and private donations would be resolved if only we were to offer an MD degree.  It is strongly implied to me in all public and private conversations regarding this debate that there are a significant number of physicians and hospital systems in Tarrant County that will make needed clinical training opportunities available to UNTHSC medical students and graduates only if we were to offer an MD degree.  Similarly, there is the perception that in training MDs in addition to or instead of DOs that UNTHSC would more easily reach research and private fundraising productivity goals set by the UNT Chancellor, Board of Regents, and UNTHSC President.  This perception is blatantly prejudicial and if true, it is discriminatory against DOs.  By law, DOs are licensed to provide equivalent medical services as are MDs.  The state of Texas and, through CMS (Medicare), the federal government directly funds undergraduate and graduate medical education at UNTHSC and at local hospitals because of the high costs of medical education and the national, state, and local need for quality physicians.  Tarrant County also uses taxpayer money to provide support for medical education and clinical services through the JPS Health Network.  Are we to now understand that local physicians and hospitals are refusing to collaborate in a community wide, taxpayer supported process of physician training unless the trainees are working toward an MD instead of a DO degree?  This is nothing less than extortion.  Who are these physicians and hospital administrators?  What guarantee is there that even if UNTHSC offered an MD degree that they would collaborate in medical education in the metroplex?  There is no such guarantee, and can be none, because to put this in writing and create an MD degree based on such an agreement is to institutionalize discrimination and prejudice against the osteopathic profession in this community.

Research funding and productivity is not enhanced by virtue of offering an MD degree on campus, but instead is the direct result of judicious investment in personnel, equipment and space required to conduct research.  The only way that MDs will be more successful than DOs in the conduct of research is if UNTHSC invests more heavily in MDs than it currently invests in DOs.  I certainly support the judicious investment in research.  But the prejudicial misperception that creation of an MD school will more efficiently grow research productivity is misguided at best and deceptive at worst.  Now, philanthropic giving may indeed increase from some wealthy individuals or organizations that are eager to see an MD degree offered in Tarrant County.  However, again, there is no guarantee that this will occur.  Further, if there are individuals and organizations that feel that strongly and have sufficient resources to create an MD option in Tarrant County; let them create a separate MD institution instead of usurping the talent, reputation, and productivity of UNTHSC-TCOM to the detriment of the DO training program without the potential for any additional benefit to the community.

It is also wrong to offer an MD degree at UNTHSC because of the manner in which the decision making process is being conducted.  The manner in which this question has been addressed is very distracting and detrimental to UNTHSC-TCOM, its focus, and its morale.  For the last two years, President Ransom has denied and mocked rumors that there was any serious consideration by him, the UNT Board of Regents, or in the UNT Chancellor’s office of creating an MD option at UNTHSC.  Suddenly, a few weeks ago (late November 2008), as a member of the UNTHealth and UNTHSC-TCOM Board of Directors; I was notified that the Chancellor, the UNT Board of Regents, and the UNTHSC President had decided to officially study the possibility of offering an MD option at UNTHSC.  A process was detailed to us that was to be transparent, inclusive, and without a foregone conclusion.  As details of this decision making process emerged, it became clear that it was far from transparent and indeed highly inappropriate and deceptive.  I have spoken with both MD and DO physician leaders alike that were fresh out of the offices of the UNT Chancellor and UNT President indicating that this effort has been orchestrated for almost 2 years with the express intent of creating an MD option at UNTHSC.  This includes the pending lobbying effort required to change the Texas law which precludes offering an MD degree at UNTHSC. 

Over the last year, President Ransom has presided over a massive reorganization of the top UNTHSC leadership which many had interpreted as a deliberate effort to become more allopathic.  Like many of my faculty colleagues at UNTHSC, I may not have understood many of these changes, however I defended them and I took the President at his word that they were not part of an overall effort to create an MD option at UNTHSC.  This reorganization included internal appointments of the UNTHSC Provost, the Graduate School Dean, and the UNTHSC Vice President of Research while other Vice-President and Dean positions more appropriately undergo a national search.  Most notably, this reorganization included the demotion without explanation of the DO Chairman of the largest clinical department at UNTHSC and the pressured resignation of the UNTHSC-TCOM Dean who led TCOM through unparalleled growth to become a recognized national leader in primary care medical education.  This Dean’s resignation suspiciously came within two weeks of the announcement that UNTHSC would consider an MD degree option.  It has now become undeniable that this reorganization was orchestrated with this historic shift in UNTHSC medical education in mind.

The common use of the term ‘transparency’ at UNTHSC to indicate a fair, open, and honest process now elicits a feeling of sardonic contempt.  The term ‘transparency’ is repeatedly used on campus to imply that a process is fair, open, and honest.  Although in fact, over the last two years at UNTHSC, predestined outcomes have been repeatedly ‘validated’ by a sham process described as ‘transparent’.  This process to evaluate development of an MD degree on UNTHSC campus is the epitome of this deception under the guise of ‘transparency’. 

UNTHSC-TCOM has become great due to the vision and integrity of its leadership; due to the collaboration, excellence, and professionalism of its faculty; due to the dedication of its staff; and due to the trust and talent of our students.  A collegial and respectful culture at UNTHSC has now given way to a culture of fear and suspicion. No matter how accomplished, all UNTHSC faculty I have spoken with who are in opposition to this MD degree option at UNTHSC are fearful to speak up.  They are concerned (as am I) that vocal opposition will result in pay cuts, demotions, or other workplace retribution.  Faculty in vocal opposition have already been threatened.  The damage to UNTHSC-TCOM has only just begun.

The UNT Chancellor, UNT Board of Regents, and UNTHSC President have the right and indeed the obligation to make changes at UNTHSC and within the UNT System that they feel are in the best interest of North Texas.  And, if this includes changing Texas state law and the charter of UNTHSC to enable offering an MD degree, then so be it.  However, all stakeholders, including UNTHSC faculty and chairmen, have been asked to provide honest input.  And so, in addition to the other three reasons I have listed above, I submit that it is wrong to attempt to make these changes through deception. 

In conclusion, I would like to make it clear that should the decision be made to train MDs at UNTHSC, I would do everything in my power to provide the MD and DO students alike with the best medical education possible.  I am not opposed to MD medical education.  I am confident that MDs trained at UNTHSC would be competitive with MDs trained at any other institution.  There is simply no valid reason to dilute the DO medical education through the creation of a second medical degree option at UNTHSC.