Time for MDs and DOs to Stop The Infightings Among Each Other: We Are All Physicians After All!

Dr. Niall McLaren, a psychiatrist practicing in Australia, embraces the holistic approach of osteopathic medicine. Holistic approach to mental disorders or diseases should be emphasized instead of the reductionist approach which places priority of bio-chemical imbalances.

"In a thoughtful commentary, Delengocky offered three reasons why osteopathic medicine should remain parallel to but distinct from allopathic medicine.

First, there is the widespread and growing interest in complementary and alternative medicine (CAM) in the United States. For a number of reasons, osteopathic medicine is an alternative to the reductionist biological tradition of allopathic medicine. Osteopathic medicine places great emphasis on the fact that the body is a self-regulating unit in which structure and function are reciprocally interrelated, providing a basis for a rational, holistic therapy.

Second, he argued that because of the prevalence, the morbidity, and the huge cost of musculoskeletal disorders, there is a place for a form of medicine that sees a need to manage these debilitating conditions as more than “simply pains.”

Third, he saw a political advantage in medicine having two “separate but equal” traditions to counter the aggressive push by nonmedical professions for equal rights (eg, laboratory investigation, prescribing, procedures) with physicians within their narrowly defined areas. Medicine must see the patient as a whole, must advance by rational scientific research and must be distinct from the paramedical professions, which seek to advance themselves by legislative advantage. Medicine is strengthened, not weakened, by having the two traditions of allopathic reductionist biology and osteopathic holism."

Open Letter to Dr. Ransom About His Testimony that MD Faculty Members Do Not Want to Teach His DO Students

Dr Ransom presented in his testimony that ‘culture’ is the primary reason why MDs want to teach MD students and DOs want to teach DOs students.

We respectfully and fundamentally disagree with this statement. We believe that MDs and DOs at all levels are true professionals and are passionate about teaching and passing on their medical arts to ALL medical students regardless of race, sex, national origin, or osteopathic/allopathic degree/heritage/philosophy. We further believe that Dr Ransom’s statement regarding such alleged ‘culture’ only reflects a miniscule minority within the MDs and DOs community.

Moreover, is Dr Ransom implying in his testimony that a majority of his clinical faculty members ‘CULTURALLY’ DO NOT WANT to teach his TCOM DO medical students? (Note: 2/3 of clinical faculty members at UNTHSC are MDs). If Dr Ransom truly believes that, we respectfully ask that he undertake immediate and appropriate measures to ensure that his TCOM DO medical students are not ‘short-changed’ by the  ‘culture’ of  MD faculty members at his state-funded institution. We believe that those hard working and dedicated DO medical students deserve it. Indeed, we believe that the state of Texas deserves and expects this, at the very least, as well.

State CME Requirements for MDs and DOs

Source from AMA

Ophthalmology: Differences between D.O.s and M.D.s are not as important as what we can accomplish together.

An often asked question: What's the difference between an M.D. and a D.O. ophthalmologist? Some D.O. ophthalmologists would reply: "Practically speaking, very little, or nothing". My own reply, and the intent of this article are to go beyond the "practically speaking" response, and offer another perspective.

Personal History

My osteopathic heritage begins with my father, a 1952 graduate of Kirksville College of Osteopathic Medicine (where osteopathy originated). He received his postgraduate training in orthopedic surgery at the Detroit Osteopathic Hospital, lovingly referred to as the "mecca" of osteopathic specialty training.

My own path started at Michigan State University College of Osteopathic Medicine, followed by an osteopathic internship. Ophthalmology residencies were scarce in the D.O. world when it was my turn to apply — only two openings were available in the entire United States. I was fortunate to have been accepted to the Kresge Eye Institute. Having just married a D.O. ophthalmologist whose medical educational route mirrored that of my father's, I found myself in a unique position to compare the educational experiences and philosophical differences.

Osteopathic principles and philosophy were founded by Andrew Taylor Still, M.D., toward the end of the 19th century. He noted that the medical treatments of the day were killing more people than they were curing.

He felt strongly that the body has an inherent ability to heal itself, and that structure and blood supply are vital to that healing process. He developed manipulative techniques that strive to restore skeletal alignment and improve blood/lymphatic flow throughout the body. One of the many tenets of osteopathic medicine states that the body has the potential to make all substances necessary to insure its health. No medical approach can exceed the efficacy of the body's natural defense systems if those defenses are functioning properly. Teaching the patient to care for his own health and to prevent disease is part of a physician's responsibility.

An Eye M.D.'s perspective: Practicing Another Brand of Medicine

 

If I brag about one of my sons, it wouldn't surprise or necessarily impress any of you, because we're all proud of our children, and we all think they are special (for the most part). But let me brag anyway for just a moment.

My middle child, Michael, has been a great kid to raise. He excelled in sports, was a natural leader in many areas, went on several medical mission trips with me, and was very gifted academically. He finished college in 3 years with a 4.0 GPA. But he, like so many, struggles on standardized tests … including the MCAT. So while his MCAT scores were respectable, they fell just shy of what the major medical schools sought. The allopathic medical schools, that is.

The Alternative

It turns out there's a whole other brand of medical school, the osteopathic variety, about which many of us "M.D.s" and our patients know precious little. It seems they also look at MCAT scores, but don't consider them the rigid screening criteria our traditional M.D. programs do. They focus more on your grade pattern over the years, your character and the kind of doctor you'll turn out to be. Let's face it — when you were in medical school, you saw some of your fellow students who, while brilliant, seemed, well, socially maladjusted. And those students are now doctors! Surely we can strike a balance between intelligence and a good ability to interact with patients.

The pathways to become a DO or an MD: Subtle Differences

The medical curriculum of MD and DO is very similar except that DO students receive an extra 200 hours of training in Osteopathic Manipulative Medicine (OMM) and one month core-clerkship of OMM in their 3rd year of medical school. Upon graduation, physicians are required to complete one year internship and will be eligible for full licensure to practice medicine and surgery. This old rule or law is still in effect across the country. However, the reality is much different than what is in the law book. As there are more regulations imposed by healthcare insurance companies, physicians have to be board-eligible or certified, i.e, physicians must have completed residency program, in order to be on the insurance panels.

The DO profession/ Osteopathic Graduate Medical Education (OGME) still requires its physicians-in-training to complete a year of rotating internship or an internship with emphasis track to their respective residency specialties. The MD profession/ Accreditation Council for Graduate Medical Education (ACGME) has eliminated the internship year for most specialties, with a few exception, in which the specialties are too specialized like ophthalmology, orthopedics, radiology, pathology and etc.

MCAT scores and Medical Schools: There is some hope for low score!

The MCAT scores and GPAs are the objective indicators of how well the applicants will perform academically in schools and on the licensing board examinations. These are not the only determining criteria for acceptance to medical schools. However, other extra-curricular actitivites or life experiecnes can also play an important  factor in the decision making process by the admission comittee. According to Association of American Medical Colleges, there are matriculants with MCAT scores less than 15.Out of 56,255 current students, 7,292  have less than 26 on MCAT scores, 12,014 have 27-29 on MCAT scores, and the rest have higher scores than 29.

Medical School Rankings Average MCAT Scores

Washington University in St. Louis School of Medicine 12.5

Harvard Medical School 11.9

University of California--Los Angeles 11.9

Columbia University College of Physicians and Surgeons 11.8

Johns Hopkins University School of Medicine 11.8

Brown Medical School 11.7

University of Michigan Medical School 11.7

Baylor College of Medicine 11.6

Stanford University School of Medicine 11.6

University of Chicago Pritzker School of Medicine 11.6

University of Pennsylvania School of Medicine 11.6

Cornell University 11.5

Duke University School of Medicine 11.5

Emory University School of Medicine 11.5

Vanderbilt University School of Medicine 11.5

Northwestern University The Feinberg School of Medicine 11.4

University of California, San Francisco, School of Medicine 11.4

University of Pittsburgh School of Medicine 11.4

Mount Sinai School of Medicine of New York University 11.3

Yale University School of Medicine 11.3

Case Western Reserve University School of Medicine 11.2

New York University School of Medicine 11.2

Ohio State University College of Medicine 11.2

Dartmouth Medical School 11.1

University of Southern California 11.1

University of Virginia School of Medicine 11.1

Mayo Medical School 11

Philanthropic donations to new medical schools and centers across the nation

A number of medical school construction projects across the United States have received pledges of financial support that exceed the $25 million pledged to the proposed UNTMD campus.  These successful fundraising efforts frequently included extensive community outreach in which alumni, trustees, business and civic leaders, and community members offer major donations and sponsor challenge grant proposals designed to jump-start contributions from individuals and foundations.  The list below outlines some of the major contributions to new or expanded medical schools in recent years:

Campbell University (North Carolina)

Campbell University, a private, Baptist university in North Carolina, is spending $60 million to develop a new medical school that will open at its Buies Creek campus in 2013.  The school will use “savings, donations, loans, and other funds” to fund its project.[1]

Southeast Alabama Medical Center (Alabama)

The Southeast Alabama Medical Center is developing a private college of osteopathic medicine at the SAMC campus.  According to the SAMC Web site, the $40 development cost “includes a $15 million operating budget funded by SAMC and $25 million construction costs financed through bond sales.[2]

Marian University (Indiana)

Marian University, a Catholic, liberal arts university in central Indiana, received a $30 million pledge from an anonymous donor in support of its planned college of osteopathic medicine.  The college’s projected development cost is $75 million.[3]

University of California, San Francisco (California)

The University of California, San Francisco is planning to build a 183-bed children’s hospital that includes a pediatric emergency room and research facilities.  The children’s hospital will be part of a $1.5 billion hospital system, scheduled to open in 2014, that will also include a cancer center and a women’s hospital.   The university plans to raise $600 million through private donations.  As of June 2010, Marc Benioff, the founder of salesforce.com, and his wife Lynne pledged $100 million.  In addition, philanthropist Charles Feeney, founder of Duty Free Shoppers Group, pledged $125 million toward the project.[4]

The Deceptive Income of Physicians

The following excerpt from the book "Informed Consent" by Benjamin Brown, MD

Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher.  Physicians spend over a decade of potential earning, saving and investing time training and taking on more debt, debt that isn’t tax deductible.  When they finish training and finally have an income – they are taxed heavily and must repay their debt with what remains.   The cost of tuition, the length of training and the U.S. tax code places physicians into a deceptive financial situation.

Want to know more about the U.S. medical education system?

Purchase my book at:   www.InformedConsentBook.com

Supporting the osteopathic identity of UNTHSC

The following is a guest post by Donald Phillips, DO, FACEP, FACOEP.

I would like to add my comments to those regarding the proposal to add an allopathic training program at the University of North Texas Health Sciences Center (UNTHSC) in Fort Worth.  I will start with the fact that I am a 1991 graduate of the Texas College of Osteopathic Medicine (TCOM).  When I entered the school, I knew relatively little about what a DO was and how it differed from an MD.  With maturity and experience, I have come to realize that I agree more now with the basic philosophy and roots of osteopathic medicine, than I did then.  I will also readily admit that I have known good and bad doctors with both sets of initials behind their names. I have worked in Texas, Missouri, Ohio, and Alaska while in medical school. I served a traditional rotating internship in a rural hospital in Rolla, Missouri.  I completed a three year residency in emergency medicine in an osteopathic program in Columbus, Ohio.  Out of my residency, I entered active duty in the USAF at Scott AFB, Illinois, then practiced at a catholic hospital in St. Charles, Missouri and finally back to Texas where I worked for four years at JPS Health Network.  I am currently the ED medical director in a rural hospital northwest of Fort Worth.  My point?

The State of Texas Medical Education

The DFW metroplex has the largest concentration of medical students.

• “Texas has a shortage of physicians, both primary care physicians and specialists. The state currently ranks 42nd out of 50 states and the District of Columbia in physician-to-population ratio for patient care. The shortage is now evident in both rural and urban areas of the state. Even though medical liability reforms have brought more than 21,000 new physicians to Texas, we still don’t have enough physicians to keep up with the state’s robust population growth.”[1]
• According to an October 17, 2010 story in the Houston Chronicle, Texas already loses 45% of its medical graduates to out-of-state residencies.[2]
• Texas will lose $200,000 of its investment in each medical student who will move out of state for residency training.  As the Texas Medical Association has observed, “It is not good fiscal policy to make a state commitment of $200,000 for each Texas medical student over four years, and then force graduates to leave the state for GME. Those new physicians very likely will never return to Texas.”[3]

• In December 2008, the Texas Health Care Policy Council released a report, “Physician Workforce and Graduate Medical Education in Texas,”[4] in which it analyzed future trends in the supply of physicians, physician training opportunities, and the demand for medical care across Texas.  Among the panel’s findings:

Ø      “Texas medical school enrollments are at historically high levels. Entry-level enrollments are on track to meet the AAMC’s recommended 30 percent growth rate… In 2007, there were 1,300 Texas medical school graduates but that number is expected to grow to 1,700 by 2012.” (p. 18)

Ø      “Of the Texas physicians in DPC [direct patient care], 45 percent trained in Texas medical schools; 32 percent trained in other states; and 23 percent trained in other countries.”  (p. 19)

Ø      “The majority of Texas’ first-year medical students are in the metropolitan regions of the Metroplex and the Gulf Coast (see Figure 10).”  (p. 19)

    Ø      “Since the passage of medical liability reform in 2003, the Texas Medical Board (TMB) has licensed 10,878 new physicians (see Figure 2). By comparison, 8,391 new physicians were licensed in the four years preceding the passage of liability reform (1999-2002).”

Ø      “In 2007, the TMB received a record 4,041 physician licensure applications, and issued a record 3,324 new licenses.” (p. 12)

Ø      “The TMB issued 811 more licenses in 2007 than 2006, almost a one-third increase.” (p. 12)

Ø            “Texas is a net importer state. In 2007, of the new Texas licensees, 43 percent were from other states, 31 percent were from Texas, and 26 percent were from another country.” (p. 12)

In 2010, Texas had 1,390 residency slots and 1,404 medical graduates (already a surplus of medical graduates compared to residency slots).[5]  According to the Texas Health Care Policy Council, the entry-level residency slot total for 2010 is actually less than the 1,481 positions reported in 2007.[6] (p. 21)

According to the Texas Higher Education Coordinating Board’s 2008 “Projecting the Need for Medical Education in Texas” report, the “…state should encourage growth of more first-year residency positions with a goal of 10 percent more first-year, entry-level residency positions than graduating medical students.” To achieve the Coordinating Board’s goal of increasing the number of first-year residency slots by 10 percent more than medical school graduates, an additional 150 first-year entry residency positions are needed by 2012. This important step has not yet been done. (p. 32)

---

[1] Texas Medical Association.  “Graduate Medical Education Funding.”  Accessed December 26, 2010.  URL: http://www.texmed.org/Template.aspx?id=19657.

[2] Ackerman, Todd.  “Medical emergency: Keeping doctors in Texas.”  Houston Chronicle, October 17, 2010.  URL: http://www.chron.com/disp/story.mpl/metropolitan/7251540.html.

[3] Texas Medical Association.  “Graduate Medical Education Funding.”  Accessed December 26, 2010.  URL: http://www.texmed.org/Template.aspx?id=19657.

[4] Texas Health Care Policy Council.  “Physician Workforce and Graduate Medical Education in Texas.”  December 2008.  Accessed December 26, 2010.  URL: http://www.governor.state.tx.us/files/thcpc/Physician_Workforce_and_GME_in_Texas_12-2008.pdf. 

[5] Ackerman, Todd.  “Medical emergency: Keeping doctors in Texas.”  Houston Chronicle, October 17, 2010.  URL: http://www.chron.com/disp/story.mpl/metropolitan/7251540.html.

[6] Texas Health Care Policy Council.  “Physician Workforce and Graduate Medical Education in Texas.”  December 2008.  Accessed December 26, 2010.  URL: http://www.governor.state.tx.us/files/thcpc/Physician_Workforce_and_GME_in_Texas_12-2008.pdf. 

Osteopathic Oath

Only 50% of US medical dotors take Hippocratic Oath upon their graduation from medical schools, all doctors of osteopathic medicine take Osteopathic Oath. Even though the oath does not carry any legal obligations, it inculcates the common ethical, professional, and moral values that physicians should have.

The need for a modern version of the Hippocratic Oath specifically designed for  the DO graduates was first suggested by Frank E. MacCracken, D.O., of California to his state society. Within a year, the suggestion was transmitted from the state to the national association, and a committee was formed under the Associated Colleges of Osteopathy to prepare the text. Members of that committee included Dr. MacCracken as chairman and Drs. R.C. McCaughan, Walter V. Goodfellow and Edward T. Abbott. The first version of the Osteopathic Oath was used from 1938 until 1954, at which time minor amendments were proposed by the AOA Bureau of Professional Education and adopted by the AOA House of Delegates. (see JAOA 54:77, Sep 54.) This version has been in use since 1954. (From the American Osteopathic Association's website)

I do hereby affirm my loyalty to the profession I am about to enter.

I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity, to perform faithfully my professional duties, to employ only those recognized methods of treatment consistent with good judgment and with my skill and ability, keeping in mind always nature's laws and the body's inherent capacity for recovery.

I will be ever vigilant in aiding in the general welfare of the community, sustaining its laws and institutions, not engaging in those practices which will in any way bring
shame or discredit upon myself or my profession.

I will give no deadly drugs to any, though it may be asked of me.

I will endeavor to work in accord with my colleagues in a spirit of progressive cooperation and never by word or by act cast imputations upon them or their rightful practices.

I will look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for its best interests and for the interests of the students who will come after me.

I will ever be alert to adhere to and develop the principles of osteopathy which were first
enunciated by Andrew Taylor Still.

Hippocratic Oath

It is a popular myth that all physicians take Hippocratic Oath upon their graduation. According to a study “Content Analyses of Oaths Administered at US Medical Schools in 2000” published in Academic Medicine, out of 122 U.S. allopathic schools, only 60 administered the Hippocratic Oath or its modified version, 30 administered the oaths authored by medical students or by the schools, and 32 administered other forms of oath. All osteopathic schools administered Osteopathic Oath. The Hippocratic Oath was created by a Pythagorean sect 2,500 years ago in ancient Greece. It was a protest document chastising the practice of abortions and euthanasia. The study concludes that "the impact of using a nonstandardized medical oath on physicians' professionalism and the inculcation of common ethical values and principles remains unknown."

Original Version

I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:  

what is the curriculum of the proposed medical school (UNTMD)?

At a Town Hall meeting on August 23, 2010, President Ransom presented the future UNTMD curriculum as, “The MD School will build on the success achieved at TCOM by adopting a similar, although not identical, educational delivery model, teaching style, and curriculum, subject to meeting all the requirements for curriculum content for an MD program.”[1]

A few minor changes will involve scholarly concentrations, certificates of recognition, and inter-professional education.[2]

Learning Medicine in France

The following is another guest post by Yveline Van Anh 

You have the power to change your future. Sure, some things are meant to be and fate does have play a role in it, but we only have so much luck. You have to go and grab those chances.

My mother left Vietnam at the age of 19, eight years after the end of the Vietnam War. Her family had attempted to escape via the sea mere days after the end of the war, but the ship's engine broke down just miles away from international seas where her family could be rescued from foreign ships. It took the next eight years for them to get a visa and be allowed to leave. She arrived in France in 1983 and was sent to Rennes where she lived in a refugee camp with the rest of her family for a year. Refugees from all over the world were there. Meanwhile, she was in a country whose language she did not know.

New York Times: Medical Schools in Region Fight Caribbean Flow

For a generation, medical schools in the Caribbean have attracted thousands of American students to their tiny island havens by promising that during their third and fourth years, the students would get crucial training in United States hospitals, especially in New York State. But in a fierce turf battle rooted in the growing pressures on the medical profession and academia, New York State’s 16 medical schools are attacking their foreign competitors. They have begun an aggressive campaign to persuade the State Board of Regents to make it harder, if not impossible, for foreign schools to use New York hospitals as extensions of their own campuses.

The entire article can be read at New York Times

It is a very good article about the competition between US medical schools and off-shore medical schools for clinical training sites. New York State has been an attraction state for importing physicians and medical students from abroad. Some of the off-shore medical schools have big bucks, $100 million over 10 years, to pay the local hospitals for their students to do rotations.

Texas budget shortfall and addressing physician shortage

This is an interesting by Mike Norman from Star-Telegram

You ought to be able to cut $20 billion or more out of a two-year state budget that started out at $182.3 billion, right? That's what the Legislature apparently will have to do next year.The governor, lieutenant governor and current House speaker have been working on it for almost a year. It's an ugly task.

First,you don't really have all of that money to work with. More than half of it comes from federal grants and other sources that state leaders and legislators don't necessarily control, so you have to focus on "general revenue-related" funds.

That's $80.7 billion in the current budget. That number is already $1.6 billion less than what it was before the last Legislature worked on it, delivering a spending reduction for

only the second time since World War II.

You can read the entire article from Star Telegram.

This deficit number keeps rising as recently suggested to be $25 billion by Texas Tribune. A push for a new medical school in Fort Worth is unwise and uncalled despite the claims of “cost free” to the state. In 2010, Texas produced 1,404 medical graduates and has only 1,390 residency slots available.

Operational Cost Comparison between the allopathic and osteopathic colleges at Michigan State University

The following testimony by Dean Strampel givent to UNT Board of Regents in November 2009.

The Michigan State University College of Osteopathic Medicine experience started in the late 1950s among the members of the Michigan Association of Osteopathic Physicians and Surgeons with the idea to form a new school. The osteopathic profession “taxed” each individual physician $200 a year for ten years to create the Michigan Osteopathic College Foundation and the school started as the private Michigan College of Osteopathic Medicine in Pontiac in the 1969.  However, it quickly became evident that it was not financially viable, and the profession almost immediately began lobbying for the school to become a public institution.

                                                               

In the meantime, Michigan State University had formed an allopathic medical school, the College of Human Medicine, in 1966 because it was attempting to achieve AAU status and this was a requirement. Because of the strong lobby within the state from the osteopathic profession and the need in the state for primary care practitioners (particularly in rural areas), the Michigan legislature was receptive to funding an osteopathic medical school, and in 1969 Public Act 162 ordained that “A school of osteopathic medicine is established and shall be located as determined by the state board of education at an existing campus of a state university with an existing school or college of medicine.” Of the three schools that qualified, only MSU offered the fledging college a home, and in 1971, the private MCOM was moved to East Lansing. This simple decision has created an interesting environment.

Why is there such a rush in creating a MD school within 2 year time span even though the accreditation process timeline (less than two years) is unrealistic?

According to the Texas Higher Education Coordinating Board, the following residency programs in Family Medicine, Internal Medicine, General Surgery, Pediatrics, and Obstetrics/Gynecology are required for the establishment of an LCME medical school.  Currently, among the potential affiliated hospitals with UNTMD[1]:

• John Peter Smith Hospital has ACGME residencies in Family Medicine (dually accredited by ACGME and AOA), Emergency Medicine, Obstetrics/Gynecology, Orthopedic Surgery and Psychiatry (dually accredited by ACGME and AOA).
• Methodist Medical Center has ACGME residencies in Family Medicine (dually accredited by ACGME and AOA), General Surgery, Internal Medicine, and Obstetrics/Gynecology.
• Texas Health Harris Methodist Hospital, HCA Plano Medical Center and Plaza Medical Center are in the planning process of starting up ACGME residency programs.
• Cook Children’s Medical Center and Baylor All Saints Medical Center are not interested in establishing residency programs.
• None of the potential affiliated hospitals is planning to establish a residency program in Pediatrics.  Would this pass the LCME requirement for accreditation?

Comparison between Michigan and Texas COM

The following Open Letter to UNT Board of Regents and Chancellor on March 29th, 2009

The recent public hearing at UNTHSC regarding the proposal to add an M.D. degree to UNTHSC clearly showed the passion among the osteopathic community for their heritage and the acknowledgement of the prestige of an M.D. degree held by the local business and hospital leaders. Proponents of the M.D. degree argue that it will bring prestige and research funding to the school.

Despite the general consensus that Texas College of Osteopathic College (TCOM) is a great success story, it is ironic that the proponents of the M.D. program are willing to waste resources of duplicating a parallel program to produce M.D. physicians instead of DO physicians. This is absurd in business sense and purely discriminatory towards the osteopathic community because M.D.s and D.O.s are all physicians, period!