The next step in DO and MD getting along?

Umm, this seems like it’s going to suffer from split-focus when they go recruiting, but maybe someone out there knows of an instance where this has been tried before?

Star-Telegram.comThe University of North Texas Health Science Center is considering a plan to offer M.D. degrees, in addition to the osteopathic program that it historically has provided to physicians-in-training.

University President Scott Ransom this week notified students and faculty that the Fort Worth medical school will do a "complete evaluation of various proposals" to create the MD program.

The science center’s Texas College of Osteopathic Medicine now offers a D.O. degree, with most graduates going on to practice primary care such as general internal medicine and pediatrics.

In his message to students, Ransom said the university is contemplating the addition of the MD degree in order to expand training opportunities and recruit a total class of 250 medical students.

I don’t get it.  Be a proud DO school, be a new allopathic school, but make a choice.  (I think this is a start on a change from DO to MD school, but that’s just a guess and based on nothing whatsoever).


Comments

  1. Wonder if the two camps could ever settle their differences and agree on ONE degree – the MD, just because of tradition and numbers – with “concentrations” or specialty tracks within for Osteo, etc.

  2. Yes, seems like an MD-lite idea.
    We have a DO in our group, an excellent neurologist. In the past, people who went to DO schools were those who couldn’t get into MD schools. It sounds like perhaps there is a glut of enrollment slots available now, so they want theirs to stand out somehow.

  3. I know Michigan State has had both a DO and MD program for as long as I can remember. They really work with applicants to get students in “the right school for them”.

    More and more DO’s are a bit more multidisciplinary, having a bit more knowledge in kinesiology, athletic training, or just something other than the biochem major who tends to get into the MD programs.

  4. I’m a bit confused here… What exactly makes a DO seemingly inferior to an MD, and since when can a DO not be a specialist?

    My late parents saw a DO when he was on call and the “family pulmonologist”, a member of the same group practice unavailable. A friend has seen the same DO for a couple of matters, including a sleep study and bronchoscopy. Everyone was satisfied with their care, nobody had any adjustments, except in the billing sense.

  5. Sounds like the school is pulling for more research dollars by having an MD program in their bid to become a “Top 10 Health Science Center”.
    At this stage it sounds mainly like a study group just to study the idea and see people’s opinions, and from the rhetoric we’re getting here, “there are no preconceived notions about this idea”. Evidently there’s been talk about the idea for several years, and this is just an idea to “formalize that talk and study the idea in greater detail”.
    As a DO student at said institution, it’s a little upsetting that we heard this news mainly from the newspaper, aside from a brief email earlier this week. I just hope TCOM doesn’t become the bastard stepchild to an MD program and undermine what is currently the top osteopathic medical school in the nation. It will be interesting to see how the idea affects school-hospital relationships in the area, as well.

  6. The difference between MD and DO is mostly overblown in my experience. Apart from a few DO’s who like to do manipulations and so forth, both tracks produce perfectly adequate physicians. Plenty of guys in my residency program were DO’s, and I had no issues with any of them.

  7. I am a TCOM student and very disappointed in the Texas Osteopathic Medical Association’s response. Dr. Tesson does not care about the issues facing UNT. In fact, the President of TOMA Dr. Monte Troutman came to our student governement group and tried to get political support in trying to get students to talk bad about the UNT administration. This is horrible and unprofessional. Putting students in the middle of a big fight between UNT and TOMA is wrong. Dr. Troutman should be fired!

    From most TCOM students perspective, it looks like the UNT administration is trying to improve health and expand the physician supply. Yes, there are a few radical students in my class. The big majority want to be good physicians and don’t really care about the big DO and MD fight. Most students are for a choice at UNT.

    Dr. Tesson sounds like a polarized radical that is only interested in protecting the osteopathic profession. He obviously does not care about health.

    Tim OSMI

  8. Someone should remember the reasons that the Fort Worth Osteopathic Hospital is now closed. It had bad care and many malpractice law suits. A M.D. school in Fort Worth is just what the doctor ordered. I am an employee at Baylor and we don’t want any part of the D.O. medical school. We have a few D.O.s at Baylor and they seem like really good doctors but an M.D. school will improve care in Fort Worth and help make the city proud. Mr. Tesson sounds like the Malcolm X of the D.O.s. Most citizens in Fort Worth would trade our good D.O. school for a M.D. school in a second. The better choice would for UNT to offer both M.D. and D.O. degrees. Mr. Tesson and his group is obviously not from Fort Worth given his polarized views. Choice is a good thing.

  9. Someone should remember the reasons that the Fort Worth Osteopathic Hospital is now closed. It had bad care and many malpractice law suits. A M.D. school in Fort Worth is just what the doctor ordered. I am an employee at Baylor and we don’t want any part of the D.O. medical school. We have a few D.O.s at Baylor and they seem like really good doctors but an M.D. school will improve care in Fort Worth and help make the city proud. Mr. Tesson sounds like the Malcolm X of the D.O.s. Most citizens in Fort Worth would trade our good D.O. school for a M.D. school in a second. The better choice would for UNT to offer both M.D. and D.O. degrees. Mr. Tesson and his group is obviously not from Fort Worth given his polarized views. Choice is a good thing. Joe

  10. Tony Bagadonuts says:

    How does this benefit the relationship between UNTHSC and JPS, since UNT provides many docs to JPS does this mean it will create a bigger pipeline? And are DOs limited in some way that would make an MD program more appealing to provide a wider array of physicians to Texas, the local medical community and JPS?

  11. Why shouldn’t UNT start a MD school? Sounds like it will help health care and the physician supply. Why should UNT pay attention to Mr. Tesson and TOMA? This sounds like a good idea to me.

  12. “We have a few D.O.s at Baylor and they seem like really good doctors but an M.D. school will improve care in Fort Worth and help make the city proud.”

    Joe, you did an excellent job of contradicting yourself in the same sentence. I’m curious as to why you think an M.D. program will improve care in Fort Worth when you think so highly of the D.O.s with whom you have worked. In this day in age, there are so few differences in the way M.D.s and D.O.s are educated and licensed (aside from the additional manip in which D.O.s are trained) that I’m not sure that people even pay much attention to that distinction anymore. It all boils down to patient care: whoever can efficiently and compassionately treat patients will be a successful physician; regardless of the letters behind their name.

  13. Funny

    I was struck too by the contradictions in “Jim’s” post. From “I am an employee at Baylor and we don’t want any part of the D.O. medical school” To “We have a few D.O.s at Baylor and they seem like really good doctors.”

    I wonder if he read his comment before posting just missed how inane it sounds.

    The Osteopathic school in Texas has a fine (and long) history of providing fine primary care clinicians to the state. Many of it’s graduates provide primary care to underserved areas of rural Texas.

    That “most citizens” of Fort Worth would be “proud” to see this fine medical school replaced by an M.D. program is dubious. Just as dubious is just how many rural and urban primary care physicians the proposed M.D. school would produce to offset the consequences that would result from losing the Osteopathic Medical School.
    An inane, contradictory and arrogant post.

  14. So we finally got a solid explanation for the proposition:

    UNTHSC has been approved for up to 250 spots in each class by the state funding board (which TCOM could easily accommodate for the pre-clinical years). However, currently there are not enough slots for clinical rotations, and it has been difficult for TCOM to form a primary affiliation with any area hospital. Evidently, no one wants to be the “osteopathic” hospital (…maybe for good reason; all 10 Texas Osteopathic hospitals are now closed). So, an MD option could relieve some biases and get some hospitals to open up more slots for clinical rotations. Sounds like an interesting solution to a difficult situation.

    However, I have to take some issue with the fact that hospitals are standing in the way of education. It’s obvious that the idea of a purely osteopathic hospital has passed, but I’d venture a guess that that has more to do with finding adequate specialist coverage and business management rather than there being a lack of sick people. What’s the harm in opening up a few more clinical rotation spots for D.O. students? There won’t be a hostile takeover of your hospital by D.O.s (I promise; we’re too few), but limiting student opportunities based on historical bias seems a little unfair to both the students and your patients.

  15. paul walker,MD says:

    Lets give the DO’s a MD degree. They are our equal. It would good for both professions.

  16. I am a past President of the TCOM Alumni Board and graduated in the 1970s. I would rather see TCOM close than offer an MD degree. Yes, I understand the challenges of finding clinical rotations for the students. I generally have a TCOM student in my clinic. Yes, I understand that TCOM will probably reduce its class size to stay DO. I would rather have TCOM close its doors than change its philosophy even a little bit.

  17. response to robert:

    Osteopathic medicine was created at a time when medicine in the United States had no scientific basis (or very little). A.T.Still reacted to the fact that medicines in his day were poisons more often than they were of therapeutic benefit. Chemistry was still an immature Science and the Biochemistry of today was not even born. Hence, the “Osteopathic Philosophy” was created as a child of its time.

    The time for that philosophy and your time as well, Mr. Past TCOM alumni President, is long since past.

    If you believe that only rigorous scientific thought and proof of concept by well designed experiment has been the TRUE benefactor of the human condition, then the existence of the old guard of Osteopathy, such as yourself, should be recognized for what it really represents: the defense of the status quo, regardless of the merits of changing that status quo. It is merely a kind of vested interest of the egos of the old guard.

    Biochemistry and Medicine today may be approaching the cusp of transformation into truly rigorous disciplines. All physicians, in my view, should strive to do more than just subscribe to the silly political correctness of the health care environment by endlessly parroting phrases such as “wholistic medicine”, “whole person”, “compassionate such and such”. To the extent that manual manipulation of the spine and extremities can benefit some clinical pain syndromes, and to the extent that such therapy is proven to be of equivalent efficacy or better than other approaches, let it be so incorporated into Medicine-say Manual Medicine. This, however is surely not a reason for a “separate but equal” branch of Medicine. In addition, “separate but equal” can never be truly equal-which was the entire basis of the civil rights movement and the busing of students between schools.

    Physicians should strive to excel in translational efforts to bring laboratory science to the bedside, as well as to be excellent clinicians. Compassion and care of the whole person should be expected as a matter of course, without excessive and absurd commentary.

    The time for Osteopathic Medicine to be separate from mainstream (MD) medicine is long past. Medicine should be one unified profession, with high entry and uniform qualification standards, whose members should strive to make Medicine both more scientific and of greater service to humanity- the stupid political strife is an utterly needless distraction.

  18. Mark,

    While your thoughts are appreciated, I don’t believe that the time of the Osteopathic Philosophy has passed. Here are the 4 tenets of Osteopathic Medicine from the AOA:

    1. The person is a unit of body, mind, and spirit.
    2. The body is capable of self-regulation, self-healing, and health maintenance.
    3. Structure and function are reciprocally interrelated.
    4. Rational treatment is based on these principles.
    (http://www.osteopathic.org/index.cfm?PageID=ost_tenet)

    One of the great things about A.T. Still is, that while he was arrogant enough to shun his profession and create a new one, he was not arrogant enough to believe that he had all the answers. He developed the Osteopathic Philosophy in broad enough terms that, much like the Constitution, it is timeless. I’d challenge any health professional to disagree with any one of the tenets (I’ve tried…I like to play devil’s advocate).

    However, in addition to that, the idea that Osteopathy is the end-all, be-all and that a school that has been prolific at generating excellent physicians (especially to work in underserved areas) would close rather than create an M.D. degree is, IMHO, misguided. I agree that I would much rather see TCOM stay D.O. (mainly for logistical and competition issues… do you have didactic lectures together? Would the D.O. students be able to score as highly as the M.D. students in light of their extra coursework?…etc.). However, the resistance to the expansion of the program, which is vitally necessary in these days of physician shortages (esp. in TX), seems to be mainly hospital-based.

    Robert, I salute you that you take the time in your office to teach students, and it’s a shame that we don’t have more slots available with great docs such as yourself. Maybe this proposed venture will open some ivory-tower eyes to the fact that in the end it’s about patients, and physicians will continue to work for patients’ best interests whether they be an M.D. or a D.O.

    As medicine has evolved from the blood-letting, snake-oil-pandering bygone era into modern biomedical science, it appears to me that Osteopathy and Allopathic medicine have grown up together, much like brothers. Yes, there’s a bit of sibling rivalry, but in the end there (is/should be) a common respect, appreciation, and camaraderie amongst the professions. Neither wishes to lose its identity, yet they serve the same purpose in a nearly identical fashion. And while I appreciate the differences in osteopathy, I don’t see myself as any better or worse than my friends that have chosen to attend allopathic medical schools. Cheers to all of you…I’ll be coming to see you some day.

  19. EJ,

    Discussions such as these invariably assume a circular form. At the clear risk of folly,however, I endeavor to make reply to your description of the 4 “tenets” of Osteopathic Medicine, and so lets take each of them one by one:

    1). “the person is a unit of body, mind, and spirit”

    Consider, then, the definitions of each of the terms so employed. Are any of these terms even defined without specific reference to a human being? I would answer that they are all defined in terms of a human being, or person. The notion of a “mind out of body”, and of a spirit separate from the body belong entirely to the realms of religion in the latter case and mysticism in the former case. Therefore, I would take the position that, as these terms are commonly used and to the extent that they represent physical or other reality in the natural world, this statement is true. The statement may be argued against depending on whether one accepts the existence of the “spirit”, etc .
    However, the REAL point is that physicians trained at MD schools ALSO would not deny the statement or even consider that they practice medicine without the assumed validity of the statement being granted.
    Hence, I would argue that this statement and its attendant consequences signify nothing profound or worthy of a separate medical profession. On, then, to the second statement.

    2). ” The body is capable of “self-regulation, self-healing, and health
    maintenance”

    Consider, if you will, that homeostatic self-regulation is one of the very first concepts taught in medical physiology, and in particular, for example, A.C. Guyton does a masterful job of describing and explaining the several mechanisms of short-term and long-term (renal) mechanisms for the regulation of mean arterial blood pressure. His development of cardiac output and venous return diagrams is another masterful example of self-regulation in cardiovascular physiology.

    Consider, further, that general surgeons train first in the ICU recovery areas, where they have first hand-opportunity to witness self-healing and wound healing mechanisms from the very wounds they themselves have inflicted.

    Considering also that the above two observations together with the development of modern immunology largely or even entirely incorporates one’s notion of “health maintenance”, together perhaps with ideas involving nutrition, and I am compelled to ask you, EJ:

    What precisely is present in this philosophy not also present in MD training programs and philosophies? I put to you that the honest answer is “nothing”.
    On then to the third tenet:

    3). ” Structure and Function are reciprocally interrelated”

    Here, now, caution is required. That two things should be “reciprocally” (inter)
    related implies a notion of multiplicative inverse and Field theory in the
    discipline of Real or Complex Analysis. But, since this does not involve what is commonly understood to be Medicine, I feel certain that the terminology here is used very loosely, colloquially. If, then, I am allowed to seek a more precise definition of this tenet, may we agree that what is meant here is something of the form that ” Structure Determines Function” and “Function is Bounded by Limits Imposed by (Natural or Altered) Structure”. In this way, mathematical meaning is removed where it was not originally intended. Please restate the tenet if I am not understanding the meaning correctly, EJ. My response is based on my own reformulated version.

    Consider, if you will, that both Orthopedic surgeons and Physiatrists would hardly be in a position to disagree. Further, this particular notion has been around for several centuries in basic evolutionary biology, and not even specifically in relation to medicine. To the extent that Osteopathic Medicine adds
    to this notion, neither profound nor unique, why is a division of “Manual Medicine” not logically and functionally equivalent? My challenge to you is that it is just so equivalent. Lastly,

    4). “Rational treatment is based on these principles”

    Consider that the MD profession would not disagree in the least. I would myself add that rational treatment is based on considerably more than is articulated in the “Osteopathic Principles”.

    In conclusion, I feel strongly that there is nothing new in this philosophy, that its principles do NOT offer anything of profound wisdom in the development of medicine, and even that they are also present ( yes, one may well uselessly argue to what degree) in the MD training system as well. They do NOT, in my judgment, constitute a basis for “separate but equal” medicine.

    Finally, let me clarify one point. I was really attempting to articulate the idea that the time for antagonism between MD and DO is long gone. Note, for example, that “allopathic” is just the pejorative word used by Osteopaths to describe mainstream medicine- the MDs do NOT entertain such nonsense. It is for reasons like this that I decline to grant any validity to notions of “Allopathic and Osteopathic” Medicine- what is needed is Scientific Medicine-period.

    Lastly, if you really want to investigate and understanding the living state in the natural world, let me suggest the works of Prigogine and DeDonder in irreversible thermodynamics and the production of ordered states far from thermodynamic equilibrium- it is in disciplines like these that the life sciences are beginning to actually become rigorous and exact. I do not see how medicine can make progress with “Osteopathic Philosophy”- but entire worlds can be opened with a truly scientific medicine.

  20. So we’re in agreement, then. Relatively revolutionary in the 1870’s, but self-evident truths that are commonplace now. It also looks like Evidence-Based Medicine (“Scientific Medicine”) is how we’ll be expected to practice in the future, whether M.D. or D.O.

    And wow, you’re very well read.

  21. I am most impressed by the words of both Mark and EJ. Evidence-based medicine should be the standard for both MD and DO physicians. If doctors do not use evidence-based medicine, what is their alternative? As a patient, I would strongly suggest all physicians use the most scientifically sound and evidence-based diagnostic tools and treatments available. The days of non-scientifically based witch doctors should be eliminated from American medicine.

    As a student of organziational behavior at TCU, it appears that the emotional and non-fact based arguments used by the various DOs in these blogs and editorials presents evidence of the cold hard truth about osteopathic medicine. Stated differences between DOs and MDs is all based on history and tradition. If the stated diffences is not true, then why should two separate professions exist?

    The three areas that DOs claim substantive differences include:
    1. DOs are more likely to become primary care physicians. While this is true, according to US News and World Reports it showed that DO schools graduated primary care physicians from 33% to 87% of their graduating classes with a nationwide average of 64% of DO graduates going into primary care from 2004-2007. This is compared with MD schools nationwide graduating between 27% and 77% of their graduates going into primary care with a national average of 51% of all MD graduates going into primary care from 2004-2007. Do these differences constitue a reason for having separate professions? What about the DO school (Kirsville) that only had 33% of its graduates entering primary care when compared with a MD school (such as University of North Dakota) graduating 77% of its class into primary care? Does the osteopathic profession own primary care? Based on the evidence, I don’t think so.

    2. DOs report that they utilize an uniquely holistic approach to health care. In doing a comprehensive review of the science, there is no evidence that any differences exist between DOs and MDs regarding this wholistic approach. There may be a historic difference between MDs and DOs regarding whole body care but the days of snake oil and leaches are gone. Today, all medical schools, both MD and DO, approach medicine from a whole-body perspective. Any differences that may have existed between good quality MDs and DOs are now history.

    3. DOs are trained in osteopathic manipulative medicine. This difference is real and represents an additional 4-5% of the DO student’s time being devoted to osteopathic manipulative medicine when compared to MD students. The evidence for these treatments is very limited with questionable benefit when compared to, say, massage therapy. Cranial manipulation has no fact basis and should be eliminated. Other manipulative treatments may have some benefit to some patients but needs much more study to consider these treatments as evidence-based medicine. One article highlights that only 3% of DOs practicing in the United States utilizes osteopathic manipulative medicine for their patients. This compares to Physical Medicine and Rehabilitation specialists that do similar therapies and represent over 1% of all physicians. Many MD schools do offer electives in manipulative techniques which has presented a bridging between the DO and MD educational experiences. Does the few extra hours of required study for DOs (versus elective opportunities for MD students) of mostly non-evidence based therapies that are not likely used by graduates enough to maintain a separate medical profession? I don’t think so.

    The osteopathic profession’s response to adding an MD school to the Fort Worth university has been limited to emotional pleas and personal attacks. So far, DOs have not presented any contradictory evidence to not agree that an MD school in Fort Worth would help improve health and the physician supply. So far, the osteopathic physicians have presented themselves as nothing more than thugs with only vague and emotional statements. As a student of organziational behavior, people and groups will normally use all their facts and logic to shape the opinion of others. In the absence of logic, truth and facts, the only other approach that can be taken is limited to emotional statements and personal attacks.

    I wonder if these DOs view themselves as the keepers of the secret traditions of osteopathy as the Knights Templar are the keepers of the secrets of christianity? I hope the osteopathic profession can start acting in the best interest of the patients that they claim to serve. While I hope that the DOs that have spoken so far are only the bad apples and fringe of the profession seeing themselves as the Knights Templar protecting the history of their profession, other members of this historically distinguished profession must speak out or loose their credibility as a result of the more outspoken thugs of their profession. Please present the facts of any differences that may exist. Most of us are looking for the truth.

  22. Change is inevetable. Although the initial response may be to resist change, let us all consider what is best for the patients and the profession. After all, there is more that unites MD’s and DO’s than what devides them. I say, let us have both MD and DO program for the love of medicine and mankind. Pleae donot let politics stand in the way of progress. If that is what it takes to open more slots for aspiring medical students, why not?

  23. All questions answered:

    http://www.hsc.unt.edu/sites/StudyGroup/index.cfm?pageName=FAQ's

    This should be the go-to source for all news DO/MD at UNTHSC.

  24. TCOM Alumnus says:

    I am a recent graduate at TCOM and was just reading through the blog here and would like to ask a couple of questions:

    (1)If TCOM does decide to grant “MD” or “MD,DO” instead of “DO” degree, will it then be easier for osteopathic medical schools around the USA to do the same? I hope so.

    (2) Also, will previous TCOM osteopathic medical doctor graduates,like myself, then be able to use “MD” or “MD,DO” if TCOM does decide to grant the new degrees or not (since graduates like myself had graduated only when the “DO” was degree awarded)? I believe that alumni should be given a chance to change their degree as well.

    [Also, no disrespect to Robert, past TCOM alumni board president, but you did graduate in the 1970s, whereas I am a recently new graduate, and would like to inform to you that most of all of my fellow colleagues that graduated from TCOM with me are not siding with you. Most of my classmates and I had applied to MD and DO programs and got accepted into a DO program because we wanted to become medical doctors. For you to say you would rather see TCOM close than offer an MD degree is stubborn, selfish, and not changing with the times of mainstream medicine and evidence-based medicine. Anyway, TCOM’s proposal to change the “DO” degree upon completion of med school is the 1st breath of fresh air I have seen towards making progress and change in our profession.]

  25. TCOM Student says:

    TCOM is not looking to change the DO program to a MD program. The Study Group will look at adding a MD option in addition to the DO degree program at the UNTHSC. I have heard that the program may be similar to the Michigan State University model that has both a DO school and an MD school. The other model seems to be offering a simultaneous DO degree from TCOM and an MD degree from a separate school within the UNTHSC. To the TCOM Alumnus, you earned a DO degree and not a MD degree. You will need to go back to medical school to earn the MD degree if that is your choice.

    Personally, I like the idea of getting both a MD and DO degree from UNTHSC during the four years of medical school. It seems to be consistent with what we say about our program. I have heard repeatedly that the DO degree is a MD degree plus extra training in OMM and holistic medicine. The joint MD and DO degree will prove this concept. Also, it will probably help me get a good residency in an ACGME program. The older DOs had lots of choices of AOA approved programs that were pretty good. Now that all the DO hospitals are gone in Texas and most of the rest of the country, I must go to an ACGME program to get good training. The duel MD and DO program will help me get a good residency while maintaining our osteopathic traditions for holistic primary care and OMM. This sounds like the best of all worlds. I applaud the administration for considering this novel and innovative concept.

  26. TCOM Student says:

    TCOM is not looking to change the DO program to a MD program. The Study Group will look at adding a MD option in addition to the DO degree program at the UNTHSC. I have heard that the program may be similar to the Michigan State University model that has both a DO school and an MD school. The other model seems to be offering a simultaneous DO degree from TCOM and an MD degree from a separate school within the UNTHSC. To the TCOM Alumnus, you earned a DO degree and not a MD degree. You will need to go back to medical school to earn the MD degree if that is your choice.

    Personally, I like the idea of getting both a MD and DO degree from UNTHSC during the four years of medical school. It seems to be consistent with what we say about our program. I have heard repeatedly that the DO degree is a MD degree plus extra training in OMM and holistic medicine. The joint MD and DO degree will prove this concept. Also, it will probably help me get a good residency in an ACGME program. The older DOs had lots of choices of AOA approved programs that were pretty good. Now that all the DO hospitals are gone in Texas and most of the rest of the country, I must go to an ACGME program to get good training. The duel MD and DO program will help me get a good residency while maintaining our osteopathic traditions for holistic primary care and OMM. This sounds like the best of all worlds. I applaud the administration for considering this novel and innovative concept. Thank you.

  27. TCOM Alumnus says:

    TCOM student,
    True I earned a DO degree from TCOM and UNTHSC, but you are also ONLY earning a DO degree currently from TCOM, not an MD degree. If the med school changes it to allow an MD and DO degree upon graduation from UNTHSC, then I believe (medical doctors) alumni from TCOM should also be entitled to have the option to change their degree to the possible future degree being offered: MD,DO. Especially when an alumnus as myself contributes money to TCOM annually. If the med school does not allow this option to alumni, then there will be no more contributions from me ever to UNTHSC again and there could be possible law suits from alumni which develop if they do not allow this option. This is all theoretical since their has been no MD yet offered.

  28. Anonymous says:

    It’s sad that the rate-limiting factor with TCOM growing its class size is the Fort Worth hospitals. I think we are seeing the gradual demise of osteopathic medicine in Texas. If, after almost 40 years of serving the state of Texas and the city of Fort Worth, TCOM has not developed a good enough clinical reputation for area hospitals to allow more clinical opportunities then maybe it’s time to reexamine whether or not Osteopathic medicine is still relevant. The majority of TCOM students train in ACGME programs due to the paucity of Osteopathic training programs in Texas. Rather than asking whether or not to start an MD program, TCOM should ask itself if Osteopathic medicine is worth saving.

  29. Interesting perspective Anonymous. TCOM is the last remaining organization devoted to promoting osteopathy in Texas. All of the osteopathic hospitals in Texas are long gone due to poor quality, poor business practices, and falling admission rates. Why would a hospital want to be labeled “osteopathic” in 2009? The osteopathic traditions in hospitals are dead and the profession needs to consider a modern solution. While I hope that TCOM survives the modern era, it is clear that their administration is on an uphill climb to survive unless they stay with the times. The economy is crashing all around the United States and the TCOM administration must figure out a way to maintain relavence or face the same fate as all osteopathic hospitals have already done in Texas. It appears that TCOM must change to earn hospital’s acceptance and support clinical opportunities for students. I can’t imagine the circumstances that will force hospitals to significantly change to support TCOM. The administration and alumni of TCOM must start thinking like it is 2009 and forget dreaming about returning to the past. The past is the past and the administration must look to the future unless you agree with past Alumni President Robert who say’s he would rather see TCOM go out of business than offer a MD degree. If TCOM does not do anything, Robert may get his wish and the last remaining osteopathic organization in Texas will close its doors forever.

  30. I’m a TCOM graduate who did my transitional internship at JPS before residency and fellowship in the upper midwest. TCOM trains very good physicians. I felt more than adequately prepared to go to “toe-to-toe” with my MD colleagues in residency and fellowship (both ACGME-accredited) at a major international tertiary care medical center. I think that adding an MD program is probably something UNTHSC should do for practical reasons. The DO program is not going to go away. No one is going to “change degrees” or “add degrees” any similar nonsense. It would simply be two medical schools in one place: One awarding a DO degree, the other awarding the MD degree. Now here is a news flash: THIS IS ALREADY HAPPENING AT TWO OF THE OTHER STATE-SPONSORED MEDICAL SCHOOLS THAT AWARD DO DEGREES…MICHIGAN STATE AND UMNDJ (NEW JERSEY). Both are great institions and neither DO school is diminished by having a MD program in it ranks. Texas should follow suit—everything is bigger in Texas!

    There’s a lot of history, a lot of professional rivalry, and many bruised egos fueling this “controversy.” For the most part, past generations of MD’s who descriminated against DO’s are responsible for the high emotional tone of this debate. As late as the 1960’s DO surgeons and specialists had to go abroad to Europe or train in the military to learn the latest subspecialty advances in medicine because the AMA would not allow MD’s to professionally affiliate or (god forbid train them). Many of the DO’s who suffered the brunt of those professional insults are still alive and remember the sting all to well. And, before anyone dimisses those feelings as just “sour grapes” remember how you felt the last time *YOU* were professional insulted or discriminated.

    The fact that Texas as suffered the closure of most of its osteopathic hospitals, has everything to do will local health care markets and little to do with quality. In some markets (the Midwest and Northeast) large osteopathic institutions are not uncommon and are market leaders.

    So what should UNTHSC do?? It should do what’s best for Texas, best for meeting its mission, and best for its university stakeholders. That probably means adding an MD program to its thriving DO program or opening a branch campus (the latter being a very popular expansion strategy for DO medical schools). I personally favor adding an MD program just like the other two large state sponsored DO Academic Health Centers in the country as there are too many “McDO” schools out there for my preference. Besides, I think that having an established DO program next to a nascent MD program would have a positive effect on the MD program’s education. There is no rule that says an LCME-accredited medical school *can’t* teach osteopathic manipulation to its students—wouldn’t *THAT* be an interesting twist?? I guess that those students would just be “DO wannabe’s.”

    At Michigan State, the osteopathic manipulation classes and rotations are offered to the MD students as electives and some sign up. Moreover, osteopathic manipulation is commonly offered to MD’s in several continuing medical education venues including Michigan State and Harvard. So, this is not *THAT* unusual a development. Besides, as AT Still himself, the founder of osteopathic medicine, used to like to say, “Tradition shapes the future.” Kudos to TCOM for getting out in front.

  31. Bruce Stafford, DO says:

    To Allen and my other physician colleagues who served in and with the Marines I wish to first off, from a former Marine, say – “Semper Fidelis.”
    And next I ask that readers entertain comments from one not necessarily learned nor suited to debate yet on the inside as it were. There is both subjectivity AND objectivy contained in my comments but I will strive to keep the emotion to a dull roar.
    The DO vs MD thing has been a subject I have followed for a number of years. I became a DO mainly because I was 43 years old before I finally decided to go after my true passion, medicine. This is a decision I have never regretted. I love family medcine but the simple fact is that none of the MD schools I applied to would give me the time of day. None of them of course would say that it was because of my age. I completed medical school (osteopathic) at the age of 52. The training I received was excellent. What I do regret is the designation DO as opposed to MD simply because it is not necessary to continue to maintain the difference designations. Comments to the admissions committee notwithstanding, I have never always wanted to become a DO. What I HAVE wanted to become is a physician and that goal has been achieved. Other bloggers have pointed out the fact that there just is no real difference any more and I agree. Some MDs do manipulation (I do not, and neither do most of my DO colleagues) and MDs have just as much of a holostic attitude toward health care as I do. I practice evidence based medicine as well as most of my MD colleagues, etc., etc. I have long since become weary of trying to explain the difference between DOs and MDs so now I just say not that – “there is no difference.” And I am very weary of the CULT (yes, that is what it is!) of Andrew Taylor Still, who while innovative in his day, I would consider to be a quack within the context of medicine today. What I am also tired of is the attitude that strives to maintain a separate but equal status between DOs and MDs; is a class distinction really necessary? Who has to move to the back of the bus? The desire to maintain the exclusivity of a club that is not exclusive escapes my reasoning. Great amounts of energy are expended trying to keep that club in operation when the more reasonable and productive approach would be to combine forces to go after the real enemy – managed care and lawyers who have a vested interst in keeping our healthcare system in such turmoil. Of course, the ultimate benefactor is the heirarchy of the club to which I do not even belong. Without input from the evidence-based main stream, or allopathic (as it were) medicine there is little real science in osteopathy, only emotion and anecdote. The losers in this game are, and will always be the patients who sometimes wonder if what they are getting is quality medical care. Furthermore, in some respects the losers are the graduates of DO schools who cannot always find a residency program within their osteopathic profession. I was smart enough to heed to advice of my pulmonologist who told me in no uncertain terms “Do an MD residency.” Administrative issues also prevail in some states, like Oklahoma where separate licensure boards, and consequently licensure requirements exist to even practice. While I have never investigated it, I suspect, but do not know for sure that reciprocity agreements among states are much more liberal with respect to MD licensure than DO licensure. Consider also that the issue of whether DOs are real doctors is still a point of contention when looking to practice in many foreign contries.
    If I were given the opportunity to have myself redesignated MD I would do so. That fact is that my degree says Doctor of Osteopathic Medicine. There really is no difference and the concept of osteopathy has in this day and time blurred to the point of non-recognition save to those striving to maintain the status quo.

    I haven’t figured out how to subscribe to this site, that is to leave a fancy calling card like “gutter_snipe” or “seekers_beware” but will just say that my comments do not need to remain anonymous. If you feel the need to verbally slash my tires or send the boys from Chicago to break my fingers for simply expressing opinion you may reply with email to famdoc at cox dot net. I would love to hear from colleagues in reasoned dialogue as I am taking a sabbatical from the madness of managed care and an association with a local hospital which basically destroyed my practice and filled me with anger and cynicism.

  32. I am on the inside of this one. the problem is hospitals in DFW are saying they don’t want to be known as “D.O” hospitals. So they might not let our students rotate there anymore. Offering a dual degree is one thought in how to solve the problem, but there are a ton of obstacles to overcome. Im a DO, chose to be one, but just don’t see the real difference anymore. Honestly, they just should combine the whole thing and offer an osteopathic tract in every medical school.

  33. Bruce Stafford, DO says:

    Insider,
    Yes, wouldn’t that be the real way to go? I say have one physician (medical) community with training encompassing those aspects of OPP that are evidence based or with at least a HIGH DEGREE of confidence and call it what it is, a medical degree plain and simple. Offering a so called “osteopathic” track would accomplish what AT Still likely had or at least should have had in his long term vision for the future of medicine – a combined medical profession not bound by the simple dispensing of medicine or the wielding of a scalpel but also the whole body concept of medicine which was hammered in to use at OSU in Tulsa. That would be vindication for the concept of osteopathy and in truth vindication is what we need to move on. As far as I’m concerned I am a medical doctor with training in Osteopathic Principles and Practices. With respect to the above, I know for a fact that while not necessarily getting those aspects of “holistic” training in medical school many allopathic residencies, including the one I attended do integrate whole body teaching into their training. Isn’t all this just academic?
    The AOA (to which I do not belong)and the enthroned rulers will never go for anything but the current status quo; no one ever dismantles an ivory tower, they just build it bigger and charge more to join.

    Cheers, from Oklahoma where it is cold and snowy today and the only thing worth doing is sitting around with a cup of hot chocolate with my cats and watch the wildlife scarfing down the seed I put out this morning.
    Cheers

  34. TCOM Student Tim says:

    An evaluation of research on the differences between MDs and DOs is very limited. Osteopathic Manipulative Medicine has ONLY proven to be helpful for low back pain. The American Osteopathic Association has funded a ton of research but has blocked most of it from publication due to the poor results on much of OMM. This is a truly horrible act of unprofessional people that are trying to save their jobs and a profession that cares more about their historical pride than the people they claim to want to serve. The literature also shows no difference between holistic medicine approaches between MDs and DOs. 65% of DOs go into primary care and 45% of MDs go into primary care which is good. DOs are sued a bit more than MDs when you compare specialty by specialty which is bad. DOs have more disciplinary actions by medical boards on the average than MDs which is scary. I have learned that AOA residency training is far inferior to ACGME and plan to do ACGME training when I graduate. My father is a DO and I only applied to TCOM. Now I am disappointed as I have learned some of the facts of the profession that has helped put a roof over my head for my entire life. As I have learned more about the big MD fight it appears that UNT adminstration is trying to find good clinical rotations for the students. I am all for the administration in doing what it can do to support my fellow students in becoming good doctors. Unfortunately, with all the osteopathic hospitals now closed it looks like we will only get the hand-me-downs that are not taken by the other medical schools. I am also horrified by the acts of many of the alumni that are only thinking with their emotions and not their brains. I would like to encourage the alumni and older DOs to at least listen and try to understand the current situation at TCOM. It is clear that they remember the TCOM that had several osteopathic hospitals to teach students. The MD degree may just help bridge the gap and allow TCOM to get the clinical rotations that we need and deserve. I am mostly disappointed in seeing the actions of TOMA and their president Dr. Troutman. He has been a fanatical leader that has tried to enrage students for his political purposes. I would like to suggest that DOs everywhere and especially TOMA leaders to start thinking like caring doctors that want to help people rather than emotional protectors of the status-quo.

  35. Here is one of the most succinct explanations between a DO and and MD that I’ve seen. It also contains a link to the AOA’s questions you should ask yourself before selecting a DO as a primary care provider.

    http://lifebridgeblogs.blogspot.com/search/label/osteopathic%20medicine

  36. Community Leader says:

    I have carefully reviewed various actions by the AOA, TOMA, and other osteopathic leaders. I am shocked about the low levels of professionalism by the osteopathic community. While I have heard of various examples over the past 20 years at TCOM of horrible behavior and poor quality care by DOs, any reasonable person that has reviewed the actions by the AOA leaders can have no doubt of the untruthful, insecure, sometimes evil and harsh, and unknowledgeable leaders of TOMA, AOA and others. The actions that have been completed by osteopathic leader, include: attempting to close TCOM through non-accreditation by their AOA accrediting body, not funding the osteopathic research center, voting whether a new degree program should exist at UNT (that is the UNT Board’s job), horrible language and attacks on TCOM leaders, untruthful and outright lies to legislators and other community leaders, and a complete disregard for improving health of the population or the physician supply of the region. I see no other option for TCOM but to drop the DO program immediately, and add an MD degree as the exclusive program at UNT. The hospitals, physicians, patients and entire Fort Worth community will enthusiastically support this action and with open arms. Clearly, the AOA and the osteopathic leaders do not desire for TCOM to exist. The osteopathic leadership has been nothing more than bullies in trying to sell their position. TCOM has no choice but to turn to the strong desires of the Fort Worth community for many years. My advise to TCOM leaders….stay strong, drop the AOA and certainly TOMA, and get a big hug from the Fort Worth community that truly loves that you are here. TCOM and its leaders have been abused long enough by these horribly unprofessional thugs that live for professional pride and for a history that no longer exists.

  37. Holly,
    You are wrong.
    The degree should be changed from DO to MD or MD,DO.

  38. Robert, You said the following: “I am a past President of the TCOM Alumni Board and graduated in the 1970s. I would rather see TCOM close than offer an MD degree.Yes, I would rather have TCOM close its doors than change its philosophy even a little bit.”
    Robert, your statement is rhetorical. TCOM will be fine if it offers the MD degree. Why? It will let go of the minute poor dull funding of the AOA and begin to get a largess in funding from the AMA.
    So, Robert, you are wrong. And, again, the little girl Holly, you are wrong –> time to grant the MD degree at TCOM and time to grant MD to other DO in the U.S. and now!

  39. gary,
    You are wrong. Certainly, you had 1 correct statement in that the school does have a history of providing primary care physicians serving primary care, but the hospitals here in our great Texas state just does not want to have the label “osteopathic.”

    gary, I just want to correct you. Most citizens of Fort Worth would be proud to have a fine MD school alongside the DO school. People are just more comfortable with MD, that is just what the world knows. The MD school is a brilliant idea and Scott Ransom,DO,MBA,MPH is just the astute, honorable, and amazing man us DOs are thankful to have to bring us into modern medicine, what all DOs want. Again, gary, you are wrong. It’s time to change the DO degree to MD or MD,DO and I wish I could stand right in front of you and tell you that in person.

  40. Ku,
    You are wrong.There is no reason you should be confused. DOs are not inferior to MDs and DOs can be specialists. The family pulmonologist you saw was a DO. The issue at hand here is not satisfaction with care or your comments, rather it is for the public to know that DOs are medical doctors. You are wrong Ku. There should be a change from DO to MD,DO.

  41. Tony Bagadonuts,
    You are wrong. UNTHSC will benefit with the relationship with JPS. The MD program will be very appealing to provide a wider array of physicians to Texas, the local medical community and JPS. Once again, Tony, you are wrong. The best interest is for UNTHSC to have an MD school along side the DO school, and ultimately an MD,DO degree may eventually be created. Tony, you are wrong.

  42. Garry,
    You are wrong. You are not funny.

    You are wrong, Garry.

    Garry, the Osteopathic school in Texas does not have a fine (and long) history of providing fine primary care clinicians to the state. Many of it’s graduates do not provide primary care to underserved areas of rural Texas.

    Most citizens of Fort Worth would be proud to see this d.o. medical school replaced by an M.D. program.

    Garry, you are wrong! The citizens of Texas want an M.D. program!

  43. Greg P,

    You are wrong.

    No, this does not sound like an idea from the MD-lite idea.
    No, this is not about a glut of enrollment slots or trying to make UNTHSC stand out.
    No, Greg P, this is about the recognition of DOs as physicians, equivalent to MDs.

    The plan is that UNTHSC will offer MD degrees with the new MD school and eventually
    then combine the degree for the DO & MD school together to form a “MD,DO” degree.

    This will set a trend for other osteopathic schools around the USA to follow suit soon after.

    So, Greg P, you are wrong.

  44. DOMD,
    If you’re going to individually tell every commenter they are wrong, you’re going to be an even more tedious bore than you already are.

    As an aside, persuasive arguments don’t start and end with ” you are wrong”.

  45. GruntDoc,

    You are wrong.

    I am not tedious. I am not a bore. My argument is persuasive with starting and ending “you are wrong.”

    You are wrong that TCOM should “be a proud DO school”. You are wrong that UNTHSC has to “make a choice” on being osteopathic and/or allopathic.

    Your guess is wrong, however you are correct in that your answer is “based on nothing whatsoever”.
    UNTHSC is not a “change from a DO to MD school” , but rather a blend of the two, a new change to “MD,DO” eventually.

    You are wrong GruntDoc, but great website!! (please do not delete my comments; thank you).

  46. Thanks for proving my point.

  47. Concerned TCOM Student says:

    The osteopathic profession appears dead-set on killing TCOM. While the leadership of the American Osteopathic Association and the Texas Osteopathic Medical Association claim they hope to support and secure the Texas College of Osteopathic Medicine, their actions are very different. One of the Deans told me that the AOA and TOMA leaders have recently blocked state support for the Rural Osteopathic Medical Education Program that would have helped support students interested in practicing in rural parts of Texas. I am told that the several million dollars of state support per year would have permanently supported more than three dozen students and new faculty with scholarships and other support. I am a ROME student and would have liked the scholarship money that TOMA and the AOA eliminated.

    I am now told that TOMA and the AOA are attempting to kill the accreditation of TCOM. I overheard one of TCOM Deans say that the AOA is looking to block accreditation due to the talk of the MD degree on campus.

    When will the osteopathic profession stop trying to commit suicide? TCOM leaders claim they want to protect and improve TCOM. I am not aware of anything that TCOM leaders have done to block the actions of TOMA and the AOA. Perhaps they want to secretly kill TCOM so they can start their MD school.

    It sounds like a perfect storm. AOA and TOMA leaders are blocking funding and now trying to end the accreditation of TCOM. TCOM leaders want a MD school. It sounds like TCOM will soon be closed given the actions of the leaders of the osteopathic profession. Good job AOA and TOMA, now that you have already killed every osteopathic hospital in Texas, you are near killing the only osteopathic medical school in Texas.

  48. Concerned TCOM Student,

    You are Right.

    “The osteopathic profession appears dead-set on killing TCOM.”
    The actions of the AOA and TOMA are different when claiming they hope to secure and support the TCOM.

    You are right that these AOA and TOMA personnel are provincial,stubborn,lacking ingenuity, and dogmatic in “blocking state support for the Rural Osteopathic Medical Education Program that would have helped support students interested in practicing in rural parts of Texas.” You are right that you would have benefited from scholarship money if it weren’t for the obstinence of these cheap suits at the TOMA and AOA.
    You are right that “TOMA and the AOA are attempting to kill the accreditation of TCOM.” You are right that this “AOA is looking to block accreditation due to the talk of the MD degree on campus.” You are right that this osteopathic profession will never try to “stop trying to commit suicide.” TCOM leaders do not want to protect and improve TCOM.

    Yes, it is a perfect storm. TCOM leaders do “want a MD school” and should have one. TCOM will not be closed if the UNT and the AMA step in helping grant the MD school and degree. Then the AMA and government funding will come in for research and all the medical students’ rotations. It’s fine if the AOA and TOMA destroy the osteopathic school in Texas, the MD school will thrive.

    You are Right “Concerned TCOM student” and you should continue to be very concerned….. Pray for the initiation of an MD school at UNT, “Concerned TCOM Student”, and pray for possible degree change from “DO” to “MD” or “MD,DO” at UNT (TCOM) and the degree change to be followed suit around the Nation.

  49. Concerned TCOM Student says:

    Domd,
    I recently completed a surgical rotation with a group of MD General Surgeons in Fort Worth that were recently made faculty at TCOM. This was the highest quality group of physicians that I have had the opportunity to work with during my third year. They were passionate, caring, great teachers, and amazing surgeons. Why shouldn’t TCOM students have the opportunity to work with these great doctors? One of my classmates was required to rotate with a TCOM DO surgeon and the experience was horrid and non-beneficial. The surgeon had poor volume, more concerned with getting home than caring for patients, and not a quality person. While I am sure that there are some excellent DO surgeons, I was so impressed by my experience with this Harvard trained surgeon that it turned my head to fully support the MD degree on campus. It appears that an MD degree on campus will expand the clincial opportunities for both DO and MD students which will have a dramatic and positive impact on my education. I have also heard that the surgery rotation at JPS is excellent and exclusively with MD surgeons.

    I did enjoy working with my rural family practice DO for a month; however, TCOM must work with these excellent MDs to create outstanding opportunities for TCOM students. Why are these older DOs scared of letting MDs train on our campus?

    I only applied to TCOM and am happy with my choice. My doctor was a DO and convinced me only to apply to TCOM. I had a 29 on my MCAT and probably could have gotten accepted to a MD school. Now that I have worked with a few MDs, I just don’t get the paranoid attitude of TOMA and the AOA.

    It is clear to me that these osteopathic leaders only care about their own jobs, and osteopathic pride (whatever that is), and certainly do not care about my education. Why would TOMA and the AOA challenge accreditation at the nation’s top osteopathic school with the best COMLEX scores? They should start focusing on quality and close a few schools that are diplomat mills. TCOM is great and getting better as MDs become TCOM teachers.

    Sorry for the rant. TOMA leaders have been misleading my classmates over the past few months on this MD issue. Frankly, TOMA should just disappear and leave us alone. I know that the majority of my classmates are tired of hearing of the paranoid presentations of Dr. Troutman and his TOMA gang. TOMA has proven to me and most of my classmates that they are simple-minded and unprofessional. I plan to stay in Texas and will not ever become a TOMA member, but plan to become a member of TMA. TMA seems interested in improving the quality of care and actually help physicians with real issues like tort reform.

    Concerned Student

Trackbacks

  1. […] Osteopathic schools offering MD degrees, is the recession to blame? December 13, 08 by admin An osteopathic school in Texas is considering adding allopathic MD degrees. (via GruntDoc) […]