UNT Thinks an Osteopath is Inferior to an M.D.?
Texas is apparently suffering from a doctor shortage. But really it’s not so much a doctor shortage as a primary-care/family practice physician shortage. The University of North Texas says it wants to help this problem by opening a second medical school in Fort Worth.
Apparently they want an M.D. program, in addition to the existing osteopathic medicine college that they have over there. But here’s my question: D.O.’s have historically been more committed (a greater percentage of them make the choice) to going into primary care than have those with M.D.’s. From an old New York Times article:
One of osteopathic medicine’s most marketable features these days is its longstanding commitment to general medical practice, or primary care. Osteopathic education has historically prepared students exclusively to take care of patients rather than become specialists, academics or researchers. Osteopathic medical students generally spend considerably more time working as apprentices in clinics and private offices than their conventionally trained counterparts. ”We live with patients in the wild,” said Dr. Tyler Cymet, an osteopathic internist in Baltimore. ”We get
to see what they’re like.”Although the number of osteopathic doctors in primary care has fallen in the last 20 years, about half of all practicing osteopathic doctors are still primary-care doctors, Dr. Wood said, in contrast to only about a third of M.D.’s.
Sorry that article is about a decade old, but I think that’s still generally true. So if what you need is more primary care doctors, and osteopaths are more likely to make that career choice, why not push to expand the school you have, rather than create a whole new one?
The answer is that a D.O. still doesn’t command the same respect as an M.D.?
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I think many in the general public have a misconception that a D.O. is inferior to an M.D. But I don’t think that has anything to do with why UNT wants an M.D. program.
It seems to me that they’re trying to dramatically raise their profile. They’re building the new stadium, pushing for the law school downtown, and now talking about an M.D. program. You can’t really fault them for that and, as a UNT grad, good for them.
It was generally well known thought that D.O. schools accept much lower MCAT scores and GPA’s than do the M.D. programs. At least this was the case when I was pre-med 10 years ago. That is why most of my classmates and I considered a D.O. to be less important than a M.D.
Well…osteopaths have made great progress in repairing the previous attitudes toward their qualifications. It’s important to go back and understand where the perceptions started.
Up until 10-15 years ago, very few DO’s had a residency or internship. Yep, that’s right. The first day you, as a newly graduated DO, got to touch a person (live or dead) was the same day you opened your practice. Practicing on live victims, I mean patients, has some benefit. IJS.
The UNT program is OUTSTANDING. As a former healthcare administrator and consultant, I judged the quality of a practice by the doctor to doctor referrals. Many of the DO’s in the UNT program have equal parts referrals from MD’s to DO’s. It’s one bright shining example nationally as to how a DO program should run.
Here’s the real skinny…UNT wants both programs because it wants both programs…that kind of cross coverage gives it a unique appeal and will further med training in this area exponentially. It’s a good thing.
I’m not sure the stats in the story hold true. If we really wanted more PCP docs, we would work to get international accredidation to Asian med schools. (Like the University of Karachi.) Yes, in the US, this (family practice, internal medicine) is deemed a “lesser” discipline than say surgery or specialization like dermatology, but globally, there are docs waiting in line to get into private practice here.
Also, if we really wanted to solve the PCP issue, we would expand training of “adjunct” providers like PA’s (physician’s assistants) and NP’s (nurse practitioners). Using those two types of providers in a PCP clinic makes a practice at minimum 30% more efficent per professional. I suspect the real motivation behind the MD expansion at UNT is to have another PA program that will give the one at UT Southwestern a run for its money.
It’s a win-win for patients.
Jeff, you shoulda gone to med school in Grenada. I’ve seen you tan. It’s hot.
D Magazine should be familiar with this issue: It’s about research dollars.
The D.O.’s are great. But there are more research dollars for M.D. schools.
“So if what you need is more primary care doctors, and osteopaths are more likely to make that career choice, why not push to expand the school you have, rather than create a whole new one?”
Easy: resume inflation. “Created new institution” looks better than “added another wing.”
If we want more doctors (DO or MD)in the USA we need to set up a national health care system that limits what the doctors can charge, forces more patients than they can safely see into the system and then allows attorneys to sue the docs for outcomes that the patients don’t like.
As is often the case, the answer is complex, too much so for a complete answer here. Traditionally osteopathic medicine was based on the premise that all diseases originated in the bones. Osteopathic medicine has evolved and much of their teaching and practice is now very much the same as allopathic medicine. They were over represented in primary care as that was often the only opportunity available to them as typical residencies in specialities were closed to osteopaths. Given the convergence in training, there is little reason going forward for more osteopathic education. It is not about inferiority but simply an unecessary duplication of service. Good for UNT to be willing to take on the huge undertaking of creating another (badly needed) medical school in Texas.
Amanda,
If we wanted more primary care docs we would address the average debt of kids coming out of medical school (175,000 on average currently) and the differential specialists like me get paid. How can you expect really bright kids who want a reasonable life style to be asked to take on that kind of debt without a hope of making what a dermatologist does working 8-4 four days a week. We dont need more foriegn doctors at all…i do agree that we need more extenders but state legislators are unwilling to allocate any money to expand those schools. Oh well…gotta go to work. My fees were just cut 40% for next year. Lots to do and no more time to talk.
Very good Dubious. I was thinking thinking the same thing. This is a stupid time to open another medical school when there will probably be a huge drop in applicants. A lot of people are going to think twice about going into medicine when they are not sure what their future holds. Why go in debt for thousands of dollars to get government payments?
MNS, MD: Thank you for educating everyone. I know three docs tossing in the towel, which means their employees will be out of work, their rents not paid. We were at a medical conference last weekend and I asked, why are you guys and gals so darn complacent about this? Where’s your fight? Every doctor I know equates Obamacare to a four letter word. From watching my husband, I know you’re weary. What about unionizing?
Funny how no one wants to talk about tort reform.
Tort reform is not the issue. Insurance companies will still charge an arm and a leg as there is NO relationship between what they pay out and what premiums they take in — based on necessity that is.
I know plenty of MDs who are FOR Obamacare.
Do you Drs. wish to cancel Medicare and Medicaid too?
And in general, are there a bigger bunch of whiners than doctors?
Geez.
It would be nice if we could go back to a cash for services system where A doctor would only deal directly with his patients on the cost of necessary healthcare. The first doctors who accepted insurance as a form of payment really let in a Trojan Horse into the doctor/patient relationship. Perhaps that is why doctors ‘whine’ the most. They have lost most of the control over their own profession. I wonder if government intervention will bring control back to the doctor patient relationship or take away what very little is left.
@VDHOAWP
Tort reform has been great for Texas. Malpractice premiums have decreased and there are now areas in south Texas which could not attract neurosurgeons or OB-GYN’s who have been able to get these docs to come to practice. You are incorrect about premiums as the TMLT is one of the largest carriers in the state and it is DOCTOR owned. Doctors are for whatever is good for our patients…unfortunately the AMA endorsed health care reform hoping the SGR would be repealed without actually knowing what it was going to be. It is not that we want to cancel anything but remember that as of next year MC will pay cardiologists 40% less than this year…it is hard to be a big fan when that occurs or they pay primary care docs $12 for an office visit…that is below what it costs to keep their office open. Doctors=whiners? That really gets me mad. I spend 4 years in college, 4 years of medical school, 3 years in Internal Medicine training then 4 years of Cardiology training. I still work 60-70 hour weeks taking care of people who abuse themselves and expect us to fix them quickly and without any participation on their part. They call us at all hours (for which we don’t charge) and expect us to be available at nights and on weekends without fail. If we make a mistake we are sued often. With all that our incomes are steadily being and our President accuses us of abusing the system and treating patients based on their ability to pay. Candy is correct that many of us are terribly discouraged by all this and looking for a way out. Your sentiment is all too common these days….remember that when you have your heart attack and cant find a heart doctor to come in at 3 AM to save you life with an angioplasty.
UNT TCOM in Fort Worth is already an excellent school. However, creating an adjoining M.D. program would open even more doors for the D.O. students. Area hospitals have said, flat out, that they will offer more rotation programs for 3rd and 4th year students only if there are dual programs – they do not want to be labeled as “D.O. Hospitals”. Currently some students must move out of state for months at a time to complete certain rotations. With that in mind, and also the fact that an M.D. program will bring in more funds, UNT TCOM has decided to explore this M.D. option. It is widely thought that if UNT doesn’t, another existing school will enter the Fort Worth community with a branch. We should be excited that a sorely needed medical school is being added to an underserved state and appreciate the people and revenue this will bring to the metroplex. And for the record, most young M.D.s and D.O.s think there is no difference between them and they treat each other with respect.
Aren: Whose resume?
@ MNS
LOL. Yes, patients, by definition, are the largest group of whiners.
MNS @ looks like you need a good consultant. My clients were happy AND profitable. It can be done, but for the most part, no medical schools were teaching doctors business theory and practice management until 15 years ago (and it’s still rare.)
And, yes, we need more foreign docs if they are willing to work for the wages made by PCP disciplines, which they are.
“It would be nice if we could go back to a cash for services system where A doctor would only deal directly with his patients on the cost of necessary healthcare.”
sure if the patient would pay their bill. I remember watching my father and mother sitting down at the dining room table each month preparing the patient’s bills. I remember one month dad commenting “I see where Mrs. soandso still hasn’t paid her bill. I notice she has not problem buying a new Cadillac each month”
Amanda: Medical schools teaching business theory and practice management? Are you kidding? The current reimbursement system created by our government is a poster child of how NOT to run a business. If you are a medical consultant, surely you know what CLIA is. http://wwwn.cdc.gov/clia/default.aspx One tiny example: your nurse draws a patients’ blood, you don’t just throw away the needle in the trash. All medical waste has to be picked up by a company that disposes of medical waste according to CLIA guidelines. Guess who pays for that: the doc. Guess who doesn’t reimburse for that: the insurer. Get the picture: for years the government has been laying more and more regulations on the docs, all contributing to more overhead, while the insurers have been lowering reimbursements and patients whine about $10 co-pays. I’d love to see the day when a patient goes to the doctor, an intern hands her a bottle of Lysol and says, here, clean your own exam table. Bring your own paper and exam gown in, too. How are foreign doctors going to work for PCP wages and still maintain the laws imposed by our government if they practice here? Far less to give us all a plane ticket to India to go see a doctor there.
By the way, while you are all whining about physician pay, let me tell you vets now earn more than most physicians. And don’t even get me started on what Wall Street execs pull in… bonuses as large as what many physicians make in one year!
@DallasIsHometoJimmyCarter?!
Wow, doctors are the whiners? Yeah, Fred Baron and his ilk are the real freedom fighters in this country. 1 ambulance chaser down, millions more to go.
UNT has never suggested that a DO is inferior to an MD. The Texas College of Osteopathic Medicine is expected to grow to 230 new students per class in the next two years after a new building is constructed to support the growth. Nationwide, 230 students is the normal large size for a good medical school. Thus, UNT is raising the DO program to the logical maximum size before the MD program is started. An MD class size of 100 is targeted to increase the physician supply and utilize existing facilities at UNT. This is a good way to create more doctors at a very low cost for a rapidly growing region that needs more physicians.
This is bad, but I almost hope we have another plague or something like Swine Flu squared that will make people stand in line for days to see a doctor. The problem is we are all relatively healthy in this country, and the poor get care, free care, they just have to wait for it. But when everyone has to wait, there is going to be an uproar like nonething you’ve ever imagined. Of course, maybe that will finish off the democratic party. And all of us.