what are we doing to stop the mini-clinics popping up in wallmart, grocery stores and pharmacies run by nurses and physician assistants playing doctor and taking patients away from doctors offices whom actually went to medical school. How are we letting this happen? VERY CONCERNING!

"Family Practice", if not already, will probably be dominated by PA's and CRNP's in the immediate future for a variety of reasons, probably first and foremost, that medical students cannot pay back their loans from college and medical school in primary care given any reasonable time frame, causing a shortage in primary care docs. Also, it's not unusual to see a private practice with a couple docs, to be followed on their marquee by 5 or 6 physician extenders, such as PA's and CRNP's. DO's and MD's themselves are contributing to the changing landscape in primary care by sponsoring physician extenders not only in private practices, but in "pop-ups" at Wall Mart and other locations. When PA's first arrived on the scene many years a go, there was an outcry that any physician that would sponsor a PA would put their own profession at risk, now it's commonplace and more economically feasible for physician owners to hire physician extenders, rather than hire physicians for their practices based on salary differences.

i fear radiology will be the same in a few years as technology improves. it will be outsourced to india and australia for cheaper prices.

Sometimes I wonder why I join and pay annual association fees, when the medical profession continues to errode. Medicare and insurance companies are forcing us to allow nurses and physician's assistants to play doctors by cutting reimbursement, making us spend $10 to collect $5 and the legal system driving up insurance, as well as outsoucing medical care to other countries. I thought the "association" was suppose to be in our corner and not sellout our corner. GOOD LUCK

addendum to previous; this is occurring in many specialties and not just family practice

hi aoa

please see this video

http://www.forbes.com/video...

is this the future of primary care america? where will DOs be, in a Walmart?

There was a good selection of comments on a variety of topics last month, they suddenly disappeared and there was no activity on the blog almost the entire month of December. Then just recently a select group of mostly older blogs were reposted. Activity in general, is very low on this site. I would suggest not removing the blogs and categorizing them by topic at some point so the discussions, some of which were very good, could continue. I've also noticed there is rarely an answer by questions posted to the AOA or webmaster.

Just wanted to inform you that the new AOA daily template my university has been receiving are not displaying correctly (even when the pictures are unblocked). The old format worked perfectly.

It would be great if someone could fix this so I can read the Daily Reports in their entirety.

Thanks.

I am amazed that both MD and DO medical directors and physicians who sit on the boards of trustees of most hospitals are not just allowing family practice physicians to be removed from those practioners who can admit and care for hospitalized patients, but are encouraging it. Many hopitals will allow a hospitalist program to not only include but be directed by nurse pratitioners, but not allow family practice physicians to admit patients. I am not denegrating nurse practitioners, but I do not think that they are more capable of caring for hospitalized patients than any board certified family practice physician, including myself.

And with many insurance companies not allowing board certified FP's to have patients referred to them for OMT (and my certificate says that I am board certified in FP and OMT, year 2000, last class to allow these words) we are also losing the ability to do OMT. I know that the OMT or NMM specialists are lobbying for this practice, even though the reason many people seek our FP's for manipulation are because, not only are we good at it, you have to wait several months to get an appointment with many OMT or NMM specialist, and you can see me right away. Again, I know many NMM and OMT specialists who are wonderful, but there are not enoughof them, and I may not be able to care for all the patients who need OMT, but I am capable of caring for most of them.

If I cannot do OMT, or care for patients in the hospital, I am left with filling out paperwork for referrals to those nurse prationers and chiropractors and physicians who apparently received much better training than I did. I guess the quarter of a million dollars I had to borrow just doesn't amount to enough training.

I want to know why I was encouraged to become a family practice specialist when I graduated in 2000 when the powers that be in MD and DO circles were intent upon pretty much eliminating my specialty. All my training was done in an inner city hospital, side by side with internal medicine dotors, who actually had to learn how to do fewer procedures and care for a much narrower patient population than we did.

And why is it family practice doctors have the highest number of CME credit requirements of ANY specialty, at least with the AOA, if we are so incapable that a nurse practitioner and a chiropractor are better qualified to things we are not allowed to do?

I wanted to become a physician, not a paper pusher. At this point, if Walmart would let me care for my patients , do OMT and admit my sick patients to a local hospital, I'll sign up right now. Walmart is only one many major problems primary care is facing today, and it is our own fault.

Dr. Katherine Grover, DO

Hello

I am a Nurse Practitioner and I feel that we have the same level of expertise as family docs (DOs or MDs) and we should be able to get even more practice rights.

Family docs and NPs will be competing closely in the future and NPs will make sure that we do not lose out.

We are cutting health care costs and giving the same level of care as family docs.

NPs cannot replace internists or specialists, but we can and will replace family docs.

Since most DOs are mainly family docs, we will be competing with not only family docs but also with Physician assistants.

We invite family docs to collaborate with NPs and Physicians assistants and lower health care costs.

Dear Dr. Sharretts:

Let me apologize for what you noted regarding the absence of many older comments and items from the AOA Daily Reports Blog. In December 2006, the Daily Reports Blog "crashed." Because of this crash, the entire archive was erased, and we were left with no other option but to rebuild the blog from scratch. I thank you for your patience as we continue this process. As you can see, most of 2006 has been reposted as have many comments; however, we unfortunately were unable to recover all comments and posts. We will continue to update this blog every day in 2007 to stay current and hope to have all the archives restored soon.

--JBC

Hello,
It is really interesting to find that PA and nurse practioners will be competing with DO's. Since the public in general are confused of what a DO is because medicine is not in the letter designation as we have talked about in this blog and the Presidents Blog with over 80 comments, majority wanting a change letter designation. Physicians assistants and nurse practioners which their names reflect meaning will have more patients because of the public knowing what they are getting. As it has been said 1000 times but AOA does not want to do anything about or anyone in that matter, yes in the future there is a high chance we will be working in Walmart but we would not getting as many patients in a day, since most are time will be explaining to the confused public of what a Do is instead of treating them.
I am not making fun of the situation but some do not realize that just being proud of our profession is not help bring in patients and make us known and reconized as physicians worldwide, making sense by changing the letter designation to reflect our diplomas will and actually become a catalyst in doing so.

Thank you for your feedback Mr. Crosby.

excellent comment MD-O...i agree with you...the problem is, i dont want to be competing with phy assistants and NPs as a family doc. i rather be a good DOC instead with a lot of respect and have no confusion about it.

Hello Family doc michigan,
Htnak you for agreeing with me, I think many have been in the President's Blog. If there is a change of letter designation, there will not be any competition with NP's and physcian assistants. When the public nationally and internationally reconize that we are physicians with the special ability that MD do not practice, then patients will see that local stores will not be able to provide it. The best to get the message across sooner and efficiently is by simply changing the letter designation which will correlate to what we practice and our diplomas. As it is now, we are competing these groups since if we are not being logical of what we do and practice, how do we expect the public to come to us rather than go the local Walmart if they do not want a DO is or stands for.
The change will take time and effort, but it will be worth it. Why are their people who are opposed to having an M in the DO, if they are they should go to Europe where the DO's there do not practice medicine at all. The DO's who are medicinephobics even though they practice it everyday should not be afraid of their work. It sounds harsh, but I do not see the problem to changing a title to one that correlates to the practice!!!!!!
Again it is not about gaining respect, being a good doctor, or any other personal glorification, it is about making sense and being recognized of what we do to those we are trying help, the public.

Sorry to disagree with you, NP, and PA but ou are not as qualified as a Physician. You must and should practice under the supervision of a Physician. Yes you are cheaper but less experienced in many ways. I know because I supervise and have been involved with the training of many PA's and NP's. A good physician should know his skills and his or her limitations. Gloified Physician "Extenders" many times do not recognize their limitations when they exist. and they many times do exist. There is nothing worse then an egotistical health care provider what ever their title, M.D., D.O., PA, or NP.

I keep looking on this website for a jobs available posting. It would think it would be to the advantgae of not only the Osteopathic schools but also the AOA to have a job listing readily available on the Do-Online website. I know certain schools are desperately searching for instructors/professors..yet I can't find them listed on any DO oriented website...WHy?? and what are those of us who are looking to relcate supposed to do?? We might want to stay in Osteopathic oriented education ut we can't find the jobs?

I know the fallacy of ad Hominum assaults but the NP (or PA for that matter) who feels their training rivals a residency-trained physician is delusional. The irony of ignorance is that you do not know what you don't know. When a disease is not on your broad differential diagnoses then it cannot make it to the final Dx. As an ER Attending I see many "bounce backs" from PAs who treated Trigeminal Neuralgia as a toothache with PenVK as one example. Can you think of 30 causes of abdominal pain? How about 100? 200? A two year program cannot complete with 7-10 years of formal training.

Dear Dr. Grover:

The AOA Division of Socioeconomic Affairs works to resolve all credentialing disputes where OMT certification is challenged, and where there is failure to recognize the validity of osteopathic training in OMT. Anybody who has experienced discrimination based on osteopathic education, training, and credentialing should feel free to bring it to our attention so that we may challenge such a policy. Contact the AOA Division of Socioeconomic Affairs at 1-800-621-1773 extension 8282 or by email at practicemanagement@osteopathic.org.

The AOA advocates at the state level to protect physicians' scope of practice from encroachments from less-qualified non-physician clinicians (NPCs), including nurse practitioners, and a wide range of other health care professionals. The AOA and several state osteopathic medical associations are facing dozens of scope of practice encroachments in numerous state capitals. To address these NPCs attempts to expand their practice rights, the AOA has joined the AMA Scope of Practice Partnership to strengthen and coordinate our advocacy efforts.

With a wide variety of NPCs seeking broad new authorities without corresponding increases in education and clinical training, physician organizations are working together in opposition to these efforts. The osteopathic family holds the position that physicians are the most educated and trained medical practitioners and as such physicians should be the leader in the team approach to health care delivery.

JBC

Dear Dr. Robinson:

Thank you for pointing out the importance of having an online employment resource for DOs to post and apply for osteopathic jobs. DO-Online has such a service available to all members of the osteopathic family. At the very top of the DO-Online home page you will notice a link to DO Jobs (http://www.do-online.osteot...) that will take you to DO Jobs Online, your online source for jobs in osteopathic medicine. I encourage all members of the osteopathic professional family to use this great resource for recruiting prospective employees and applying for osteopathic jobs.

JBC

Dear Mr. Harry:

While I recognize the valuable role that Nurse Practitioners play in the health care delivery team, I disagree with your claim that NPs hold the same level of expertise as family docs (MD or DO). DOs and MDs both complete four years of graduate medical school, an internship and a three-year residency, exceeding the training required for NPs. Further, DOs and MDs are the only two clinicians recognized by state and federal statues for the unlimited practice of medicine.

The AOA has carefully researched and developed a policy paper citing efforts by non-physician clinicians (NPCs) to expand their scopes of practice without similar expansions to their education and training, which is available in the members-only section of DO-Online. While some facets of a family physicians practice at times may overlap with an NPs, the fact remains that the physician, by virtue of his or her education, training, and federally-designated right, should be and is the only provider who can practice with full medical practice rights.

As patient safety remains the primary concern of physicians and the organizations, like the AOA, that represent them, we will categorically oppose such expansions until it can be demonstrated that they are accompanied by expanded education and training and pose no threat to patient safety.

JBC

Thank you Dr. Crosby! That is a refreshing post and kudos to the AOA for working with the AMA to preserve physician rights! - OU

Jason Harry, Know your role and stick to it! The safety and well-being of the public depends on it. Master of obvious comments are well stated. Further more the cost of primary care physicians is a minute portion of the high cost of health care. Litigation, insurance companies and advances in technology are a major contributing factor to costs. From what I can tell NP and PAs are already overpriced. The AOA and AMA need to take action to stop this coup d'etat or doctors (family,internist, specialists and surgeons) will be dinosaurs.

excellent response to the NP...thanks Dr.Crosby

I get D.O. students from 4 colleges and they consistently complain that the AOA serves no purpose for them because they want to seek the best residency [many times allopathic] and the AOA won't approve it because there are D.O. residency spots available. I see this as a crossroads for the D.O. profession. I believe the day of the "Osteopathic Hospital" is over, there were numerous Osteopathic hospitals in PA when I was training [early 80's], now none that I know of still carry the Osteopathic name, they have mixed D.O./M.D. staffs, but still cater to D.O. students and have D.O. programs. Increasingly, D.O.'s are occupying residency spots in what historically were strictly M.D. hospitals. Case in point: I trained at Jefferson U in Phila [AOA approved] because no D.O. spots were available in that specialty, at the time there were only a few D.O.'s in residency there, now there are around 25 in the first year classes alone. I wanted to pose the question to other D.O.'s and the AOA, what is the problem with encouraging our young grads to seek the best residencies available, approving them, and moving towards ACGME as the accrediting body for residency training for both D.O.'s and M.D.'s? If new D.O. grads are being lost to the AOA because they are choosing the best programs they can get [and don't we want D.O.'s to have top training?], isn't it a moot point to worry about maintaining distinctive and separate Osteopathic training programs?

Where did the link for the "President's Blog" go? Please re-establish the link on the do-online webpage.

You can reach the President's Blog by clicking on "AOA" on the gray menu bar, then "blog." The corner spot where the President's Blog link appeared is used to highlight new or timely features.

Dr Crosby,

Could you by any chance contact Blue Cross Blue Shield and request that they use the term "osteopathic physician" over "osteopath" on their link? The world "osteopath" is an archeic term and denotes negative implications.

http://provider-directory.a..." rel="nofollow">https://secure1.anthem.com/...

Upon clicking on the word "Physician" - A description of professionals who meet the definition appear below. Instead of classifying us as osteopathic physicians it merely states "All doctors consisting of Primary Care Providers, Generalists, and Medical Specialists including Ophthalmologists, Oral Maxillofacial Surgery and Osteopaths."

Thank You

Could you also please encourage this DO to substitute the words "Osteopathic Medicine/Physician" in the stead of "Osteopath/Osteopathy" as the nomenclature has changed to better adapt to the current times. Thank you.

hi

the new AOA website is awesome. very professional look and has everything nicely organized.

i love coming to it and felt i would leave the comment.

Dear Dr. Sharretts:

Thank you for passing along comments that youve heard from your osteopathic students about osteopathic graduate medical education (OGME). To me, they beg one question: If there is no distinction between a DO and MD, then why is there an osteopathic profession?

The US Department of Education recognizes osteopathic medicine as a distinct profession. The osteopathic profession in turn supports a continuum of osteopathic education, not just medical school. The best reason I can think of to maintain separate OGME is to preserve our established coherent educational model highlighting OPP as a core competency and teaching physicians how osteopathic philosophy can enhance every specialty and practice. If you attended an osteopathic medical school and there were no osteopathic graduate programs, osteopathic board certification, or osteopathic CME, what would happen to the osteopathic profession?

Osteopathic medicine is not a place, i.e. an osteopathic hospital; its a profession, a philosophy, a tool that many MDs are anxious to learn. The AOA works with the ACGME and does not restrict trainees from entering their programs; however, five states have enacted laws requiring at least one year of OGME to gain licensure. We encourage students who enter ACGME training programs to remain connected to their osteopathic heritage through AOA membership, CME, and certification, especially if they want to be considered for an osteopathic academic leadership position.

Please tell your students that the AOA works for them to ensure access to the best postgraduate training, which we strongly believe are OGME programs. While many ACGME programs happily accept osteopathic graduates, as LCME schools expand while the number of GME positions remains stable, ACGME programs will no doubt begin replacing DOs with MDs. Without the OGME option, DO students could face a bleak future.

Thankfully, osteopathic students have much to be proud of in 2007. Osteopathic medicine is the fastest growing medical profession in the US. We are about to open new schools with a growing number of underserved communities in the US that sorely need our graduates. Experts are suggesting that schools increase enrollment by 30% to address an expected physician shortage and the osteopathic profession and AOA are working to meet the needs of patients in a growing number of locations, particularly the underserved. In fact, our profession, which currently numbers at 59,000, is expected to reach 100,000 DOs by 2020. Choice is an excellent benefit and our graduates have many. We hope your students find the ideal training program.

John

I disagree with a lot of what Mr Crosby has to say. Although it is true that the AOA needs IMMENSE improvement in GME, CME, and virtually everywhere else - my perception of osteopathic medicine alters from that of the typical person. I don't merely confuse it with someone who does OMM, as international osteopaths - practice OMM as well, infact that's ALL they do - and they have earned the same degree. Also, the philosophy arguement is no longer validated as there are holistic MDs as there are holistic DOs. The education you recieve has nothing to do with the mentality with which you practice medicine. Perhaps, statements attesting to the uniqueness of Osteopathic Medicine should be limited to physicians and not those outside the osteopathic medical profession.

As an osteopathic medical student in 2004/2005 I was an active participant in a program to portray Doctors of Osteopathy in a positive light in the media. I filled out postcards to major studio executives, and kept an eye on popular media to monitor the results of the effort. Recently I was watching television and a commercial came on for RapidSlimSX, the worlds fastest weight loss pill. The spokesperson for RapidSlimSX is Dr. Bryce Swanson, DO. A little research shows that Dr. Swanson is a resident in anesthesiology. While they say "there is no such thing as bad publicity", I am saddened that the first person that I see on TV with DO following their name is an osteopathic resident peddling diet pills.

This is a forum for discussion among practicioners mainly D.O.'s. We should be allowed to offer constructive critism and vent our concerns about the future of our profession. I some times feel that to criticize the A.O.A. is to bring out retaliation. Dr. Sharrets should be listened to and I would like to add my perceptions. First, I come from an Osteopathic heritage, My God Father was a prominent D.O., Harold Davis Hutt brother-in-Law to Thomas E. Dewey. Second I graduated second in my class in undergrad school. I did not default into Osteopathy! third I lecture frequently for the last 45 years, most of them to M.D.'s They seem to accept me for what I offer, without discriminating. In My home town I have a stellar reputation as a D.O. and I have over 250 Articles,Papers, presentations, and research, some of which have recieved first place and other recognitions. I was instrumental in the fight to get the first state funded Osteopathic Medical College at Michigan State and have been on their faculty for over 30 years. I am one of only a hand full of D.O.'s to be accorded the prestigious Fellow in the American College of Sports Medicine. and am a 25 year member in that orginization. I am a member in the A.M.A.S.M. from their onset. My credentials are many and I am considered a long time leader in the field of Sports Medicine, for my expertise, and contribution. I am medical director for McLaren Sports Medicine Centers one of the largest such in the nation. Medical Director for the International Crim Festival of Races for 30 years. My C.V. is long and I am proud of it. However, My point in all of this is that Osteopathy is distinct only in that we do O.M.T. and that is only an adjunct to the whole scope of medicine. I believe that the powers of Osteopathy are parinoid of their own future and as such risk losing many of the fine young physicians, whom they seem to want to corral, not let loose. There is nothing wrong with taking osteopathy to the allopaths, nothing wrong with teaching in an Allopathic program. We are separate and distinct just as this country recognizes Democrats and Republicans. The A.O.A. seems afraid to "Mix" with the A.M.A., for fear of their own personal loss. But the reality of it is that D.O. programs are not all up to quality speed and those of us who are not afraid of the A.O.A. have spoken up. Not to the liking of the power of the A.O.A.
Recently, it has come to my attention that even certification does not measure up. The recent exam for certificate of added Qualification in Sports Medicine was a sham. Of 100 questions 22 were disqualified as invalid. If an organization cannot validify 100 questions then their ability to conduct an Exam is certanly a serious question istelf. I have never heard of such a fiasco. I am embarassed to hold it up to my allopathic colleges. I am not a member of the A.O.A.S.M. because their programs have not had the quality I expect from my other Sports Organizations. Cranking out physician numbers and programs without attention to quality will doom our profession. Lets get back to the basics, QUALITY, not quantity. Too many of us D.O.'s have worked hard to get where we are. Lets not embarass ourselves now. You don't ask for respect, You earn it.
Jon L. Schriner D.O., F.A.C.S.M. Flint Michigan

Dr. Schriner,

As a second year osteopathic medical student, I commend you the exquisetly elequent and refreshing post. I agree, OMT is a part of who I am and doesn't not solely represent me as an osteopathic physician. I graduated in the top ten percent of my class in undergrad and had MCAT scores higher than the average at Harvard, yet I decided to attend an osteopathic medical school because I felt that it would make me a more well rounded physician. However, by observing the way my institution runs and the low quality osteopathic training programs, it makes me feel as if I have made a mistake. To top it off, I wil have to explain that I am a medical doctor to patients for the rest of my life. Probably why I will end up subspecializing so I can avoid any confusion for being a chiropractor who happens to be a medical doctor for the rest of my life. After having experienced what I have, I can earnestly say that I would not recommend DO school to any of my peers in undergrad. The best thing the AOA could do is merge with the AMA and increase the quality of medical training for the sake of our patients.

I feel that we as a profession don't give the general public credit for their intellect. Thus far in my three years of an internal medicine residency in an allopathic program, no patient has ever asked me what a DO is and if I am a doctor! It appears to me that the only practitioners worrying about this are those who feel inferior in some way to their allopathic colleagues.
Do you ask your Dentist why he or she is a DDS and not a DMD?? No! They are all Dentists!
If anything at least we can say we graduated from an American medical school and not from some second-rate Carribean medical school that cranks out MD's to try to hide amoung the real MD's that went to reputable universities. Just appreciate the training you received and represent it well and there will be no reason for anyone to question it!

It's not about giving credit to the general public about their intellect. Your patients may not ask you if you're a doctor or not but they assume that you're an MD. When the fact is that you're an osteopathic physician with entirely different initials. So when your patients, your friends, and your family read a headline health article or observe TV news over a health issue, the letters "MD" are interchanged for physician. Perhaps you may not feel this to be an issue, however, after being over 150 K in debt, 8+ years of education and training, it's enough for me to voice concern.

As far as the students that went to foreign MD schools, I agree that they hide behind the MD and aren't US educated physicians but at the same time no will ever ask them why they don't have an "MD" behind their name. The inferiority complex arises as a result of inadequate media recognition and misrepresentation as non-physicians.

This is my last comment as I don't care to waste time on this subject and only stumbled on this while checking out the AOA website.
If you are a future DO and feel this way then I would ask you why you chose an Osteopathic education? Change professions now and allow those who are confident in their knowledge base to carry on and represent the DO title with pride. A doctor is a doctor is a doctor.
Carry yourself with dignity and display confidence in your knowledge and respect will follow. Look like an idiot and perform with incompetence and yes patients will question your credentials.

I disagree with Dr. Cope,

I am a board certified cardiologist and at times have attempted to commit manipulation on certain patients who complained of back pain while in my clinic. Now despite being an osteopathic physician and having pride in my profession, it irks me when patients confuse my manipulation with that of a chiropractors. I have over 14 years of training experience in the medical profession and rightfully, I want the due credit it deserves. I would think it's a loss to lose bright students just on the basis of something so superficial. After all, osteopathic medicine or allopathic medicine - the goal is common: heal the sick and serve others. I feel that you are being all too harsh on the young lad.

The degree of "D.O." is commonplace where I practice, the hospitals are all mixed, private practices are mixed, you see "D.O." everywhere, very few people are ignorant anymore, at least here, what D.O. means, but the discussion needs to be had, and it needs to be honest. Aside from the degree debate, I believe more importantly, the best possible opportunities for D.O. post-graduate training needs to be embraced. I am the only D.O. in my department and I hold a leadership position, I'm proud to be a D.O., always have been. For future D.O.'s., I agree with Dr. Cope, hold your head high, grow your knowledge, know that you're legit, probably better trained than the vast number of FMG's, and preferred by the general public to FMG's, and I hope more docs "stumble" onto this blog because it's a discussion we need to have. We need to share our support, thoughts and experiences with future D.O.'s. Disenfranchised D.O.'s who go allopathic, who are refused AOA approval, who are restricted in their state practice rights because of post-graduate training choices, will be lost from the AOA for ever, and as this trend grows, the threat to our profession grows.

I think that Dr. Schriner made some excelent points. It worry's me as a soon to be Osteopahtic Physician that we are growing our numbers with out checks. It worries me that one umbrella organization (AOA) is in control of both Accredidation and Promotion. It worries me when I object to a policy of the AOA, I get asked questions about why I chose Osteopahtic Medicine. Upon reflectio, had I known these issiues when I was applying I porbally would have gone allo.

I recently matched into an Osteopathic Program (my first choice between allo and osteo programs) but it bothers me that I cannot be board certified by the AOB___ unless I am also paying dues to the AOA. I feel that by not allowing me to withold my money, my most effective method of communicating my displeasure with the policies and actions of the AOA leadersip was taken away from me. This is quite bothersome.

As yet I have not heard John Crosby JD check in with his comments. As D.O.'s we are waiting for the A.O.A. to respond to our concerns.

Dear Concerned DO:

Thank you for bringing the RapidSlimSX commercials to the attention of the AOA. Just to clarify, the AOA did not work with any of these product manufacturers to have DOs endorse their products and was not made aware of the DOs intention to be involved in the commercials.

While the AOA Code of Ethics addresses physicians and advertising, it does not directly address product endorsement. In general, the AOA does not restrict its members from choosing to endorse products or services that are available on the market. However, this does not mean that the AOA disregards complaints of DOs engaging in unethical practices. In fact, any individual who feels a DO is acting in an unethical manner is encouraged to register a complaint with the AOA's Bureau of Ethics.

Again, thank you for bringing the commercial to the AOA's attention. We always appreciate the help we receive from our members monitoring references to osteopathic medicine in the media and in other public forums.

JBC

To praise a doctor for advising immediate "medical" treatment for a virus induced "cold" in the ear, goes against evidence based medicine and adds to the cost of medical care. An antihistamine and tylenol or ibuprophen would have been better advice even in the child. Also council is good for smoking cessation but Chantix works wonders. It's a hard habit to break but a healthy one.

Dear Mr. Crosby,

As a future osteopathic medical student (c/o 2011), I am fully aware that osteopathic medicine is the fastest growing field in health care. I also recognize the need for an increase in quality and quantity of OGME. You have previously stated that you believe OGME is the highest quality available to osteopathic medical students. However, the fact remains that many of my peers will abandon prospects of OGME for ACGME, leaving many osteopathic internship/residency spots unfilled, especially in the fields of primary care. Even if every graduating osteopathic medical student were to apply for the osteopathic match, there would not be enough spots for everyone. If you compound the lack of OGME positions with the rapid opening of new schools and creation of virtually no new OGME programs, this creates quite a bleak outlook for those investgating a career as an osteopathic physician. I am excited to see our profession growing at such a rapid rate, but I am fearful that the AOA is not doing enough when it comes to ensuring production of quality osteopathic physicians, and is more concerned with pumping out as many osteopathic physicians as possible. My suggestions would include requiring new schools to also create new residency positions as a part of gaining accreditation. Furthermore, I would like to see a forceful push by the AOA to create enough quality OGME positions as possible, and not just in primary care. I think it's time to really focus on quality issues rather than quantity. If we're to gain widespread recognition as quality physicians, quality OGME needs to be available for every graduating osteopathic medical student.

john crosby
It seems that once again many of our young, and old D.O.'s agree that quality over shadows quantity. If the A.O.A. continues to promote numbers to match the A.M.A. we will demean those of us who are proud of our profession. recognize that there is only one way to the top. Be the best. The road to the top is open to us but not by false pretence. You must recognize sooner or later that as much as thou dost protest Osteopathic GME is to often a joke. Certification is often without merit. As much as you wish to hide the facts the truth will shadow you.

Well said JRS, I am a medical student as well and share similar views. It's about quality and not quantity. I'm sick of accepting criticism for wanting quality education when it's absolutely imperative for the sustainance of our field.

Soon to be DO raises many issues around the value of AOA membership, its requirement for board certification, and how displeasure with AOA policies is most effectively communicated to the Board of Trustees. AOA certification follows a different model from the ABMS board certification program, which is solely based on completion of postdoctoral training and passage of an examination. AOA certification looks to factors beyond completion of approved postdoctoral training and passage of an examination, such as adherence to a Code of Ethics and satisfaction of Continuing Medical Education requirements, both of which are ensured through maintenance of AOA membership and bring added value to the public.

All AOA members are required to comply with the AOA Code of Ethics and holding membership is an indication of an individuals commitment to follow the high ethical standards embodied in the AOA Code of Ethics. Likewise, the CME requirement reflects the mission of the AOA Certification Boards to advance continuous learning and improvement in the skills of all its diplomats and ensures that they receive professional education that will help them remain at the cutting edge of their respective specialties.

JBC

John Crosby you should look at what you just said. to paraphase what you said," as D.O.'s we must remain loyal to our A.O.A. profession no matter what other wise we are "unethical?" The high standards you are refering to do not hold up to scrutiny and although many of us hold to high standards we are saying the rote acceptance of the A.O.A. line doesn' cut it in the real world. face it in many if not most instances our OCME does not evn come close to quality. For a fact the AOA Certification Boards do not advance "continuous learning and improvement of all of it's diplomats" We recieve most of our "quality education" from outside of the AOA. The cutting "EDGE' is from the whole real world. I know from the fact that to become a diplomate in the AOA you must pay financially to the AOA. and not on your merits. Come into reality or cease to represent us. I don't care any more for retoric.

I shall respond to Mr.Crobsy's comments later. Is there anyway that we can see how AOA funds are spent? Who keeps the books? Are the books open for public inspection? If so where can I inspect them. I would like to know how the AOA spends it's membership dues.

Hello,
I looked at the AMA website and I looked for anything regarding becoming a DO, there is not anything on it unless you do some very intense searching. However there is a section called "becoming an MD" on medical school and residency section. Interesting it is that for all those saying we are really working to get the word out but we are nor even listed on the main page of AOA. How is that for all those against having an M in their letter designation. This makes my points and others stronger about how we are looked over and not recognized as physicians. Again how are we supposed to be reconized as physicians by the general public internationally and nationally, when we are not listed on the Medical School and Residency main page of the AMA website???????????????? Again not about an ego, but being given the the respect, we put many dollars, hours, and time into. If we can not get the AMA to reconize us, how are we supposed to get the general public to, where is the PR you all are talking about?????????????????????

John Crosby
We are not all fringe lunitics or opposed to the AOA, but voice concern over the direction the AOA is taking. We all espouse quality over quanity and as long as you and the body ignore us the gap become worse. Mere retoric does not appease the situation because if it did we would all be sheeps. If you are concerned about the quality of GME then you shoud not be fearful of a dissenting voice. Why not invite constructing opinions to your meetings in Chicago, I for one will not " bring down" the AOA that I love but will work to build a better future for our profession. To ignore dissention is to reveal your parinoa toward us and the shadod of allopathic medicine. ignoring the "Eagle" does not mean that it will go away. Please feel free to call me and talk to me direcly and to Ray Sharretts. I demand a response and diserve it. Why not? Dr Jon

Dr. Schriner:
If you think the rhetoric on here is bad, you would be nauseated at what we as students are told on our official visits from the AOA to our schools. It all sounds nice to the first year students who don't know how things really are. You would think that they would listen to someone in your position. Thank you Dr. Schriner for stepping up to the plate and offering a dose of reality.

Dr. Schriner could you keep us posted on the out comes of your talks and meetings with the AOA? It is very refreshing to see some-one finally give us (the concerned members of the AOA) a voice. May I make a suggestion that we make posts in the Osteopathic Forums of Studentdoctor.net. A lot of students and residents who dont visity this web page visit student doctor.

Thank you, but on a positive note I was pleased to read and article on political activism by D.O.'s In the JOAM about Dr. William Anderson. He sould be an inspiration to all of us. Not only did he stand up, under reprisal, to injustice, but with dignaty and quality. I have already stated in privious blogs that my God- Father and mentor was a politician and D.O. Brother-in-Law to, Thomas E. Dewey. We have much to be proud of, that our predicessors have faced the country and represented us well. My hat will always be tipped to them for they represent us well Dr. Andreson is more than a shinning example of humanity he is a guiding light fot the future of Osteopathy and our country. That is the creed that drives me and many others to br proud D.O.'s. I can name so many others such as Lewen Wyatt D.O. an afro-American D.O. who stood to the odds. WE must not let their legacy die because of the short sightidness of the A.O.A. at present These men and women have invested their souls to humanity and Osteopathy. Because of them and others I want to stay with Osteopathy but Osteopathy must stay with me. Dr. Jon

Dr. Schriners comments of 3/8/07 raise many concerns among AOA members and staff. First, it is a disservice and an affront to certified osteopathic sports physicians to call the recent recertification examination a sham. Like all of the AOAs board certification examinations, the sports medicine recertification exam was developed by recognized experts in the field and subject to review under strict psychometric standards. While Dr. Schriner correctly notes that 22 of the items on the sports medicine exam were disqualified as not valid, he does not explain that validity is a technical term among psychometricians and that properly administered tests often have several items that are not counted because they are not valid from a psychometric standpoint. The fact of the matter is that the disqualification of exam items points to the strength and quality of the AOAs exam review process not a weakness.

The AOA, through its Bureau of Osteopathic Specialists Standards Review Committee, provides a mechanism to evaluate the validity and reliability of all certification examinations conducted by the certifying boards including the Sports Medicine certification. That exam was judged by this key BOS Committee to follow all appropriate psychometric methodologies and the statistical analyses were evaluated by testing specialists or psychometricians as they more commonly known in the testing world. The AOA is confident that its board exams, including its Sports Medicine exam, are legally defensible, valid and reliable.

JBC

lets stop the blogs and call me. you should have my phone number. I don"t like hanging my linens out on the line if I don't have to. This is the first response I have had with the AOA office. An by the way I "am" one of the formost Sports Medicine experts in the country, and a long history of leadership in the field. Don't hide behind Psychometrics. In the international field I am an expert. If you are not afraid of discussion call my office at 810 732 4007 Michigan Center for Sports Medicine A Fellow in the Prestigous American College Of Sports Medicine. One of only a handful of D.O.'s ever to be accorded this honor. Eight Seminars, two hundred and fifty or more presentations and articles, six centers for sports medicine, twenty certified athletic trainers, twenty two schools, three pro teams, and one college, forty five years of expretice and service to athletes in both the regional national and even international arena, including olympans, I shoud know what I am talking about. I should write the test not have to let alone take it. I challange that no one has more knowlledge than I in this field, This is not ego but fact, If you are insecure about this then it is out of envy of my recognition as a sports medicine leader. On the original certification exam I scored in the nintiies out of aome 400 question, So there, Any one who wishes to share with me call me. Dr jon

Medical Director McLaren Sports Medicine Centers (25 years) Med Direct Crim Festival of International Races(30 years), Team physician Flushing Community Schools (40 years), F. A.C.S.M. twenty years and spokesperson for them, Member of the A.M.S.S.M.. ASK THEM IF YOU WISH. email sportdrjon@aol.com

I moved to the Bay area of CA. four years ago and in attempting to get situated in the medical community, the lack of knowledge of what a D.O. is and is licensed to do is astoundingly ignorant..

I previously lived and practiced in CO for 20 years and with one Board there was never a need to explain oneself. I have always said that the greatest difference between a D.O. and a M.D. is that we have to explain ourselves.

Having graduated from the charter class in Pomona in 1982 and in light of the sensational success of Phil Pumerantz's visionary mission to create a new and bold statement for the profession and medicine in general, someone is NOT making it work above the southern CA. area. There is the Touro school in this area yet I have approached them twice re: a connection yet with NO response.

Finally, on websites nationally where one's school of training is a hyperlink, rarely, is my school on the list of hundreds of schools and for that matter the hyperlink for degree rarely has the D.O. credential.

This to me is unacceptable almost 30 years since I helped charter the course for our profession in CA.

Who is responsible for this lack of information being appropriately disseminated? Why should I pay dues to either the AOA or CA. society other than to keep my BC.

Fortunately, my experience and other credentials have afforded me great opportunities yet at a price of waiting to damn long for "employers" and "contractors" to "get it".

I am not angry, bitter, nor arrogant(as others in my profession have suggested in the past) but simply speaking my mind with strong talk based on facts.

Drs Schriner and Dietz,

I am refreshed to hear your decent towards the inadequacies of our professional organization. I can only hope that your words are noted and the quality of our education continues to improve. As a medical student, I am often timid to express my concerns over the lack of advocacy and recognition DOs recieve in the national and international venue. Thank you again for your vocality.

Very intersting that your blogs are public. You should be more critical!Nursing and doctoring are two different things and evidently patients like the treatment they receive from physician extenders. With rising health costs do you have a better solution?

Osteopathic philosophy and practice are learned in medical school and carried out in practice. OMM is but one area of practice, not the end all of what it means to be a DO. The OGME system is broken and redundant, espepcially for non-primary care areas. As a pediatric cardiac anesthesiologist trying to support my profession and the AOA, I am met by obstacles at every step due to my ACGME training. Apparently the Yale University Department of Anesthesiology does not measure up. I would ask, what OGME program exists in pediatric cardiac anesthesiology now, or in 1988, when I trained? Currently, over 65% of our graduates enter ACGME training. Probably more would enter if the osteopathic match was held on the same day as the ACGME. Isn't it time that the AOA tried to welcome these doctors back into the profession instead of shunning them to protect an archaic and duplicate certification system? OGME is important, but not for everyone. I call on the AOA to establish a committee and open a dialogue with the majority of our graduates, those training in and who received ACGME certification. I practice osteopathic medicine every day, like today when anesthetizing a 3 day old, 4kg child for repair of tetralogy of Fallot. OGME would not have made me "more of a DO" or a better physician. I believe in osteopathic medicine and philosophy and I am in great fear of the reckless growth of our schools and xenophobia of our leadership.
George Mychaskiw II, DO, FAAP
AOA Health Policy Fellow 2006-2007
Professor and Vice Chairman, Department of Anesthesiology
Professor of Anesthesiology, Pediatrics, Surgery, Neurosciences and Physiology/Biophysics
Chief of Anesthesia, Blair E. Batson Children's Hospital
University of Mississippi School of Medicine

Dear Dr. Dietz:

Thank you for your comments and for working to promote the osteopathic degree. Unfortunately, as you know, discrimination continues to exist. While the situation cannot be fixed overnight, we are making progress by advocating for equality and educating the public and federal and state agencies about the DO difference. Remember when the State of California tried to eliminate the DO degree by converting all DOs to MDs? Now California houses 2 osteopathic medical schools, a separate state licensing board, and a growing state organization - all supported directly or indirectly by the AOA!

The AOA is the professional family that advocates on the behalf of DOs and osteopathic medical students while also educating the public about osteopathic medicine. The AOA is the primary organization prepared to take on national issues of discrimination and public education, and we appreciate support and continued advocacy as we work together to combat discrimination.

JBC

Hello,
Thank you for all the working you all doing advocating the Do degree. Why not add the M in it so that it would stop most of the discrimination. We should be called MD-DO since we have the extra task. Why is the allopathic medical schools called AO's rather than MD's, this not just confusing to both officials and the general public. Without making sense in the forefront then it is uphill battle in trying to convince everyone we are physicians especially all these new groups pop up everywhere claiming to be physicians also. We practice medicine but how dare we ask to put it in our letter designation.

I belong to the AOA because I have to, I not because I want to. I believe in Osteopathy because I want to not because I have to.

Dear Doctor Mychawskiw:

The AOA shares your concerns about responsible growth for the profession to address the predicted physician workforce shortage. We are working to increase patients’ access to care by calling for expansion of our student numbers and the training programs needed to support this growth. Allopathic schools likewise are building their numbers and aim to have a 17.5% increase in the number of graduates by 2015. This means that we may see fewer ACGME training slots open to osteopathic graduates, throughout the country and in every specialty.

The AOA held a Medical Education Summit in January 2006, bringing together 70 osteopathic medical education leaders, from specialty colleges, colleges of osteopathic medicine, the AOA Board of Trustees and AACOM Board of Deans, to work collaboratively in response to the predicted shortages of physicians and training opportunities. Out of this Summit emerged 61 recommendations on how to address workforce, growth, recruitment, and quality, all of which are in motion. A second Medical Education Summit will be held this Fall to address Osteopathic Graduate Medical Education (OGME) in particular.

We also recently launched an OGME Development Initiative. Headed by AOA Trustee Michael L. Murphy, DO, this initiative will establish a group of advisors to assist new hospitals develop osteopathic training programs in designated geographic and specialty shortages. You can see information on these programs in The DO and on DO-Online.

Please feel free to attend future Osteopathic Medical Education Workshops to voice your perspective on this issue. These are held in January and updates on all osteopathic medical education, including information on progress from both summits will be presented there. The 2008 Workshop is scheduled in Scottsdale, Arizona. Look for details on DO-Online, or contact Director of Education Diane Burkhart at dburkhart@osteopathic.org. Thank you for contacting us.

JBC

Dear Dr. Crosby,

As a second year medical student, I am somewhat saddened to note the irresponsible number of osteopathic medical schools emerging in the coming years. It's concerning to me that most of these schools are private and not affiliated with any major undergraduate/graduate universities. I find it to be immensely disconcerting to proliferate in this manner. What is being done to augment student quality with this increased supply to medical education. Especially considering, the poor facilities and low resources that currently exist. Not to sound callous; however, I cannot but help prompt that the AOA and AACOM revisit the Flexnor report before making such an overzealous proliferative effort. Thank you.

-Medical Student Y2

Of course these schools are entrepreneurial in nature and do not reflect any attempt at academic responsibility nor where these graduates will train or impact on the health care system

Dear Dr. Crosby,

As an osteopathic physician who is practicing OMT and trying to carry on the traditions invisioned by AT Still. I recently heard some news that disturbed me that I would like some clarifications to, and I am als saddened by the actions and non-actions of the AOA.

First of all, why are we establishing more osteopathic medical schools when there are not enough faculty members to teach at these institutions, especially in the OMT department?

Why are there international DOs (who are not recognized in the US) teaching at these instiutions?

If we are using OMT as a way to distinct ourselves from the rest of the medical community, then why is OMT because taught to the PT, chiropractors, massage therapist, and etc? And they are being taught by D.O.s? Are there no governing bodies to regulate this?

I recently encountered a patient who told me that when she went to see a PT, the PT told her that she was getting an osteopathic manipulation treatment. Her question to me was what makes your treatment different when it is still OMT and why should I get one if the OMT done by the PT didn't help? I had to do a lot of patient education. But is the AOA doing anything about this? I have been degraded to a physical therapist. I can now definetly say that there is nothing that makes osteopathy special. In the general publics eyes, we are just MDs that practice physical therapy, massage therapy, and some form of chiropractic.

Please enlighten me on what the AOA is doing to solve the real issues out there, instead of worrying about not having enough numbers. Numbers won't matter if the public doesn't even know the difference.

I am in France and have observed the French medical care System. every thing is almost free but the access to the care is limited. Care in the rural setting, and much if not most of France is rural, is reminisent of care from the early fifties in the states. Old time praaticioners in single room officies with not much in the line of equipment and very provencial. Even the best of hospitals do not match the level expected of those in the USA. People here do not demand much of their needs for medical care and much of it is only emergent. Lawyers are few and far between and malpractice is remote. MRI's scaners, and such are miles and miles away and not generally accessable. D.O.'s do practice here and for you ten fingered D.O.'s they mostly are manipulators. Obviously, alternative medicine is rampant here. the same is prevalent throught central and eastern Europe. Free but antique like the landscape. I am sure that Americans would be uncomfortabe with this kind of system. we should rethink about the need for "distruction" of medical care in America. In Central america the care system is even worse. We have the most modern and appropiate care in the US of A. travel a litte and sample.

Dear Medical Student Y2 and Saddened DO:

The heart of the issue both of you address in your comments is responsible growth of the osteopathic profession. With a predicted physician workforce shortage, a cap on the number of federally funded residency programs, 46 million uninsured Americans, and lack of medical care in many urban and rural areas, not to mention the professional liability insurance market for physicians, ensuring access to high quality medical care is one of the AOA’s top priorities.

That said, I must address a common misconception that has arisen time and again on this blog: the AOA does not and can not open new colleges of osteopathic medicine (COMs). Rather, the AOA Commission on Osteopathic College Accreditation (COCA) is obligated to recognize any COM that applies for accreditation and meets COCA’s rigorous standards; it would be illegal not to do so. The standards established by COCA have been reviewed and found to meet the requirements for recognition by the U.S. Secretary of Education as a reliable authority in postsecondary education. I urge you to visit the website http://www.aoacoca.org to view the standards for yourself.

In response to your other issues, the number of private colleges of osteopathic medicine (COMs) has always outnumbered the publicly supported colleges, which did not appear in the osteopathic profession until the 1960s and 1970s. Whether privately supported or publicly supported, COMs must meet the same standards. Of the current 23 COMs that will be offering instruction this fall, only 2 of them are free-standing; the remainder are part of parent institutions of varying size and scope, which are in turn reviewed under those universities’ regional accreditation activities.

The “quality” of the COM applicant pool is a proper question in looking at the strength of any profession. I direct you to the American Colleges of Osteopathic Medicine (AACOM) for their annual report (see http://www.aacom.org). If you look at Table 4 on page 9 of the current 2006 report, you will find that the entering academic credentials of osteopathic students have remained stable over this decade.

In closing, you mention the medical education study completed by Abraham Flexner in 1910, seven years after the AOA began conducting visits to COMs in 1903. Much has changed in higher education in the nearly 100 years since that report, including the development of a much more robust system of private accreditation at both the institutional and programmatic level. This development has caused the standards for education in the learned professions to be raised to its current high level.

JBC

Dear Saddened DO:

As you can tell by reading the comments posted above yours, many DOs worry about the expansion of the profession through the establishment of new COMs. While the AOA cannot interfere with those wishing to start osteopathic medical schools, we can ensure that only high-quality institutions are created by keeping the AOA’s accrediting standards high as well. Please see my comment above for more information about new COMs.

The AOA believes that OMT and OPP are the hallmarks of osteopathic physicians and, as such, should be protected. This is the essence of the “Back to the Basics” theme espoused by AOA President John A. Strosnider, DO. We share your concerns regarding the practice of osteopathic manipulation by unqualified practitioners. At the same time, the AOA also recognizes that instructing other physicians regarding osteopathic medicine allows for referral of patients who may benefit from osteopathic medical services. To balance these concerns, the current AOA policy states:

When instructing other health professionals in the performance of manual therapy, the osteopathic physician should teach techniques within the scope of practice of the attendees. Persons other than licensed osteopathic physicians who receive education or training in manual therapy from osteopathic physicians shall not represent to the public that they offer osteopathic manipulative treatment services. Nor shall they promote themselves as an “osteopath,” an “osteopathic practitioner,” as having received “osteopathic training” or practicing “osteopathy” or “osteopathic medicine.

Though our policy opposes non-osteopathic practitioners from advertising themselves otherwise, there is little we can legally do to prevent this from occurring. We will fight all cases of discrimination and misrepresentation that we can, but we rely on our members to contact us in such cases and let us know about the issues they’re having getting recognized as osteopathic physicians.

Many schools utilize non-physician osteopaths to train osteopathic medical students in OMT. Some of these practitioners are recognized in the US as “manipulators,” rather than as physicians, and are part of the international osteopathic family. I think many colleges rely on such practitioners because there are not enough DOs willing to teach OMT. Perhaps the larger question you should ask is why aren’t more of your colleagues practicing OMT and osteopathic medicine?

JBC

Thank you Dr. Crosby for replying to my concerns. Yes, you're right, the question is why aren't more of my colleagues practicing OMT. Perhaps the problem is at the "basics" if you will. It begins in the first years of education. Osteopathic medical schools have turned into allopathic schools with and added OMM curriculum. There is little done to incorporate the ideals of our founding fathers into the daily approach to the medical patient. OMT and medicine should not be separated and yet because that is the way the curriculum is set up this is what is promoted throughout "osteopathic" education. It is the obligation of the AOA to insure that OMT, osteopathy and the principals are incorporated into every aspect of the education of future D.O's. This quality of education has been curtailed by the "need" to increase our numbers of D.O's rather than the quality of the osteopaths we graduate. This lack in education continues throughout the clinical years as 3rd and 4th year medical students go out into hospitals and get an allopathic training. Where does the responsibility lie? Is it not the job of the AOA which accredits programs and schools to evaluate the quality of the education provided? Is it not the duty of the AOA to uphold the ideals of the founders of osteopathy?
Also, let it be noted that the postgraduate training is falling short as well. Our graduates get little in the form of formal osteopathic training in their residencies. Two problems exist here. Not only do we have too few programs to supply positions for all our graduates, we also lack formal education in the osteopathic programs that do exist. Perhaps the existing programs need more in the form of support from the mother organization,AOA. The change needs to be initiated at the top. We need more Osteopathic residencies to continue the traditions of what it truely means to be a DO. Otherwise we will continue to lose our graduates to allopathic programs.
Im sure that the stuendts we accept into osteopathic medical shcools are "qualified" when it comes to numbers. However, how can we evaluate their quality and dedication to ostopathy? A majority of students entering osteopathic schools are using our field as their back up. The are the so called "MD rejects" who just want to be physicians. This problem will only amplify as we attempt to increase numbers of graduates rather than quality of graduates. we are losing our identity as healers, as osteopathic physicians. It has become harder to identify the crucial difference between MD and DO.
Fifty years ago people did not know what a DO was. Today I still have a majority of helathcare professionals as well as lay people ask me "What is a DO? It that eye? Are you and eye doctor?" The AOA has failed to raise awareness to the community.
It is estimated that only 30 percent of DO's will ever do any form of manipulation or apply the ideals of ostopathy. That means that 70 percent of DO's dont even believe in the education that was afforded to them. They do not believe in osteopathy. Which brings me back to where we started. Medical education. It is a vicious cycle that may lead to the obliteration of our precious profession.

Mr. Crosby,

Are you aware of any states that offer or allow D.O.'s to use the M.D. designation. I came across this topic on the president's blog regarding the NY State Medical Board and was confused,as it seems to suggest this possibility there.

I appreciate Mr. Crosby's comments regarding the relationship of the AOA to COCA, however, this is a politically correct way of ignoring the elephant in the room.
COCA's standards are flawed, regardless of US Govt approval. COCA permits the establishment of for-profit medical schools. Because of this, COCA has now approved the Rocky Vista school in Denver, the first for-profit school in the US since 1930, owned by the same investors who own the American University of the Caribbean in St. Maarten. This will, possibly fatally, damage the credibility of Osteopathic medicine and our educational system. The AOA may be restricted from preventing accreditation, but it is a bully pulpit. The president of the AOA can and should publicly disapprove of the Rocky Vista school. The AOA can pass resolutions condeming for profit medical education and declare any assocaition with same to be unethical.
I will be speaking at the next AACOM meeting and would like to propose the following resolution:
Whereas osteopathic medical education is a public good, and
Whereas all available resources should be devoted to educational programs of the highest quality, therefore be it resolved that:
The AOA strongly disapproves of any school of osteopathic medicine operated on a for-profit basis, and be it further resolved that,
Any association with such institutions at any level, student, faculty or administration, is unethical.

I challenge the membership of the AOA to put this resolution forward. As an osteopathic physician, I also make the following statement:

I DISAPPROVE OF FOR-PROFIT OSTEOPATHIC MEDICAL SCHOOLS.

George Mychaskiw II, DO, FAAP
AOA Health Policy Fellow 2006-2007
Professor and Vice Chairman, Department of Anesthesiology
Professor of Anesthesiology, Pediatrics, Surgery, Neurosciences and Physiology/Biophysics
Chief of Anesthesia, Blair E. Batson Children's Hospital
University of Mississippi School of Medicine

I, too, disapprove of for-profit osteopathic medical schools as a third year medical student.

For my like-minded colleagues, I am thinking about having buttons made up to wear at AOA, AACOM and COCA meetings, saying:

I DISAPPROVE!

I agree with Dr. George Mychaskiw that for-profit osteopathic medical schools would be the demise of the professional credibility. Imagine what kind of standards for admissions they would have. It may increase the number of osteopathic graduates intially, but it's not a long term solution. I disapprove of for-profit medical schools.

The news in the Daily report points to the major problem with the American Health care system. Rewarding Someone 25+ million for a baby delivered with C.P. is outragious and should not be tolarated by the health care providers in our society. While in France I was appraised that Malpractice there is decided by a Tribunal of three Physicians who look at the merits of the case and decide whether restitution is or is not warrented. No lawyers no jury no out landish settlements, no frivolus lawsuits, works well. Why don't we demand such a system here. We have given up our birth rights to the lawyers, and it is costly both in dollars and in emotion. And in passing I also "Agree" with George Mychaskiw.

I urge my colleagues to write to the AOA and COCA regarding the for-profit school in Colorado. This cannot be allowed to stand. Did you know that Kansas, by state law, prohibits for-profit health professions education? Did you know that the LCME, the accreditating agency for allopathic schools, also prohibits for-profit schools? Stop this giant step backward.
I DISAPPROVE!
DOCTORS NOT DOLLARS

George, are we the only ones that care?
Dr. Jon

The tale will be told at the next House of Delegates.

I DASAPPROVE!
DOCTORS NOT DOLLARS

Dear Dr. Mychaskiw and Student Doctor OMS-1:

Thank you both for your interest in the accreditation of colleges of osteopathic medicine (COMs). The AOA's Commission on Osteopathic College Accreditation (COCA) is recognized by the US Secretary of Education as the accrediting agency for colleges of osteopathic medicine. You may be assured that all COMs are evaluated against the same standards for admissions regardless of their tax status. I invite you to officially communicate your position on for-profit schools by writing a letter to COCA and addressing it to:

Dr. Konrad Miskowicz-Retz, PhD,
Secretary Commission on Osteopathic College Accreditation
142 E. Ontario Street
Chicago, IL 60611

JBC

I agree that the profession should prohibit for-profit schools. If the goal is to produce more/better physicians, we need to first fix the "degree" problem. The D.O. degree is not attractive to a great percentage of potential students. If we acknowledge this and fix the problem by simply adding the missing "M", we will attract alot more potential students.

In memorium of Dr. Stro and our great osteopathic profession, what are we going to do about this: http://www.msnbc.msn.com/id...
http://forums.studentdoctor...
This type of negetive publicity is the very thing that is drowning our profession. I know Dr. Stro would have responded in interest of preservation of our mission. Please respond in discernment.

This sad episode on msnbc illustrates very clearly the failure of the AOA's public relations campaigns. The public equates MD with physician. That may bother you as it does me but we need to recognize this plain truth and do something about it. Let us keep the DO degree while adding the MD degree.This simple move will silence the critics and doubters while maintaining our separateness. I have yet to read one compelling reason why we shouldn't do this now.

There is a copy of a letter from the AOA president to MSNBC regarding the misleading comments about DOs posted in the "What's New" section of DO-Online (http://www.do-online.org/in...). For anyone interested in sending their own response, there is also a template letter that you can download.

Dear Mr Crosby,
You ignored my question about New York State allowing DO's to use the MD title. I have provided a link to the NY State Education Dept website for your convenience. At this site you will find this:

§6529. Power of board of regents regarding certain physicians.
Notwithstanding any provision of law to the contrary, the board of regents is authorized, in its discretion, to confer the degree of doctor of medicine (M.D.) upon physicians who are licensed pursuant to section sixty-five hundred twenty-four or sixty-five hundred twenty-eight of this chapter. Each applicant shall pay a fee of three hundred dollars to the education department for the issuance of such degree.

Section 6524 includes this:
§6524. Requirements for a professional license.
To qualify for a license as a physician, an applicant shall fulfill the following requirements:

Application: file an application with the department;
Education: have received an education, including a degree of doctor of medicine, "M.D.", or doctor of osteopathy, "D.O.", or equivalent degree in accordance with the commissioner's regulations;

Please comment as I am sure there are many interested parties.

Here is the link where you can read these artcles in their entirety.

http://www.op.nysed.gov/art...

July 2, 2007
Peter B. Ajluni, DO
President, American Osteopathic Association
142 East Ontario Street
Chicago, Illinois 60611
Dear Dr. Ajluni:
I am an academic physician and 2006-2007 AOA Health Policy Fellow. Although I work in the large world of sub specialized allopathic academic medicine, I am very proud to be a DO and practice Osteopathic medicine everyday. Significantly, in the extraordinarily competitive world of anesthesiology, our residency of 28 spots, is usually composed of 20-30% DO’s, most of whom are exemplary physicians and go on to become chief residents. I see, on a daily basis, the benefits our patients receive from application of Osteopathic principles and philosophy and I am truly gratified to provide this care to the people of our state.
I am writing to you today because I and a large group of my Osteopathic brothers and sisters are very concerned about the future of this profession and about the negative impact we believe a for-profit osteopathic medical school may have. As you may be aware, all for-profit medical schools in the US were intentionally closed by 1935, following the Flexner report of 1910. Since then, all medical education in the US has been non-profit. We are very disturbed that an Osteopathic school has to be the one to break this standard. Although COCA permits for-profit schools, they are prohibited by the LCME and are even illegal in some states, such as Kansas. The Rocky Vista School, to be operated as an investment by the owners of the American University of the Caribbean, will bring into the public eye the image of Osteopathic medical schools as mercenary entities, treating desperate students as just another profit-making commodity. In an era where there are 47 million Americans without health insurance, where the US ranks 43rd in infant mortality and where medical costs are the leading cause of personal bankruptcy, how can this profession justify the existence of for-profit schools? If we are serious about health care access, cost and quality, then we cannot stand idly by and allow this profession to stand for money, profits and investments. Any excess revenue generated from medical education should be returned to the schools for development, used to open patient outreach clinics or simply used to lower the costs of tuition that, in of themselves, are contributing to disparities in the physician workforce force and are already a source of criticism of Osteopathic medical education.
I understand that, by established policies, we cannot necessarily prevent accreditation of this school under COCA standards. There is nothing, however, to prevent you, as the public voice of organized Osteopathic medicine, to use your bully pulpit and state your disapproval of this backward step. Will you?
Please do not hesitate to contact me if I may be of assistance. This is a unique opportunity in our history to demonstrate that we, as Osteopathic physicians, stand for our patients and not our profits.
Sincerely,
George Mychaskiw II, DO, FAAP
Professor and Vice Chairman

In the course of my years in practice I have been able to evaluate several "MD's" who have Graduated from Offshore for profit Medical Schools. Although they had the title of MD they were not as knowledgeable as a second year Osteopathic Student rotating through my practice. Most could not pass licensure even though they were American undergrads. If this is what Osteopathy is to come to then count me out. You can have my proud degree back!!!

Dear Dr. Schriner:

You are confusing for-profit schools with unaccredited schools. They are not the same. The business status of a school does not determine the quality of its product. The accreditation status of a school is an indicator that a school has met identified pre-requisites necessary for a quality education to occur. It also indicates that a school has agreed to be measured and, therefore, has incentives to produce a quality product or face exposure in the marketplace for not meeting the standards.

The offshore MD schools to which you refer are not accredited by the LCME, the accrediting body for US medical schools. To our knowledge, the offshore schools do not have accreditation from a regional accrediting agency that is recognized by the US Department of Education. If those schools were accredited by LCME, they would need to meet the same quality requirements as the not-for-profit MD schools located in the US and Canada which are recognized by the LCME, and they would need to produce the same benchmark quality of product and the not-for-profit MD schools.

What concerns many people about for-profit schools is that resources that could go into medical research or indigent care might go back to shareholders instead. We will be monitoring such issues to see how an osteopathic for-profit school might allocate its “profit.”

JBC

Its almost comical that you mention that LCME in the same statement as Rocky Vista. The LCME would laugh at their application instead of accrediting it and trying to keep an eye on their profits. It is truly pathetic that the AOA has no power over COCA in matters like this. I thought it couldn't get much worse when I hear practicing DO's laugh and shake their heads in embarrassment at the opening of new DO schools like Starbucks. I guess I was wrong. This has the potential to be a huge black eye for the DO profession and medical education in general. I think a little more then sitting back and "monitoring" the school is warranted here.

Dr. Cosby:

You note that the LCME does not accredit those "offshore" schools that do not "meet the same quality requirements as the not-for-profit MD schools located in the US and Canada which are recognized by the LCME" and do not necessarily "produce the same benchmark quality of product." At the same time, you fail to note that Rocky Vista likewise could not survive a run through the LCME gauntlet. Are the standards of the AOA COCA so inferior? It seems to follow that they are. Which is why, I'm sure, its founders chose to run the COCA parade instead.

"We will be monitoring such issues to see how an osteopathic for-profit school might allocate its “profit.”"

Dr. Schriner is not confusing anything, he is merely making the connection made nearly 100 years ago (and repeatedly since then) that for-profit medical schools are, by design, irreparably flawed. It is indeed unfortunate that the AOA COCA, and an Executive Director of the AOA, appear ready to ignore these lessons of history and common sense.

I was writing a response yesterday and got interupted. So my message was lost, but today I see that others have have responded in my place. No james Cosby I amnot confussed. Maybe it is the AOA and you that is confused. Offshore Medical schools have been producing subtrained MD's for years and infusing them into our system. Argentina and arguably other countries have been doing the same. Pakistan must have a boat load of undertrained MD's who come here to prey on the US medical system. Why do we after years of struggle to earn recognition want to turn around and turn out the same product fpr the enrichment of the entrepreneurs. You are correct that these schools do not have LCME accreditation but none the less graduate M.D.'s. Must we allow these schools to exist and turn out D.O.'s or exert pressure to keep them at bay. The AMA has keptFor profit off shore why can't we. History says shut them down and perserve the DO immage as it is. I.m not confused you are!

Lest Dr. Crosby be misled by comments posted falsely under another's name or identity to create a straw man, I suggest that we email our comments directly to Dr. Crosby at jcrosby@osteopathic.org.

Please contact the COCA by July 25th for your comments to be heard. We do not want for profit medical institutions in the US. This must be stopped.

Mr Crosby;

I agree with Drs. Schriner, Mychaskiw, and "Currently Anonymous" and must say that I whole-heartedly oppose the opening of the first for-profit medical school on US soil in 70-plus years.

I think the idea that the AOA will be "monitoring" Rocky Vista to see how "an osteopathic for-profit school might allocate it's 'profit'" is ridiculous. How is the AOA going to monitor this school? Once a school is open and has begun classes, it is already too late for those students who have "invested" their tuition money in that school if final accreditation is not granted. We must look at this pro-actively rather than retro-actively. The board/CEO of Rocky Vista must be forthright and give a solid plan as to how they will re-invest their "profits" BEFORE the school opens, not after they have taken hundreds of thousands of tax-dollars from students.

How about looking at this school as the LCME might? The LCME has forbidden, yes forbidden, the accreditation of for-profit medical schools, why has the AOA-COCA not done this? Is there some unseen benefit to for-profit osteopathic medical schools?

Also, what about the conflict of interest involved with having an AOA board of trustees member on the board of this new for-profit medical school?

What safe-guards will be in place to ensure this school will accept qualified applicants, train them well, and produce quality physicians, rather than accept anyone willing to sign on the dotted line to give them money and abandon the students to their own means while the CEO and board vacation in the carribean all summer long? How are we going to ensure that needed upgrades to the facilities will be made and qualified faculty will be hired in an adequate faculty:student ratio? In a for-profit business model, the goal of the business is to make as much profit and spend as little as possible - how do we know a for profit school will not do the same?

What is the benefit to this school to engage in academic discovery and research? There is practically no monetary benefit to research - it is therefore not beneficial to a for-profit institution to pursue it. We need medical schools that foster an attitude of academic inquiry, not quash it to meet the bottom line.

Many in the Osteopathic physician's community are very concerned with this school's opening. Why is the AOA offering platitudes rather than giving real answers to these concerns?

If the AOA and COCA cannot prevent the accreditation of new schools, what is the point of having accrediting bodies? If this is truly so, we must change the standards or be rid of the accrediting bodies altogether. The rampant spread of osteopathic schools must not be allowed to continue. Branch campuses must not be allowed to open uninhibited and ride on the accreditation of the parent insitution - these 'new schools' must be made to stand on their own and receive separate accreditation as well as have their own endowments, administration, and faculty rather than share that of the parent institution. We must bring our accreditation standards into line with those of the LCME - requiring all schools to be not-for-profit and preferably associated with a free-standing not-for-profit university.

I urge you, Mr. Crosby, as well as any who might be reading this, to visit the LCME website and peruse their accrediting standards and compare and contrast those for our own osteopathic medical schools. It is a real eye-opener.

The most worrisome aspect of all of this is the reluctance to discuss the issues in the open. I have received numerous phone calls and messages to be sure I disavow myself and my opinions from the Health Policy Fellowship and the Mississippi Osteopathic Medical Association. There seems to be a culture of silence, intimidation and "go along to get along." I have had comments like "you don't want the AOA to retaliate against the Fellowship, Association etc." After presenting these issues at AACOM in June, I was surrounded by people saying, basically, "thank God you are saying what we want to, but can't." One of my friends, a professor at a major, well-established DO school, was forbidden by his dean from commenting on these issues because they didn't want trouble from COCA. Why the silence? If a for-profit school, operated as an investment by owners of a Caribbean medical school is a good thing, then say so and debate the matter in an open, policy format, with the interests of patients as paramount. Although I disagree, there are arguments that can be made for such a position. If the AOA is opposed, then also say so. I have a great deal of respect for Mr. Crosby and Dr. Aljuni. Their statement of approval or disapproval of for-profit education is worthy of consideration, but let's not keep these issues in the dark and rest on statemtnts like "the dean is a good guy, so leave it alone." I believe that we are better than that.

I DISAPPROVE
DOCTORS NOT DOLLARS

These are my opinions only and not those of the AOA, Mississippi Osteopathic Medical Assocaition or the Health Policy Fellowship - but they should be!

It is unfortunate that the AOA and COCA have so little regard for both the osteopathic profession and osteopathic physicians in general.

As has been repeatedly stated above the Rocky Vista school is a horribly bad idea for the profession for a multitude of reasons (already stated above).

Perhaps the associations supposedly in place to support and preserve osteopathic medicine should begin to do so rather than disavow any responsibility in regulating the profession.

Please maintain the integrity of osteopathic medicine and address the concerns of your constituency.

Unfortunately, time and time again, the finger of blame transitions from one COCA to another AOA. Why is it that conversations the effect the livelihood of so many become subdued for so long? As a third year medical student attending an Osteopathic institution, it is disgraceful to hear of a for-profit medical school CEO'd by an offshore Carribean medical institution to go up so quickly. As it already stands, it is hard enough to justify the already increasing number of branched campuses of osteopathic medical schools let alone a carribean run US DO school. Let's try to incorporate cerebral premise and re-evaluate the justification for opening a medical school and then act on the notion. That is, schools should rise in order to foster the betterment of mankind, promote scientific inquiry, and produce quality physicians who will continue the trend. Not to generate profit and then be scrutinized to see if and where "an osteopathic for-profit school might allocate it's 'profit'". If this school goes up, I can almost guarantee that I will be transferring to a US allopathic program and will indefinitely reject the notion of encouraging peers to pursue a career in Osteopathic Medicine at any institution accredited by AOA/COCA.

P.S- How can AOA not claim responsibility as an accrediting body when almost every allopathic clerkship form requires that visiting students attend an institution accredited by LCME or AOA (Not COCA - even though it is a branch of the AOA responsible for accreditation)

I fail to see what is inherently wrong with a for profit school other than that the LCME does not allow them. We are not obliged to follow LCME standards as we are independant from them. If you recall the LCME (AMA) called us cultists. So what is so compelling about their standards when it comes to osteopathy? We have an obligation to promote our profession and at present that means we need more DO's.

In 1999, the AMA and Wyoming medical society successfully defeated Ross University (another Caribbean school) in its attempt to open a branch campus in Wyoming. Clearly, the AMA and LCME see for-profit education as inferior. In the future, as competition for resources increases, it is not difficult to see the AMA and LCME lobbying Congress to invalidate COCA as inferior for approving for-profit schools. They then can puush for the LCME to be the only acceptable accrediting body to HHS. A couple of more leaps of logic and they lobby CMS to only reimburse for physicians trained in an LCME school. Good bye DO's. Is that what we want? Just so the owners of the American University of the Caribbean can make a few dollars on the backs of desperate students? Our schools are already criticized for high tuition and the two-year nature of instruction with inconsistent clinical training. If COCA does not stop this, I see the end of Osteopathic medicine in my lifetime. There is a difference between measured expansion and irresponsible growth. We have an obligation to not only promote, but also protect the profession, not the self-interests of a Coral Gables investor.

July 28, 2007
Peter B. Ajluni, DO
President, American Osteopathic Association
142 East Ontario Street
Chicago, Illinois 60611-2864
Dear Dr. Ajluni:
Thank you for your letter of July 24th. I appreciate your taking the time to respond to my concerns. I am very disappointed that you are taking a “wait and see” stand regarding the Rocky Vista COM. Although I agree with your statement that there are many socially-minded for-profit companies in the world, I submit that a medical school is different from, for instance, the Apple Corporation. Although a for-profit corporation may indulge in charitable activities, it is, by definition, beholden to its investors. Medical education serves a higher purpose and students are not iPODs. Morality and ethics aside, the challenges facing osteopathic medical education are substantial: decreasing federal resources, competition for talented applicants and professors, expense of contemporary technology (such as patient simulators), inconsistent clinical training and an obligation to undertake research to increase the body of knowledge leave very little room to take a profit. It is also troubling that members of the Colorado Osteopathic Medical Society and the AOA Board of Trustees sit on the Board of Directors of Rocky Vista. As these individuals have some role in the accreditation and review of the school, the impression of an improper conflict of interest is difficult to dispel. Frankly, our organizations will be seen as a “fox guarding the henhouse” and lose credibility.
As the baby boomer generation enters retirement, America faces a formidable challenge to provide health care to this large demographic. Scarce finances are being ever diminished to meet these demands and there are many who are in great fear of our health care system collapsing. Clearly, the allopathic community views for-profit medical education as inferior. As the structure of Rocky Vista becomes widely known, particularly its ownership as an investment by owners of the American University of the Caribbean, there will be substantial backlash from organized medicine. In 1999, the AMA, Wyoming Medical Society and LCME defeated Ross University’s attempt to open a branch campus in Wyoming, under the accreditation of Ross’ offshore campus. By accrediting Rocky Vista, COCA will be placed in the same category as accrediting bodies for Caribbean medical schools. As fiscal pressure on medicine increases, it is not difficult to imagine a lobbying effort to discredit COCA as inferior and recognize only the LCME as a legitimate agency. Continuing in this vein, a case could be made to CMS and other insurers to end reimbursement to physicians trained in non-LCME accredited schools. This would make osteopathic medicine a memory. In its incorporation documents to the State of Colorado, Rocky Vista has stated it intends to open other for-profit osteopathic medical schools as well. Where is this going to end?
A young man came to my office yesterday seeking pre-med counseling. His father is an osteopathic physician in Tennessee and had advised him to apply to the University of Mississippi and not to DO schools. When I asked why, he told me that his father thought it would be foolish to spend enormous amounts of money to enter a profession that, when the for-profit school becomes known to the world, will become a laughingstock. His father felt that an MD school would provide his son better opportunities, greater credibility and superior education at a far lower cost. I was speechless and heartbroken, but it was hard to disagree.
There is still time to correct COCA’s standards and there is still time to save osteopathic medicine, if we have the courage to do so. I have expressed these concerns to COCA and I appreciate your willingness to entertain them, even if we disagree.
Fraternally,
George Mychaskiw II, DO, FAAP
Professor and Vice Chairman

Dr. Mychaskiw: How do you feel osteopathic principles affect your practice? Also, given the problems in osteopathic education that you mentioned, do you feel the new DO's you see in your training program have been adversely impacted and are in some way inadequate?

Even in the practice of pediatric cardiac anesthesiology, I use osteopathic medicine daily, as an appreciation of the body's ability to best maintain homeostasis and healing. This leads to a commonsense approach of less "heroic" interventions, simpler and more elegant anesthetics and better outcomes. OP&P also allows me to see the patient's family as patients themselves, requiring attention and concern. All in all, a very good approach to very complicated cases. We have noticed a deterioration the last two years in the quality of some of our DO residents, including one from a newer school, who was fired. Unfortunately, to a degree, the MD's see all DO's as only as good as our most recent. We still get very good DO applicants, however, with outstanding test scores and we still look on them favorable when recruiting. Living in the MD world I can see how tenuous our position is, especially given the overall expansion of MD schools. Now is the time to maintain or standards and continue to demonstrate the difference we make. The mercenaries at Rocky Vista should not be allow to threaten everything that this profession has accomplished.

Even in the practice of pediatric cardiac anesthesiology, I use osteopathic medicine daily, as an appreciation of the body's ability to best maintain homeostasis and healing. This leads to a commonsense approach of less "heroic" interventions, simpler and more elegant anesthetics and better outcomes. OP&P also allows me to see the patient's family as patients themselves, requiring attention and concern. All in all, a very good approach to very complicated cases. We have noticed deterioration the last two years in the quality of some of our DO residents, including one from a newer school, who was fired. Unfortunately, to a degree, the MD's see all DO's as only as good as our most recent. We still get very good DO applicants, however, with outstanding test scores and we still look on them favorably when recruiting. Living in the MD world I can see how tenuous our position is, especially given the overall expansion of MD schools. Now is the time to maintain our standards and continue to demonstrate the difference we make. The mercenaries at Rocky Vista should not be allowed to threaten everything that this profession has accomplished.

Dr. Mychaskiw: As an academic physician what do you feel about the qualifications of American grads of the offshore MD schools? Have they applied to your program and have any been accepted? If so how do they perform?

Some do quite well, academically. Many, however, have very little compassion or caring for their patients. They bought their way through school and do not feel it is any special or sacred duty to practice medicine, but rather an easy buck. I would much rather have my anesthetic done by a less academically gifted inidividual who cared about me, than an offshore rich kid who didn't care if I lived or died. We only accept people scoring very high on the USMLE, but that does not a caring, dedicated physician make.

DR. Mychaskiw: Why would the off shore MD's be any different from any other students, in so far as buying their way through med school goes? All students seem to be greatly in debt to the same extent more or less. Also are US MD grads presumed to be the cream of the crop choices for programs such as yours? Do you feel they sometimes are arrogant just for the fact they attended LCME schools which are presumed to be superior to our schools and the offshores?

as an osteopathic resident in an osteopathic training program, where I am trained by a 5:1 MD/DO ratio, I find it difficult in this day of age to define my background by OMT alone. OMT is a great tool in the arsenal of an osteopathic physician that should be reserved for the talented and trained physicians who choose to further it through research and excellence in there practice. I am rather more inclined to define myself as an osteopathic physician who prescribes to the osteopathic philosophy and model of health care, which I think is the hallmark of our profession.

with this said, I do agree with those who wish to change our title to MDo, which I feel is necessary in this era to reflect what we do as physicians first, embracing the progressive model of osteopathy created by our founding father A T Still MD, DO. that realized the shortcomings of the system in his time and worked on solutions and alternatives rather than adhering to the archaic and antiquated to improve patient care, and for this he became a legend and not solely for his revolutionary contributions to the basis of osteopathy.

We don't see the arrogance. Possibly a result of regional culture? Regardless, most of the issues have been with people from the proprietary Caribbean schools. US LCME grads viewed no different from DO's. Selection based on data, especially board scores.

With the modern licensing standards in place under trained DO's would not be a real threat. For profit schools are not necessarily bad. If their mission is education I do not see why they cannot carry that out and be for profit too. After all they are not pretending to be centers of research or charity so at least they are not hypocritical. SO what if the AMA does not look favorably on a for profit school, do you think they will like us better if the school does not open? Can anyone name one thing that a not for profit school can do better that a for profit one?

My Two Cents:

Not presenting a conflict of interest is one thing a not-for-profit school can do better than a for-profit one.

Huh: What conflict of interest do you specificly mean? Do you mean to imply not for profit schools have no conflicts of interests?

How much research has come out of the Caribbean medical schools? Of course the AMA will have a lower regard for the profession if the school opens. Does it matter? Well, they speak with the loudest voice to Congress and CMS about reimbursement and scope of practice. Shouldn't medical schools be centers for research and charity, or are we just satisified with skimming the cream off what others have accomplished? We are free to ignore public opinion, but it doesn't go away or decrease the threat to the profession.

Dr.M:Our schools produce practitioners.Do you mean to say our older schools are centers of research? If I am mistaken please tell me which of our schools is noted for research and what they have produced over the years. Isn't it admirable to produce docs who help alleviate the shortage of physicians in the US? We are good at that so why shy away from expansion. I doubt the AMA will ever like us and they will take a swipe at anything DO whenever they can.

While not as prominent as the allopathic schools, several of our schools are funded and producing research, like TCOM, for example. Sending money to the Rocky Vista Corporation will not change the shortage of docs in underserved areas. Their grads will have tremendous bills to pay and will go into lucrative specialties in affluent areas. There is a difference between measured expansion and irresponsible growth. Even if the AMA does not like us, (which I would question) there is no reason to throw gasoline on the fire. The Rocky Vista Corporation has no history of regard or special relationship with osteopathic medicine; we were just the gullible suckers in the right place at the right time. They knew they couldn't go to the LCME, so they went to the next best thing.
Shame on us.

Dr. M: I maintain that none of our schools are the "go to places" for specialty care or research. What we do is produce practitioners and not researchers. I do not see where RV would differ in any real way from the other COMs other than in the profit area, if there is a profit to be made.

Simply put, it's a quack move to allow an offshore carribean program to generate revenue on US land via a profession that is extolled for its humanistic and intellectual attributes. Med schools are identified through their dedication to serving the underserved and preserving human life. Should RV establish presence, not only will it damage the already misconstrued aspects of Osteopathic Medicine but perhaps even set us back further. I am currently a 3rd year medical student attending OU in Athens, OH and have published over 6 manuscripts (i.e ranging from letters to studentBMJ, NEJM, case reports in peer reviewed journals, encyclopedia chapters, and editorials) and serve on the editorial board for renown student peer reviewed medical journal. So while I agree that not all DO schools establish research prominance, it doesn't mean that we have no reason to preserve all that is currently good. And perhaps, instead of establishing new institutions, we should focus on refining the ones that already exist today. Perhaps we can work on affiliating stand alone DO schools with universities instead of putting up new ones like department stores. Let's try to proliferate RESPONSIBLY instead of disregarding the premise of good judgement.

I am waiting for someone, anyone to come up with a coherent argument to suport the RV business enterprise, aside from "well, it's only a tax designation and the standards are the same, etc." If it's such a benign thing, then why not be non-profit and avoid the outcry of protest? In a time when there are 47 million Americans without health insurance, we rank 43rd in infant mortality and medical expenses are the leading cause of bankruptcy, can someone provide any justification to for-profit medical education? Osteopathic schools are already widely criticized for relying on high tuition rates as a means of support. I am waiting for RV to make a public, coherent and rational argument to justify putting cash in investors pockets instead of opening charity clinics or lowering tuition. I know they are well aware of the backlash against them. We are not satisified with, "they meet COCA standards." COCA standards are flawed and not a justification for the opening of the first for-profit medical school in the US since 1930.

Osteopathic schools have in the past been justifiably criticizedfor not being research oriented. We live in a world of evidence based medicine, i.e. research. Schools associated with a univerfsity tend to be research directed. All of my students and/or residents must research the literature and do their own research projects.I have and my residentshave in fact won awards for their research. I have more then ten research studies that have been published and/or recieved awards. To hold to the argument that we (DO's) have never been noted for research is invalid in todays world. Osteopathy is not manipulation but a philosophy.
Also as I stated earlier many of the offshore "MD's" are ill trained because as George Machaskiw states, their qraduateshave
literally purchased the MD degree. I could have sent them money a few years ago and they would have granted me an MD degree. We have a slew of doctors on both sides of the fence who cannot pass their boards. This is not the quality that we should foster on the public for the sake of numbers. Traditionalist should get with the time and not rely on the was it used to be.

when I graduate I will practice medicine not osteopathy. Osteopathy is not the practice of medicine, but medicine may incorporate OMM as a diagnostic/treatment modality. I am a doctor of medicine not an osteopath. all I have done is taken a course in OMM per semester for 4 semesters and that will not alter the core truth of who I am or what I do; I practice medicine. I expect to be addressed as a doctor of medicine and I want my official title to reflect the fact that I am a doctor of medicine. The practice of osteopathy is not the practice of medicine, a modern DO practices medicine and not osteopathy. For this reason, the title DO is illegal and unconstitutional for a person who practices modern medicine, unless this title specifically states to affirm the doctor of medicine in whatever, combination or variety that may be possible. The modern DO must have the letter "M" incorporated in its title.
All DO's can expect to see some changes happening, remember, we hold the power, it is our title , our honor, we have worked for it, and we hold the ultimate say on this matter.

Mr.Crosby, What is the AOA's timetable for updating the designation if not the degree to MD,DO? Also what does it say about the AOA that menbership is mandatory in order to have AOA board certification? The AMA has no such thing!! Really many are tiring of AOA foot draggings especially the new grads who are going AMA for residencies in greater numbers all the time. One reason is to avoid AOA mandatory menbership for board certification.

That is a huge reason. Also a reason I see many of my colleagues leave the AOA. It is very difficuly to get AOA CME credit. Their policies are archaic and xenophobic. Recently, we had a prominent DO give a talk about OMM to our residents. The DO residents (25% of the group) could not get AOA CME credit because the talk was at an MD medical school, not approved to sponsor AOA CME, but thet got AMA Cat 1 credit. People on the AOA board of trustees tell me that policies are like this to protect the incomes of small state DO socities, since they make most of their funds from sponsoring "approved" CME conferences. This is not the way to run a professional organization.

Mr. Crosby is an excellent attorney, he very skillfully defends the many indefensable positions of the AOA.Who else is ready to drop AOA membership, until they behave retionally? Time to change our degree to MD!!!!!!!!!!!!!!

Is it true that in order to be AOA board certified you have to maintain your AOA dues?

Is it true that a joint match committee was formed in 2005 and nothing has been heard from them since?

Is it true that RVU is acting shamelessly in soliciting applicants before they are even accredited?

It is true that 50% of all osteopathic graduates never look back to the osteopathic profession after residency? Especially those 50% that go to ACGME residencies?

Is it true that AOA makes it impossible for ACGME DO's to keep their board certification by making them go to AOA activities that have nothing to do with their subspecialty?

Is its true that there was an Osteopathic Unity campaign that increased dues back in the early 2000 era? What ever happened to that?

I'm proud of being a future DO. I'm sick of explaining what it is. We have overcome so many hurdles to practice medicine in the US and internationally. Yet our own organization lacks support for us as physicians, well at least it seems with all the negatives.

Where are the voices? When can we lobby this to AOA? When will those who are so embedded in the AOA decide to listen to the new generation (and even the OLDER generations) of physicians who don't like how things are run.

Dr. Mych. I work with many fine Dr's who are off shore grads so these schools must be doing something right. I agree that RV will be looked down upon and the students who enroll will be stigmatized, but this is unfortunate and prejudging is not the American way. I hope you would be open enough to allow RV students/grads into your program if they apply and ere otherwise qualified. If you feel COCA standards are flawed you can try to change them democraticly.

I agree. The fault is not with the individual students, but with the owners/exploiters. That being said, when comparing a student from RVU to one with similar grades/scores, say from Kansas City, the KC student will get the preference. Perception is also the American way and Rocky Vista is going to be preceived by the larger world as a "fake" medical school. Grades/scores are but one aspect in the evaluation of a phsyician. The overall quality of the school is also an intangible part of the picture. Of course, Rocky Vista will bring down ALL DO schools, in the eyes of the world.

I understand from insiders that the overall plan is to have a COM in every state, this could be by branch, for profit or Univ affiliated. I for one support this plan as we move forward to realize Dr Still's dream to reform medicine.

I understand from insiders that the overall plan is to have a COM in every state, this could be by branch, for profit or Univ affiliated. I for one support this plan as we move forward to realize Dr Still's dream to reform medicine.

A group of students at one of our colleges has organized an online petition to COCA/AOA voicing disapproval of for-profit medical education and asking them to do the same. You can access the petition at: http://www.petitiononline.c...

If you are interested, please take a moment to look this over and add your signature if you are in agreement.
George Mychaskiw II, DO, FAAP

Dear Progressive Voice and Impatient:

The AOA does not control the designation given by our Colleges of Osteopathic Medicine; movement or resolution to change the designation should emanate from them. You need only scroll through the list of comments above or visit http://blogs.do-online.org/... to see several responses I’ve posted to this discussion regarding changing the DO degree designation.

AOA President Peter B. Ajluni, DO, has also weighed in on this topic on his blog, http://blogs.do-online.org/... Let me share his thoughts on this matter:

“I have followed the DO degree discussion on the blog and I’m listening to the arguments of those in favor of changing the DO designation and those who are against it. There seems to be quite a bit of division among the osteopathic family on this. I encourage you to keep an eye out for the fall issue of “The DO” magazine, which will discuss this topic (it could be a cover story). I will link to the article once it is published. I think that will encourage more discussion on this issue from both those who agree and those who disagree.

Those who feel strongly about changing the DO degree designation always have the ability to bring a resolution forward to the AOA Board of Trustees on this issue through the appropriate process. I realize that osteopathic medical students and our young DOs are especially concerned about this topic and I want to assure you it is on my radar.”

You can read this response in context on President Ajluni’s blog at http://blogs.do-online.org/...

Kindly yours,
JBC

Please everyone:
I have been practicing for 20 years, mostly in charity hospitals. I am simply calling on physicians to stand for their patients and stand for what is right. I understand the history of COCA and the issues surrounding why RVU will likely be accredited. There is nothing, however, to prevent us from saying, I Disapprove! Mr. Crosby, this is not what our patients need. In this time of economic challenge, our stdents shouldn't be commodities to be exploited. I believe any assocaition with this venture is unethical at any level, administrative, faculty or student. We are better than that.
The AMA and LCME are watching this closely. They face the same issues as we do, but they are not reluctant to voice their disapproval. We spend a lot of time making empty pronouncements about things like smoking and obesity - of course we are opposed to that. Why not show the larger medical world that we are opposed to something meaningful. This is our chance to either take credit for opposing the unethical association with for-profits or get the blame for opening the floodgates. It is our choice.

Today's AOA fact of the day indicating that more D.O.'s prescribe new medications than M.D.'s is not necessarily something to be proud of, the vast majority of trials today are sponsored by the pharmaceutical companies and 26% of D.O.'s vs 18% of M.D.'s who are more likely to prescribe brand new medications may be more easily influenced by pharmaceutical rep's representations of their new product, rather than the literature.

I started practice in 1988, following residency. In 1992 I was recruited to a town of 35000 as the only D.O. on the medical staff and the only one in my specialty, otolaryngology oro-facial plastic surgery. Other D.O.'s have come since then and my rural state of Idaho continues to grow in D.O. numbers. I had never heard of a D.O. before my second year in college. My older brother went to KCCOM (Kansas City College of Osteopathic Medicine) and I then decided to go osteopathic as well and applied to only one school, KCCOM. I made a conscious decision when I chose Osteopathic Medicine. Through study, I knew its history in general and I knew I might have to defend my training against some challenges. I knew Osteopathic Medicine was much smaller and minorities always have to compete for recognition and standing. I had no expectation of osteopathy ever developing dominant numbers. Witnessing the growing acceptance of D.O.’s by the general medical sector has been gratifying. I have always been accepted by my patients. I keep “What Is A D.O.” brochures on my front desk and occasionally, much less often now, explain what I am, a D.O. I have never had a challenge from a colleague as to my training or competence though there may have been some backstabbing about which I was unaware. My D.O. trainers and teachers had it much harder than me. Before I applied to school I talked with one of the California D.O.’s who had been induced to take an M.D. degree in the 70’s after a required fee of about $85 and a short exam. I knew fairly well what I was getting into and so should every applicant to an osteopathic school.
There really is no excuse for one to complain too loudly about their profession of anticipated profession. Rather, D.O.’s should get involved to make a difference; for osteopathic medicine. I pity one who attends D.O. school who would rather be an M.D. What a shame to have accepted something you didn’t seek or desire. I ask, why do it?

I’m not naďve to osteopathic medicine and AOA problems and challenges. There were weaknesses in my residency program that I had to fill in with extra effort and training while in practice. Interestingly, so did the M.D. students I knew during my training. I wish my program would have corrected those weaknesses before I got there. I know that they are much better now. I disagree with the AOA on a number of issues and have another message somewhere on this website on another topic.

My take home message is this; YOU are osteopathic medicine, and, osteopathic medicine is YOU. If you turn your back on osteopathic medicine you turn on yourself. Professionally, it gave you your degree and your chance. Like it or not, you asked for a cause when you became a D.O., the osteopathic cause. Take up the cause and make it better. Let the challenge make you stronger, as adversity always does. Life for D.O.’s is far easier now than ever before and I fear it may be our undoing. Weak hearts, weak commitment and short vision will undermine the profession. And if osteopathic medicine falters and is absorbed by larger organizations what will you, a D.O., be then? A stepchild yearning for recognition and acceptance by those whom you see as better than you?

I am proud to be a D.O. Regardless of its problems, osteopathic medicine is what I choose. I challenge all readers to find a way to get involved at any level in the government of osteopathic medicine. Seek to have a credible voice with the AOA. Learn what it takes to become a delegate and become one so you can help steer the organization. It will take commitment to a greater degree than simple blogging.

Regards,
Russell T. Snow, D.O.
KCCOM 1983

I agree with the nurse practitioner that it may be advantageous for well-trained nurses to take over roles that doctors often perform needlessly. Throat cultures, vaccinations, and STD testing are simple procedures that nurse practioners are trained in and well-qualified to perform. This is not an insult to the doctors, but rather a compliment. So much has been invested in the training of a doctor. An appropriate division of labor would allow the doctors to focus on more difficult cases and procedures, thus allowing more sick patients to receive quality care. People who would otherwise not be able to pay for preventative healthcare would now be able to afford checkups (yes, at Walmart). Doctors roles would only become more complex, challenging, and respected, not less. Of course some people would come to a PA/nurse-run clinic with some issues "out of the nurses' league," but if the nurse is uncertain (and we can trust their judgment here- after their 3 years of training), he or she could refer the patient to a doctor. In an ideal world, maybe docs would take complete care of the patient, but there are limited resources, and a doctor's expertise is a resource. Perhaps some mistakes would be made by the nurses, but I'd bet that the incidence of mistakes would pale in comparison to the number of people who currently have been undertreated due to lack of resources for medical care or a strain on their doctors' time.
Adina Cappell
Medical Student (allopathic)

Dear Student Dr. Cappell:

While the AOA is certainly mindful of the vital role of nurse practitioners in delivering quality health care to patients, we firmly believe physicians are needed in both primary and specialized care settings. It would be a mistake, in my opinion, to regard family physicians doing throat cultures, vaccinations, STD testing, or other apparently “less difficult” cases as an inappropriate use of resources.

DOs value the time they spend with patients in providing a whole-person approach to evaluating a patient’s overall health and diagnosing conditions. DOs also utilize their time with patients to ask lifestyle questions to get the bigger picture of what may be happening with the patient. While nurse practitioners and physician assistants are well-trained to effectively perform many services, they do not have the same level of education as a physician. There needs to be proper oversight of NPs and PAs, as physicians are the leaders of the health care team and medical home that is coordinating care for patients.

Case in point, a 2007 study by the Commonwealth Fund Commission on a High Performance Health System found that states performed better in providing high quality patient care when they put physicians at the center of the team approach to health care delivery through a “patient-centered medical home.” The study found that fostering relationships between primary care physicians and patients promoted wellness and routine checkups, and prevented more serious medical problems from ever occurring. Indeed, physicians coordinating a patient’s care at all levels promotes patient health.

JBC

i luv the AOA !!!

keep it up JBC!!

going thru med school, residency etc makes someone a physician...

I agree with our Presidents Fit for Life cause. However it is sad that in the AOA's backyard, Chicago, a fit runner dies from unattended hyperthermia. We cannot let things like that happen.
Jon Schriner D.O., Medical Director for Michigan Center for Athletic Medicine

Dear Dr. Schriner:

While the death of a runner in the Chicago Marathon is a tragedy we all regret, it illustrates the sobering point that accidents do happen in races around the world. However, this runner did not die because of “unattended hyperthermia” or other conditions related to the race (high heat, distance, lack of access to water), but rather from a mitral valve prolapse. This condition caused cardiac arrest around the 13-mile mark, despite the efforts of doctors and paramedics on site. Autopsies have confirmed this fact, not your allegations or charges regarding the AOA’s presumed responsibility in this regard.

JBC

I did not say that the AOA was responsible for his death only that it was sad that a healthy runner died of hyperthermia. To send a message that a prolapsed mitrial valve caused his death sends a wrong message to the many thousands of individuals that share this benign condition. The temperature in Chicago was at least 96 degrees and this is incompatable with racing. History will prove that that was the real cause of his demise. We need fitness and running promotes fitness but care must be taken to protect athletes. At autopsy his temperature was hypothermic and he had to have a cause of death so they blamed the valve. This does not promote care for athletes in extreme weather conditions. In hyperthermia immediate cooling is the treatment of choice and the window of opportunity is measured in minutes. Death occurs from Rhabdomyolysis and finally cardiac arrest. See Dr. Douglas Casa F.A.C.S.M. and his literature on Hyperthermia. See Pope L. Mosley, M.D.,PhD, F.A.C.S.M. University of New Mexico School Of Medicine, Quote from ACSM meeting May 29 2003. "The key determinant for an exertional heat stroke outcome is the time above critiacl temperature, not the maximal temperature obtained". A cruse around Chicago did not inhance his treatment and rapid cooling was not performed. True Fact. Race directors and race personel need to realize these facts and not conviently blame mitrial valves. If you ared interested in a dialog on this please contact me. 810 7324007.

"The JFK residency program is seen as more significant because it will train a larger number of doctors and they will be M.D.s instead of doctors of osteopathic medicine"

This was taken from the Palm Beach Post posted on November 2, 2007. The article's title is "JFK joins ranks of teaching hospitals". I still can't believe this was written.

Here's the link.
http://www.palmbeachpost.co...

Dear concerned OMS-II,
You will have to get used to this type of thing unless the AOA and all the COM's change our degree to MD,DO instead of just DO. Unfortunately this is how it is.

The marathon runner Shay, in the New York Marathon apparently died of a cardiac abnormality called Hypertrophic Cardiomyopathy and may have had a fatal cardiac arythemia. Unlike the runnner in Chicago who was hyperthermic.

Dr. Schriner:

From the Chicago Tribune:

"Chad Schieber, 35, a Michigan police officer and father of three, collapsed during the Oct. 7 race. An autopsy blamed his death on a heart condition called mitral valve prolapse and ruled out heat stress."

http://www.chicagotribune.c...

JBC

I know,but that does not mean that it is true

When does Crosby's term end? Hopefully soon. I don't understand how a non-physician can earn the title of executive director for the AOA when MD's can't even obtain a department chair position at an osteopathic medical school. This is somewhat quizzical isn't it?

Dear Concerned OMS II:

Thank you for drawing the AOA’s attention to this opportunity to promote osteopathic medicine. Our media relations division has contacted the Palm Beach Post alerting them to this error, which stemmed from erroneous statements in the JFK Medical Center’s press release on their program. The Palm Beach Post has acknowledged the error and further printed an article educating their readers about osteopathic medicine and the existing osteopathic residency programs in the county. See this post for more information:

http://blogs.do-online.org/...

JBC

Dear “Help Me UnderStand”:

If you are referring to the recently revised standards issued by the Commission on Osteopathic College Accreditation (COCA), which go into effect on July 1, 2008, then you are correct \ that osteopathic medical school Department Chairs of Internal Medicine and Family Practice must be DOs. There is no such requirement for other Departments, although COCA encourages them to recruit DOs to ensure that osteopathic principles and practices are being taught.

However, the AOA is separate and distinct from COCA and does not have anything to do with its developing or overseeing its standards.

JBC

I was very impressed with the recent AOA convention in San Diego. It was very well done and I was particularly impressed with the advances in technology, the quality of the breakfast and dinner meetings, the outstanding speakers, and especially the significant Osteopathic threads that exist throughout global medicine. I was also encouraged that the executives of the AOA personally attended/endorsed the kick-off meeting of the International Osteopathic aspect of the convention. I had no idea the osteopathic profession was so involved and ahead of the game from a global perspective. There are many positives that are unique to the D.O. profession. I also thought Huckabee's opening session was right on target, that we have to promote disease prevention; the "fit for life" theme is key and I hope we move forward with liberalizing AOA approved residencies, bring D.O.'s back into the fold, and continue our worldwide reach and influence on preventative medicine and research. Well done.

Dear Jon Schriner D.O.,

Your career is impressive, but it appears that you are not able spell correctly.

I'm sorry that spelling in haste over rides context. If you disagree with me come forth in principle not grammar. I have over two hundred articles, presentations, and research articles, do you? I am used to being judged on fact not typo's. Are you a dupe to the system? Huh?

I previously lived and practiced in CO for 20 years and with one Board there was never a need to explain oneself. I have always said that the greatest difference between a D.O. and a M.D. is that we have to explain ourselves.

Dear Dr. Sharretts:

Thank you for your kind words. I’m glad that you had a good experience at the AOA Convention in San Diego, and I hope that you will return to the AOA’s 113th Annual Convention & Scientific Seminar, scheduled on 10/26-30/08 in Las Vegas, NV.

Your comment highlights the AOA’s commitment to international practice rights and global health care. Our advocacy in this regard is carried out by the Osteopathic International Alliance (http://www.oialliance.org) and the AOA Bureau on International Medical Education and Affairs (BIOMEA). We also work closely with the World Health Organization, the World Health Assembly, the World Osteopathic Health Organization, and DO-Care, to name a just a few. For more information on our international outreach, contact AOA Director of State, Specialty & Socioeconomic Affairs Mike Mallie at mmallie@osteopathic.org.

Kindly yours,
John

How is the AOA planning to respond to the proposed changes to the USMLE? If these new changes go into effect, osteopathic medical school grads are effectively going to be prevented from entering allopathic GME for non-primary care specialties. The USMLE is a major determinant for PDs to gauge competitiveness of applicants, especially for highly desirable specialties. If these changes go into effect, we're going to see many more students forced to apply only osteopathic for competitive specialties. With the limited number of programs available in certain medical specialties, we're going to see a lot of applicants go unmatched or forced into primary care specialties they do not want. I leave you with this thought: could these proposed changes to the USMLE be the leverage the allopathic-powers-that-be have been searching for to boot osteopathic grads out of allopathic spots with their own impending expansion of schools?

What are you talking about worried?? You make no sense. Try to not confuse everyone and learn how to be clear.

Dear “Worried”:

Thank you for voicing your concerns about ensuring that osteopathic graduates have equal opportunities for postgraduate training. Based on your comment, I assume the change you refer to is the USMLE’s possible move to a two-part exam. While this change, which has not been approved by either the NBME or the FSMB, may well have an impact on osteopathic students getting into allopathic programs, it is not clear how extensive it ultimately will be. In fact, it may result in fewer of our students bothering to take the USMLE if they no longer see it as helpful in getting into allopathic programs.

We have heard recent reports that several ACGME programs are restricting who may apply for sub-specialty training by requiring completion of general ACGME training, which may limit DO choices if they completed AOA residency training - but this is not a new issue. As the LCME schools gear up for increasing numbers of graduates, there will no doubt be increased competition for postgraduate slots. The AOA Osteopathic Medical Education Summits have been addressing this very issue. In the meantime, our statistics show that the majority of DOs who enter ACGME programs are going into primary care, primarily Family Practice followed by Internal Medicine.

At the Annual Meeting of the American Association of Osteopathic Examiners in Texas this past weekend, I raised these issues to see if the state boards had any other insights. No one is aware of any other changes to the USMLE that would prevent DOs from entering programs.

If this does not answer your questions, perhaps you could provide more information on the changes to which you are referring.

JBC

As a DO who trained in an AOA-approved ACGME program, I would appreciate information regarding the USLME changes that would prohibit DO grads from entering the residency of their choice. In previous blogs, I have stated that the vast majority of medical students that rotate through my dept take the USLME's because it affords them more choices. I have been an advocate of the AOA being more user-friendly by approving allopathic residency spots to avoid the importance now placed on USLME boards by osteopathic students. It's obvious that the number of DO grads is geometrically increasing, a threat to the AMA. I would restate my position that unless the AOA finds a way to incorporate it's post grad training with the allopathic profession under an independent umbrella of governance, that steps will/are being taken to limit the range and scope of residency training available to DO's, a tragedy and a step backward for the DO profession, and spear headed by the AMA. As I have said before, to maintain a position that the DO profession needs to have osteopathic-specific post grad training programs flys in the face of the reality that almost all hospitals have mixed staffs, residencies have a mix of DO and MD grads and to even think of going back to distinct/alienating training programs/hospitals that are DO specific is a giant leap back in history.

Dear Dr. Sharretts:

Thank you for your suggestions to improve osteopathic graduate medical education (OGME) opportunities through collaboration and inclusiveness between DOs and MDs. The AOA OGME Development Initiative is currently researching proposed solutions, like allowing MDs to train in osteopathic programs, that would ensure every osteopathic graduate has a postgraduate training opportunity in the specialty of choice.

The proposed changes to the USMLE are not quite as clear. I have previously posted a response on this topic, which you no doubt read above. After attending the American Association of Osteopathic Examiners’ (AAOE) Meeting earlier this month, I have some additional insight into this topic.

According to a presentation by Frederick Meoli, DO, President of the National Board of Osteopathic Medical Examiners (NBOME), under the new regulations DOs will still be eligible to take the USMLE. Rather, it is the timeframe of when the retooled USMLE Part I would be available that could impact DMEs. For example, it Part I is not given until the 4th year of medical school, then DMEs may be unable to use USMLE test results when determining who will fill available residency positions. Without USMLE scores, would DMEs tend to choose MD candidates over DO candidates? I am hesitant to believe that they would exercise such a blanket judgment rather than considering the merits of each individual applicant.

However, the outcome of this issue depends on the final decision of the National Board of Medical Examiners (NBME) of when candidates would be eligible to take Part 1. If enough ACGME programs voice objections and the decision is made that students can take Part I during their 3rd years, then the status quo will remain. If the NBME opts for the 4th year scenario, then we will respond to the challenge. On the bright side, it may increase the number of graduates who enter osteopathic GME.

JBC

As a 1st year DO student, with the unchecked expansion of DO schools and seemingly little parallel GME development (particularly in the specialites), I find your last sentence incredibly disconcerting Mr. Crosby.

Dear “Jimmy Buffett”:

The AOA has made no secret of its goal of enhancing and expanding osteopathic graduate medical education so that every DO graduate has an OGME opportunity in the specialty and location of choice. The AOA OGME Development Initiative and the collaborative Medical Education Summits are but two of the ways we’re actively addressing this issue.

The statement with which you take issue is based in fact. While it’s easy to complain about the availability of OGME, the simple fact remains that 526 OGME positions went unfilled in the 2007 Osteopathic Match. I find this to be incredibly disconcerting.

Competition for OGME spots likely will increase over the next several years as allopathic and osteopathic colleges grow in number and class sizes. Rest assured that OGME will continue to evolve and expand to meet DO graduates’ changing needs.

JBC

I appreciate your response. A cursory glance at the unfilled OGME spots reveal that these are almost entirely family practice spots in very un-(not less) desireable locations.

For me personally, I will owe $250,000 in medical school loans and another $100,000 in undergraduate loans. Say what you wish, but with declining reimbursement, FP is not a realistic option and not even on my radar. If I were walking away from med school with just $50-70K like some of my allopathic collegues, now we're talking about a different scenario.

Frankly, I'm nervous and afraid about my future. It is my hope the powers that be will remedy this dire situation prior to when I have to match. Lastly, I do thank you for the forum and the opportunity to hear about efforts that will effect my future from the top. Hopefully they come to fruition much sooner than later.

Here Here

Dear Jimmy Buffett and Med Student IV:

Thank you both for providing your perspectives. Your additional concerns have been noted and understood.

JBC

I would have to agree with Jimmy Buffett. You can "address" the OGME situation all you want with summits and such. However, the fact remains that there has been no ACTION. Furthermore there is the unarguable fact that a gross lack of QUALITY specialty positions for graduates exist. Those who want to pursue optho, for instance, have 12 programs to which they may apply. Many of those require extensive away time from the home institution (up to six months). We have NO pathology residencies. We have 5 psych residencies. We have 6 urosurgery residencies. We have 14 radiology residencies. Our fellowship opportunities are laughable. We demand action, not summits that address the situation.

Jason Henry wrote: "I am a Nurse Practitioner and I feel that we have the same level of expertise as family docs (DOs or MDs) and we should be able to get even more practice rights."

I am a nurse clinician. My mother was a CRNA. While I believe nurses and PAs can and do fill an important niche in the continuum of health care, I disagree about NPs having the same level of expertise as Family Practitioners. Jason's statement indicates he is very confident. Sometimes this level of confidence needs to be tempered with humility.

I just spent days trying to find a Family Practitioner for my husband and myself. I was quite happy to find a DO. I worked in Metropolitan (formerly GROH) Hospital in Grand Rapids, Michigan a number of years ago in the lab and morgue while going to college.

To the DO students, interns and residents, please know there are many other health care professionals who know their limitations. We (consumers and other professionals) need Family Practitioners. Insurance companies and the government make it difficult to make it, but this does not eliminate the need.

JRS, sorry to hear the limitations for pathology residents! I learned more than I could ever have in any classes from working with two fantastic pathologists. I also learned how to review charts which served me well when I worked in epidemiology.

I used the AOA website to help find my family's new Family Practitioner, and, while exploring the site found this blog. Keep the faith. You ARE needed!

A lot of strong feelings about whether to change the degree granted by Colleges of Osteopathic Medicine to am M.D. degree. I wonder whether the same debate should also include whether to teach osteopathic principles and practice as well as osteopathic manipulative treatments. After all, the degree should identify the type of education (curriculum) taught in the school or the deeming authority for accreditation could not accredit it. The education of M.D.s currently includes medical schools in the Caribbean, Central and South America, Europe and Asia. Would all D.O.s want to be lumped into that pool; is that a better way of explaining our education. It seems that the Federation of State Boards of Medical Examiners agree that the LCME and AOA-COCA standards are the gold standard in judging whether or not to accept credentials for licensure. It is with the foreign schools that the Federation and individual states have issues.

The last head of ACGME asked the AOA and AACOM "why are your students so much better prepared going into post graduate programs than M.D. students?"

A few years ago AAMC adopted six core competencies for all allopathic students to be judged on clinical rotations. They asked the AOA-COCA why the D.O. students came out of school alresdy competent in those competencies. They wanted to know where it was in the curriculum of the osteopathic schools.

Statistics of those serving in the National Health Service Corps have always been skewed toward many more D.O.s in proportion to the numbers of M.D.s out there. Statistics about where D.O.s practice are heavily weighted to inner city and rural areas; especially Health Professions Shortage Areas and Medically Underserved Areas.

I wonder if it would be prodent to change our designation and our curriculum to better mimic the M.D. models. Remember, the Dartmouth Atlas study about the quality of care when more specialists are taking care of patients. Do we want to contribute to the flawed system that is allopathic medicine?

The patient centered medical home, the Physician Quality Reporting Initiative and other ideals associated with changing the health care and population health are two examples of how the AOA is leading and framing the health care solutions. The AOA's Clinical Assessment Program has been accepted for the PQRI initiative as one of many pilots. The CAP has been used by many Family Medicine and Internal Medicine Residencies to not only assess quality of care but has demonstrated performance improvement. Every D.O. in primary care should participate in the CAP now to find out how well you are practicing. Last I checked no allopathic residencies measure the quality of the care they provide. How do you know whether the M.D. residency is better than the D.O. residency unless you measure the quality of care provided, not just whether everyone passes the certifying boards. That is what the AOA is doing. If you'd like to ask others about the CAP ask why the National Quality Forum, Agency for Healthcare Research and Quality, CMS, United Healthcare, Aetna have all endorsed the CAP in one way or other.

How dare the AOA say they represent the osteopathic medical community! The recent opposition to West Virginia SB554 is absolutely ridiculous! WV is trying to eliminate the requirement of the osteopathic internship needed to grant licensure in the state, and the AOA has the nerve to say that they represent the osteopathic community, which opposes such measures. Have you even consulted with people in the osteopathic medical community, other than yourselves? Do you realize that those of you in the AOA are extremely out of touch with the actual desires of real practicing DOs and osteopathic medical students? Do you realize that only 5 out 50 states still require this ridiculous requirement? Those other 45 states' DOs who didn't do an osteopathic internship aren't crippling medicine in those states in any way. The only thing this amounts to is a desperate attempt of the AOA to keep graduating osteopathic medical students in AOA residencies. IT ISN'T WORKING! Nobody wants to be forced to enter a residency of lesser quality just to satisfy an out of date licensing requirement. Those students just won't practice in those states! And when I say lesser quality residencies, well, this issue has been addressed ad nauseum by myself and other posters, so trying to defend the quality of osteopathic residencies will not cut it. WHEN WILL THE AOA GET IN TOUCH WITH REALITY AND THE COMMUNITY OF PHYSICIANS AND STUDENTS THEY CLAIM TO REPRESENT!

I absolutely agree with JRS. The measures taken by Aljuni and AOA in regards to West Virginia SB554 are preposterous. It's quite evident that the AOA has no invested interests in its constituents. Please amalgamate already and quit trying to quagmire quality and progress for those of us that live in reality.

I completely agree with the above two posters on the WV situation. As someone who wishes to practice in one of the "big five" states, this situation is very personal to me. I don't understand why we have to have these antiquated rules. Please, wake up and smell the truth.

Dear JRS, Med Student IV, and JPH:

In response to your comments about West Virginia’s SB 554 regarding licensure requirements for osteopathic physicians and surgeons, the AOA has been working with the West Virginia Osteopathic Board, the West Virginia Society of Osteopathic Medicine, and the West Virginia School of Osteopathic Medicine regarding the state’s requirement that the first year of postgraduate training for DO graduates be osteopathic. All of these parties are in agreement that this licensure requirement should be maintained, not abolished as SB 554 would do.

The US Department of Education recognizes the Commission on Osteopathic College Accreditation (COCA) as the sole accrediting body for colleges of osteopathic medicine, distinguishing osteopathic medicine from allopathic medicine. Likewise, osteopathic postgraduate training is separate and distinct from its allopathic counterpart to give DO graduates more options when considering their internship and residency training.

The osteopathic profession will not amalgamate into the allopathic profession, as a very small minority would like to do. The licensing boards in the 50 states, the District of Columbia, and US territories recognize COCA’s determinations and those of the Liaison Committee on Medical Education as the “gold standard” for osteopathic and allopathic medical school accreditation. As long as we set the gold standard, you can be assured that the AOA will not begin operating under anybody else’s standards.

Notwithstanding the above, AOA Resolution 42, a policy recently enacted by the AOA House of Delegates, is currently being amended in order to provide more accommodation to DOs who opt for allopathic postgraduate training instead of an osteopathic first year. The changes, which will go before the House this July, aim to reduce the burden of having the osteopathic postgraduate training year waived.

JBC

One of the reasons that the general public confuses DO's with Chiro's is that the Chiro's have a HUGE presence in EVERY community. They have a HUGE lobby in D.C. ...and why? They have the MONEY because they don't pay a fortune to attend school, lawyers leave them alone, so they don't have huge malpractice insurance bills and they have no problems asking their patients to buy 15-50 visits up front and sign a contract, when they have NO clue how many appointments it will REALLY take to resolve the issue. Also, they are not targeted as "medical" real estate when looking for a facility to practice in.
One last note...changing your letters - or adding more letters like MD-O is NOT going to solve the identity/respect issue - I think it would be even more confusing!! I have had both good and bad DO's and MD's. I've worked for both, and I must say that The DO's I worked at AZCOM - were so far superior to any MD in kindness and caring for their patients and students (NOT saying MD's are not kind or caring) -my point is that there IS something special to being a D.O. - Most patients I know would be extremeky disappointed if they didn't have access to their D.O. - whether they perfoem OMT or not.

Uh- that's extremely not whatever I typed! : )

The new issue of The DO got me thinking about the whole identity issue. I would like to know the official response of the AOA regarding the identity issue. From a student's perspective, we are no different than our MD counterparts, except for learning OMM. The "holistic" approach to medicine may have been pioneered by DOs, but it is not unique to us anymore. The "old guard" of osteopathic medicine may have been educated differently, but now osteopathic medical education is absolutely no different than allopathic medical education, save for OMM. I urge the AOA to point out a REAL difference in osteopathic medical education, except for OMM, which by philosophy is NOT our defining characteristic.

I have been weighing in on this issue on this blog for a long time, and here I go again. When I graduated from my first residency, I applied to a Philadelphia Hospital for admitting privileges as part of my Public Health Service payback, I was denied because they didn't know what a D.O. was [1985] despite the fact that there was an Osteopathic Medical College in town from which I graduated. The AOA, at my request, in addition to PCOM, stepped in and I got credentialed. When I left that same hospital 4 years later, there was an on-site D.O. D.M.E., and D.O. student training programs had been established. When I went back into residency after 10 years, the AOA approved a ACGME [MD] residency for me in the city where I lived, because it would have been a hardship for me to go elsewhere for personal reasons, despite the fact that there were similar open positions in nearby states. When I applied for my first job again, the contract didn't recognize the AOA as the accrediting body for D.O.'s, but because I met the requirement for ACGME training, I was hired and credentialed. Despite this, I asked the AOA to step in and help me get the language changed and they did, the contracts changed reflecting recognition of the AOA, and the AOA specialty colleges as the certifying bodies for D.O.s, in addition to ACGME approved residency training. I appreciate the fact that the AOA keeps track and has on-line CME records for their physicians, the AMA doesn't. My M.D. collegues complain constantly that it's frustrating to keep track and prove to accrediting agencies, insurance companies and state licensure boards they have adequate CME's. I have been in the field for 25 years and the AOA and the D.O. profession has grown in leaps and bounds. Not once have I received a cold shoulder when asking for help from the AOA and my local state medical society and I'm very thankful for all of those things. They have been invaluable to me over the years. I will restate my position on post-graduate training however: I think rotating internships promote better, more well rounded physicians but I do not believe they should be tied to state licensure, simply a recommendation. I practice in one of those states, I did a rotating internship and was better trained to enter my residency program. I do think times are changing, and the AOA needs to realize that graduating D.O.'s, are savvy and smart, and are going to get the best residencies they can get as they should, and that if the AOA doesn't loosen up and start validating these D.O. graduates [approve more residencies] instead of disenfranchising them [trying to force them into inferior D.O.-specific residencies in some cases, in undesireable locations in some cases] , the AOA runs the risk, as do the D.O. specialty colleges of becoming obsolete. The D.O. profession will find itself without a strong membership organization and vulnerable to hostile outside forces that for decades, have wanted to diminish the D.O. profession. For those training and graduating D.O.'s despite on-going conflicts and disagreements with the AOA, don't forget your roots, don't forget who gave you an opportunity to practice medicine, and don't be fooled by sheep in wolves clothing. The AOA has a place in your professional life and it needs your support. Let's all try to work together for balance in policy, and promote the best possible training for our graduating D.O.'s in the current climate of change.

Sorry, wolves in sheeps clothing.

Dear JRS:
I am not alone in disagreeing with you that there is a “DO Difference.”

The AOA’s official response is that once you’re a DO, you’re always a DO. The appropriate initials to designate “Doctor of Osteopathic Medicine” are DO. This has always been the case, and will remain so until the colleges of osteopathic medicine change their degree designations and the state and federal statutes change to reflect such a change.

While other health care fields may borrow from the basic tenets of osteopathic medicine, the AOA believes that osteopathic medical education, training, and practice are truly unique and will continue to be so as long as the osteopathic medical profession exists.

This is what the AOA believes and stands for; it is what our members want and need.

JBC

Since the DO Magazine just came out with the possible initials change for more public awareness, can the AOA now send out a mail-in vote to see if all DOs and osteopathic med students would like the change from "DO" to "MD, DO" as A.T. Still, MD, DO had behind his name at all time because he wanted people to know he was a medical doctor who also did OMT and believed in osteopathic philosophy and principles? If so, I am all for it and I am sure if there all costs involved most DOs would send money to the AOA or their osteopathic medical schools to help with the administrative red tape and laws to change this. When could this vote or name change start since the recent article in the DO Magazine seemed to indicate most DOs want this change?

Much that Dr. Sharetts and I have disagreed with the AOA, we share a common thread. That the time is ripe for us to stop fighting between our selves and form a common ground. Although the AMA may not totally like us, we should first like ourselves.I am proud to be a D.O. and do not at this time wish to change my title, although I recognize that to be an M.D. would give me instant recognization and acceptance globally. Our profession has reached the threshold of that same recognition. If we continue to stand on the precept that we are deserving of our place in modern medicine we shall perservere as D.O.'s. Why give up now. Forty five years ago I forged my own way , preceeding from what those D.O.'s before me had accomplished. I believe that now I have not to prove myself anymore. If you young D.O.'s will go forth and prove yourselves as proud Osteopathic Physicians the public will follow you. Don't bail on your profession which has given you an oppertunity to be the best that you can be. MDO DO DOM Seems DUMD at this time Keep D.O. and make it one to be proud of.
DO you think that the AMA will change M.D. to M.D.O.
I for one will remain a D.O. and try to make our profession the best.
Although I do not always agree with the AOA, and that is my right, I still would rether be a D.O. and fight then turn chicken and run.

It seems like it would be better and most pragmatic to allow DOs to either have "DO" as their initials or "MD,DO" as their initials. It does not seem like laws would have to be changed that much since A.T. Still went by "MD,DO". I think AT Still,MD,DO would be proud of the change since he had those initials for public awareness and to highlight his osteopathic philosophy and ability to use OMM. If this were allowed, there would be no further jaded discussions on this issue because physicians on both sides of this debate could chose which initials they would want-- "DO" or "MD,DO". Most osteopathic physicians would continue to be proud of being osteopathic physicians and support the AOA and their respective alma mater osteopathic medical school that each physician attended with eagerness and financially.

JohnCrosby,
You did not answer my question at all. What is the significant difference in DO medical education, aside from OMM? The AOA keeps touting the "DO difference," but aside from OMM, which few graduates will use, what is this difference in training that is making new DO grads so different than their MD counterparts? Please cite specific examples.

I would like to share the following letter I recently sent to the deans of my medical school. I am reaching out on this forum in the hope some one can help.


March 13, 2008

Thomas Scandalis, D.O.
New York College of Osteopathic Medicine
Northern Boulevard
Old Westbury, NY 11568

Dear Dr. Scandalis:

This afternoon I learned that I failed the Comlex Level II PE. I immediately went on-line to reschedule the exam and was devastated to find out the next earliest test date is not until December 2008.

It is irresponsible and negligent of the AOA not to have built in a contingency plan for fourth year medical students to have an opportunity to re-take the test. I am now faced with the reality of not graduating and thus not starting my residency. The shock of facing this after four years of successful hard work is indescribable.

I would suggest that the AOA admit that the infrastructure was not in place when the decision was made to make the COMLEX Level II PE exam mandatory for graduation. Immediate action should be taken to rescind the mandatory nature of this exam as a prerequisite for graduation until the AOA can provide a schedule that supports the opportunity for students to retake the exam beyond the current restrictive dates.

I am aware that there are many other students who are facing this same crisis. This situation is a disservice to NYCOM students. This must also be occurring at other osteopathic schools. We cannot sit by quietly. We need to unify and petition the AOA to change the current process.

I send this urgent email to you to look for an acceptable solution to this situation. I implore you to find out immediately how many NYCOM students are in my same situation. Is there time to fix this so I and others can graduate in May?

Personally, I cannot sit here feeling helpless while my life and future have been turned upside down. My hope is that the course of my journey has not been completely taken away.

I would very much appreciate a quick response from each of you.

Sincerely,

Matthew C. Cauchon
mcauchon@NYIT.edu
413-265-9313

I was dismayed to see ratings of my career on the internet connected to the medical school I attended which was rated at 1 out of 4 stars. Then I checked the US News and World Report and Princeton ratings of US medical schools and was surprised to see that only 2 Osteopathic medical schools even made the ratings as the 2 lowest rated schools in the survey, Michigan U and West Virginia at 125 and 126th in the nation. The rest of the D.O. schools didn't even make the survey. [ratings based on mixed scores including applicant MCAT scores and the NIH] In my opinion, it flows from the top down, if the AOA does not endorse top training and post graduate education for graduating D.O.'s, which would indicate a new approach to approving residency training programs, D.O. schools will undoubedtly be a fall back position to applicants, rather than their first choice. If being a D.O. is in fact, "unique" and our training is "unique", it's not well understood even by D.O.'s, and D.O. schools are obviously considered inferior by the rest of the medical community. Let's start thinking out of the box and continue to move forward with innovative change in our training programs. If as much energy was spent on our training programs both in medical school and post graduate, as is being spent in trying to change our degree, we may tap into new and leading edge ideas, but as long as our graduates feel defeated in their goals for top residency training that may be outside the scope of the AOA and are disenfranchised from the AOA and the AOA's specialty colleges, the Osteopathic profession will continue to experience a "brain drain", as new graduating D.O.'s distance themselves from the AOA and move forward with what they know is right for them. Can't we start listening and responding?

Dr Sharretts makes a good point about osteopathic medical education needing to step outside of the box. Most people have such tunnel vision on osteopathic medical education being unique in its teaching of OMM, however, this is not what our philosophy is based upon. Osteopathic medicine arose out of the failure of conventional medicine, offering an alternative method of treatment. Conventional medicine, today, is effective. If we are to succeed as a unique entity, maybe we should start addressing the business of healthcare in our schools, as this is the aspect of medicine that is failing. Teaching our students how to navigate the system better will make better clinicians. Training clinicians early on about how the system works will potentially motivate positive changes. This is in contrast to young clinicians who just sign up with a group fresh out of residency to avoid the issue of dealing with the system that is difficult to navigate. Step out of the box and address the future of healthcare. This is exactly what AT Still did.

Today was my last day at my current employer after 14 years, a corporation that distanced itself from principals that I hold true and close to my heart, but very common in today's climate. I am starting at Geisinger Medical Center which is the strongest system in my area [Central PA], which endorses D.O.'s [decades of MD promince], which has a Children's Hospital, a level 4 trauma center, which has thousands of employees, has 25 residency programs, wecomes D.O.'s, has an Osteopathic Internship and is on the cutting edge. Take note. There is a reason that Geisinger Health System is one of the strongest systems in the country [check the internet for more information] D.O.'s we are well trained. That has been my experience in 30 years of teaching. So take heart D.O. trainees, stop fretting about your degree, and get out there and start training and treating patients, your future awaits you as a D.O.

ray,
You are correct stating that DOs are well trained. No one is questioning that. The issue at hand is having the DO degree change to MD,DO which would just allow the public to know a little better that you are a medical doctor and have osteopathic medical training. This should not require much changes legally I would not think and those expenses could be covered by current osteopathic physicians. Your name title would be slightly longer but looks great: Ray E. Sharretts MD,DO,FACN
Instantly, everyone knows you are a medical doctor(MD) know matter who they are in the U.S. or from a foreign country and you can still have DO in your title to show you have additional osteopathic medicaltraining. That is why AT Still, a man I have great admiration for, went by
A.T. Still,MD,DO.

Dear JRS:

My gut instinct is to tell you that if you don’t “get it” now, then you never will. But, like the dedicated faculty at the 25 colleges of osteopathic medicine in 28 locations would attest, the immense benefits and value of osteopathic medicine can indeed be taught.

My understanding of osteopathic medical education rests in large part upon my impressions formed over the 11 years that I have served as AOA Executive Director. During that time period I have attended meetings of the osteopathic state divisional societies, specialty practice affiliates, and had the opportunity to visit a majority of the COM campuses. I have also had the opportunity to talk with those individuals who have experienced osteopathic care both in the office setting and in the setting of being a hospitalized patient.

Admittedly, not all osteopathic physicians will have the same high level of skills with OMM, or necessarily have practices in which their patient population will require use of OMM. However, the use of touch, both in the physical diagnosis and in the treatment phase is evident. The practice of medicine with a holistic perspective is also very apparent. Osteopathic physicians are much less likely to practice a healing art that is focused on what disease, and therefore which specialist, must be the physician of record. Rather, osteopathic physicians are much more likely to practice a continuity of care.

This difference in practice has been handed down from generation to generation. I cannot cite specific differences in the names of the courses offered in an osteopathic curriculum versus those offered in an allopathic curriculum. But, I can see the difference in the practice philosophy of the DO versus the MD.

JBC

MD,DO: Isn't it ironic that the first 2 graduates of PCOM [Philadelphia College & Infirmary of Osteopathy] in 1900 included a woman, and an MD? Over 100 years later, the advances of the Osteopathic profession absolutely rival the Allopathic profession, including international medicine and research, Osteopathic programs that offer concomitant MBA, MPH, and PhD degrees, etc. I find it interesting that you keep citing AT Still in your remarks. You obviously have some respect for the history of the D.O. profession. I don't know where you are located geographically, but where I live, everybody knows what D.O. means. I agree with Mr. Crosby's remarks regarding the holistic approach by D.O.s, and the resistance to compartmentalize a patient's care by farming care out to specialists based on diagnostic categories, especially in the hospital environment. But it's not obvious to training D.O.'s, it's an art of medicine that blossoms only after one graduates, finishes residency and starts practicing. It's subtle but powerful and patient's gravitate to it because they have a sense of being cared for as a "whole" person, not a diagnosis. I absolutely agree with that sentiment and coming from a non-D.O. administrator, Mr. Crosby has good insight in that area. I have to restate my position however, that opening up the approval process of excellent residency programs that aren't necessarily D.O.-specific is key to the survival of our profession, because as Mr. Crosby cites, the holistic approach and "art" of medicine is passed down "generation to generation" and this will continue and in my belief occurs in medical school, less so in residency. Residency training, in my opinion, will not change an inherent D.O. philosophy unless that philosophy was missing in medical school. Why not inject new/alternative thinking into the process and evolution of the D.O. by listening to the out-cry for better post graduate education, and then taking action to insure that D.O.'s are afforded the best possible residency training programs?

Dr. Sharretts,
I am located in southern California and specialize there and that is all I will tell you. Like you, I love osteopathic medicine and always lay hands on my patients with wholistic care. Example, every diabetic I treat, certainly I may prescribe Metformin,Glyburide, Januvia, Janumet, Lantus, or whatever and check a HbA1c,Microalb/Cr UA, and cmp,etc..., but do I always look at diabetics feet for peripheral pulses and check for ulcers and apply my hands on their feet? You bet! Would all MDs apply their hands to a diabetic's feet? Perhaps, or perhaps not. Would all DOs? I bet most would! As most DOs would tell their diabetic patient to try and exercise more and follow a 2000 cal or lower ADA diet with each and every visit. I agree with everything your saying and you make very good points. All I am saying is that it would be nice if DOs could either list "MD,DO" with their name. It just makes sense. It let's the general public and naive reporters know that we are medical doctors with a wholistic viewpoint and have osteopathic medical training. If some DOs do not want this, perhaps they could have just have "DO" behind their name.
Is it possible that all DOs can just start begin using "MD,DO" or could that lead to legal reprecussions? If so, what can be done to change the initials to this? Would all DOs have to contact their state licensing agencies to do this? Look, I am just saying I have to explain to everyone that I am a doctor and love to treat patients instead of someone calling me an osteopath and not a complete medical doctor, which amazes me that it happens frequently even today in 2008.
Thanks for any info on this subject, Sir.

Dear John Crosby,
I have a feeling you will never "get anything" since you are:
a) not a physician
b) not an osteopathic medical student
It is hard for anyone to believe sweeping statements coming from a lawyer and not a student/physician. You may have observed society meetings, practice meetings, visited campuses, but the art and practice of medicine doesn't happen in the administrative sector. You may have seen or heard anecdotes about osteopathic physicians being more holistic, etc... but be reminded that the standard of care does not vary much from practitioner to practitioner. Will every physician prescribe meds for the diabetic? Sure. Will every physician check for a diabetic foot wound? Sure. Will every physician recommend a low cal diet with exercise? Yes. It's called evidence based medicine (which maybe you don't know much about being a lawyer and all) and is nothing unique to osteopathic medicine. Now, once again, you have neither cited specific examples of educational differences, nor specific examples of how osteopathic physicians differ in practice. I will tell you that, as a student, I have experienced osteopathic medical education and observed osteopathic physicians in practice (from primary care to ortho surgery) and there exists no practical difference. Osteopathic physicians practice evidence based medicine, nothing more and nothing less. I have seen some OMM done in a clinical setting, but it was not the be-all-end-all of treatment modalities. I will also reiterate a previous point - the holistic approach to patient care may have been pioneered by osteopathic physicians, but is no longer unique to them, as it is the standard of care. Also, hearing about patients' experiences is not valid as neither the patient, nor you have any clue as to what is the standard of care. The AOA needs to start examining the identity issue with a little more effort. OMM is a fine treatment modality to have, but it cannot be our defining characteristic (which, if you ask any current student, recent grad or practitioner not involved with the AOA, they will tell you that OMM is what separates us from allopathic physicians). I will apologize if I have seemed a little direct in my postings, but the AOA needs to address this issue and recommend serious changes to the educational divisions. If we don't start getting back to the basics (as the late Dr. Strosnider preached) and addressing the changing face of medicine NOW, rather than back in the late 1800's (ie development of OMM by AT Still), osteopathic medicine will be headed for amalgamation when my generation is in your position. In other words, the basic philosophy of osteopathic medicine is to address the changing face of medicine head-on by stepping out of the box. Evidence based medicine is the standard of care for osteopathic physicians and our allopathic counterparts, and this is not an issue that needs addressed. OMM, the modality of treatment developed by AT Still and rooted in a holistic approach to care had offered patients a new form of treatment in the face of failing conventional medicine in the late 1800's and early 1900's. Evidence based medicine has been pioneered by both allopathic and osteopathic physicians throughout the years, all while taking a holistic approach to patient care. Essentially we live in a time where osteopathic physicians are no different than their allopathic counterparts, whether you like to think so or not. The waves of this sentiment are beginning to lap at the shores and if it is not addressed in due time, the osteopathic community will be in the midst of another amalgamation tsunami. If you don't believe me, take a look at all of the talk about the DO designation change. Seems like beginning of a series of events that could lead to amalgamation (DO -> MDO/MD, DO -> MD). And whether or not the AOA thinks they can prevent that from happening, just think about how successful the AOA was in stopping the California amalgamation. In the future, the osteopathic physicians will ultimately decide whether they can offer something different to their patients that warrants a separate degree.

Dear Student Dr. Cauchon:

Thank you for commenting on your experience regarding the issue of examination scheduling. You should note that the AOA does not have any control over decisions of the National Board of Osteopathic Medical Examiners (NBOME). The NBOME is a separately incorporated entity with its own board of directors, offices and staff. Your letter has been forwarded to the NBOME for its consideration.

JBC

Dear MDDO:

AT Still completed formal medical education to earn the degree of MD before he founded osteopathic medicine and added the DO degree. The osteopathic profession has no authority to confer the degree MD. Even if thousands of osteopathic physicians wanted to change titles, many DOs would be against it. Our goal is to build public knowledge on the DO difference and respect for the profession, not change the title.

If you are interested in having a vote on this issue, the best way to do this would be to work with your state association to bring a resolution to the AOA House of Delegates floor this July, where 500 osteopathic leaders will vote on it.

We are proud of the DO degree, and that degree is what we currently produce. The DO degree has served the profession and the public it serves for more than 100 years. We respect your opinion, and thank you for your comment.

JBC

Hello DOs,

I am a 4rth year med student at CCOM. I have created an online exercise prescription tool for healthcare professionals (DO, MD, PT, PA….). I would like to invite you to http://www.healthyprogress.net , the website is free and it takes less then a minute to create your account. You can use the website to print or email exercise handouts for your patients. You can create exercise programs from scratch using our extensive library of exercises, or you can use programs created by HealthyProgress. The website is easy to use, but I encourage you take a minute and go through the tutorial to fully understand it’s potential. The website is still new and you may run into bugs, so please send me any comments or suggestions (any exercise you would like to see in our library). We are constantly adding new exercises, programs and options to the website. My goal is to encourage exercise prescription by healthcare professionals, so please take a minute to explore this wonderful tool and let me know what you think.

What is the AOA's position on the Doctor of Nursing Practice (DNP)? The National Board of Medical Examiners is (NBME) is going to prepare an exam for the DNP: http://online.wsj.com/artic...
About half of all DO’s go into primary care. As other professions continue to expand their scopes of practice, I think that it is very important that an "M" [(MD,O; MD(O); etc. ] be added to our degree designation sooner than later. The "DNP" underscores the need for the public to understand that DO's practice medicine. Considering how the “DNP” will be the new standard for NPs, would it really be that difficult to make the "MD,O" (or similar) the new standard for DO’s?

ProudMD,O is right. What's next is that PA's may try to get "doctorates" in Physician Assistant as nurse practioners get "doctorates" in Nurse Practioner and then open their own practices without physician supervision. And to the general public, their degrees are more recognized.

To distinguish ourselves the best in this changing society, it would be best to have "M" in our degree and change the degree from DO to MD,DO or MD,O or MD(O), etc...

Why does the AOA not understand this? The recent DO magazine brought up this issue but is the AOA going to follow up on this issue. One would think they would jump all over this and be eager to do this based on all the osteopathic medical students graduating these days with over 3/4ths in favor for the change. Perhaps, new graduates of osteopathic meidicine should try to get leadership positions in the AOA and state organizations and replace older members to help facilitate this change.

Dear MD,DO: if what you say is correct, that 3/4's of osteopathic medical students want the D.O. degree altered, then you're right, new blood will have to assume leadership positions in the AOA to affect change. 30 years a go when I was a student, we wanted to change the degree also, MDo was the favorite, and this same debate rages on today. I have to admit that after 30 years of practice, I have come to respect the D.O. degree and appreciate all the opportunities I have been afforded because of my D.O. degree. I'm also concerned that if our new generations of D.O.'s, want change, whether it be issues with our degree, or post graduate training programs, that they get involved, hold positions of leadership, work towards change, give back, and not walk away from the AOA. The AOA is only as effective and responsive to calls for action and change, as the leadership within it's structure. The older generation of D.O.'s have fought many battles that have opened many doors to new graduating D.O.'s, I have fought many of those battles myself and have mixed feelings about changing the degree. I also believe the AOA could highlight some of the differences in philosophy of the AOA and the AMA because there are differences and have been for decades. OMT aside, The AOA has pushed international medicine and preventative health care which is the future of medicine, preventing disease, rather than treating preventable illness. D.O. schools are ahead of the curve offering concomitant degrees [MBA, MPH, PhD] which open doors and further propels D.O.'s into positions of leadership, and are also introducing new fast track programs. I would like to see us as a profession, focus on encouraging new D.O. graduates to get the best possible training, to give back to their profession through leadership roles, to think futuristically and "out of the box", and try to get away from feeling inferior as D.O.'s

Dr. Sharretts, I have been an AOA member for several years and send the organization money annually, I only just now wanted to get involved since The DO Magazine brought it to mine and everyone's attention about the initials change with its front cover and based on that article it seems most DOs and students are in favor of the change. I did not even know the DO-online blog existed until The DO Magazine mentioned in the FEB 08 issue. Thanks to the DO Magazine is why I am here. It has made me excited for change to bring osteopathic medicine to the forefront and national recognition with a simple change of initials -> MD,DO , MD,O , or MD/DO. It just makes sense to me. It represents that we are medical doctors with an osteopathic approach. I will continue support the AOA and my osteopathic medical school with annual money donations (and much more if the initials change), be proud to be in osteopathic medicine, and work hard to do best for all my patients with evidence-based medicine and preventative medicine with an whole-hearted osteopathic approach and never have to explain to patients that I am a real medical doctor again because MD is in the title, it just makes sense. I will also be able to go on humanitarian missions to foreign countries and be able to help due to international recognition of an MD as one able to prescribe medicine and perform surgery. Because as you know, DO in the UK, Australia, and other countries do not recognize DOs as the US does as a full medical doctor.

MD,DO, the PA doctoral degree (DScPA)is on the horizon:http://physician-assistant.advanceweb.com/editorial/content/Editorial.aspx?CC=101913

Dear MD,DO
I appreciate the passion you express for Osteopathic Medicine and essentially, we're on the same page regarding our commitment to the Osteopathic profession. It is my hope that the other issues that I have brought forth throughout this blog have importance also, in addition to expressed concerns about our designated degree. I think it's important to listen and not diminish other's points of view and I hear what you and others are saying about the degree issue. I also wish this blog had more participants as I suspect most D.O's don't know this blog exists, I stumbled on it as you did, by accident. I would ask Mr. Crosby, who undoubedtly follows this blog, to weigh in again soon, and to make it more visible to the D.O. population. I do agree that the D.O. magazine had on it's front cover the variety of possible degrees that D.O.'s could carry, and there seemingly was no conclusion or follow-up. Was it an attempt at pacification? Those known to "Sermo.com" are aware of the power of numbers, although I must say I have no respect for that website, it's money driven, and personality disordered. I quickly lost interest. It would be refreshing to have a blog for DO's, and other interested parties, that was objective, had nothing to do with awarding prize money and Ipods, and was simply a forum for exchange and expansion of ideas, another way for D.O.'s to think "out of the box" and get ahead of the curve through innovation, sharing of ideas, and just general communication. I wonder if the next front page of D.O. magazine might not inform our profession of this blog and request that others weigh in on a variety of subjects important to the Osteopathic profession?

Dr. Sharretts,
That would be great to let more DOs know about this blog on another DO magazine. I hope the AOA Executive Director, John Crosby, J.D., will honor your request.
Your Friend,
MD,DO
P.S. -- ProudMD,O -> that's scary. Who would have thought Physician's Assistants could be become Doctors of Physician Assitant? Here is a quote from the website you mentioned:
There's a new PA degree in town, and its name is "Doctor."

The U.S. Army and Baylor University have created the first clinical doctorate degree for PAs. Army PAs will receive a doctor of science physician assistant (DScPA) degree after successfully completing an 18-month residency in emergency medicine at Brooke Army Medical Center at Fort Sam Houston in San Antonio.

Here is a quote from the Nurse Practioner's web site you mentioned:

By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners.

But some physician groups warn that blurring the line between doctors and nurses will confuse patients and jeopardize care. Nurses with doctorates use DrNP after their name, and can also use the designation Dr. as a title.
If PAs and NPs are going to use "Dr" instead of Mr. or Ms./Mrs. when introduction to their patients and have their own practice with "DrNP" and "DScPA" after their name, wouldn't it be better for DOs to have "MD,DO" or "MD,O" or "MD/DO" in their initials,especially when putting that on a sign in front of their office when down the road nearby PAs and NPs are opening their practicings with these new titles I mentioned?
If they are changing their initials so easily to compete with us, shouldn't we? DO would still be in our initials,as I have expressed, but I think it would allow us to be more distinguished then mid-levels to get more business, you know?

Dear MD,DO
I taught PA's and NP's for years in the early 80's, from University of Pennsylvania and Hahneman [sp] Medical College, both new programs at the time. It prompted me to specialize [was in primary care internal medicine at the time] because I could see it coming, primary care, because of physician shortages would be overtaken by these specialties, as I mentioned in my blog at the very top of this column. Regretfully, I believe it to be true, like it or not. I believe the degree issue to be separate. I have worked under administrator/doctors and nurses for years with 5 degrees behind their names, it doesn't change their character, and it doesn't change the respect they command from others. To me, simplicity can be a good thing. Patient's are totally confused in today's climate about health care professional's degrees. Practice rights by virtually all medical specialties have expanded. I personally trust my eyes to an O.D., who I trust very much and who diagnosed a retinal tear and prescribes medication, not so when I was in medical school in the same city as the College of Optometry. Most patients think they're seeing a doctor when in front of a PA or a NP. So maybe you're right about the degree, but I personally feel resistant to being lumped into the M.D. pile with an "O" in there somewhere, where I work, D.O.'s are known for who they are, doctors of Osteopathic medicine for over 100 years. As you have proven in many of your entries, your patients come to you, trust you, return to you, because of you, not because of your degree. As patient's get to know us, our care, our expertise, they could care less what our degree is, they come to us as individuals. Let's see, how many degrees can I think of, D.O., M.D., O.D., D.P.M., D.C., CRNP, PA, PsyD, PhD, MPH, many nursing degrees I can't recall, now hearing about a doctorate program for NP's and PA's, where will it end? Is it the right time to cause more confusion by changing the historical D.O. degree? Is the challenge not more exposure, more initiative on the part of the AOA for the expensive dues we pay, a call to arms for new ideas and support? A call to arms for top training and giving back?

"Is it the right time to cause more confusion by changing the historical D.O. degree?" - You bet, in a sense. You are right that the historical degree D.O. is historical and causes confusion in the modern day, add MD to it, immediately no confusion. If NPs and PAs are going to be called "doctors" and try to compete against us, then I think having "MD" in our initials is universally recognized globally, and I feel most patients would choose to go to us instead. If the general public just sees "DO" behind our name, that patient may choose to go to a "DrNP" and "DScPA" instead nearby because they do not know the difference or another naive family may drive miles away to see an "MD" because they do not know what a "DO" is, no matter how much the AOA tries to market it or put out pamphlets on what a DO is.

I've exhausted my sentiment, I respect my fellow Osteopathic physicians, so I invite a response by Mr. Crosby as our executive director of the AOA, this is not a debate between 2 people, but about our profession. I also invite responses from fellow D.O.'s that may be passively reading this blog but not participating. I have put my name out there throughout this blog, time for some new names and ideas.

I couldn't agree more. As Dr. Sharretts has stated, I hope more DOs log in and support the change that myself and proudMD,O have mentioned here to make our Osteopathic medical profession more recognized to the general public and make us proud to be a part of the osteopathic medical professon now and always. If the initials change, my funding to the AOA and my osteopathic medical school will triple annually effective immediately and I will donate as much as I can annually every year to the AOA and my osteopathic med school I graduated from. That's a promise for as long as I live to help osteopathic medicine.

Dear Dr. Sharretts and MD, DO:

Thank you both for your active participation in the AOA Daily Reports Blog. It was designed for this exact purpose: to provide DOs with a forum in which to discuss issues critical to the profession.

Regarding the DO degree designation, I have expressed the AOA’s position on this issue many times already. You need only scroll up through the 200+ comments above to read about our stance on the DO designation. In short, the AOA stands proudly behind the historic identity and distinction conveyed by the DO degree. Twenty-five osteopathic colleges in 28 locations confer this unique degree. The federal government, all 50 states, and close to 50 countries worldwide recognize the DO degree in statutes for full practice rights.

Changing the degree would require changing all of those governmental statutes, not to mention the bylaws of every osteopathic medical school, specialty college, and state divisional society. In fact, the AOA has no authority to enforce this change upon the schools – rather, the movement to change a degree designation would likely start from them. Yet above all these restrictions, the majority of DOs do not support this change. The AOA, representing 61,000 DOs, must obey the majority of its membership.

I concur with “MD, DO’s” point that those advocating the change must assume leadership roles within osteopathic institutions, for those already in such positions are not in favor of this change. As Dr. Sharretts wisely pointed out, the AOA answers to our DO leaders. Those leaders in place in the AOA and in state and specialty organizations across the country are proud of the DO designation as it stands.

JBC

Mr. Crosby,
I respect your position and your thoughts. I am proud to be an osteopathic physician and love osteopathic medicine

. I just wanted to ask two more questions: You stated "Changing the degree would require changing all of those governmental statutes, not to mention the bylaws of every osteopathic medical school, specialty college, and state divisional society." --> Can there not be a national poll to the 61,000 DOs to see how many DOs would contribute money to change this? If myself and other DOs voted that we would fund these changes, then it seems that would be possible, even if it takes a year or two.

The other question--> You stated:

"In fact, the AOA has no authority to enforce this change upon the schools – rather, the movement to change a degree designation would likely start from them. Yet above all these restrictions, the majority of DOs do not support this change. The AOA, representing 61,000 DOs, must obey the majority of its membership." --> Has the majority of DOs been polled? I haven't, so who has? No DO I know has. Have any of the passive readers been polled? Please answer on this blog. Can the AOA please send out a poll to the 61,000 DOs and then if the poll supports that statement, then I will believe it and never blog again because I will then be a minority on this issue. If the AOA represents the majority of DOs, then to defend that statement, a poll must be send out,right? If not, then what was the FEB 08 DO magazine all about? No follow-up? Please explain.Again, proud to be in Osteopathic Medicine, but would like more recognition in my initials that I am a medical doctor and have a holistic viewpoint, which MD,DO I think makes sense. Thanks!

There is an online petition that can be accessed at this link: http://www.thepetitionsite....
Those interested may sign it and post comments about the degree change issue.

Dear Dr. Sharretts:

Thank you once again for your active participation on the AOA Daily Reports Blog. I, too, wish that more DOs would take advantage of this great forum. In fact, I send the AOA Daily Report out to nearly 27,000 osteopathic family members every day to this end.

The AOA Daily Reports Blog consistently is one of, if not the most, viewed pages on DO-Online. The home page of DO-Online keeps a live list of new links on the Blog to direct new users to it. New commenters emerge every day. Rest assured that we will continue these efforts, and more, to continue to promote this great member resource.

JBC

Dear Proud MD, O:

The AOA is concerned with and has been monitoring the development of Doctor of Nursing Practice (DNP) degree programs. Our Bureau of State Government Affairs has been studying and responding to this issue since 2004. In addition, the AOA is very concerned about the National Board of Medical Examiners developing a test that DNPs and nurse practitioners could take to obtain a “certification,” presumably to practice at the same level of health services as primary care physicians.

The AOA’s policy on non-physician clinicians, such as DNPs or nurse practitioners, is that they should work in collaboration with or under the supervision of a DO, and certainly not replace the primary care physician’s role.

In addition, the AOA is a member of the AMA Scope of Practice Partnership (SOPP) Steering Committee, which soon will release a comprehensive background data series on the nurse practitioner to assist SOPP members in addressing and educating government officials. As one example, we point out to state lawmakers that not all DNPs complete a “residency” and this inconsistency is significant to patient care and patient safety.

Furthermore, the AOA has also been advocating at the federal and state levels for truth in advertising that allied health professionals should identify the type of license under which they are practicing when they meet with patients. Allied health professionals with doctoral degrees, i.e., the DNP, would identify as, “I’m Dr. Jones, a Nurse Practitioner.” This adds truth and transparency that is of benefit to patients, and several states have embraced this concept. Florida, for instance, passed the Truth in Medical Education Act in 2006 that requires these disclosures and also requires practitioners to wear name badges with their license type on them. Other states, such as Oklahoma, have legislation pending that would require the disclosures. We will continue to monitor this issue closely.

JBC

In regards to the MD,DO issue, I think the only arguments against the change I have heard is that it "betrays" our heritage and it would be too difficult to enact on a national and state level. Well, my take is that an MD,DO would propel osteopathic medicine from good to great. We've been around for over one hundred years and still the public has no idea what a DO is; most, in fact, think a DO is either an eye doctor or chiropractor. What a great way to allow the public to know we're physicians, but much more! When a patient sees the MD, they know the branding and automatically know we're medical doctors, but with the DO added, we can inform them we have more to offer. This is in contrast to explaining and justifying what a DO (by itself) is. The difference is you automatically command the respect of the patient with the MD,DO, rather than having to win it over by explaining what the DO by itself is. It is simply a matter of branding, and the MD wins out, despite over one hundred years of the AOA being around and not getting the message across. This will also potentially bring back more DOs who hide behind the prefix of "Dr." rather than advertising their designation.
Another point I'd like to make is that some think that changing the degree designation now will just confuse the public. The fact is, the public doesn't know who we are to begin with, so it is a moot point.
As far as implementation, I doubt the federal and state governments will have a problem with the change. If schools want to grant MD, DO degrees, it is highly unlikely the government is not going to recognize the thousands of graduates from these medical schools. That would just dig a deeper hole for the physician shortage crisis that they're trying to address with the whole med school expansion initiative.
Bottom line, osteopathic medicine is about adapting. It would do us a world of good to change the designation. It doesn't change the education at all. Everybody still practices osteopathic medicine, but now you let the public know you are a physician with more to offer (MD = good, MD, DO = great)

Glad to hear your visit to the acting Surgeon General went well. AMOPS will be delighted to have more DOs join the uniformed services. We would welcome any efforts on the part of the AOA to encourage uniformed service to our country.

Glad to hear your visit to the acting Surgeon General went well. AMOPS will be delighted to have more DOs join the uniformed services. We would welcome any efforts on the part of the AOA to encourage uniformed service to our country.

JohnCrosby wrote:
"The AOA is concerned with and has been monitoring the development of Doctor of Nursing Practice (DNP) degree programs. Our Bureau of State Government Affairs has been studying and responding to this issue since 2004. In addition, the AOA is very concerned about the National Board of Medical Examiners developing a test that DNPs and nurse practitioners could take to obtain a “certification,” presumably to practice at the same level of health services as primary care physicians."

With all due respect - THE AOA HAS DONE TOO LITTLE TOO LATE. The DNP already has full practice rights NY and as of this date one is currently practicing in Mastic, LI, NY. WHY HAS THE AOA BEEN SO COMPLACENT. This is now the biggest threat to osteopathic family medicine and marks the beginning of the end. In the relatively near future Osteo (as well as allopathic) FP residencies will dry up as less and less graduates apply. IM resiencies will also suffer, however, those graduating from an IM residency will have the option to persue a fellowship (something not open to FP's) so their demise will take longer. Primary care eventually will be the domain of the DNP with DO and MD physicians being the specialists. THe reason - the DNP will work for less and the primary care market will be flooded with DNPs.

Dear DL,

I'm concerned that there will be no turning back regarding the landscape of primary care medicine. I posted a blog at the top addressing this. It's been 20+ years in the works, insurance industry supported CRNP and PA programs pumping out practitioners initially under the auspices of a DO/MD but of course are seeking autonomy after establishing themselves in the system. Very few medical students are choosing family practice or even internal medicine because they can't pay off their debts and are well aware of the changing landscape of family practice. I personally believe we must, as a profession, think out of the box, bring our membership back, approve the best residencies available for D.O.s, support the remaining family docs and fight for their practice rights, but realize the issues you raise are not new and I can't imagine it ever returning to docs ruling family medicine, I just don't think it will happen. As a profession we need to evolve, pay attention to global medicine, preventative medicine, pursue and maintain OMT principles and practice which absolutely are effective, and move forward. I personally have had excellent experiences with CRNP's and PA's, and doubt they will ever go away. In my department, the CRNP's do better work than the MD's, [I'm the only DO]. Sorry if that offends you but it's reality in today's medical environment.

Ray Sharretts,
I highly doubt the CRNPs do a better job then the MDs in your department. Please reconsider what you say. Perhaps the MDs say the CRNP works better then the only DO in their department.
The truth of the matter is you and the MDs do a better job then the CRNPs in your department due to overall knowledge level. That will stay the same once CRNPs become DNPs instead.
Please retract your statement saying that the CRNPs do better then the MDs in your department, the truth is, that's just not the case. I am surprised you so readily say they do better then the MDs. Do you engage in Peer Review? Perhaps you will change your mind after participating with Peer Review in your group.
As far as competing with these soon to be new doctors (doctors of nurse practioner, and doctors of physicians assistant), wouldn't it be better for DOs to stand out from them by including MD in their intials. The initials would then be either MD(O) or MD,DO for Medical Doctor, Diplomat of Osteopathy.
That would be a good start to compete with these dogmatically independent nurse practioners and physicians assistants.

Dear Med Staff,

I have identified myself, and I wish others who post comments would do the same. I stand by my post, the CRNP's in my department are excellent, and we are a specialty group, not a family practice group. I also have been an instructor for CRNP programs not necessarily by choice but it was an existing program when I was an internist joining a group, I have now specialized and no longer practice internal medicine. I'm glad that my comments brought you to the table, I wish other D.O.'s would log in and join the discussion about these topics. You're talking about our degree designation, I'm talking about primary care medicine in the current age, and I don't think it will change, CRNP's and PA's are here to stay and have been the landscape for decades, DO's and MD's welcomed them as they were cheap labor compared to hiring physicians in their practices, so let's not be hippocritical and let's not diminish the expertise these folks have to provide basic medical care to those who otherwise would not get it.

In addition, I have been a medical director for 12 years, I participate in quality assurance, peer review, I am a hospitalist, I am published, I am a fellow, I have taught medical students and residents on a full-time basis for 30 years and feel justified in my comments. I'm not trying to offend anyone but I would ask that you read my post again, and try to get the true message. Non-physicians often work much harder at comprehensive exams to prove themselves as worthy, physicians who work with CRNP's and PA's will often tell you the same thing. It's not an issue of knowledge, it's an issue of attempting to fulfill a need and do a good job in the absence of physician man/woman power, and I think CRNP's and PA's fill a void and do a good job at it. My opinion will not change. The landscape of primary care has been changing for decades and that does not diminish the commitment D.O.s have made to primary care for a hundred years, but the landscape has changed, is changing, new D.O. grads are much less interested in primary care, and are seeking residencies in advanced medicine, as they should, and they should be encouraged by all of us and the AOA in seeking the best training they can accomplish. Currently, that is not the case and in my opinion, threatens the future of the AOA, our profession and our specialty colleges.

Physician extenders lack the training to practice without onsite physciain oversight. The training that a NP receives is 4 years of UNDERGRADUATE education leading to a BSN. Then 30 post graduate credits and 850 hours of clinical work (via two 8 hour days for one year.) During my MSIII year I accumulated 2300 hours of clinical experience (50 hrs/wk x 46 wks). I am absolutely sure that there is not one physician reading this who feels that he/she was qualified to practice independantly after their 3rd year of medical school yet the law in my state allows th CNP to set up a practice, Rx all meds including those that are scheduled, with the only prereq being a cursory review by a physician every 3 months.

Dr Sharrett wrote - in my practice "CRNP's do better work than the MD's. I'm sorry if I offend you but that is a sad commentary. Perhaps it doesn't speak well for the CRNPs but rather speaks poorly for the MDs. I say this because there is no subsitute for formal training. The CRNP training cannot even marginally compare in breath and depth to the training found in any American medical school. It would be interesting to see if other physicians reading these posts have the same impression/feeling about their CRNPs and physicians.

Thank you for taking the time to respond to me DL, and I essentially agree with you. The issue in the area where I practice is that we have not been able to recuit good physicians for over a decade, the malpractice premiums are very high, my state has a poor reputation of standing up for physicians, we have had a huge physician brain drain, and although D.O.'s are strong and visible, CRNP's and PA's have been practicing here for decades. My initial reaction to your blog went way back to physicians on this same blog, expressing concern about family practice being "taken over" by physician extenders, concern over "Walmart" physician offices, etc. My contention, right or wrong, was that it has been in the works for many years. I would never suggest that a CRNP or a PA had an advantage or better training than a physician, but here comes the irritating part, CRNP's and PA's play a role in today's medical climate, like it or not, they have been endorsed by physicians, they are much cheaper labor hired by D.O. practice owners and our [yours and mine] medical community has some responsibility in their rise, and they strive to excellence in my experience. Technology continues to advance, and especially D.O. physicians are afforded additional degrees concomitant with their D.O. degrees, such as MBA, MPH, PhD which I think is the future. I have dealt with too many "bad behavior" hearings regarding physicians who are bulking new trends, and being disrespectful to staff and families. I'm a big advocate for D.O.'s, and new graduating D.O.'s getting the best residencies they can muster, if you've read my blogs, you already know that. And I agree, I would like to hear from other physicians who read this blog that have opinions. I would also advocate that bloggers state their names and degrees. My experience is that graduating D.O. students are looking beyond primary care, knowing that physician extenders are replacing them in many primary care fields. I remain respectful of the Osteopathic history, reputation and future. Please know that I'm not denegrading D.O.'s, I'm advocating for advance, not the status quo.

Thank you for your thoughts and commentary. Although I do not employ physician extenders, I understand why some overextended (no pun intended) practices, in order to meet large a overhead, find it necessary to employ these paraprofessionals (NPs and PAs.) Thus I feel there is a legitimate place for PAs and perhaps NPs (training for PAs is more akin to the physician model as opposed to the NP's nursing model.) My main objection is that the AOA and AMA have sealed the fate of primary care docs, by failing to mount a major concerted effort to stop the credentialing of DNP's. If the AOA continues their current course of inaction, all recent past, current and future FP PGYI, II and III's, will find it impossible to have their own practice. If they feel (as do I) that the AOA failed them miserably, the backlash might foretell the death of the AOA.

Thank you for your comments DL. I understand your stance, as I practiced IM for 10 years before specializing. Mr. Crosby states that this blog is the most widely viewed blog on the website, I think others need to blog on, make their comments, because this is an important issue, and a source of great contention.

I believe ray sharretts believes in the ol' DO way, inflexible to change. It is time to break out of the shadow of ray sharretts good ol' boy DO tradition and become a new type of DO, a modern medical school graduate DO willing to work with the AMA and pay fees not only to the AOA but the AMA as well. It is time for DOs to leave the stalwart narrow minded ray sharretts of this world behind and to emerge into the new type DO, one willing to work along side well with MDs and to blend with them with the initials MD,DO , not to remain separate as ray sharretts wants.
It's time to fight within our AOA in partnership with the AMA against the DNPs, doctor PAs, and PharmDs and try to thwart their efforts in getting more independent practice rights to make it difficult for them to compete with the family physician (MD and DO) for patients. DOs changing their initials to MD,DO will help unify all physicians and help fight all the old-fashioned ray sharretts out there and also help stagnate efforts of all the mid-levels rising trying to take over the family physician realm.

Dear premed, Are you confusing me with DL?, I'm glad you blogged, thank you. I wish you would post your name and your medical school, there's no shame or repercussions to stating your opinion, that's what this blog is about, I'm glad you logged on. If there is backlash from training D.O.'s on this website, please let me know, I would take strong action right to Mr. Crosby. I'm an item writer for the NBOME and I have taught students and residents for 30 years, I know the sentiment. I would encourage you to read my previous blogs, I'm with you, not against you. Please log on and encourage your colleagues to do the same, let's fire up this site. It needs it.

As a PGY1 in family medicine I am very worried about my future. Throughout medical school I was told of the great opportunities that family medicine held by the ACOFP and the AAFP. I was told that family physicians have the flexibility to be hospitalists, work in ER's, deliver babies, and perform numerous procedures. It turns out that this is not the truth. If you want to live in BFE where the nearest grocery store is 40 miles away, then maybe this can be done. Maybe. I am 280,000 in debt because of osteopathic medical school and I am wondering how I am going to pay these loans back and have a family with an FM salary, if there will even be a job for me.

Going into family medicine was a big mistake and i advise students not to go into it.

That said. There is no way that a DNP or PA could do half of what a physician can do. I worked with both throughout medical school and my first year of residency and they have nowhere near the knowledge we do. So they might think that they are now "doctors" and they are a low cost alternative. The truth is that the health of the public is going to decline as the midlevel practioners increase their scope of practice. I havent found one NP or PA that could give me ten causes for an acute abdomen.

ER physicians are going to have to watch out also. Hospitals are staffing ED's with mid levels.

Good thing I am good at OMM.

From personal experience the proof of a physician's worth is not in the letters of her/his degree, rather it is measured by his/her performance. Be assured that word travels fast among physicians as to another physician's competence or incompetence with nary a thought to his/her degree. I was an ED physician in the Northeast area for about 9 years before going into private practice. Over the last 15 years there has been a considerable attitude change towards the DO. In fact I am not aware of any allopathic residency in my large metropolitan area that does not accept an Osteopath and further the DO is considered a capable and sought after asset in all residencies. In my community hospital, which up to 12 years ago had less than 5 DOs on staff, the DO is now represented in nearly all the specialty groups and some are considered outstanding. My intention in stating all the above is try to add some perspective to the DO/MD nomenclature controversy. (As a side note I would advise anyone with talent in OMT to develop their skill to the fullest extent. The brightest prospect for being successful in medicine at this time is to have a niche that is rare. Referrals will be plentiful, patients will pay cash and your overhead will be minimal if you are one of those rare individuals who are well skilled in OMT and can produce results. If I had the innate skill and I had it to do over again I would do a residency in OMT.)

One of the reasons why I did not do an OMM residency is because as a physician, you still have to be up to date on the latest treatment modalities and meds for various conditions that you will encounter. The OMM residency was too focused to provide this.

Dr. Sharretts,
Sorry about my previous very callow statements and wish I could take them back now. I know and everyone knows you are a very smart and talented medical doctor who has taught many osteopathic and allopathic students,residents, and midlevels who also has many published medical documentations/journals and regret my previous statements.
I guess it just looks like I was recently accepted into my backup osteopathic medical school and not a regular medical school, and just frustated that some osteopathic physicians/students do not want to change the DO degree to MD,DO or MD,O to allow everyone to know that DOs are medical doctors without confusion.
Another reason is that with the advent of the doctors of nursing practice and doctors of physician's assistants (and possibly then them having their own assistants since they now have their 'doctorates') it is very frustating. It seems like MD,DO would just stand out better away from the midlevel doctors -DNP and DScPA.

If I only knew then what I know now.... To avoid the whole DO-MD multiple personality disorder crisis, I recommend going allopathic from the beginning. Even taking the allopathic exams during medical school and certifying through an allopathic board after graduation would be a great option. I pay over $1100 a year to the AOA and ACOI in compulsory dues to maintain my certification (but they thank me for being a loyal member). As a DO I have to keep track of different CME requirements for 3 organizations (AOA, ACOI, State Medical Board of Ohio) on staggered schedules. My allopathic counterparts have no such expense or craziness that is not common to us all in the medical profession.
In Ohio, DO's are fairly numerous so public perception is not so much of an issue, although I occasionally find myself stammering through an explanation for "What is a DO?" when the higher-ups aren't really sure what we are either. For what it's worth, I think changing the designation would be a mistake; decide what it means to be a DO first, then choose the name that fits, not the other way around.

Premed I sense an undertone of prejudice in your post i.e. that the DO degree is somehow inferior to the MD degree and thus you are settling for a DO degree. For that matter I sense that in a lot of posts in this blog as it pertains to the DO/MD controversy. Although one may occasionally encounter a physician who feels the DO degree is inferior this is rare. If you read my prior post you will see that my experience has been it is a respected degree. However one will experience prejudice in medicine, but it concerns the SPECIALITIES not the DEGREE.

I would like to convey a story that may be pertinent. In my class an acquaintance left after the first year to enroll in an allopathic school. His rationale for leaving was that MD degree would provide him with a better opportunity for eventually obtaining a residency in the specialty of his choice (dermatology.) I met his several years later and he admitted he applied but never got that residency. He also stated that 1 of his friends that remained in the osteopathic school eventually went on to an Osteopathic dermatology residency. He admitted he made a big mistake leaving. I may be mistaken but as an osteopath you have available both allopathic and osteopathic residencies whereas the allopathic has only allopathic residencies available. Again I may be mistaken but all factors being equal an OMM fellowship (something not available to MD students) gives an advantage when applying to allopathic and osteopathic orthopedic residencies.

Dear PGY1:

The AOA fully agrees with you regarding DNPs, PAs, and other non-physician clinicians (NPCs). The AOA opposes any efforts by NPCs to expand their scope of practice without similar expansions to their education and training. To increase public awareness about the risks associated with NPC scope of practice expansions, the AOA has launched a media campaign to prevent unauthorized practice of medicine by so-called doctors, like the DNPs.

I am sorry to hear that you are having second thoughts about your choice of family practice. If I were a physician, being in primary care would be the place I would go because it is the most satisfying physician/patient relationship. In addition, most FPs that I know are also financially well rewarded for their services and hard work. The future of family practice and primary care is gaining much attention, as they lie at the center of patient centered medical homes and other primary care based models of health system reform.

JBC

Mr. Crosby,

I have capitalized important parts of your response that need to be clarified and addressed. I don't mean to be disrespectful, but it seems to be a political statement of no substance.

Quote 1-
"The AOA opposes any efforts by NPCs to expand their scope of practice WITHOUT SIMILAR EXPANSIONS TO THEIR EDUCATION AND TRAINING."

Based upon your statement, one could reasonably conclude that the AOA does NOT oppose a certified nurse practitioner expanding their practice rights after completing a DNP program. I and many other primary care physicians feel the AOA should oppose, with every ounce of energy and every resource imaginable, NP’s from gaining any further practice rights whatsoever no matter how much their education is expanded.

Quote 2
"To increase public awareness about the risks associated with NPC scope of practice expansions, the AOA has launched a media campaign to prevent UNAUTHORIZED practice of medicine by so-called doctors, like the DNPs."

What is meant by unauthorized? Several states have already authorized NP’s who have completed 60 credits via a DNP program to practice I N D E P E N D A N T L Y essentially granting them same privileges as a physician.

I feel that the AOA and AMA have failed the primary care physician and this is a shame since Osteopathic medicine has prided itself on producing family practitioners.

Mr. Crosby,

Primary care financially well rewarded? Are you serious? When a family doctor gets paid $50 and spends an hour to sort out a patients diabetes, HTN, CHF, anxiety, neuropathy, 10 medications, herbs and supplements, plus ensure that their labs and screenings are all up to date and complete..while a Gastroenterologist gets paid $1500 to do a 20 minute colonoscopy. You have got to be joking.

Instead I have to see 50-60 patients a day or practice OMM in Beverly Hills and charge $400 a visit to keep the lights on. Medicine is not about money, but my $2800 a month student loan payment is all about money. I guess I can move to BFE for 4 years and do govt work and get a salary of 110,000, while everyone else starts out at 200,00 plus.

Even the CRNA get paid more than the family doctor who has 11 years of education. The ACOFP and the AAFP have to lie to get us to join family medicine. And once your in, its very difficult to get out.

To any pre-med/PGY I, II, III students who want to personally communicate with me regarding your concerns about family practice, residency training, the AOA, your future, etc., I'm at your service. You can email me at home at the following address:
wildcatridge11@embarqmail.com
You can and should research my opinions by reviewing my previous blogs on this website before contacting me so you know where I'm coming from. I will not respond to any emails without your name, if you want to make one up, that's up to you but I have nothing to hide and I hope you don't either. I'm not an employee of the AOA, I'm not collecting information, I'm not doing a study, but I'm concerned about the anxiety and angst I'm reading on this blog and I know it's widespread after 30 years of teaching. Looking forward to hearing from you. I would hope other experienced D.O.'s would do the same.

Mr Crosby,

May I respectfully request that either you or an AOA spokesperson respond to my above post dated 7 May. It is vitally important to all practicing osteopathic FPs as well as all FP PGYs that AOA’s position be completely and fully explained concerning physician extenders. I think valid question were asked concerning your post and it’s important they be answered. Sincere thanks for your response

Mr. Crosby,

I would also like an answer to my post Re: how I am supposed to make ends meet as a Family physician in todays health care industry.

Mr Crosby,

Still waiting for a reply. Please don't allow your silence to speak volumes.

Dear “DL”:

I would like to clarify any misconceptions regarding the AOA’s position on non-physician clinicians (NPC) expanding their scope of practice. Yes, the AOA is very concerned not only with the Doctor of Nurse Practice programs, but also with optometrists doing scalpel surgery, psychologists prescribing psychotropic drugs, and in any case where the NPC performs a service that exceeds his or her training. Unless NPCs’ education and training equals that of medical school and residency, we will oppose their efforts to practice like physicians.

There are hundreds of “scope” bills introduced in the states every year and the AOA tracks each one. The AOA actively works with our state osteopathic societies to address the issue of unwarranted expansions, providing resources that will assist in state advocacy efforts on behalf of the profession. We provide information to highlight the differences in education and training – and by training I mean postdoctoral training, residencies – between a physician and a NPC professional. We develop talking points, model testimony, charts showing each state’s laws or rules on the issue at hand.

The AOA’s Bureau of State Government Affairs (BSGA) has researched and produced documents on several of the allied health professions and continues to provide even more in-depth information to use when talking with state legislators and regulatory authorities.

The AOA has also provided advocacy training seminars for the profession in order to assist them in honing their skills when presenting information to legislators. State legislators look to the experts for information and there is no better expert than an osteopathic medical student or a practicing physician.

JBC

Mr. Crosby,

A while back, I wrote a post about family medicine and how to make ends meet. I still have not seen a response. After speaking with the loan companies I dealt with in medical school, I found that I owe $310,000 in student loans. Of which, $250,000 is due to my osteopathic medical education. I ask you again, Mr. Crosby, how am I supposed to pay back these loans as a family practioner in todays healthcare industry?

Dear PGY1

Looks like you are screwed. Maybe you should declare bankruptcy like the whole rest of the country.

As a stood in an mixed training institution today as a D.O. I was surrounded by FMG's that called themselves M.D.'s and who will likely get jobs I won't get and fellowships I will not be allowed to apply for. It is a shame that I too was accepted to Ross University but thought that staying in the US for training would be looked at as positive and not a stubbling block. I think the AOA should either change the initials or do a better job of securing our futures. Lets face it the lay people don't care or know that you are a DO vs MD, they just want a good doctor. The real issue is how we are treated by fellow physicians and how we are received in residency fellowship programs. I wish that the AOA would secure a single spot in each of the large University training institutions in each specialty for a DO. You may be looked at as the TOKEN DO, but your training should you get one of those spots would be looked up to and not questioned.

Older and Wiser,

You are probably right. And the leaders from the AOA still have not responded because they have no idea what to say. I know that I am not the only one in this position, and they know that many DO's got screwed, especially the ones that went to private institutions.

I know of several "MD's" who graduated from carribian medical schools. They were undertrained and underskilled compared to the "DO" students that I have trained in my office from MSUCOM. Yet they are MD's an accorded more privledges than the US trained DO's. One "MD" practicing in my area flunked out of Kirksville and then twice flunked out of Kansas City but after Grenada U he is a much accorded "MD" although is a money hungry physician in our community. Flint Michigan. Believe me this is not right nor fair to the fine graduates of MSUCOM etc. I don't know the solution but I do recognize the problem. I serve on the quality assurance board of our hospital (Genesys) and I believe that I am able recognize quality when I see it.

Greeting,
Call all DO's
After reading some of the posting I want to cast this posting out the many DO Practitioners The opportunity to make the right career move can exist with in your next career move. The opportunity to plan out your career and practice relies on a plan on how you will serve the community. A well establish Hospital on Los Angles is seeking to bring on an experience DO.

If you have a moment, I'd appreciate your help. Please take a look and
forward this job on to anyone you think would be interested in the
position, or anyone else who could help me find a great candidate.

Thanks for your help!

Company: The Domar Group, Inc
Job Title: Medical Director Osteopathic Medicine D.O.
Description: CONFIDENTIAL
SEARCH
Executive Consultant Don Martinez (714) 674-0391

POSITION: Medical Director Osteopathic Medicine D.O.

ORGANIZATION: Hosptial

LOCATION: Southern California

SEARCH FIRM: Retained Search The Domar Group, Inc.

Don Martinez MCC, NLP/P
Founder & Sr. Managing Partner
The Domar Group, Inc.
(714 674-0391 (O)
(714) 674-0338 (F)
dmartin@domargroup.com
http://www.domargroup.com
http://www.linkedin.com/pub...
http://www.adbcreative.net/...

President & CEO
The Southern California
Association of Hispanic Healthcare Executives
http://www.ahhe.org

Confidentiality Notice:
This e-mail message, including any attachments, is for the sole use of the
intended recipient(s) and may contain confidential and privileged
information. Any unauthorized review, use, disclosure or distribution is
prohibited. If you are not the intended recipient, please contact the
sender by reply e-mail and destroy all copies of the original message.

It's unfortunate that this blog has ground down to a stop. D.O.'s have all the opportunities as M.D.s do, if not, move to a D.O. friendly state. Mr. Crosby is not responsible for answering to medical school debt, it's high, and for those who are not aware of their debt, that's your issue. Family practice is a precarious issue, and as I've said in previous blogs, CRNP's and PA's, have been moving into "general medical practice" for 30 years, it's no surprise. D.O.'s have made it, and are entering high end residency programs all over the country, I am one of them, occurred in the early 90's. The AOA is your advocate and has helped me in many ways over my 30 years in practice, see previous blogs. I try to be empathic to new D.O.'s with struggles to have residencies approved and I have been an advocate that the AOA "lighten up" on approving on graduating D.O.'s obtaining the best residencies they can acquire. The AOA approved an M.D. residency for me in 1995 despite openings in D.O. residencies so I can only encourage graduating D.O.s to appeal to the AOA to approve their residency of choice, only then will change occur.

Dr Sharretts,

NP's via the DNP degree (and perhaps in the near future, the PA's thru a similar type degree), HAVE INDEPENDENT PRACTICE STATUS, REPEAT, INDEPENDANT PRACTICE STATUS. This is far different than their initial status which mandated physician oversight. The Osteopathic profession has prided itself on producing family practitioners. This is (was?) our claim to fame. The AOA and AMA must join forces to stop the paraprofessional from becoming, for all intents and purposes, a "physician." I have yet to see any significant legal challenge from either organization and invite anyone especially Mr. Crosby to produce a court case/suit or cite any pending legislation to that end. Incidentally, no sane medical student should consider primary care at this time.

Dr. Sharretts,

When throughout your 4 years of medical school, your mentors, your teachers, the osteopathic leaders, people that we trust, all state that family medicine is a promising career. That it is a career that has the most demand. And that a person can make a good living in family medicine, then yes Mr. Crosby and the AOA, AMA, AAFP, ACOFP all have to answer to the fact that it is all lies. And to tell me that I need to be aware of my own debt is an ignorant statement considering you attended medical school when it was $50 a semester. We are very aware of our debt, but we have no choice but to apply for student loans to pay for tuition, books, and living expenses. You are a very well respected and decorated physician, but at times are very wishy washy regarding where you stand.

Perhaps in the past when Osteopaths when osteopaths were struggling for equal opportunity, the AOA served a useful purpose and was an organization to be respected. They have since become relatively impotent. For instance their impact on maintaining the domain of the physician against paraprofessional infringement has been dismal at best. About 3 years ago we had the president elect of the AOA address our regional osteopathic organization. When confronted with the question about how the AOA was addressing the paraprofessional’s broadening practice rights, his statement was (nearly exact quote) – the nurses union is too strong and entrenched to fight. I nearly fell off my chair. I practice in NY where the malpractice rates have gone thru the roof. The AOA has made no impact on NY’s malpractice. Furthermore unlike other states, NY state osteopaths are not afforded the opportunity to obtain lower malpractice rates thru the AOA sponsored malpractice carriers. The carriers will not insure us. Why hasn’t he AOA can’t use exerted their influence, flexed a little muscle and come to NY’s aid? My advise to all training osteopaths – don’t do primary care. Apply to the best non primary residency available and don’t give a second thought to AOA approval.

Please read the "Letter to the Editor" articles in the NEJM discussing the cost of medical school, issues regarding primary care, IMG's, expansion of both allopathic and osteopathic medical schools. It's not just an osteopathic issue. You can get there by following links referenced "Daily Report Blog" regarding the past AOA president's response. The original article is by Iglehart JK. Grassroots activism and the pursuit of an expanded physician supply. N Engl J Med 2008;358:1741-1749.

"AOA President Peter B. Ajluni, DO, Ronnie B. Martin, DO, President of the American College of Osteopathic Family Physicians (ACOFP), and Robert W. Hostoffer, DO, President of the American College of Osteopathic Pediatricians, have signed on to a joint letter with the American Medical Association and other health care organizations to The National Board of Medical Examiners (NBME) regarding our great concern with the NBME’s participation in the Doctor of Nursing Practice certification examination process. The letter requests the opportunity to meet with NBME representatives to discuss these matters in greater detail, particularly the actions of some DNP organizations to use the NBME’s involvement as a means of demonstrating alleged equality between DNPs and physicians."

A step in the right direction. However, whether or not the NBME certifies, the point is THE AOA AND THE AMA MUST FIGHT ANY LAWFUL CERTIFICATION WHICH WOULD AUTHORIZE A DNP TO PRACTICE INDEPENDANTLY. Once allowed independant practice rights from any lawful source, hospitals will be obligated to provide admitting privileges, then med insurance companies will negotiate contracts effectively cutting reimbursement.

I would like to elaborate further on what I feel is the most pressing matter concerning primary care medicine (much more pressing than malpractice.) NPs are graduating at alarming rates and are flooding the market place. The rate is alarming because one is able to obtain an NP degree relatively easy. The mandatory 30 credits can be obtained ONLINE and only 850 hrs in clinicals are needed to fulfill the NP degree requirements. In the near future many institutions will have developed their DNP curriculum and then the flooding the market with DNP’s will commence. So the pending scenario is this. DNP’s will become relatively common place. Insurance companies will see the monetary advantage of having them on their panel and will negotiate contracts. The patient will then be given a choice – see your primary care physician and have a much higher deductible and copay or see the DNP and save considerable money. Since money drives the system the patient will opt for the DNP especially when the DNP will triage the patient to the appropriate specialist and then do the follow up. Incidentally, in NY some of our pharmacies have set up in store “clinics” hoping to snag the walkin for the URI, UTI etc. These “clinics” are manned by paraprofessionals and the owners of the corporation staffing and running the “clinics” are, you guessed it, NP’s. The writing is on the wall.

Dear PGY1, PGY2 and DL, the passionate debate you have been raising about the degree designation of DO's, the issues regarding practice rights, etc., are being discussed on the President's Blog under "Reaffirmation of the DO, and "Degree Designation", I haven't seen you express your viewpoings in that forum and would urge you to do so. The AOA Daily Reports has become somewhat dormant with only the same few respondents. You may find fresh feedback on the other site.

Unfortunately the degree change issue has essentially been killed off by the old guard once again. Most of the people who were interested in changing things have become discouraged and have given up. Maybe it will be revisited in another ten years.

Dear “Another Discouraged DO”:

While I appreciate that you took the time to share your opinion on this many-sided issue, I feel the need to point out what I see as an error in your reasoning. In referring to an “old guard” killing off the degree change designation, you do a disservice to the vast assemblage of DOs from all walks of life – students, interns, residents, practicing DOs, and other leaders – who carefully considered this issue before agreeing, unanimously, to retain the DO degree designation.

In fact, it was the AOA’s House of Delegates, a group of elected leaders numbering over 500 strong, who ultimately acted to keep DO as the designation for osteopathic physicians. These delegates include representatives from all 50 states and every specialty college, including student and intern/resident representatives from our 25 colleges of osteopathic medicine and numerous postgraduate training programs. That not one of this diverse group of DOs and students voted against the degree affirmation resolution speaks to the passion they feel for the DO degree.

I am also passionate about the democratic process embodied in our House of Delegates. If you disagree with its unanimous action last July – the only unanimous action it made – then, as I have always said, identify yourself, get involved with your state or specialty leadership, and work to change it. That no degree change supporter did so this year speaks multitudes to me.

Kindly yours,
JBC

jbc,
a comment on your comment "AOA’s House of Delegates, a group of elected leaders numbering over 500 strong, who ultimately acted to keep DO as the designation for osteopathic physicians."
who voted for these delegates? DOs should be able to vote for these delegates via mail send out. did any DOs get a vote in the mail to elect the delegates? no.
why not just send out a vote - DO degree change to MD,DO or stay as DO initial to all DOs and DO med students around the nation and get an opinion to see what the majority of DOs feel about this issue? or maybe your just afraid to because of what the results will be.

As a future resident in the surgical specialities, I am concerned over abuse of residents in regards to work hours. I have repeatedly heard of residents and seen on rotations reidents working 100+ hour weeks. On one rotation in detroit, the residents covered 4-6 hospitals when on call and weren't considered post-call because its "home call". It's not safe for patients or residents, please address these issues.

Dear “concernedstudent”:

The AOA sees eye-to-eye with you regarding resident work hour limits. In fact, the AOA Council on Osteopathic Postdoctoral Training (COPT) Standards and AOA policy several years ago limited residency programs to an 80-hour work week. We monitor this closely and regularly consult with Andrew Farber, DO, who is the Intern/Resident representative on our Board of Trustees, to determine how his fellow residents across the country are handling this and other postgraduate training issues. We have also advocated this policy to the Institute of Medicine of the National Academies, who wrote to the AOA on September 8, 2008, to commend us for this advocacy.

In addition, the AOA has established a confidential hotline for reporting instances when the AOA policy is not followed, such as violations in work hours, the AOA match, and other standards and policy violations. All complaints are kept anonymous, but must be submitted in writing. I encourage you and all osteopathic residents to visit DO-Online at https://www.do-online.org/i... to learn more about this program. Together, we can ensure all residents have excellent postgraduate training experiences.

Kindly yours,

JBC

The American Association of Orthodontists has a 30sec national TV commercial running; it is short, simple, but very effective in conveying what orthodontists do, how they are trained, and why their services are important. I would highly recommend watching it. The AOA should seriously look into doing something extremely similar. If anyone else has seen this commercial, please post your thoughts.

Mr Crosby

Where can osteopathic family physicians find info on how to code for omt and be reimbursed properly for it. Also, I read that performing OMT on all patients who need it can lead to insurance companies auditing physicians and that we have to use it sparingly.

As a family physician, not only can most of my patients benefit from some OMT, but I can also increase my revenue for the extra work I am doing

Dear "JS":

Thank you for making us aware of the American Association of Orthodontists’ television commercial. Your point is well taken that we need something short, simple and effective to communicate what DOs do. Listen to the AOA’s “What is a DO?” radio spot located at http://www.osteopathic.org/...
Let us know what you think of it. So far, we’ve run these ads in the Chicago radio market but we’re hoping to use them in other markets as well.

The Osteopathic Physicians and Surgeons of California also developed a television public service announcement (PSA) that does a good job of explaining DOs and osteopathic medicine. You can view their PSA on YouTube at http://www.youtube.com/watc...

The AOA knows that DOs and osteopathic medical students want more public promotion of osteopathic medicine. You should know the AOA is committed to making DO a household word. The AOA’s Greatness Fund aims to do just that by supporting public education advocacy . Learn more about the Greatness Fund at https://www.do-online.org/i...

JBC

Mr. Crosby,
To elaborate, I think a television commercial is warranted in a national prime-time slot, as the AAO has done with theirs. I think this "shotgun" approach would be more effective than picking certain markets. What are the prospects of such a TV spot?

Dear “FM”:

Thank you for this timely inquiry. Many DOs have experienced difficulty in properly billing and obtaining fair reimbursement for OMT, especially billing for evaluation & management (E/M) on the same date of service.

To attempt to alleviate some of this confusion, the AOA Division of Socioeconomic Affairs has developed a “Coding Hint” to guide DOs and their billing staff on the correct coding procedures for OMT and E/M. The document is posted on the AOA Daily Reports Blog at http://blogs.do-online.org/...
In addition, AOA Health Reimbursement Policy Specialist Kavin Williams is on hand to answer additional questions about OMT billing and dealing with the insurance carriers. AOA members can contact Kavin directly at 1-800-621-1773 ext. 8182 or kwilliams@osteopathic.org.

JBC

Dear “JS”:

While I recognize the wide-ranging audience of a national TV ad, picking targeted markets are considerably more affordable than launching a national TV campaign, if TV is selected as the best media venue in which to advocate. If a national campaign does occur, it will probably consist of a mix of media outlets to ensure the best possible reach.

However, none of these ambitious plans are possible without funding. During the Unity Campaign in the late 1990s and early 2000s, DOs were asked to contribute just $100 each to help with the national print advertising campaign being done at that time in national magazines like "Readers Digest," "People," "Oprah," "American Baby," "US Weekly Magazine," "Self" and others. Less than 1/2 of our DOs chose to contribute.

Yet a national advertising campaign may be made possible through the AOA Greatness Fund, which also depends on how much support is raised from the osteopathic family at large. AOA leaders have established national advocacy and public education as one of the primary goals of the Fund. If you would like to see a national TV campaign become a reality, contribute to the AOA Greatness Fund today.

JBC

I too just recently saw that same commercial and also feel that this was an effective way to explain to the public what credentials an orthodontist has and agree with JS that television commercials are warranted to explain to the public what an osteopathic physician is. I would like to reiterate the question JS asked: What are the prospects of such a TV spot?

Mr. Crosby,
I think the whole funding issue comes down to one thing: if you TRULY support and advocate for what the rank-and-file wants, they will, in turn, support you. I don't think the AOA has done this recently. There has been a lot of hand waving, but little progress in listening and advocating for the "average Joe, DO." This sentiment has been reitterated by many over the ast months. Again, look to the future, support progressive movement, and listen to the rank and file. Continue on the same path, and you're going to see funding drop significantly b/c you'll have fewer and fewer dues paying members (a la now, with the whole free memberships to rope in members, requiring AOA membership to "trap" DOs who complete an AOA residency, etc...). We can be great as a profession, but it requires the executives to listen to members and enact change THEY want, not YOU (executives) want.

Dear “JS”:

With all due respect owed to one of America’s 64,000 DOs, what do members want?

Your comment above hints at an ulterior motive for the AOA, i.e. that we aren’t doing what our members want but rather what we want. Yet you offer no examples whatsoever; more pointedly, you fail to enunciate what, exactly, it is that you want that the AOA isn’t doing.

We cannot do everything; this is true. However, we define our top priorities as what AOA members tell us is most important to them. Specifically, the top three initiatives supported by the Greatness Fund did not come from an AOA staff conference room; rather, they were taken from countless surveys and focus groups conducted with AOA members and affiliates to determine what were the most important issues facing our profession. Likewise, each and every AOA policy that drives our work is passed by the AOA House of Delegates, comprising 500 representatives who are selected by the general membership. These 500 DOs regularly tell the AOA’s 20 Senior Staff Members what to do.

That said, I’m listening to you right now. Tell me what you want, but don’t just recite rhetoric or tell me to listen to you. I can’t promise the AOA can do it – we have to do what 64,000 DOs want us to do – but I can promise that we’ll try.

JBC

JBC,
The HOD reps don't listen. I know the rep in my area was heavily petitioned to support the idea of the degree designation change, but was not receptive.
I'm not tell you to listen to ME. I'm telling you to listen to everyone (not just the reps). You want an example? You have numerous posts in favor of the degree designation change. You have online petitions to have the degree designation change. You have schools voting in favor of it (I know of one school that actually had a formal process which supported the change, but was shot down at HOD). You say you have 64000 DOs telling you what to do, but it sounds to me like you have 500 hardcore DOs, who will not change, telling you "what members want."
Furthermore, I think it would be useful for members to know how many of the "growing" membership numbers are from those "locked in" by AOA residency/board cert. I think it would be a more honest process if AOA membership was not required for board cert in an AOA specialty.
Another thing is the advent of the for-profit medical school. The floodgates have opened, and, again, members don't like it. This is already attracting bad publicity (e.g. Forbes article). The AOA has the power to change, or at least lobby to change, COCA standards since COCA falls under the AOA umbrella. I've already heard of students planning on taking all steps of USMLE and wanting to obtain ACGME training even moreso to cover their end should something bad come about from these schools(I say "these" b/c I'm sure all Carrib schools are looking to move on shore now that RVU has set the precedent).
Also, as has been said on the presidents blog by many, members want to know what the AOA is doing to develop the osteopathic identity; OMM is a failing modality (as has been shown in many JAOA articles - see the presidents blog) and is the only difference most see between DOs and MDs. The "holistic" image the AOA likes to purport is also bunk, as this is the standard of care throughout medicine and has been for a long time. This may be difficult to comprehend as a non-clinician, but it is true.
These are major issues that have come up time and time again. When members and students feel like no change or progress is taking place, they're not going to continue to support the organization.

jbc,
JS notes some good points above. it should also be added that in the recent d.o. magazine, AT Still MD,DO was discussed and Robert M. Goldman MD,PhD,DO and Ronald Klatz MD,DO were allowed to advertise as such in the magazine. If having MD was not so important behind a name, then why is it being displayed behind AT Still, Robert Goldman, and Ronald Klatz. jbc, perhaps, because it is important. j crosby, it is just a matter of time until the DO degree is changed to MD,DO; when new DOs replace the old DOs in the AOA, then it will happen.

amedstudent,

From my understanding the individuals who have the title MD,DO have those titles because they earned them. Don’t get me wrong, I agree with you as far as the whole degree designation. It just makes more sense that it should be MD,DO. I do however disagree with how you stated your comment to Mr. Crosby and felt it was more of a threat than action. Mr. Crosby is a legal voice and respectfully has no say in the matter. Who has the say are all the students and practicing DO’s. If you want the degree change then get out there, do the research and provide an argument that can’t be beat. If you want the change, MAKE IT HAPPEN! Until then this is all just mental masturbation.

TM

Dear “amedstudent”:

For readers who may not know to what “amedstudent” is referring, an advertisement the American Academy of Anti-Aging Medicine ran in a recent issue of The DO magazine referenced Dr. Goldman and Dr. Klatz, printing “MD, DO” after their names. Amedstudnet, I am sorry to disappoint you, but the “MD, DO" in the cases cited is not one degree – each of these DOs has earned both the MD and the DO medical degrees.

The AOA has long accepted physicians using whatever medical degrees they have earned. So if someone earns a medical degree from an osteopathic medical school and another medical degree from an allopathic medical school, AOA policy allows that person to use both degrees after his or her name. State licensing boards, on the other hand, require that physicians with both degrees obtain their state licenses under either their DO or MD degree, not both.

TM, thank you for your support.

JBC

What happened to the blog regarding the U. of Miami's decision to omit LECOM students from their extern application process. I was very interested to hear the responses to this one. Must have made NSU feel all warm and fuzzy.

jbc,
I understand what u said about MD,DO and I understand the individuals both got two seperate degrees, but are you not disappointed that Dr. Goldman and Dr. Klatz both got their MD degrees overseas after earning their DO,PhD and DO degree,respectively, in the US and yet they do not put the DO degree 1st; they instead put the MD degree 1st, comma, then put the PhD next, then put the DO degree last.
To me it just makes perfect sense, in this modern US medicine today, but to others in the AOA, perhaps, they just don't get it nor understand common sense.

There is nothing really unusual about dr.'s Goldman or Klatz. They both got their M.D. degrees in Carribian "SCAM" schools after brief "schooling" and payment of a fee. I suspect that they also may have recieved their PhD the same way without the usual Disertation or rigid certification. At what we refer to as "Match box U". It took us "D.O.'s four years and post graduate training to recieve ours. This is not to say that they are bad physicians as a result of this, and I personally do not know what motivates them, but I am proud of my D.O. to really feel the need to change it. However, after the way the A.O.A.treats its own like little children,I personally believe that the A.M.A. may be better at represting us practicioners of "Medicine"

Just go into ER, anesthesia, pathology, or hospital medicine. No one will ask about what DO stands for and you dont have to worry about what the AOA thinks.

Yesterday I was scrolling through my channel selections and came upon a show on CBS called "The Doctors". This as you may know is a show where four physician panelists are asked questions and or give information to the public about various medical conditions. As I was watching yesterday's episode they had a guest speaker named Dr Kirby. Dr Kirby is a dermatologist on the hit show "Dr 90210". Dr Kirby happens to be an osteopathic physician however when they introduced him on the show for his segment they listed him on the screen as being an MD. I am sure this was an oversite of the producers but I get the nagging feeling that they are conforming to only what the public views as "a physician". What a perfect opportunity for public awareness. I am submitting a letter to the show and ask them to be more cognizant of the osteopathic degree. I am asking the same (including the AOA) of everyone who reads this.

TM,

The producers dont care about getting the degree right. They care about making money. A while back, there was this campaign where the AOA asked all DO's and students to send in postcards to producers of shows like ER asking them to ontroduce DO's in the show. That had to be the dumbest idea. Why should they do that? Is it going to make commercial slots worth more money? Is it going to make the show more dramatic or interesting? Did someone at the AOA really think that there would be a scene where Noah Wylie sees a DO doing OMM and says "whats that you're doing" and then the DO actor responds "Well, its called OMM. We DO's believe that 1. The body is a unit, 2.blah blah blah". Get real. Maybe if we sent them some cash with the postcards then something would have happened.

I am so happy that someone finally had the vision and courage to do what has needed to be done. Of course I am referring to the TCOM attempt to add MD to their degree program. I hope that they are able to succeed and predict that if they do, that other COM's will soon follow. Hopefully then we will see an end to international discrimination as well as a boost in high quality applicants to our schools

Agreed. At least 1 COM is willing to admit the idea that this degree makes absolutely no sense any longer. We can dress it up all we want (primary care, OMM, whatever). We all know the truth. We practice medicine and we should have an MD. This gets absurder by the day.

http://www.star-telegram.co...

The above is just more propaganda from the AOA.

Will the AOA release copies of it's tax returns so that the membership can see where their money is going?

Since AOA is probably a tax exempt organization, it's tax returns are available upon request from AOA.

After you release the tax returns can you merge under the AMA? This organization and profession for the most part are simply a duplication of the AMA and MDs. Honestly....I dont know how any of us are supposed to buy this PR you guys spin. I guess I would buy it if I were you, since you get paid by the organization that spins it.

Merge us and stop wasting time and money to promote this identical profession as something other than MD schools/physicians granting/carrying DO degrees.

What is wrong with TCOM adding an MD school if they so choose? I am totally against giving existing students a choice of degrees..if they wanted to be MD's they should have gone to an allopathic college domestic or foreign. But we currently have 2 schools that offer both degrees in Michigan and New Jersey..Having both MD and DO programs offered at those schools have not hurt either program as far as I can see. And students that would like to live and go to that school have the choice of two distinct professions..just like some schools offer dentistry, veterinary medicine, or business school...

I am an osteopathic physician. I even questioned the PA two year practice once I seen how doc's placed so much trust in them. One time an ER a doctor gave his Rx pad to a PA and went golfing with friends. Anyway I do feel a lot better about it. I just thought this could lead some burn-out doctors an easy way to still be a physician.
I took the PA course myself. I just put a lot into things and I guess feared the worse. Bottom line, how can I receive this info as much as possible, it’s great and needed. Do you send physical info instead of internet? What ever you can do I want to be involved. Surgery a couple months back gives me six more before hitting the emergency department.
Pc’s are difficult very difficult for me to use currently – this took an hour. My wife’s been a great help. However she’s in surgery. Please send any reading material to:
Anthony Michael Salerno, DO. PA-C
435 Elk Spur Street Elkin, North Carolina 28621
Wednesday 15 April 17:04

Dear Blog Readers:

Having published this blog for over five years, I know firsthand that the osteopathic professional family does not always agree. One need only read the comments on this blog to see the diversity of opinions and beliefs among AOA members. Professional unity amongst this diversity is one of our profession’s greatest strengths.

I often publish posts regarding AOA policy matters on which not everybody agrees. Still, this blog is published under my name, under my title, and under the signage of the AOA. I stand by what is posted here.

Likewise, I respect those dissenters who stand by their opinion and post their name to their position. It takes the strength and courage of conviction to post a comment that diverges from the majority, and those who put their name to the page in this way deserve full consideration and response.

Yet many commenters find it easier to post anonymously. I find it hard to give the same weight and consideration to an opinion whose author cannot even stand by it. For this reason, it is my policy and that of AOA President Carlo J. DiMarco, DO, to respond to those who leave their names, and let the anonymous comments reside in their anonymity.

JBC

Intersting, I can understand that. I dont post my name b/c of my families ties to the proffession, as well as that I have seen others with my sentiment black listed for comments similar to mine.

The reality is the AOAs lack of addressing these comments (changing the degree, merging the proffession) will lead to its ultimate demise.

Lastly, an important part of blogging is its ambiguity. It allows induviduals to express their thougths without fear of repercussion. Your idea: not to respond to these comments again furthers the idea that the AOA is out of touch with reality and the modern world.

By the way; I am a practicing DO, AOA member, and practice family medicine in rural Michigan (your "prototypical DO"). I support merging the AOA with the AMA. One more thing. I am not a bone doctor. Thanks.

http://www.fwbusinesspress....

Dr. DeLengocky,
Good article, but I disagree with you. There should be an MD program at UNTHSC. Hopefully, Dr. DeLengocky, eventually the DO degree will be changed to MD,DO as the prominent doctors Ronald Klatz, MD,DO, and Robert Goldman,MD,PhD,DO,FAASP has emphasized in their 'American Academy of Anti-Aging Medicine' Corporation and in "The DO" magazine. Based on their initials after their names, it appears they wish it was that way now.

I agree with the above post. What is the harm of simply adding an MD to the degree? You need not not change anything else; leave all the existing statutes and state boards exactly the way they are. The MD,DO's can be licensed the same way as always. If the diehards do not want to use the MD in their professional designation, they don't have to. Why is this so hard? The AOA can keep their "unanimous" vote for the DO degree while being progressive at the same time. Everybody wins!

Mr. Crosby,
Any comments on how someone has begun deleting posts in the presidents blog to destroy the conversation over RVU-COM? Dont want us talking about our for profit medical school?

Feel free to delete the above as Dr. DiMarco has explained the action to me.
I wiil try to keep my thoughts on for profit medical education PC. Thanks

Recently I was complimented by our hospital’s Chief of Pediatrics, who is an allopathic physician, on the quality of an Osteopathic Continuing Medical Education course held in a neighboring state. She was anxious to put into practice some of the information obtained at this course. She did mention however that she was surprised by the negative comments about allopathic physicians during the lecturers. She said that at first it was startling and amusing, however after repeated comments by other lecturers, it was no longer amusing. I apologized for the insensitive comments of my osteopathic brethren, and explained that this was not reflective of our profession as a whole.

I am proud of being and Osteopathic Physician and have been well accepted by my allopathic peers. As the Medical Director and recruiter for my hospital, I actively seek out osteopathic physicians for open positions. I do notice a difference in training and patient approach which favors patient care. However, I would suggest that the need for demeaning comments about any group of individuals usually reflects feelings of inadequacy in the one making the comments. This is distasteful and akin to racial stereotyping. Personally, if I were to attend an allopathic convention and the speakers spoke negatively of osteopathic physicians, I would likely choose not to attend that particular meeting again. Also this encourages reciprocation.

I simply would like to suggest that we be sensitive to our audience when lecturing. We should consider the ethic of reciprocity: “Therefore all things whatsoever you would that men should do to you, do ye even so to them: for this is the law of the prophets.”

First let me say I totally agree with Dr. Jason Hill. I have always been treated as an equal by my allopathic bretheren. I feel all the old battles are gone and we now have too many battles we need to fight together.

But, that isn't the purpose I came here to blog. I have for some time been oppose to P4P. It is not that I feel that we shouldn't use the latest research, technologies and etc. It is because I feel the rules will be inflexible and will force doctors to discharge non-compliant patients because it will make the doctors report card look bad. There is already one study that shows this is happening in CA, http://www.medscape.com/vie... Another valid point I have tried to make is what of patientd with multiple conditions who performance criteria is in conflect? Think of the S/P MI patient with DM type2, HTN and COPD. I ask anyone to produce a study how to treat this patient. Due to being s/p MI s/he should be on a Beta Blocker, but that could exacerbate the COPD and mask hypoglycemic events if trying to get tight glucose control. A bean counter with the government or insurance companies would never understand why. This link to a commentary on this subject explains my concerns, http://community.modernmedi... I think we get all caught up with the science of medicine that we forget there is also an art to the practice of medicine. Just want to give some food for thought.

Would appreciate an update on the RVU situation,thanks!

The AOA Commission on Osteopathic College Accreditation has primary responsibility and oversight to monitor every college of osteopathic medicine, including RVUCOM, to ensure that they all adhere to our rigorous standards for accreditation. AOA Past President Carlo J. DiMarco, DO, wrote an open letter to RVUCOM students last month to keep them in the loop about the situation at hand. Read more at the following link, which was posted on this blog on 7/9/09. http://blogs.do-online.org/...

Mr. Crosby,
Why does the AOA discriminate against MDs? Why is the AOA trying to kill the osteopathic profession's best school--The Texas College of Osteopathic Medicine?

The violent opposition by the AOA against UNT considering adding a MD school while trying to keep its DO school at TCOM shows the insecure, unprofessional, and self-centered nature of AOA leaders. Please explain why the AOA continues to malign TCOM and all MDs. Beyond the arguments of osteopathic pride and traditions, what logic exists to block a separate MD school at UNT?

The AOA leaders have done the following and much much more to kill TCOM:
1. eliminated all merit based funding to support osteopathic research.
2. challenged TCOM's accreditation despite it being the professions best with the best COMLEX scores, best infrastructure, best faculty, and best students.
3. blocked $5 milion of state funding to support improvements in primary care education and research
4. continues to personally attack TCOM and UNT and community leaders as a primary method to block a MD school--I guess this proves you have no logical argument.

Mr. Crosby, please explain the actions of the AOA leaders which appears to be a self-defeating approach to something that has already happened at Michigan State, Virginia, New Jersey, and probably others to follow. Why should the AOA get involved in an independent institution's choice in adding new degree programs?

Dear Doctor Hill,

Thank you for your comments. It was very disappointing to hear that osteopathic physician speakers recently made negative comments about allopathic physicians at an AOA-sponsored CME course. I have asked the Chair of the Council on CME to present your comments to the Council for discussion at its next scheduled meeting in October. Our postdoctoral training program curriculum requires as a core competency that professionalism be taught and role modeled by faculty. I will recommend to the Council on CME that AOA sponsors require the same level of professionalism at their events.

The AOA values positive development of relationships with allopathic physicians and associations. Many of our board members and staff participate on national committees representing the osteopathic profession. They report regularly that they have been welcomed and treated with respect.

Significant progress has been accomplished; however, deliberate open disrespect is not acceptable by either MDs or DOs, no matter what setting it takes place. I fully expect the Council on CME will take action to discourage this practice in the future.

John

D.O. Ophthalmologist in the San Francisco Bay Area.

What about us D.O. Ophthalmologists? People think we are Optometrists and I spend way too much time talking about what a D.O. is and what an O.D. is and answering "if you are a D.O. why are you doing surgery? I thought optometrists could not do surgery?"

I am D.O. trained and proud. I went to MSU and trained at Flint Osteopathic Hospital. I really miss it there and have great memories. I was fortunate to get many elective rotations and that helped me get a top Fellowship. I went to Stanford and then completed my Fellowship at the Univ of Calif. San Francisco Medical Center in Glaucoma and Anterior Segment Surgery. Finally, I was trained and certified at Stanford for Lasik and refractive surgery.

Patients and the public still see us as optometrists. This, despite the fact that I get all of my referrals from subspecialty trained MDs from Stanford , Harvard, etc etc. I am proud of being a D.O. and proud when they pick up the phone and say "Tim, I need your help". However, I have been doing this for nearly 20 years and it just gets old explaining the D.O, O.D. M.D. thing.

Interestingly, I am an active Fellow of the American Academy of Ophthalmology and this Academy launched a program to educate the public on the difference between an ophthalmologist and an optometrist. It is called EyeMD. I have never used it nor am I allowed to use it. What is bothersome is the fact that I pay my annual dues to the Amer Acad of Ophthalmology yet can not benefit from this major part of the services which educates the public about the difference between a medical ophthalmologist and an optometrist. The MD ophthalmologists in our area use the following on their cards, etc

Joe Smith, M.D.
Member EyeMD

The EyeMD is a link that allows patients to get to the academy website and find out more info on the doctor , ophthalmology etc etc. I am unable to use it and thus unable to direct patients to this site that would tell more about me and what I do.

Tim Parsons, D.O.

Tim Parsons, D.O.

I agree with the AOA about D.O. training and I completed a D.O. residency and have kept my ties to AOA etc. I go to some of the Osteopathic Physicians and Surgeons of CA CME conferences and have taught D.O. students from Touro and Pamona.

Interestingly, a few years back I needed the AOA and it took one phone call and about 5 minutes for them to help me out. Optometrists needed to spend 60 hours or so under the supervision of an Ophthalmologist in order to get certified. I wasn't necessarily eager to do this , as the public thinks we are optoms and some optoms think they are ophthalmologists etc. However, it was a little annoying to see that the Univ of Calif, Berkeley had on their form that the optoms had to spent 60 hours with an ophthalmologist (M.D.). I thought about it for a few days and decided to call Berkeley. They were quite rude and said something like if you are not an MD then we dont recognize you to train our optoms. I simply called the AOA and the president of Osteopathic Physicians and Surgeons of CA and told them the situation. They said , Let me make a call. Boooommm!!! About an hour later I received a nice call from Berkeley asking when I would like to start training their optoms. I said I would get back to them. I hung up the phone and felt very proud. I know that sounds corny but oh well. Shoot, I never called them back and it has been over 5 years. LOL. The AOA is not perfect but can be like a big brother to you when someone is bullying you on the playground.

Tim Parsons, D.O.

Wouldn't it be great if as part of the reform bill, the federal gov't would issue a single national medical license. We already have a federal DEA number, it would be much easier to do volunteer work and locums. What do you think?

I don't mind being a D.O. in fact I like it. We are a small community and the idea that I could someday be president of the AOA or ACOS is very appealing. The problem isn't our D.O. it is the advocacy the AOA has put out there with reguards to the AMA. Lets face it, we are out numbered. And it is causing a problem for the residents and here is why. I am currently appyling to fellowship in cardiothoracic surgery. There is only one Osteopathic fellowship in CT and that is Deborah heart and lung. While this is a good program, the name recognition is not there and in the tough climate that CT is in, a big name is what is needed to get a job. The problem is that as a D.O. from a D.O. gen surg program a lot of allopathic programs don't want to take me because I cannot sit for their boards, ABTS. Now we all know that I can sit for the Osteopathic boards, but for some reason this does not count. I don't understand it and it pains me. I know that the D.O.'s who came before me blazed a trail so that I can have a better life and I should blaze a trail as well. I agree, but what is the AOA and ACOS for if they cannot aid in this process? I love being a D.O. and don't think we need to change the initials but I also think that if the allopaths have something to offer our residents that is better than what we have, not to say that Deborah is bad, then it is paramount that the AOA and ACOS do something to afford those residents that experience because then those residents will open D.O. fellowships that will rival those of the allopaths. At least that is my plan. I want to be different, but I want to be recognized as equal. Not just by my patients, but by my collegues as well.

To all my dear and beloved Osteopathic Physicians. I urge you to stand firm in holding on to your D.O. degrees. It is not the letters that need changing. There is better answer.
This "D.O." represents your unique degree with its particular philosophy and additional training. The cure for all controversy here is major public education in the D.O. Difference. Our osteopathic family is growing and those who learn and know and understand the D.O. difference find it refreshing, and it is logically the ideal philosophy for patient approach in our current society. It is time to be in the news, as THE physician of choice. Consider this: To change your degree just to gain acceptance, can be illustrated by putting this same concept in a religious context. Most religions have a thread of similarity to them - but should they all become the same just so everyone will understand them better? Should one religion turn over its buildings and resources to another that doesn't completely share its philosophy? Should Christians and Jews (for example only) combine under one term, since they do share many similar foundations? Or politics.... since we are all Americans, should a democratic group or republican group turn over resources to the other because we all love our same country. No. There are differences. D.O. physicians have been blessed with a unique perspective. Capitalize on your differences with public relations, public education, visibility - If you don't know how, ask for help. Become involved with AOA or AAOA with the purpose of actively participating in promotion of the D.O. difference. If the tools are not found to help you, then take an active part in getting those tools developed! My dear D.O.s, you have what it takes to become the primary choice - do not sell yourselves short. With love, Deidre Froelich - wife of Jim Froelich, D.O. of Bonham, Texas and proud AAOA member.... and a Ph.D. who could have opted for Ed.D. but made choice in my own particular degree for particular reasons as well. Choose for a reason and stand by what you have going for you. If you don't stand tall now, what's next... letting nurse practicioners take over for you, since you might do the similar things... after all, the government is pushing for that anyway - so do you care? Or would you be turning your medical schools over to M.D. degrees, since after all we all want a healthy society....? Those current D.O.s who want to be M.D.s can probably get credit for their earlier training for advanced placement. If that's what you want, go for it that way.
I am particular and prefer the D.O. Difference.

Regardless of whether or not there are "differences" between MDs and DOs is irrelevant to the fact that we do not practice "osteopathic" medicine. The general public sees the word "osteopathic" and they think that we work with diseases of the bone. Who can blame them? The word "Osteopathic" means "diseases of the bone!!!!"

If you really believe that DOs are different from MDs, fine. But, no matter how some of you twist the argument, the title DO (Doctor of Osteopathic Medicine), makes NO sense.

If we want to we can continue keeping a title that makes no sense. That's fine, but we just have to realize that problems of recognition will always plague us.

Dear Deidre,
For the millionth time , we don't have to get rid of or change the DO degree. We simply add MD to it. You are still identified as "osteopathic" but also recognized as an equal. This would eliminate a ton of hassles. The AOA has failed miserably in marketing the DO degree and it is time for all of us to admit this.

To Older and Wiser and those who care to listen:

This is why the D.O. degree (not the D.O. physician) is the "Edsel" of the health care professions:

For those of you too young to remember, the Edsel was Ford Motor Company's major product of 1957 that was a dismal failure: a good idea gone bad!

“One popular misconception was that the Edsel was an engineering failure, or a lemon, although it shared the same general reliability of its sister Mercury and Ford models that were built in the same factories. The Edsel is most famous for being a marketing disaster. Indeed, the name Edsel came to be synonymous with commercial failure.”

“The public also had a hard time understanding what the Edsel was, mostly because Ford made the mistake of pricing the Edsel within Mercury’s market price segment. 
Not only was the Edsel competing against its own sister divisions, but model for model, consumers did not understand what the car was supposed to be—a step up or a step below the Mercury.”

The name of the car, Edsel, is also often cited as a further reason for its unpopularity. The car was finally called "Edsel" in honor of Edsel Ford, former company president and son of Henry Ford. Marketing surveys later found the name was thought to sound like the name of a tractor (Edson) and therefore was unpopular with the public. Moreover, several consumer studies showed that people associated the name "Edsel" with "weasel" and "dead cell" (dead battery), drawing further unattractive comparisons.”

The quotations are from: http://en.wikipedia.org/wik...

Excuse me, but if you think the D.O. degree is recognized and UNDERSTOOD by the general public, you are either delirious or living in a bubble or echochamber. Try to convince a D.O. from a small D.O. state that the degree is well-recognized.

Attorney Crosby,
It appears TCOM is proceeding with adding an allopathic medical school (MD) alongside its osteopathic medical school (DO).
The AOA has placed a nailbiting effort to defeat TCOM from proceeding, but to no avail.
Most likely since TCOM is doing this, then perhaps the next step will be that TCOM will begin offering "MD,DO" degrees to the DO graduates, if they accept and I am sure most will accept this.
The AOA is losing this battle, as per TCOM. Time to change the DO degree to MD,DO as per the above forementioned reasoning.

Deidre Froelich, et al...
What exactly is the D.O. difference? I have yet to find it, other than the education in OMT, which about 4% of D.O.s use. The holistic approach to patient care is an old and tired argument. For one, this was the mantra of D.O.s back in the early to mid 20th century when M.D.s did in fact not view the patient as a whole. However, to tout that holistic care is exculsively the unique practice of D.O.s today is just laughable since this has been the standard of medical care for both D.O.s and M.D.s alike for many decades now.
There are good D.O.s and bad D.O.s
There are good M.D.s and bad M.D.s
Bottom line is, it usually has nothing to do with the education, and more to do with the individual.
Nobody in there right mind can articulate a difference between M.D.s and D.O.s today. Most of the time, patients don't even know or care if they see and M.D. or D.O.

Deidre,
No one wants to get rid of our uniqueness, that is why adding the MD will help us perfectly because just "adding" doesn't require anything from us (we would also be able to better highlight the fact that our training is more extensive than regular MDs' by using a dual degree designation). This is a matter of civil rights and rightful universal recognition of our training. Our first responsibility is to help people around the world as best we can, not to cling to an ideology. I fear that the few people who oppose the change just haven't thought this issue through enough.

If anyone is still reading this, I also think it is important to note that osteopathy is actually a completion, or "fulfillment," of traditional MD-practiced medicine, not a complete alternative to it. This is much the same way that Christianity tends to view itself as a "fulfillment" of Judaism, not as separate from it (hence the retention of the Old Testament). What better way is there to show that we have gone beyond traditional MD medicine and "fulfilled" it, than to adopt the dual degree (MD, Diplomat of Osteopathy) in the tradition of A.T. Still? It would show that we are fully medical doctors as well as fully osteopaths. In my mind there can be no medicine without osteopathy and there can be no osteopathy without medicine and we should all be promoting the fact that they go hand in hand by using the designation MD,Diplomat of Osteopathy.

Mr. Crosby,
As an attorney and prodigious worker for the AOA, I am sure you understand our plight, as mentioned by dr mddo. It is nice of you to have this ongoing blog here. Here is a hypothetical scenario: Imagine if there were 2 U.S. law schools of thought -> a traditional law school - J.D. & the other osteopathic law school - O.J.D. or J.D.O. or D.O.J. -> osteopathic Juris Doctor, or Juris Doctor Osteopathic, or Doctor of Osteopathic Juris.
Wouldn't you rather just have "Juris Doctor", J.D, after your name? Even if you went to a hypothetical "osteopathic" law school, you would still be a lawyer and practice Law. Wouldn't you want the public to know you were a lawyer, and a J.D. would help identify the public to you. You would probably do better financially since the public would know you were a lawyer and seek your services.
Just trying to put this in a different perspective to get my point across.You want J.D. behind your name. We want M.D. or M.D.,D.O. behind ours.
Thanks

Excellent blog for the profession. Enjoy learning about the greatness of the osteopathic profession. Keep it up Mr.Crosby.

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