Advocacy to Protect the DO Degree

AOA President-elect Karen J. Nichols, DO, joined by several AOA Trustees and Past Presidents who graduated from KCUMB-COM, has written to her alma mater, the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCUMB-COM), in response to the school’s recent proposal to offer a dual degree to incoming medical students. The letter expressed concern over KCUMB-COM seeking LCME accreditation so that the school can offer COM graduates a dual “DO, MD” degree and urged KCUMB President Karen Pletz to abandon this idea. If you are concerned about the impact this could have on the integrity of osteopathic medical education, let KCUMB-COM and the AOA know.

Comments

ADO wrote:

Not concerned, but overjoyed KCUMB is doing this. Apparently some other "better" schools have the wheels in motion to follow suit. Letters and threats from the AOA and it's cronies won't do anything (ie TCOM). I wish KCUMB the best of luck with this progressive, logical and inevitable move.
Thursday 17 December 19:47

dr mddo wrote:

Alright, usually I don't overtly ask for a response but this time I would like one from Mr. Crosby if it is possible.

Why is the AOA seemingly trying to work against itself? After all we've discussed on here, what harm could it possibly do to adopt the more universal medical degree in addition to keeping our osteopathic roots? What would it take away from us that could cause us so much harm? If you could tell us, perhaps we will understand. It just seems so illogical since our great father, A.T. Still, kept his MD after his name and was totally fine with it. If having the MD,DO after our names could help us save just one more life somewhere on earth, isn't that worth it enough? We don't seem to understand how this strategy of resistance "protects" the DO degree but are actually worried that refusal to change could lead to its downfall. Please just consider this.
Mr. Crosby, what will happen to all of the osteopathic medical students after you and the other AOA higher ups aren't there to put a protective shield over us? Are we doomed to a lifetime of having to constantly defend our credentials on our own until we retire just because of our degree designation?

My last question is this: If the AOA and COCA would adopt the MD,DO as it's accrediting standard, why would we need to have LCME accreditation to achieve the dual degree? It seems COCA could just do it for us and we could be done with it. Please explain if you have time.

Thank you for listening,
C. Zotto
Thursday 17 December 22:42

VSN wrote:

I'm just curious as to how this would negatively impact the DO profession?

If anything, wouldn't this open up even more doors to DO students? It seems like the AOA should advocate for a dual degree, rather than jeopardize the profession when one school switches and the others don't.
Friday 18 December 00:18

gmack wrote:

This is absolutely the wrong move and a direct threat to this profession. Attorney Pletz states that KCUMB will always preserve its osteopathic heritage and mission. So, why the MD? The tired old excuses about student clerkships and residencies simply do not hold water. If KCUMB becomes LCME accredited to grant the dual degree, every other DO school in the country will follow suit so as not to be seen as second-rate. Schools offering only the DO will quickly go out of business. From there is is but a short step for the dual degree schools to eliminate the DO entirely. We will see a repeat of the California conversion, nationwide.
Of course, KCUMB is just doing what i feels necessary to survive in an era where COCA accredits for-profits, allows irresponsible growth of schools without clinical standards and works in star-chamber secrecy. Frankly, the AOA has not been of any help with statements of "we don't control COCA" and the presidents consistently allowing a status quo, rather than standing up for quality and ethics.
George Mychaskiw II, DO, FAAP, FACOP
Friday 18 December 00:42

dr mddo wrote:

Dr. Mychaskiw, are you insane or just paranoid? Why would the DO degree ever be phased out because of this? The WHOLE POINT of a DUAL DEGREE is to BROADCAST that we possess MORE KNOWLEDGE. Also, we don't even need LCME accreditation, because COCA can accredit the dual degree if it wanted to, thus ensuring the continued existence of the AOA and the DO degree. Next time, think before you post illogical statements based solely on your emotions, or better yet take a few courses in military strategy as I have and you will see that we are FAR more likely to undermine MDs by using their degree (which is also rightfully ours since we practice medicine) than to BE undermined by them.
Besides, instead of wasting money lobbying for practice rights around the world because of our unrecognizable degree, we could put those resources to better use by helping more patients, saving more lives, and MARKETING OMM to the public. I'm sorry to sound harsh, but your lack of foresight kind of astonishes me and causes me to worry about the survival and proliferation of our osteopathic family.

C. Zotto
Friday 18 December 01:03

gmack wrote:

P.S. I doubt that a strongly-worded letter is going to do very much to change KCUMB's course of actions. COCA should act to withdraw accreditation of any school offering a dual degree and the president of the AOA should use her bully pulpit to publicly and forcefully advocate for same.
For too long organized osteopathic medicine has stood mute while this profession embarked along a path of self-destruction. To paraphrase, "you reap what you sow". And since the AOA, through protectionist policies regarding CME and ABMS certification has ostracized the majority of graduating DO's, where are those who can help to set things right? Where are our deans, program directors and DME's? Shut out in the cold.
I hope it is not too late, but the transgressions of recent years have made us a house of cards. This is sad for those of us who have devoted our lives to this profession and believe it offers a superior method of patient care.
George Mychaskiw II, DO, FAAP, FACOP
KCUMB, class of 1988
Friday 18 December 01:06

gmack wrote:

Dr. Zotto, your idealism is not real-world. You are correct only if every DO school offered a dual degree and if COCA could accredit schools to offer an MD degree.
Neither is possible. The US Department of Education will only allow the LCME to accredit schools granting MD degrees and the ACME will only recognize LCME accredited schools. Every DO school (how many LECOM's are there this week?) would not pass the LCME's muster, creating the DO's with a single degree as a sub-class of doctor to the outside world.
The dual degree is a surrender of the profession that KCUMB may feel necessary due to COCA's irresponsibility and the AOA's apathy.
George Mychaskiw II, DO, FAAP, FACOP
KCUMB, class of 1988
AOA Health Policy Fellow, class of 2007
Friday 18 December 01:15

dr mddo wrote:

Alright, then perhaps we need to lobby the Department of Education to give COCA more freedom. The bible says that with God all things are possible, so I say we give it a shot. I know that me and my friends will never stop advocating until osteopathy reaches the heights that it should. Thank you for your swift response. Once again, I did not mean to sound harsh (after all, this IS a family).
Friday 18 December 01:27

gmack wrote:

Given COCA's recent behavior (RVU, class sizes, branch campuses, etc.) it is surprising that the USDE recognizes them at all.
GM
Friday 18 December 01:44

dr mddo wrote:

Mr. Crosby, would you care to interject a comment or two? This debate cannot progress if we are the ones doing all the talking. The new question is this: Does COCA have the legal right to grant the MD degree? If not, is this right reasonably obtainable? Since you are a lawyer, you will probably know the answer to these questions.

C. Zotto
Friday 18 December 02:37

ADO wrote:

The fact is the AOA and COCA can't do a darn thing about KCUMB. COCA wants to play by the rules as written (eg for-profits allowed), and there's nothing in the accreditation standards regarding dual degrees, so a threat to drop accreditation would not legally stand. RVU's accreditation is now going to come back and bite the AOA in the ass.
Friday 18 December 11:32

dr mddo wrote:

Actually posts by past AOA Presidents on the president's blog, including from ones dating back to 2006 up to the current, make it seem that COCA can choose the designation that it uses to accredit our schools without having many legal woes, so perhaps their is hope. I would agree that it would not be fair for one school to get a dual degree without the others being included. Also, theoretically, the movement should probably come from within, not from external forces like LCME. Just my thoughts.
Friday 18 December 14:46

OUCOM Grad wrote:

This entire argument of "protecting the DO degree is absurd". Adding an MD is by far one of the smartest moves an institution could make. It augments visibility of our so claimed "profession", acts as an excellent recruitment tool for a stronger applicant pool, and affords international recognition. I don't feel that provoking other osteopathic medical schools to adopt the act is necessarily a bad thing. Its exactly what we need for our aforementioned "profession" to break out of the funk of celebrating the status quo. In an era where the "Doctorate" degree are ubiquitous (DNP, ND, PA, etc), the "MD" is the only recognized degree designation. This is certainly a move in the right direction.
Friday 18 December 15:38

Current KCUMB Student wrote:

As a current KCUMB student I am not concerned but excited about the potential dual accreditation of KCUMB. This means we get the best of both worlds. We would still be educated according to the osteopathic phiosophy and receive instruction in OMT. We would still be DOs but would have all of the advantages (3rd/4th year rotations, LCME residency advantage, etc.) that would come with the additional accreditation. I hope this does happen.
Friday 18 December 17:05

Another current KCUMB student wrote:

I, on the other hand, also a current KCUMBer, am appalled at the concept of a DO/MD dual degree! I chose to attend a DO school because I believe in the philosophy and I want to use and practice OMT. I feel that it has given me an advantage in my Family Medicine residency interviews. I am proud of my DO training, and if I wanted a DO/MD degree, I would have just attended an MD school. When your degree has been the underdog for years, you work hard to build and keep it strong and you embrace your differences, not conform.
I'm all about DOs and MDs having one combined match, but I wouldn't have traded my DO training for anything.
Friday 18 December 19:37

4thyearKCUMB wrote:

It's too bad Pletz was fired over this.
Friday 18 December 19:54

dr mddo wrote:

Maybe it is actually better that she was fired. She moved against the osteopathic community in a clandestine manner instead of advocating for internal change and we all know that a house divided cannot stand for long. It would not have been fair anyway for one school to have those credentials and not the rest of us. Besides the LCME and AMA are a bunch of clowns and we don't need their residencies.
Another KCUMB Student, I am 99.9 percent sure that everyone lobbying for a dual degree including myself only wants the legal RIGHT to call themselves MD to alleviate the stress of certain situations (aka fighting for practice rights, making OMT seem more mainstream, participating in medical missions, and making sure that everyone knows they are doctors, especially in a country where 2/3 of the population cannot name the vice president). In case of national emergency, anyone in the vicinity who went to any medical school should be instantaneously identifiable by the public, so if the public is used to seeing "MD" then so be it. No one is attacking OMT from what I can see on the blogs; they would be idiots to do so. Another problem is that the current DO degree is somewhat deceptive. Since osteopathy literally means "bone disease" some people think we are bone specialists, when in reality our emphasis is on primary care, not specialty (something I consider a good thing).
So before everyone freaks out at the idea, perhaps if the AOA and COCA were to make the switch to DO,MD themselves it might be something worth CONSIDERING at least. An internal change would be much better than an external one. I am now pretty sure that COCA is actually allowed to pick the designation that they grant. Any thoughts?
Friday 18 December 22:25

KCUMB OMSII wrote:

Another KCUMB Student, the problem is that you are applying for family med residencies which are fairly easy to attain. There are alot of your classmates who dont want to be family medicine doctors. With the massive expansion of osteopathic schools and allopathic schools we are at a huge disadvantage in fighting for residency spots. The number of residencies in this country hasnt grown since the early 90's. In addition, as osteopathic students we are prevented from using VSAS which essentially keeps us from doing away rotations during 4th at allopathic institutions. In previous years before VSAS was used these rotations were essential to us matching. The AOA basically expects us to do allopathic residencies but we are treated like second class citizens in the allopathic match. I also specifically applied only to DO schools and I wouldnt change being a DO student for anything. However, we work too hard for this and deserve better opportunities. Dr.Pletz recognized this and tried to do something about it.
Saturday 19 December 00:44

Yet another KCUMB Student wrote:

I am also in the camp of 'not seeing any rational disadvantages to a dual degree'.

We're the ones with 'extra' training. Why shouldn't our degree designation reflect this?

As others have pointed out, a dual degree would only open doors for graduates in terms of post-doctoral opportunities and title disambiguation.
Saturday 19 December 01:24

dr mddo wrote:

If you guys feel this way, then post your emails and ask to join the facebook group just created today. We should support calling for a vote among all AOA members on whether we should change our degree THROUGH COCA to MD,Diplomat of Osteopathy. This is a historical degree that is a throwback to our heritage (the "diploma" was first put into use by A.T. Still himself). A dual doctorate might sound cooler, I know, but people would probably think we went to school for 8 years instead of 4.
Saturday 19 December 02:58

MD student wrote:

This entire debate boils down to whether a person is interested in improving osteopathic education or if he clings to an antiquated, reactionary notion about what it means to be a DO.

The change will open up numerous opportunities for students including but not limited to more opportunities for away rotations, better prospects in the match and fellowship and being treated as an equal (which let's be honest, is far from universal). It will also force schools to adhere to a higher standard than they already do (namely the LCME's standards). For years I have heard my fellow medical students complain that their rotations were sub-par and forced them to travel across the country. COCA and the AOA did noting. The new for profit osteopathic school just shows how out of touch with its student base COCA and thr AOA actually are.

In addition to improving educational opportunities for students, the initiation of the dual degree will improve osteopathic education as a whole. This change will force schools to raise their standards and become LCME accredited or be seen as second tier. Can you honestly say this is a bad thing, to constantly be striving for improvement? Isn't that one of the core ideals of the profession? If a school currently could not live up to the LCME's standards and is doing nothing about it, the students are bearing the brunt for an institution'd laziness, greed, or inability to provide excellent education.

The detractors say that this will be the end of the DO identity. Unfortunately I have news for such people. 3he separate identity a myth. Instead it is a state of mind that has nothing to do with the degree and everything to do with a person's goals in treatment and pwrspective on intrractions with patients. So what the detractors have left is nothing more than than holding on to an antiquated idea for old times sake.

In reality the merging of the degrees means that Osteopathic training is now seen as essentiall on the same plane as the allopathic colleagues. This is a good thing and shows just how much the mainstram has come to accept DOs and how DO education has improved over the decades.
Saturday 19 December 08:24

Someone Looking out for the Future wrote:

Can I just say the this seems childish. As a DO, you have all the training you want - how is adding an MD hurtful? Some of our own professors have MD/DO degrees. With the disaster in California ND trying to be legalized by a DO commitee - which actually passed d/t politics...the whole thing is a joke. If you want to treat people with OMM and practice treating the "whole patient" your patients are going to return to your care - no matter what you will be a better doctor - reguardless of your additional "MD" -- GET OVER IT!

People want to complain about the "cult" label - there you go....acting as a "cult" by purposly disreguarding advances that will help patients -- not the "title DO". Our patients should be the biggest concern not the title.
Saturday 19 December 11:33

Dentist wrote:

As the parent of a student in osteopathic school and a dentist by profession these discussions remind me of our past "dilemma" in dentistry. The original degree was and has traditionally been DDS which the majority of schools confer. The other degree awarded is DMD. Both are equal in every way regarding education, students take the SAME boards and enjoy the same state licensing privileges. Therefore, dentistry is viewed as ONE singular, cohesive profession. Medicine however, has evolved into 2 professions that despite education being virtually identical (plus the additional training in OMM ). So all this hullabaloo over one small aspect of patient care! And the nonsense of being "holistic" is absurd as I've seen dentists claim to be "holistic dentists"as if they were self designated superior clinicians. ALL health professionals are and should be holistic and take the patient as a whole into their diagnosis and treatment. It has always befuddled me as to why the waste of 2 separate governing boards, national board exams, hospitals, residencies and accreditation bodies. Medicine and its doctors should continue this path of evolution to its seemingly logical conclusion- one universally recognized degree (MD) with the fellowship designation (DO) for those who pursue this additional training; take one board exam USMLE with an OMM section. That, I believe, will elevate those who hold the DO fellowship to a higher standing amongst peers and patients and allow recognition they deserve for this advanced training akin to fellowships in other medical specialties.
Saturday 19 December 12:53

An older KCUMB OMSII wrote:

This also reminds me of a problem seen in nursing. There are two year RN programs that prepare nurses to take the NCLEX exam. The four year degree nurses take the same test, with some extra classes on nursing theory, management and why (tongue in cheek) they are superior to the two year nurses. In the end they do the same job. It is up to the individual to make the best of the education they have.

As a KCUMB student, I am only curious about one aspect of the DO/MD dual degree. Okay, two. First would it be retro active for current students? Second, I love the osteopathic philosophy. I know there is a different vibe on a DO campus, more family-like, or welcoming, not threatening or intimidating like some allopathic schools. I would want to keep that. Would having the dual degree option allow for some students to select only the MD option and therefore not the OMM part of the curriculum, or would everyone have the same degree? What would be different about it from just DO besides the obvious? I know physicians in practice that are DOs that do not correct it when they are listed as MDs in the phone book or by their patients, because honestly it is hard to define what makes us different. Maybe it is the people drawn to the DO philosophy and not so much just the philosophy itself?

I am not ready to decry the MD/DO option as a bad thing, but I would like to know more about it. Anyone up to informing me? Kindly please?:)
Saturday 19 December 15:08

dr mddo wrote:

Guys, feel free to message me if you would like to participate in a resolution to have all AOA members vote on altering the DO degree to MD,Diplomat of Osteopathy. The resolution was written by kfarose, who posts on the AOA president's blog. Myself and several others have made revisions. President Wickless was kind enough to post a message on the blog telling us exactly what we would need to do to make the change happen. So far, the resolution consists of basic strategies that not only highlight how the MD addition can be useful for medical practice, but also describe how it will actually be crucial when we go head to head against the allopathic world when promoting osteopathy in the public arena while safeguarding our own autonomy forever. Happy Holidays!!

C. Zotto
Saturday 19 December 19:45

William W. Beazley wrote:

I am a 1993 graduate of KCUMB. When I applied to med school I applied only to DO schools. I did not want to be an MD. have never had to apolgize to anyone for my training. If you want to be an MD go to an MD school. I do not see the benefit in the duel degree approach which dilutes the profession and will result in loss of donations from many alumni
Sunday 20 December 13:44

jwatt wrote:

Dr.Beazley:

I like yourself only applied to DO schools. It was not until later in my schooling I realized the disadvantages of our degree. Applying and getting a ACGME residency in dermatology with a DO, definitely not an advantage. Check out the AOA International Licensing page. It clearly states because of the similarity of our degree to foreign DOs(non-medical) has caused some problems in licensing. Australia for example has been very specific:

Degrees in traditional Chinese medicine and the degree of Doctor of Osteopathy (awarded in the United States) are not recognised as primary qualifications for the purposes of specialist assessment.

So I guess as long as you stay in MI, PA, MO and the other primary DO states its not an issue, but it is. Despite all efforts by the AOA to propagate the degree has been a failure. The change will come as we can see from the many events occurring(Texas, Caribbean, KCUMB) I think we would like the AOA to lead this change. They will either lead the change we all desire or be changed by it.

Merry Christmas!

James Watt, DO, FAAD
Sunday 20 December 18:22

JohnCrosby wrote:

Dear Blog readers:

Thank you to all those who posted their comments regarding this contentious issue. I care deeply about our members’ differing opinions on this issue. Before I continue, I want to clear up some statements made above. First, as is stated in the top blog posting, I do not respond to anonymous comments. I hold myself accountable for all that is written in this blog, and DOs who seek responses should do the same by identifying themselves. I am making an exception in this case to clear up a number of untruths and allegations. Before we rush to judgment on this issue, we should have all the facts before us.

Second, I take issue with allegations that the AOA has blindly decided to support only the DO degree designation. We developed this position after soliciting feedback from a wide segment of AOA membership. The AOA House of Delegates and Board of Trustees then considered the issue in July 2008. Like the US Congress, our policy making body—the AOA House of Delegates—is composed of more than 500 leaders representing each osteopathic state, specialty, and student organization. Those who advocated a change to the DO degree were advised to submit a resolution to the Board and House. However, the only resolution brought forward on this issue reaffirmed the “DO” degree, on which AOA leaders unanimously voted to support as the designation for osteopathic physicians.

The Commission on Osteopathic College Accreditation (COCA) accredits schools that award the DO degree. Academic degrees are not awarded by individual membership based professional organizations, such as the AOA. Academic degrees are not awarded by higher education accrediting agencies like COCA. Furthermore, the AOA and COCA do not develop or operate colleges of osteopathic medicine (COMs).

Academic degrees are awarded by an institution of higher education based upon the authority granted in institution’s charter or bylaws. Accreditation agencies, such as COCA, are expected to have standards that reflect the general concurrence of their many stakeholders. To date, COCA has not received any requests from any COM or from the American Association of Colleges of Osteopathic Medicine to accredit any programs of instruction other than the first professional degree in osteopathic medicine, Doctor of Osteopathic Medicine.

The larger principle at hand is the integrity of the DO degree. Adding an MD to the DO degree will not automatically translate to recognition of what a DO is; rather, it will be one more degree which much of the public does not recognize. The COMs themselves ultimately decide what degree and designation they award—the AOA cannot mandate this one way or another.

Our own President Wickless gave helpful advice to those family members who support changing the DO designation. Read his advice on how to submit a resolution about the degree on the AOA Presisdent’s Blog (http://blogs.do-online.org/...).

Several made excellent points about the insufficient number of OGME positions for our graduates. The AOA fundamentally disagrees with former KCUMB President Pletz's stated intent to buy LCME accreditation to gain access to ACGME postdoctoral training. This simply is the wrong approach to expanding OGME.

Instead, the profession should work together to create a sufficient supply of OGME positions. All COMs should have an obligation to participate in this development of OGME for graduates. To this end, the AOA established an OGME Development Initiative several years ago and has been steadily increasing the number of OGME positions since then. Several AOA Presidents have warned COCA about the incongruence between class size and OGME positions, including President Wickless, who earlier this month testified before COCA outlining our concerns in this regard. However, the AOA has no say over the standards established by the COCA. We can only testify before COCA just like any other osteopathic organization. COCA itself must adhere to the strictures of the US Department of Education and the US Department of Justice.

We are also examining other options for OGME programs. At the AOA Medical Education Summit II, educational leaders asked the question, “Should we admit MDs into osteopathic training programs?” Following this meeting, the House of Delegates in 2009 referred a resolution calling for a study on the impact of admitting MDs into OGME training programs in order to facilitate widespread dissemination and discussion amongst osteopathic family members.

We are listening to our members and take these discussions very seriously. I urge all those, regardless of which side they’re on, to work with their colleagues to bring a resolution before the House of Delegates and let a representative body of peers act on it.

Kindly yours,
JBC
Tuesday 22 December 13:43

gmack wrote:

Dear Mr. Crosby:

I am writing to you to urge the AOA to take immediate action in the interest of the profession. As a practicing osteopathic physician for over 20 years and a former AOA health policy fellow, it is clear to me that osteopathic medicine in the Untied States is in serious jeopardy and, unless we act now, it will not survive the upcoming challenges to the American health care system.

The recent initiative by Ms. Pletz at KCUMB is a poignant illustration of how close we are to a precipice that, if crossed, may end my profession. Although the issuance of a combined DO/MD degree at a single institution would set a dangerous precedent, the issues identified by Ms. Pletz are nevertheless real and should not be discounted.

COCA and the AOA, through its silence, have allowed irresponsible growth of osteopathic medical education without adequate clinical training at either the undergraduate or postgraduate levels. While allopathic schools hesitate to increase class sizes by 10% over 5 year periods, some osteopathic colleges have increased enrollment by more than 50% over one year in areas where there is a paucity of existing clerkship opportunities. Osteopathic colleges have opened numerous branch campuses, at high levels of enrollment, while barely graduating inaugural classes from the home schools. COCA accredited the first for-profit medical school in the United States in nearly a century without well-publicized and open debate and without a clearly defined rationale for the economic model. Putting aside Rocky Vista University, there is no credible for-profit medical school in the industrialized world. The vast majority of osteopathic graduates enter ACGME residency training, but there is no organized mechanism for them to return to the profession as program directors, DME’s and deans, thus perpetuating the vicious cycle of ever decreasing OGME opportunities. Category 1 osteopathic CME is so restrictive in design that is a constant source of difficulty and frequently cited as yet another reason for our graduates to leave the organized profession. Concurrently, the AAMC has called for a 30% increase in allopathic class sizes, clerkship opportunities are limited or bought and paid-for by third-world for-profits and CMS has not increased funding for residency training beyond 1997 levels. Ore economy is in its worst condition since the Great Depression and political health care reform proposals continue to limit reimbursement, decrease services and limit technology and innovation as the number of ill and elderly climb to record levels. We are fixated on primary care to the exclusion of specialties, while nurses, technician and other allied health professionals deliver the same care without well-demonstrated differences in morbidity and mortality.
Sunday 27 December 00:40

gmack wrote:

Quite simply, Mr. Crosby, this profession is at crisis point. If we do not act to address these threats, then surely the US Department of Education will. Patient lives are at stake and it will only take one osteopathic Libby Zion to bring down the house of cards. I am well aware the COCA is an independent body, not controlled by the AOA, however, as you said yourself, the AOA can testify and set forth its opinion to COCA and the leadership of the AOA can use their bully pulpit to advocate for the necessary measures to protect the profession and the patients for whom we care. Surely the testimony of the AOA president and Board of Deans carries more weight than the testimony of a lone ACGME trained anesthesiologist. It should also be noted that the AOA appoints the members of COCA, so the organizations are separate, but related.

The following steps should be taken immediately:
1. A moratorium on any new osteopathic schools, branch campuses or expansion of class sizes.
2. A review of COCA standards and comparative study of LCME equivalents.
3. A prohibition of for-profit schools, including existing schools.
4. A review of all osteopathic undergraduate and graduate clinical education for standard and quality of teaching.
5. A rationalization (decrease) of class sizes in accordance with #4, above.
6. An accommodation in COCA standards, so that osteopathic physicians certified by the ACGME can serve as AOA residency program directors, DME’s and deans.
7. Acceptance of AMA CME as equivalent to AOA.
8. Development of endowment funding to increase OGME opportunities.
9. A prohibition of joint DO/MD degrees.

Mr. Crosby, I urge you and the AOA to act on this with all deliberate speed. Our profession has distinguished itself since the days of Andrew Taylor Still as offering patients a better philosophy and practice of health care. The benefit we offer to our patients has facilitated the acceptance and growth of our profession against overwhelming odds. The disappearance of osteopathic medicine would be a tragedy. Please, stand for what is ethical, stand for what is right, stand for our patients and stand for our uniquely American practice of care. If we do not police the profession, surely someone else will.

Fraternally yours,

George Mychaskiw II, DO, FAAP, FACOP
Professor and Chair, Department of Anesthesiology
Drexel University College of Medicine
Sunday 27 December 00:41

dr mddo wrote:

I agree with everything Dr. Mychaskiw has just posted with just one point of critique (feel free to evaluate the critique). I would like to point out that I believe his ninth point (again, correct me if I'm wrong, Dr. Mychaskiw) supports prohibiting joint DO/MD degrees OUTSIDE of AOA approval. This is why several students and myself are working tirelessly to write a resolution for the AOA to review which calls for ALL DOs to receive an MD degree (without needing the LCME at all), not just SOME DO graduates from a specific school. This way, we will neutralize threats coming from people who don't realize that we have medical training, neutralize threats coming from people like Karen Pletz and TCOM (applying to LCME would have no purpose then, as people can't have TWO MD degrees), and show that we are willing to sink or swim TOGETHER as one osteopathic community.
If you've read my last post, I admitted that while I was quick like others to support Karen Pletz at first, I did not realize that if she had succeeded, it would have destroyed the work of those who were lobbying for a degree change WITHIN THE AOA/osteopathic family. We don't need the LCME for this because it is up to the COMs, as Mr. Crosby pointed out.
I am curious to ask Dr. Mychaskiw, though, what would you do with all of the students at Rocky Vista? I did not support its accreditation by COCA (same as yourself), but I must say now that they've already enrolled students who have paid tuition, I wouldn't want to see any harm come to them. I am sure that they enrolled at Rocky Vista with good intentions, and would present a logistical problem if their school suddenly lost accreditation. What say you? Happy Holidays.

C. Zotto
Sunday 27 December 02:30

dr mddo wrote:

If I may add, from a student's perspective, I would not get too worried about the "disappearance of osteopathic medicine" because OMM is literally everyone's favorite class/lab and we even practice it on each other at home for fun. So I'm pretty sure that it is here to stay regardless of what happens.
Secondly, I believe we have included a clause in the resolution calling for degree change (MD,DO) that condemns any future attempts by COMs to seek LCME approval, if that makes anyone feel better. It is important that we go about this from a position of strength and unity and get it done BEFORE TCOM gets LCME approval (because then it will look as though we are just changing in reaction to what they did, which isn't true).

C. Zotto
Sunday 27 December 02:41

gmack wrote:

Point 9 specifically addresses LCME MD degrees. The changing of DO to something else through the AOA is a different issue.
What to do with RVU and its students is a complex issue deserving further study and discussion. Caveat emptor also comes to mind.
Monday 28 December 00:41

Jeffrey Anderson DO wrote:

The osteopathic profession is rapidly changing with or without the AOA. It is time for the osteopathic profession to implement a strategy to realize our long time statement and feeling that "DO's are trained as MD's yet better and with extra skills". It is time for all DO schools to become MD granting LCME accredited schools and also offer a DO accredited by COCA. This would set the profession as the best and most comprehensive without question. The unfortunate reality is that most DO schools would never earn LCME accreditation due to poor clinical infrastructure and poor clinical education opportunities. Many of our DO students cannot pass the higher standard USMLE and must earn their license through the "DO only" COMLEX examination. We should strive for excellence and live up to our statements of excellence. The duel MD, DO degree accreditated by both LCME and COCA is a win-win for the profession and the public. Unfortunately, some of our COCA accredited schools are not degree-worthy and continue to lower our profession's standards and harm our stated heritage of exccellence. It is time for the AOA to raise its standards and stop the uncontrolled growth of very low standard osteopathic medical schools. Lets finally prove that we are the preferred profession--LCME accreditation with USMLE examinations plus COCA accreditation and COMLEX examinations. Having completed both standards provides the proof of excellence and professional superiority that we all have sought for decades.
Monday 28 December 07:25

Oskie wrote:

Keep the degree designation the same, but merge the accreditation bodies so that a new dually-invested COCA/LCME organization accredits all medical degrees (DO and MD) leading to the full scope of practice of medicine in the USA.
Wednesday 30 December 10:02

dr mddo wrote:

Oskie, what would be the point of your suggestion? Gmack and Jeffrey Anderson DO have clearly outlined the fact that many DO schools would not even be up to LCME standards and all allopathic schools are not going to suddenly agree to start teaching OMM just so they can be accredited by COCA. Therefore, a full and equal merge can probably never happen between the LCME and COCA. It would serve no real purpose anyway, except to undermine the osteopathic community.
If you really want unity in the medical field, sharing a common degree designation would be the best bet.
Wednesday 30 December 23:05

Michigan_DO wrote:

WE DONT PRACTICE OSTEOPATHY OR OSTEOPATHIC MEDICINE (for that matter).

WE SHOULD HAVE an MD to clarify what we all do, PRACTICE MEDICINE.

Who in this blog practice osteopathy? Not me.

THE DO degree is strictly historic at this point. Anyone arguing differently should have an MMSE done.

Its 2010, not 1890. OMM is not the future of medicine. I hope more DO schools apply for LCME status in the future. Theyre going to need to in order to hedge against the bleeding applicant pool moving into the new 5K MD slots opening up.

Wake up AOA.
Friday 08 January 14:38

JohnCrosby wrote:

Dear Dr Mychaskiw:

Thank you for sharing your ideas to support and protect the osteopathic medical profession. Your nine points to strengthen the osteopathic medical education system deserve consideration. Consequently, we are sending your ideas to several AOA governing bodies with authority over the various stages of the education continuum. While we are prohibited by US law from implementing some of the steps you recommend, your nine points are, nevertheless, worthy of debate and may generate new ideas that can be implemented. Please note that we must move forward in a deliberate, measured process. Any pre-emptive actions or short-circuiting of due process would only generate lawsuits and injunctions, further delaying any hoped-for change.

I encourage you to be part of the process as we seek constant improvement in the continuum of osteopathic medical education. If you want to submit comments or testimony to the relevant governing bodies, let me know.

Thank you once again for your passionate support of the osteopathic medical profession.

Kindly yours,
John
Wednesday 20 January 14:27

Michael Oleyar, MS4 wrote:

I just came across this topic. MD, DO degrees make sense - it reflects modern medicine and offers students THE MOST OPTIONS upon graduation to practice medicine and further medicine in whatever direction that may be, whether it is surgery, anesthesiology, manipulative medicine, etc. This was recognized about 100 years ago in the UK. Accomplishing this through AOA action or LCME accrediation seems to be reasonable. I just wonder if it is necessary to maintain such a strong COCA. I appreciate all the hard work the group has done, but why does the country need 2 major accrediting bodies? Why not have LCME as main accrediting body and COCA for schools designating students with osteopathic training. Any updates?

On another note, I have not looked at LCME requirements vs. COCA requirements for accreditation, but I doubt vast differences exist judging by the many similarities in AOA and ACGME GME requirements. Therefore all osteopathic programs should meet LCME requirements. If not, maybe it would be a good idea to address deficiencies.
Friday 26 February 14:07

Mary Chenny wrote:

I have an osteopathic physician in the family, and here is my opinion: If osteopathic physicians want to maintain their tradition, they should remain DO's. Otherwise they should apply and reapply to MD schools if they wish to obtain an MD. DO schools will surely die out. Do we want that to happen? It also indicates that DO's think their degrees aren't as good as an MD degree.
Tuesday 16 March 21:42

yyyy wrote:

I have an osteopathic physician in the family, and here is my opinion: If osteopathic physicians want to maintain their tradition, they should remain DO's.
Thursday 21 October 20:39

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