November 22, 2014

My first lecture to DO students

I’ve been on faculty at a University of California medical school for over 10 years now. Last year, I was invited to additionally join the faculty of a second medical school. At the first school, students graduate with an M.D. degree, which is the degree that the general public typically associates with "medical doctors". At the second school, students graduate with a D.O degree. This confers on them the title of Doctor of Osteopathic Medicine. While DOs, for the most part, have equivalent training, privileges and abilities as MDs and while they function in the world the same as MDs, they are unjustifiably left with the short end of the stick when it comes to public relations. They are often confused with chiropracters, which are a whole different profession entirely. MD’s and DO’s are the only professions who can have the opportunity to pursue practicing in all aspects of medicine.

I think if I were hired to run a marketing campaign for DOs, the first thing I’d suggest is changing their name. All too often, I’ve heard stories from DO’s of patients questioning their credentials and asking to be seen instead by "a real medical doctor". I’ve worked side-by-side with DOs all throughout my medical career and I’ve had the opportunity of hearing many of their rants regarding the public’s misperception regarding their status. One memorable story told of a DO who was at a party trying to impress a girl. When he told her he was a doctor, she asked "You’re an MD"? When he corrected her and said he was a DO, the blank look on her face led him to add "Doctor of Osteopathic Medicine". When she answered back, "Er…I’m sorry, I don’t know what that is. Doesn’t that have something to do with feet?", he said at that moment, he knew his night was shot and it was time to move on.

Today, I gave my first lecture to a class of about 40 or so DO students. In the past, I’ve lectured to well over 1000 MD students. I would have to say that if I were blinded as to which group I was speaking to, I would not be able to distinguish at all between the two. Mind you, my lecture style is very interactive, meaning I regularly call on students all throughout my talk. The number of correct answers I got back on easy and difficult questions was pretty much the same as when I speak to MD students. In fact, one of the students today asked me one of the most insightful questions I’ve heard in a long career of lecturing. We were specifically discussing IVF and the advantages and disadvantages of doing ICSI. I described the dilemma of how doing ICSI had the advantage of minimizing the risk of failed fertilization, but NOT doing ICSI had the advantage of more adherence to the principles of natural selection in that sperm are permitted to fight it out and compete to let the better sperm win in fertilizing the egg. I told how many of my professional colleagues had a strategy of doing ICSI on 99% of their patients just to play it safe, while I tended to do ICSI on closer to about 70% of my patients. In reality, on many of my ICSI patients who make an excess of eggs, I will divide the eggs and do ICSI on some eggs and do conventional IVF on the others. However, I never mentioned that in my lecture. This student came up to me after the talk and impressed me by asking, "I was wondering. You said that in many IVF patients, you can generate a lot of eggs. Wouldn’t it be possible to do ICSI on some of them and not on the others?" This type of creative thinking from someone obviously unfamiliar with the field wows me more than any amount of rote memorization skills ever can.

Back to the distinction between DO’s and MD’s, I will offer my official opinion. It is clear that DO’s suffer from being a minority. There are about 7 MD schools in the US for every DO school. Because they are a minority and because DO schools emphasize primary care over specialties, DO graduates end up having fewer residency options than graduates of MD schools. A DO can theoretically get into any specialty he/she wants, but in practice, it is much more challenging than if he/she were coming from an MD school. DO’s disproportionately enter primary care fields as compared to MD’s. In fact, I’ve come to ironically look at DO’s who are in highly desired medical specialites as being exceptional, knowing the greater barriers they had to overcome to get where they did. Now because of the perception by medical school applicants of life being tougher for DO grads, this leads to it being more difficult, IN GENERAL, for students to get accepted into MD schools than DO schools. There is nothing inherently wrong with that. It was a little easier getting into the state MD school that I went to rather than an Ivy League school, but so what? While IN GENERAL, students given a choice tend to choose MD schools over DO schools, I personally know of a few excellent students who actually chose a DO school over another MD school.

One candid thing I’ll say that might invoke some ire from DO’s is that I don’t buy into the claims that some of them try to make, claiming that because they are taught special physical manipulation techniques in addition to standard medicine, that this somehow makes them better than MD’s. At least, in my field, I have yet to be convinced that osteopathic manipulations have increased a woman’s chances of getting pregnant. I am, however, open-minded to the effects of nutrition, stress reduction and overall wellness on fertility, but in no way do DO’s have an upper hand in these areas over MD’s, at least with the increased recognition of these holistic factors by all doctors as a whole.

I know that DO’s are often forced to defend themselves a lot, so this post might be the first ever documented case of an MD defending DO’s. I ask you all as patients to be open-minded. There are great MDs and bad MDs, great DOs and bad DOs. Get to know your doctors and give them a chance to prove themselves to you individually.

  • http://www.mloknitting.com/ MLO

    I think this is somewhat regional. In the Midwest / Great Lakes regions, there are several major osteopathic hospitals and schools so most around here don’t consider them less of a doctor. Some folks will not go to M.D.’s for primary care because they perceive them as too cold. (I’ve known a few of these.) They believe that D.O.’s are better rounded in overall care than M.D.’s are. The difference between a drug-pusher and a healer.

    Personally, I think it doesn’t matter which degree someone has, a good doctor is a good doctor and a bad doctor is a bad doctor – with lots of folks in-between. Whether they started life as an M.D. or a D.O.

  • http://dermgunner.com Leela

    I am a recent graduate from a DO school…applying for a non-primary care field: Dermatology. I agree with many of your points, but I do have some suggestions. I think that although the DO name has earned our field a lot of troubles, I would never want to change our title. There have been a lot of movements to change to MDO or DOM or something else. There were movements where you could pay extra and convert to an MD. I think it’s a case of apples and oranges, they are both fruits…but it is nice that they are different. It spices up life. They both have benefits and the good ones are equally committed to their patients, which is the whole point of becoming a doctor anyway. I addressed this a little on my website http://dermgunner.com

    About osteopathic medicine, I personally love the manipulative techniques. Many DOs learn it quickly and forget it, but in terms of OBGYN doctors…although, it has never been shown to increase a woman’s chance of getting pregnant, it has successfully addressed many of the lower back pain issues affiliated with pregancy. I think it’s just an extra tool…you either use it or you don’t. It isn’t the end of the world if you don’t use it, but if you do, it is a bonus!