American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

The United State of Medicine: Healing Identity Confusion

Having uniquely evolved the ability to communicate via speech, humans developed communally shared sounds, which collectively comprise language to represent objects as well as abstract ideas. Although these shared sounds are meant to convey shared meanings, the continuous process of history often changes how those meanings are interpreted and sometimes invalidates the original purpose. For example, words are often discarded, deemphasized, converted, or changed when any of an infinite number of events render their meaning inadequate or misleading.

With that in mind, we propose converting the professional title ‘DO’ to ‘MDO’ (medical doctor of osteopathy), which more clearly identifies osteopaths as medical physicians. We believe that this change will benefit the field of osteopathic medicine and help further unify our healthcare system. In no way does this imply that osteopathic medical schools should compromise their unique emphasis on humanistic, patient-centered health care. However, such a conversion would serve to enhance the vital qualities that distinguish osteopathic medicine. Regrettably, the DO degree is sometimes mistaken as a lesser division of medicine by the lay public, an untruth sometimes reinforced by the media. For example, in a recent Los Angeles Times editorial about the Larry Nassar, DO, sexual abuse case, Virginia Heffernan disingenuously distorted both the history and character of osteopathic medicine.1To correct both this confusion and inaccuracy, it is time that osteopathic physicians are represented by a title that can be more easily understood while also promoting their de facto equality with allopathic practitioners.

For many years, dating from its inception in 1892, osteopathic medicine was clearly delineated from allopathic medicine. As separate yet ever-interacting branches of medicine, each embraced different principles, studies, residencies, and boards. Adding emphasis to this distinction, osteopathic physicians have been distinguished with unique postnominal letters, DO. In recent decades, however, this distinction has been increasingly blurred as the fields of osteopathic and allopathic medicine have steadily merged. Students entering both allopathic and osteopathic medical schools are studying the same foundational courses. Students graduating from osteopathic schools of medicine are competing and entering the same residency programs as their allopathic medical student counterparts, and the residency match will be merged by 2020. Students of both disciplines are already taking the same boards. Upon completion of medical school, in both office and hospital-based settings, osteopathic physicians share common knowledge and common goals with their allopathic colleagues, with both essentially unaware of any professional differences. If osteopaths graduate from medical school, earn medical doctorates, and work side by side with allopaths as equals in every way, shouldn’t the initials after their names clearly identify them as medical doctors? If so, why perpetuate a distinction that only serves to obscure the qualifications of osteopathic physicians from most healthcare consumers?

This question of identity becomes more acute when considering the expansion of physician extenders who now provide medical services traditionally performed by physicians. The consumer rarely is aware of the training or functional distinctions between various providers whose credentials include, but are not limited to, PA, NP, DNP, DPT, and the especially confusing OD. As patients continue to ask “What is a DO?” the expanding alphabet soup has the potential to further conceal and confuse the identity of osteopathic physicians, ironically at a time when their presence in health care is ever expanding and increasingly vital. In this context, the tradition of identifying physicians as ‘medical doctors’—in other words, MD and the proposed MDO—is unambiguous and universally recognized.

We also recognize that there are 130,000 practicing osteopaths who will wonder if they will need to update their stationery, office signs, and diplomas. Our intent is to start a conversation, and our proposal is meant to prospectively include new graduates. Whether it is practical, or possible, to apply this change to existing osteopaths is a more difficult question. We are well aware that there will be strong opinions on this subject.

These days, arguably, the major difference between osteopaths and allopaths might be that it is more difficult to get into allopathic medical schools. The acceptance rate of gaining entrance to medical school is difficult to establish, because the Association of American Medical Colleges does not provide these rates by individual medical schools, and furthermore, many schools do not publish this information.2 Despite this gap in the data, a review of reporting institutions of graduate medical study reveals that across the spectrum of both MD and DO schools, single-digit acceptance rates are the norm. In contrast, the percentage of applicants admitted to Harvard Law School in 2016-2017 was 15.6%.3 The competition to gain admission into any medical school is clearly fierce. The mean GPA of matriculant DO students entering school in 2016-2017 was 3.70.2, 4 Interestingly, the mean GPA for matriculating MD students entering school in 2016-2017 was also 3.70.2 The mean Medical College Admission Test score for these same 2016-2017 matriculants was 502.17 for DO students and 508.7 for MD students.2, 4 One thing is clear: the students who gain admission into osteopathic medical schools have distinguished themselves academically at similar elite colleges with similar high grades. Nonetheless, human nature being what it is, these razor-thin academic differences that are by-products of the ‘pre-med’ ordeal serve to promote the sense that ‘DO’ conveys a lower rank. This perceptual, rather than substantive, difference dilutes the humanistic values and osteopathic manipulative medicine that not only distinguish osteopathy but are also coveted by a public yearning for accessible healthcare professionals trained to offer alternatives to drug therapy.

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-Paula N. Stein, PhD, ABPP, Andreas H. Smoller, PhD

This article originally appeared in the October issue of The American Journal of Medicine.

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