In a 2,100-word story, the New York Times (7/30, Berger) focuses on osteopathic medical schools, noting that “today, osteopathic schools turn out 28 percent of the nation’s medical school graduates.” Osteopathic medicine offers a “more personal, hands-on approach and its emphasis on community medicine and preventive care.” But, “whatever the reasons for choosing a DO over an MD, osteopathic medicine has, for decades now and increasingly so, been accepted as authoritative training by the medical establishment, including the residency programs that lead to licensure.” The article also notes that about 60% of graduates from osteopathic medical schools choose primary care, compared to about 30% of graduates from traditional medical schools.
Blogfinger Medical Commentary. By Paul Goldfinger, MD, FACC
When I was in my residency at a large NYC teaching hospital, none of the residents were DO’s. There was a stigma attached to that degree, and just about everyone who attended osteopathy schools were those who could not get into MD degree conferring medical schools, although there were exceptions. I met osteopaths when I entered practice, and most of them did not relish publicizing their DO degrees. Their “shingles” usually said Dr. Bob Smith, not Bob Smith, DO. They always referred to their DO school as “medical school,” which is sort of accurate, but they almost never would mention that they were osteopaths.
But as time went by, more and more DO’s were being accepted into conventional MD residency programs. There were some DO postgraduate programs, but not among the best.. Perhaps that has changed now—I don’t know. After training, often DO’s would join together to start group practices or would join other DO practices. I suspected that their DO degrees would be a handicap in their job search.
When my group was looking for new docs, we always looked for MD’s because we wanted the best people from the most prestigious programs. However, now there are DO’s scattered among the doctors in the most desired group practices. The stigma appears to have evaporated. If we were looking now, I don’t think the DO degree would be a game changer for a good doctor with fine training.
My personal observation was that once a DO finished a quality MD residency, he usually could not be distinguished from others with the same MD residency training in terms of quality. There are certain parts of the country where DO’s are more common than MD’s such as parts of the mid-West. At this time, the DO degree is widely accepted by patients and professionals alike. It is true that many DO’s wind up practicing general medicine, and that is, of course a good thing for our healthcare system.
There is a good chance now that patients will be treated by DO’s because of the major increase in their numbers. If you are doctor shopping, look up the doctor’s credentials—-especially where he went to medical school and where he did his postgraduate training. He must be board certified. My own personal pulmonologist is a superb doctor with excellent training and DO after his name. I would not trade him for anybody.
For purposes of brevity, let’s consider physician assistants and nurse practitioners together as examples of “physician extenders.” These professions were originally conceived of as providing a helping hand to doctors by offering a “mid-level” of care, taking responsibility for more routine matters such as changing dressings, assessing patients with common ailments, educating patients, etc., but always under the direct supervision of physicians while allowing the doctors to focus on more complicated aspects of care.
These days, such physician extenders are being allowed, in some states, to diagnose and treat without direct supervision. In fact, in some states they can open an office on their own and take on the entire responsibility for a patient event. They can be found around Monmouth County in doctor’s offices, urgent care centers, in the hospitals, and in the ER’s. Some work in mini-clinics at pharmacies. There are many ways that such providers can fit into the healthcare system.
You ask about their qualifications; they go to special schools, often for two years, usually attached to universities. Click on the link below to see about the PA program at one of America’s pioneering schools for PA’s—Duke University.
PA’s, however, have training that is not even close to what physicians receive. Physician extenders have to be certified regarding their knowledge and skills and they have to be licensed by the state.
The biggest problem, as I see it, is to allow them too much freedom on their own—They may look like doctors and act like doctors, but they are not as qualified as doctors, and they can make serious mistakes which a competent physician would not make. I have seen that phenomenon in action, twice, in local ER’s. In addition, healthcare facilities MUST make sure that every care giver wears a name tag that gives their name AND their profession.
http://paprogram.mc.duke.edu/PA-Program/
Related question : Sometimes when I go to see my Doctor I instead of seeing Doctor get attended to by a physicians assistant(PA). What are a PA’s qualifications compared to a Doctor or Nurse ? Your opinions and input is appreciated.
Thank you for this article. Enlightening.