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[mended_drum]

I've been to both DOs and MDs and could detect absolutely no difference in their approach to my specific care, except that one of the DOs seemed willing to spend more time talking to me before and after the examination.  Neither ever suggested any kind of alignment or adjustment or whatever.

But the DOs I've seen have been under age forty-five and, as someone noted upthread, the degree has changed so much that in some places it's almost indistinguishable from the MD.

On the third hand, I'm not a classically good patient and suspect I give off vibes that would shut down any suggestion of homeopathy or spinal adjustment, etc.

[menotti]

1) Menottispouse works at a medical school and as far as I can see, most of his job consists of making it possible for the students not to attend class and the professors not to teach.

2) If DOs are less entitled and convinced of their awesomeness than the average MD student, they probably provide better care.

3) Aren't plenty of words made up by someone with a Latin/Greek dictionary on their lap?  Telephone, television?

[fishprof]

Since no one really answered the question....

(Made up or not) Allopathy is the opposite of homeopathy.  Homeopathy is the (very mistaken) notion that whatever is causing a problem in the body can be fixed by treatment with the same thing.  For example, the symptoms of Arsenic poisoning would be treated with very very dilute (technically, nonexistent) doses of Arsenic.

Allopathic (Allo = other) treatment is seen as the treatment with the opposite of something that is causing a problem.  Heavy metal poisoning would be treated with a chelating agent that would bind to the heavy metals and allow them to be removed from the body.

We can debate the legitimacy of the terms, but that is the general idea.

[alleyoxenfree]

Chime to what mended_drum and menotti said.  My former DO, whom I left only because I moved, was under 40 and probably saved my life.  One of the few doctors I've had who was fantastic, and because of him, I would look for one again.  Their training doesn't seem to suck the human out.

[underground8]

I've had the opportunity for the close and sustained observation of both MDs & DOs.  I am a behavioral scientist. I taught and practiced for 18 years in a large university medical (MD) school and family medicine residency program.

A surprisingly large number of the faculty in this MD granting institution were in fact DOs.

The academic and rotational requirements in the residency programs are identical for MDs & DOs.

About 1/2 of the primary care physicians completing their residency at this MD granting university had their degrees in osteopathy. ( general internal medicine, Family Medicine, OPGYN and General Pediatrics.)  The MDs were much more likely to pursue residencies in the more technical specialties.

DO's entering residency were often 5 to 10 years older than the newly minted MDs: often having had earlier careers: I personally recall DOs who had been nurses, medical technologists, a wall street broker, a professional athletes, several social workers, an iron worker, and several soldiers, and firefighters. Most of them had masters degrees.  They'd all had a common dream of becoming a physician but each had to delay the dream in the face of other realities.   Medical schools generally give great preference to admitting as medical students, traditional students with unbroken academic records, consistently high GPA's, and undergraduate degrees in "pre-med."

(Some MD confering universities now offer 6 year BS/MD degrees: you declare Medicine as an entering -18 y/o-freshman and go straight through.  Usually medical school ( or an osteopatic school) is 4 years on top of a bachelors.  Can you say Doogie Houser?)

In my experience, DOs have been generally happier with their career choices upon completing residency.  Many more of the MDs were lamenting their great debt and a waning enthusiasm for the practice of medicine. (A practice ONLY through which they might ever be able to pay off their staggering debt.)

On "day one" in the residency (usually the first month out of school) DOs were generally much better prepared for patient care.  Their clinicals in the DO school had begun in four years earlier: they'd actually been talking to and "following" individual patients for 4 years.  Until perhaps 10 years ago, students in MD granting institutions never even talked to, let alone laid hands upon, a live patient until their 3rd year rotations.  DO's were consistently more attentive to patients’ stories and complaints. For 15 years I videotaped, reviewed and supervised evaluations of patient interviews by brand new resident physicians:  the physician’s credentials were not known by the evaluators.  DOs ( as a group) were consistently graded higher.  This particular difference between MDs and DOs did seem to narrow through the residency experience.

There were also some negatives about DOs.  In interviewing MDs for admission into residency, we were generally comfortable accepting graduates even in the lowest 20% of their classes.  We would not even interview osteopathic applicants who were lower than the 55th percentile. In fairness, the particular DO program from which most of our DO residents came did not sustain as consistently rigorous an academic standard.  But some of our BEST physicians came from that very school.   Go figure.
 

[rcarlsson]

I work for a large healthcare network and physician recruiting is in my purview, so I'm familiar with both MDs and DOs.

The DOs in America are a special species. The quackery went out the window a long time ago, beginning with the Carnegie/Flexner report. They are not the same as DOs in Europe, whose degrees are not recognized in America. Here the American DOs are professionally and legally equivalent to MDs in every state and are treated as such in every hospital. That is, in our healthcare system, a board-certified DO radiologist is the same as a board-certified MD radiologist - same reimbursement rate, same pay and benefits.

To me it's like an Anglican vs. Catholic thing. By the way, I have never met an MD who spoke ill of any DO, or vice versa. The medical training on both sides is almost identical, and they train together from clinical rotations through postgraduate residency/fellowship in their chosen specialty, so there seems to be much mutual respect at the end of the long hard road.

I think the "cultural" difference was wildly exaggerated by the UNTHSC president in his quest to add another school to his campus. It's strangely ironic that he is a DO. Well, the president of the Texas Medical Board is also a DO - in fact, a graduate of TCOM!

TCOM is a well respected medical school. Their graduates are very competitive in residencies. I know they have alumni on faculty at the very best Texas MD schools including Baylor and UT Southwestern.

I can definitely understand the feeling of betrayal (or whatever you call it) on the part of TCOM students and alumni.

[zz8435]

In the United States, DOs have a slightly greater focus on patient interaction and treating the 'whole person', while MD programs have a slightly greater focus on technical wizardry and diagnosing problems given a list of symptoms. Overall both cover exactly the same subjects and convey the same information, and every year they become less and less distinguishable. Other countries vary widely (and many continue to have graduate programs in homeopathy as well, sadly).

[fishprof]

Can anyone shed light on the differences in roles, responsibilities, and authority of DOs, MDs, Nurse Practitioners and Physician's Assistants?  It's getting harder to know where Titles place someone in the Hierarchy/Web of medicine these days.

[rcarlsson]

fishprof:

1. DOs and MDs are the same legally and professionally in our healthcare delivery system. They both can diagnose and treat disease using the full arsenal of medicine: drugs and surgery. The U.S. recognizes only those two degrees as full medical physicians. In most states they are licensed and governed by the same medical board; in a few states such as California and Nevada, the DOs have their own licensing board. Their training is identical, save for an extra manipulative therapy course that is taught only by DO schools. Quoting a standard textbook that every medical student uses, Harrison's Principles of Internal Medicine 17th ed: "Founded in 1892 in the American heartland by the physician Andrew Taylor Still, osteopathic medicine was based originally on the belief that manipulation of soft tissue and bone can correct a wide range of diseases of the musculoskeletal and other organ systems. Over the ensuing century, osteopathy evolved progressively toward conventional (allopathic) medicine. Today, the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians are virtually indistinguishable from those of allopathic physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and certification by organizations such as the American Board of Internal Medicine. Some osteopathic physicians continue to practice spinal manipulation, primarily as a tool to address specific musculoskeletal complaints." Virtually indistinguishable. (The difference is primarily historical - remember at the time the DOs split off, conventional medicine included bloodletting. But their training since the 20th century has paralleled the MD schools, and the AMA has always recognized this. In the last MD vs DO fight in California in the 1960s, the AMA had a law passed that basically forced DOs to pay a $65 filing fee and exchange their DO degree for an MD degree. The AMA was trying to drive the DOs out of business; the law was later ruled unconstitutional. Both sides have reconciled since then - many DOs are also AMA members. From my healthcare perspective, they are interchangeable because they have to pass the same certification board after their 7+ years of medical school and training).

2. PAs can diagnose and treat disease, but their formal training lasts only 2 years. They typically have a master's degree or a certificate in physician assistant studies, and there is no residency requirement. Their training takes place at a facility associated with a MD/DO school - primarily because PAs learn anatomy by dissecting cadavers just like MD/DO students. Some places they might sit in the same classroom as MD/DO students for some courses. PAs have prescription rights, but they cannot perform surgery. PAs enjoy a great deal of autonomy, but they cannot set up practice on their own. Every PA has to be supervised by an MD/DO. PAs have to be certified by a national board, and they are usually licensed by the same state medical board that governs MDs/DOs.

3. NPs can diagnose and treat disease, similar to PAs. NPs have prescription rights but cannot perform surgery. The huge difference is NPs do not have to be supervised by an MD/DO, so NPs can set up practice on their own if they want. Furthermore, the NP training route is separate: NPs are nurse practitioners, so they go to nursing school, not PA school. NPs are typically RNs who go on to obtain a master's or a doctoral degree, either a PhD or DNP (Doctor of Nursing Practice). Like PAs they have to pass a national certification board, but their state license is governed by a nursing board, not a medical board, in most states.

[fishprof]

rcarlsson,

Much thanks for such a clear sumation.

Fishprof

[kaysixteen]

It seems like the NP training standard is almost the rough equivalent of the MD/ DO-- a doctoral degree in nursing practice?

This issue comes up regularly-- I am still somewhat bewildered by our weird system of healthcare practitioners, what with MDs, DOs, plus 'chiropractors', 'dentists', 'optometrists', 'podiatrists', 'psychologists', etc.  Indeed, this degree multiplicity seems almost designed to confuse.

[fishprof]

It seems like the NP training standard is almost the rough equivalent of the MD/ DO-- a doctoral degree in nursing practice?

This issue comes up regularly-- I am still somewhat bewildered by our weird system of healthcare practitioners, what with MDs, DOs, plus 'chiropractors', 'dentists', 'optometrists', 'podiatrists', 'psychologists', etc.  Indeed, this degree multiplicity seems almost designed to confuse.

K- you are so right.   When I have advisees who "want to go to medical school", I am often at a loss as to what they really want to do, and have a hard time advising them.  The ones who have a shot, that is.....

[zharkov]

It seems like the NP training standard is almost the rough equivalent of the MD/ DO-- a doctoral degree in nursing practice?

This issue comes up regularly-- I am still somewhat bewildered by our weird system of healthcare practitioners, what with MDs, DOs, plus 'chiropractors', 'dentists', 'optometrists', 'podiatrists', 'psychologists', etc.  Indeed, this degree multiplicity seems almost designed to confuse.

Nursing and medicine (ie, physicians) are different health care fields, and while most nurse practitioners today have master's degrees, there are also doctoral level nurse practitioners who get the DNP degree.  (Doctor of Nursing Practice.)   (And profs in nursing programs may have other doctorates, sometimes PhDs in nursing, sometimes EdDs.)

Physician Assistants usually get master's degrees, although that was not the case historically.  Master's programs in PA studies are not always connected to medical schools.  While in a certain sense, PAs and NPs seem to fulfill similar roles in the health care systems, ask a member of either profession, and they will need little encouragement to tell you have different the two professions are.  (Making it more complicated is that it is not unusual for RNs to go to PA school.)