January 17, 2017

Is There a Stigma Against Osteopathic Physicians?

By: Lyn Jutronich

When I was 24, my primary care provider was a D.O., but I didn’t choose her on purpose. I had simply picked a clinic near my apartment that took my insurance, and she was the first doctor available to see me. I saw the letters D.O. after her name and noticed they were different from the others that had M.D., but I didn’t have any idea what that meant.

I also didn’t care. She was an awesome doctor: friendly, smart, and knowledgeable. Most importantly, she took the time to get to know me and find the root of my medical issues. She prescribed medicine and performed small procedures in the office when necessary. The nurses and the staff seemed to like her. I was happy.

But things weren’t this simple from an admissions standpoint. When I mentioned to pre-meds that they might want to consider osteopathic schools, I was occasionally met with a look like they had smelled bad cheese. I have come to understand that in the pre-medical community, there is stigma attached to osteopathic medicine, perhaps due to the slightly lower admissions numbers for D.O. matriculants (average GPA and MCAT).

The stigma is odd to me, though. From a patient’s perspective, I don’t think the general population knows or cares about the differences between M.D.s and D.O.s. Most patients won’t question the validity of a doctor’s intelligence and credentials, regardless of the letters that follow his or her name. They know that doctors go through many years of difficult schooling, and that’s usually good enough for them. It’s more likely that they’ll deem a doctor unqualified or unprofessional based on character traits or communication style.

After reading a New York Times article by Joseph Berger, I checked out the comments section to gauge people’s feelings on osteopathy and D.O.s. As I suspected, the vast majority of posts from patients were positive:

“When my dad moved into our neighborhood, there was a shortage of doctors taking new patients. The assisted living center recommended a young osteopathic doctor who had just set up his own practice. He was so good and kind to my ailing father that I switched doctors and became one of his patients. I'm so happy with him. When I had no insurance, he always gave me a break on price. When I got Obamacare, he helped me get the surgery I'd put off for years. He's so good with the elderly that everybody in town is now trying to get their parents in to see him. In three years he's gone from having an empty waiting room to being the most popular doctor in town. Why? Because he really cares what happens to his patients.”

Other patients had a more objective outlook:

“When I had extreme leg pain I saw a recently graduated D.O. He quickly diagnosed me with sciatica. The first line of treatment was a narcotic pain killer, confirmed slipped disc with an MRI, followed by cortisone injection, then physical therapy. Never once did I undergo any osteopathic manipulative treatment (OMT). I received the standard treatment I would have received from any M.D. The differences between an M.D. and D.O. today are practically nonexistent. Over half of new graduates from D.O. schools do their residences at allopathic (M.D.) locations. The truth of the matter is that they both receive the same training. The only people promoting the “difference” are the D.O. schools themselves. This makes sense since D.O.s have been heavily criticized by M.D.s in the past. But the holistic medical approach no longer makes a D.O. education unique. Most M.D. schools have adopted this approach.”

For the most part, it seems that patients do not discriminate based on the M.D. verses D.O. distinction. So where does the stigma come from, and how is it perpetuated?

The majority of posts that disparaged osteopathy and D.O.s were written by M.D. doctors and M.D. students.  

“I am an M.D. who precepts University of WA medical students. The reason folks go to osteopathic school is that they are unable to get into medical school. Personal, hands-on, etc. is nonsense. We have an osteopathic school in Yakima and the University of Washington in Seattle. No one would choose the osteopathic school if he or she could get into the traditional M.D. one.”
“I am a 2nd year M.D. student. People argue that they chose to attend an osteopathic school because of the unique approach to treating patients. Is this surprising? Do we really expect them to say, ‘I wasn't good enough for M.D. so I went D.O.’ Having taught pre-meds in anatomy, I know only my weakest students (who I would never want as a doctor) went to D.O. schools. Also, many D.O.s here are determined for people to know they attended allopathic residencies. I'm not sure why that would be unless they know these are more highly regarded and competitive programs. We live in a society that believes you should be able to do anything you want, including becoming a doctor without the grades to do so. Unlike any other profession, this is a field in which you take people’s lives into your hands every day. I don't think it is unreasonable to want to cream of the crop for this calling.”

These are just a handful of the hundreds of comments left on Berger’s article. Since they’re anonymous, we cannot verify their legitimacy, and we must take them with a grain of salt.

Besides the allure of a personal, hands-on approach, there are practical reasons to pursue osteopathy as well. Medical schools are failing to keep pace with the patient population, and competition for medical careers is getting fiercer. More students are seeing osteopathy as a viable alternative to conventional medical school, or a way to get a medical education with scores that don’t make the traditional cut. As a result, some people inside the medical community view D.O. schools as a “backup plan” or a “plan B” on one’s path toward medicine.  

It should be noted, though, that getting into osteopathic school is extremely difficult. According to Berger’s article, 16,500 D.O. students applied for about 6,400 spots in the 2013 cycle. A year later, Touro received 6,000 applications for 270 first-year seats for the Manhattan school and a new campus in Middletown, N.Y. As osteopathy continues to gain traction, the candidate pool grows larger and more competitive.

Many people believe there should be full integration between the two medical disciplines. If the distinction is mostly fabricated, and if they’re indeed receiving nearly identical training, then separating them seems to work against the greater good. The separation and the competition for residency spots will inevitably lead to resentment from both sides, regardless of how similar they might be in reality.  

Stay tuned for more articles in the coming weeks, where we’ll compare match lists for residency between M.D. and D.O. students, and offer our top 5 reasons for applying to D.O. schools.  

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