I have a kid who has recently gone through the system. And I know several kids of friends/etc. who have also recently gone through this. Including several who wound up at DO schools (and one at a Caribbean school) because they couldn't get into a US MD school. I'm not guessing about this.

Two of the requirements for accreditation of medical (MD) schools is they must have robust research departments and provide significant clinical (hospital) opportunities as part of the curriculum. Almost all have their own hospital or hospitals. I don't believe there's a single DO school in the US that has any significant research activity at all nor do any have full service hospitals. So, looking at it another way, few if any DO schools would successfully attain accreditation as an allopathic (MD) school if they were to apply. None ever do.

DO students take different board tests. DOs do residencies but they RARELY are accepted at allopathic (MD) residencies at medical schools. The vast majority do residencies in programs for DO grads only that DO schools arrange. Such residencies are typically in less desirable institutions and locations.

A very small minority of DO grads are able to get into allopathic (MD) residencies, they're considered more desirable but many program directors at the better programs won't even consider DO applicants. Few if any US MD grads would consider doing a DO oriented residency, they're considered inferior.

There are regions in the country where DOs are welcomed by patients and the medical community, and other places where that's not the case. I live in an area with two nearby top medical schools and there's really not a lot of space for DOs to practice. If I'm in need of a physician, I try to find those with the very best credentials, it's an indication (not the only one) of their training and ability. On the spectrum of MDs from the best to the worst, at least at the time of their medical educations and subsequent training, DOs are those who weren't admitted to even poor programs.

I have never went to a DO but I know that at my local hospital if you are a patient of a DO and need to be admitted , the DO cannot come to the hospital to treat you. At least, that is the way it used to be according to my MD.

Many doctors any more do not have admitting privileges to hospitals. Ask your own doctor if they see patients while they are in the hospital many will probably tell you no. At one time most doctors had admitting privileges which meant they could see and treat their own patients. Who had admitting privileges depended on the doctors who approved other physicians to be allowed to practice in a hospital. It sounds like your doctor's hospital blackballed DOs probably just because they were DOs.

Elmer, I can't argue for or against your stance MD's vs DO's but would like to share my one and only experience with a DO. I've been meaning to, in the hopes that it may help someone else.

My mother, who is in a nursing home with dementia and parkinson's, was crippled in her left hand with rigidity. She had lost the ability to speak other than a raspy whispered yes or no to questions we would ask her. For more than a year she was on a pureed foods diet because of problems swallowing. Well, this all goes hand in hand with her diseases, right?

The worst of it started about six months ago. Her hand so tight and rigid that her fingernails were digging into the palm of her hand causing infections, the fingers so tight that she would have to be given morphine in order to open her hand to clean it and keep the nails short. Twice a week she would have to be drugged and her hand cleaned. Even still it was a painful experience and left her with two days of the week when she was totally out of it from the morphine. The only solution was surgery to cut the tendons and relax the hand.

Should someone of her age go through such an ordeal? If so, there was a problem getting her back and forth to the Dr., hiring an ambulance to transport her, a lift to move her, and a nurse to attend her. That would be a minimum of 6 trips, back and forth. We felt like it would be too traumatic for her.

My niece, (a chiropractor!) suggested that botox injections might do the trick so we sought out another MD. He was excited by the idea and conferred with another MD who felt like she had been too rigid for too long for the botox to help her. We were unsure what to do... traumatic surgery (and all that goes with it) or leave her to suffer.

My niece then gave us another lead to a DO, whom we contacted. His suggestion was a simple muscle relaxant. Within days she was talking, eating more and was able to have her hand opened without too much pain. She told us that her throat hurt so much and felt tight so she wasn't able to talk. Although she can't eat chunks of meat, she can eat soft things that haven't been pureed.

It's just simply amazing! So, in this case, chalk one up for the DO!

I'm so blessed to have a remarkable, brilliant, awesome, compassionate, super-educated osteopath as my primary care family physician!

Malfleur01, any doctor that I have ever seen had certain days that they made their rounds at the hospital. My husbands doctor always came in to see him in the hospital as well as my mothers doctor. I have been fortunate to not have had that experience.

Moonie, how awful for your mother to go through that.. Why in the world didn't the other doctors think of that!

moonie, I'm sorry about your mother's situation and am glad there was a good outcome. I have some thoughts about that incident but they don't matter in the greater scheme of things so I'll just say that one individual incident doesn't change anything. In your comment, you described what I said as being "my stance". Please understand, what I said is factual information, not a "stance".

In another thread where this topic started, sephia_wa said "I agree with you Anglo, I'm medical snob. I want the ones that did best in their class, went to the best medical school, and did a top notch residency. I feel they are probably the best and brightest of the bunch."

This isn't being snobbish, this is being informed. It's true that many medical schools DON'T do enough personality screening in their admissions processes so that odd ducks as well as some with real mental health issues do get in. Medical students are from the general population and even with best efforts, mistakes are made. However, the ability and intelligence as demonstrated by academic accomplishments and background of any professional does matter, whether a doctor, a lawyer, or whatever. For me, I want not only those with the best possible background but also those whose abilities are recognized and practiced collaboratively (with residents and other docs involved) at medical schools. This is the domain where the best can be found.

Even though osteopaths have full practice rights as physicians in the US, it is very rare to find a DO on a medical school faculty. And at places where there are a few, there are only a few. That's something to think about for those of you who think there's equality between the two systems. Of course, there are terrific DOs and awful MDs. But in a circumstance where it's hard to tell who is whom and which is which, academic backgrounds do matter and the fact that one system is significantly less difficult to get into and out of makes a difference. Whether you think it should or not, it does.

I belong to a very large PNW health cooperative, Group Health, that recently voted to join the Kaiser network. I've never been a fan of either, but in the community where I live, GH was the best choice for me when I went on Medicare (it can be very difficult here to find a Medicare doc taking new patients). I've been pleasantly surprised by the level of care provided to me, with wonderful providers.

I also have never wanted to receive care from DO or chiropractors, just my own biases based on my observations and experiences related by others. However, I do have an extremely positive experience of my own with a DO. I was hospitalized with a viral infection that was causing me extreme breathing problems and a very low oxygen reading. After about 4 days of treatment, seeing many different doctors (GH uses mostly hospitalists, so I saw whoever was on shift, sometimes the same doc for a couple of days, then someone different). I wasn't much better when they decided to discharge me with a prescription for home oxygen (what?!! two weeks before I'd been chopping wood, doing very active things and now I need oxygen??).

When visiting me before discharge, a new doc to my case (who I didn't know at the time was a DO, a cardiac specialist) told me he was not really satisfied with the diagnosis that had been made and wanted to do more tests. So he ordered and MRI or cat scan and discovered a pulmonary embolism that others had failed to consider. I owe my life to him and my respect for DO's was raised considerably.

Kaiser has long had a spotty reputation in California. Horror stories abound. What it does best is provide a lot of medical care for a lot of people at a price lower than any alternatives. It has done so historically by fastidious cost controls, which includes metering out care with a thimble and making it difficult to access specialists. There are very many excellent docs in the Kaiser system, no doubt, and I hope olychick that ones like that will be whom you will be able to use as and when needed. They also have a lot of foreign medical school grads and DOs because it's not historically been viewed by docs as a top choice place to work. So that leaves spots for others, arguably less qualified or less "employable", to fill.

What a shocking experience you had and thankfully you were seen by a very capable person. Consider that not only was the expertise of this last doc, the DO, responsible for your finally getting the right diagnosis, but it may also have involved your getting less than the best care in the preceding days because maybe such a dangerous additional problem should have been considered and wasn't. You'll never know.

Let's remember that a lot of 'medicine' is completely dependent on *belief*. Placebos -- even the witch-doctor's remedies -- can 'cure'. (The thousands of 'medical' supplements sold are testimony to this.)

Elmer, I agree with you totally about Kaiser. I felt somewhat the same about group health, but our local clinic (with a very good reputation) was really the best choice for someone transitioning to Medicare, as other options were too limited. I worked with an organization who helped seniors and received too many calls from people who couldn't find a physician at all who would take a new Medicare patient. I didn't want to join those ranks. I've been very happy with my primary provider and haven't needed many specialists. I was NOT happy about the switch to Kaiser, as we also helped seniors with complaints about their medical care with Kaiser. In the PNW, people are clambering to move here, so we get a pretty high level of applicants for many things, including doctors. It's difficult to move to a new area and set up a private practice, especially when many others are making the same move; many are choosing the benefits of working at someplace like Group Health, so they are freer to have time enjoy the reasons they wanted to move here.

Like you say, I will never know the expertise of care I received in the hospital before my DO caught the problem. To be fair, I was very ill with a virus at the same time had no other typical PE symptoms, so no one was surprised it was missed.

Whoa, whoa. Elmer, you know not of what you write. My dh and I have been with Kaiser for 35 years and have received excellent care; we have NEVER been denied nor had a tough time getting in to see a specialist nor denied access to tests My dh had two suspected tias and they gave him all tests possible for this incident.

My mother was under Kaiser care since she the time she was on medicare and they were sooo good to her! She survived Stage 3 colon cancer 20 years ago, due to her excellent doctor (Portland, OR,) and was given a heart bypass and new valve at age 80. In the last two or three years, several of my friends who did not think much of Kaiser have switched; yes, it is less expensive but the care is very good--no different from any other medical clinic. Things change, Elmer. Keep up.

I don't believe there's a single DO school in the US that has any
significant research activity at all nor do any have full service
hospitals.

I have to admit I don't know what is meant by "full service hospital," but I looked up the osteopathic hospital (Northe ast Regional Medical Center) connected to the osteopathic university in my state. It is where my son had laparoscopic abdominal surgery 10+ years ago. They say they offer:

Specialties

• Allergy/Immunology

• Anesthesiology

• Audiology

• Cardiology/

Interventional Cardiology

• Clinical Psychology

• Critical Care Medicine

• Dental

• Dermatology

• Emergency Medicine

• Family Medicine

• General Surgery

• Gastroenterology

• Gynecology

• Hematology

• Immunology

• Internal Medicine

• Nephrology

• Neurology

Service Highlights

• Cardiac (CCU, Cath Lab, Rehabilitation, Telemetry)

• Cardiopulmonary/Respiratory

• Community Programs (Healthy Woman, Senior Circle)

• Critical Care Unit

• Emergency Department (24/7)

• GI/Endoscopy Lab

• Health and Fitness Center

• Heart and Vein Center

• Home Health

• Hospitalist Program

• Imaging (CT, MRI, Lithotripsy, Nuclear

Medicine, Ultrasound, Telemedicine/Teleradiology,

Bone Density)

• Internal Medicine

• Labor and Delivery/Nursery

• Laboratory

• Minimally Invasive Surgery

• Lymphedema

• Physical Therapy

• Swing Bed Program

• Sleep Center

• Sports Medicine

• Surgery

• Women’s Health

• Obstetrics

• Oncology

• Ophthalmology

• Oral Surgery

• Orthopedic Surgery

• Osteopathic

Manipulative Medicine

• Otorhinolaryngology

Otolaryngology

• Pain Management

• Pathology

• Pediatrics

• Plastic Surgery

• Podiatry

• Radiation Oncology

• Robotic Assisted Surgery

• Thoracic Surgery

• Urology

• Vascular/Vein Surgery

We have an osteopathic school which places interns in all of the hospitals in this area working side by side with the interns that are working toward their MD. The DO interns do the same rotations the MD ones.

MO happens to be a state that is more accepting of DOs in medical practice than other places are.

I'm familiar with the situation in the two ends of Missouri. Matthias mentioned Northeast Regional Hospital in the small town of Kirksville where AT Still DO school is located. It's a 100 bed (are you kidding me?) community hospital that the AT Still school is involved with. I know someone who went to this school. Still doesn't have its own hospital nor does it conduct research as is required of MD schools. I'm not aware of any MD school in a small town because the accreditation requirements of making a major hospital operation available to students pretty much requires an urban location. One exception may be Dartmouth, in a small town with a 400 bed hospital but with a very small student body - half the size of AT Still. But it's a prominent hospital that attracts patients from a wide area. Same is true for Mayo.

In Kansas City, that I believe maifleur refers to, is the Kansas City DO school. I also know someone who went to this school. It also doesn't have its own hospital nor conduct much research. It "sponsors" residencies at community hospitals as most DO schools do and that no MD schools do. Here's their page laying out what's available for graduates:

Kansas City DO School residencies

MD grads are free to go to any programs nationwide and they do. As I said, DO grads must take the MD boards to get an MD residency (which they normally don't do) and absent top scores (which some are able to get), mostly do DO residencies at institutions their schools sponsor.

As I said before, for someone who is not in the field personally, I believe I'm pretty well informed.

Edited to add:

The 3rd and 4th years of "medical school" are spent being exposed to and beginning to learn clinical skills. Because DO schools don't have hospitals, they have to pay community hospitals (often those not located in the school's area and sometimes at some distance away) to allow their students to do their rotations with their house staffs. What's the quality of these experiences with non-faculty members? Whether good or bad, they're wholly outside the school's control.

DO or MD, reminds me of the saying, “what do you call the person who graduated last in their medical class?” ... badum...bump....”Doctor.” So we are all left to research as best we can, the physicians we have access to.

sjerin, the two best centers in our (mutual) area are the medical schools at Stanford and UCSF. I think that's uncontroversial. I'm relatively healthy but have been to doctors at both and the doctors I see regularly are faculty members at one. Both schools also accept Medicare so it's not like using the services of either has any elitist element to it. Since Kaiser customers can't go to these providers on their own decision, would you say you have access to the best care available in our area? I'd say No. Does it matter? It often does.

When my firm paid 100% of employee health insurance costs, nearly everyone in my office chose PPO coverage and almost no one took Kaiser. Why?

A distant but not too distant family member has always had Kaiser - his parents did too going back to the 1950s. 5 years ago, he was having mobility and pain problems following a traffic accident. After being "diagnosed" by Kaiser, he was prescribed physical therapy. When the problems persisted, they prescribed more PT. He paid for a second opinion outside of Kaiser with his own money. The doc he saw said he had a problem that required surgery. He was able to negotiate a reduced fee and paid for the surgery himself using money from his retirement savings. The procedure cured him of his problems.

I'm glad you're happy with Kaiser and wish you nothing but continued good experiences and good health.

Thanks maifleur, I changed the state mentioned in comment to correct as per your info. From this distance, both adjacent states aren't that distinguishable. Everything else said, including my knowing a student who attended each, stands.

The confusion about each state having a Kansas City, also adjacent, extends to other things.

We have many here in FL who practice in hospitals and some of them are great and some not. Same as MD's. We used to go to one who was the only one who could do injections into heel spurs without causing excruciating pain for my hubby. He could do everything from treating colds and flu to pelvic exams. But then my MIL went to one that over-diagnosed and dispensed drugs, so there are good ones and bad ones.

Do you want to use someone who graduated at the top of their class or someone from the middle or the bottom?

Just an observation: There are many factors that go into class ranking. Some people might for financial reasons have to work and go to school. Others might have life experiences such as a sick relative or a new baby that might affect study time. Still others may take a holistic approach to life and perhaps spend more time with patients and less time chasing grades. And finally, some people are simply better than others at taking tests.

Lucille, you're taking my comment too literally. Applications for entry into college, into medical school, into residencies, are all competitive. Those whose track records show accomplishment and success at the most selective and demanding programs were selected by people in the field at each level who know what applicant factors are the indicia of success. These people have a greater likelihood of continued excellence in professional practice. If you don't think so or if you think someone whose background suggests mediocrity (or less) or an inability to attain more challenging goals is acceptable to you, that's fine with me. But don't suggest it doesn't matter because it does.

But don't suggest it doesn't matter because it does.

You've invented a whole conversation for me that I didn't have and then shot it down. That's plenty of exercise this early on Sunday morning.

You've lost me with that comment but Happy Sunday to you too.

Matthias mentioned Northeast Regional Hospital in the small town of
Kirksville where AT Still DO school is located. It's a 100 bed (are you
kidding me?) community hospital that the AT Still school is involved
with.

What are you trying to communicate by saying "are you kidding me" ? Are you incredulous at the fact that there is a 100 bed hospital?

Of course, small towns would tend to have small hospitals. There is not the surrounding population to make a large hospital workable. It's in a largely rural area, not just the suburb of a big city.

Thank goodness for the small and rural hospitals and the medical people who work there. Thank goodness for doctors and other health workers who work in rural areas and small towns at all.

The "are you kidding me' comment speaks to how little real hospital patient exposure a school in such a location can offer its students. Or, the lack of diversity of procedures and skill of docs performing them that can be observed to learn from. Like, zilch. That's exactly why MD schools are almost exclusively located in populous areas, to provide a diversity of patients and the treatments they need. For the very few exceptions I mentioned, prominent medical schools in smaller communities attract patients from outside their immediate areas.

I think the thing we should all be worried about is not whether your doctor is a DO or MD, but is your provider qualified? The best and the brightest today are not going into medicine. That's what should worry you. Due to government and insurance company interference and dictates, any provider has mountains of paperwork per patient, just to get reimbursement. You wonder why it's so hard to find a doc who takes medicare patients? Thank your government for decreasing reimbursement so much that taking these patients is not worth the time. We have surgeons at my rinky dink 25 bed hospital (I know, astounding that we can function at such a miniscule size) that won't take medicaid patients either. Now my hospital is spending MILLIONS to install Epic electronic medical charting even though we already have an EMR. But Epic is supposed to be top of the line, but it still doesn't communicate with all other EMRs. And yes, this is a government mandate. The best and the brightest today go into tech, not medicine. That's what you should be arguing about.

"The best and the brightest today are not going into medicine."

This has decidedly NOT been the experience of young adults I know who have recently gone through the system. (Kids of friends, friends of my kids, my kids.) The competition for admissions is intense and those who get through the screenings are bright, motivated and capable. And often with a strong desire to care for others, make a difference, AND have a good quality of life (measured by having regular hours and, except for surgeons, a short work week).

"Due to government and insurance company interference and dictates, any provider has mountains of paperwork per patient, just to get reimbursement. You wonder why it's so hard to find a doc who takes medicare patients? "

Group affiliation rids a doc of the need to manage a business that deals with insurance reimbursements. The group's admin staff handle it. Yes, medicare reimbursement rates are too low and that often forces docs who can keep themselves busy with better paying patients to choose not to accept it. Another reason for those near a medical school to use them, they all take Medicare and often Medicaid too.

I have a lot of respect for you sleeperblues. I'm wondering if time and place (you in a rural setting not near a large city perhaps, me in an urban/suburban setting) affect perspectives? Short of that, the trend in most of California has been for docs to affiliate with large practice groups, I have to imagine that's also the case in other metro areas. Some are under the umbrella of medical schools, some run by some large hospital chains, some just standalone and unaffiliated. The docs decide what insurance to accept and what not and then the admin people of the groups handle the details. There are still separate offices/small partnerships for some specialties around here - ER docs, dermatologists, orthopedists, etc. but even most of these (not ER docs) are in groups.

"The best and the brightest today go into tech, not medicine.

Here in Silicon Valley, I have a different perspective. When you look at the technical people at the companies around here, you don't see the cross section of America that you might expect. You see disproportionately Asian engineers - from the Indian subcontinent (Indians and Pakistanis) and Chinese from the mainland and Taiwan. Some foreign educated, some US educated. Yes, some native born Americans of all ethnicities too, but they're often a minority. The companies are willing to hire qualified workers of any background but what I described is what predominates here in the engineer/technical pool