麻豆传媒

This is a sidebar to a story on combined MD and DO state medical boards. For the main story, click here.

If DOs fear they'd be robbed of their autonomy and philosophy and suffer unfairly at the hands of MD-dominated boards, much of it stems from what happened more than 60 years ago in California, which still maintains separate DO and MD licensing boards.

DOs practicing in that state, who then were 10% of physicians, grew increasingly miffed that members of the American Medical Association and others belittled osteopathic teachings. DOs were called "inferior" and "," had limited postgraduate opportunities and were segregated in hospitals and clinics. They sought a more mainstream identity with MDs.

In 1961, they agreed to a merger with the California Medical Association in which California DOs could instantly become MDs by taking a course and paying . According to a 1975 in the Western Journal of Medicine, of the 2,240 DOs in the state at the time, 83% did so. That year, California voters approved Proposition 22, which took away the state's Board of Osteopathic Examiners' ability to issue new DO licenses, although it retained the ability to discipline licensees.

"At the time, there were still important practice differences between DO and MD physicians," said Bryan Carmody, MD, a pediatric nephrologist and associate professor at Eastern Virginia Medical School in Norfolk and an expert on medical training. "Even in the early 1960s, some DOs -- especially those that had trained in earlier eras -- wouldn't prescribe medications."

Norman Gevitz, PhD, senior vice president of academic affairs at the nation's first osteopathic medical school, A.T. Still University in Kirksville, Missouri, spent much of his , "The DOs," explaining the California osteopathic medicine story.

He said California DOs were more progressive. They agreed to give up their osteopathic identity because they felt "alienated" from DOs in other states and thought themselves more "scientific. By amalgamating with the MDs, they thought they could achieve equal social status." Indeed, after the merger, they "were able to demonstrate that their differences were inconsequential."

In 1974, eight graduates of out-of-state osteopathic medical schools filed a lawsuit claiming that their inability to get DO licenses in California was unconstitutional. They won, re-establishing the DO board to license DOs as DOs, once again.

The idea that MDs in one state nearly obliterated the DO degree has made some DOs feel like they have a kind of PTSD, even though it was so long ago.

Given that history, Holly Macriss, executive director of the trade group Osteopathic Physicians and Surgeons of California, bridles at any suggestion the state's 13,000 osteopathic licensees should be judged by the Medical Board of California (MBC), which oversees 148,000 MDs.

"We maintain our separate licensing board for our physicians so that we can ensure that their scope of practice doesn't get trampled," she said.

Brian Loveless, DO, medical director of Western University, a large osteopathic medical school in Pomona, California, said the Osteopathic Medical Board of California "has a duty to specifically look out for osteopathic physicians," adding that he's "skeptical of the MD board being able to specifically pay attention to the issues regarding osteopathic physicians."

Also, Loveless noted longstanding accusations that the Medical Board of California allows MDs with long histories of professional misconduct to continue practicing. "They've done a worse job of policing doctors than the osteopathic board, and so I would not want to be lumped together."

MD discrimination and bias against DOs still exists, Loveless acknowledged, but "it's showing up less. I don't know if you can ever make it go away completely. But I tell my students that bias goes away one obituary at a time."

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