Ranier

Actually, CPT and CMS/Medicare do not currently limit the use of the OMT CPT codes to DO's only- any billing provider (MD, DO, PA, NP) can use it if within the scope of their practice. Except DC's, who have to use chiropractic codes. I have no idea how a non-DO demonstrates that OMT is within their scope though. I know there are lots of continuing medical education conferences (20-40 hour courses, weekend seminars, those kind of things), even one offered through Harvard, teaching OMT techniques to MD's (not sure if mid-levels are invited) but other than a certificate of completion of that course I'm not sure any kind of formal, state "certification" or licensure exists to demonstrate OMT competency for the non-DO provider. My source is just being the wife of a DO, so I can't pretend to be any kind of expert though, sorry.

These markers have different kinetics. CPK peaks within a few hours and then declines relatively rapidly. Troponin takes about 24 hours to peak and then days to decline. So you were probably testing in that window between the two peaks- CPK was already on the way down and troponin was still rising. This would happen within a roughly 12-24 hour window post-event, which seems to fit your scenario.

Wow, as the spouse of an osteopathic family practitioner, let me just correct you on a few points: to imply that a D.O. program "doesn't even begin to compare" to M.D. education is absolutely ludricous. You are correct in stating that there are slightly lower admission standards in D.O. programs (just as there are lower admission standards for public state university allopathic schools in comparison to Ivy League allopathic schools), although the gap in GPA/MCAT has been narrowing considerably every year for the past decade and at this point there are several top osteopathic schools with average MCAT scores higher than some of the "lowest" LCME allopathic schools- look it up. However, once through the med school admissions bottleneck, the education of osteopathic and allopathic medical students today is indistinguishable with the exception of the addition of OMM instruction in the D.O. programs. Please, I challenge you to name one core piece of the M.D. curriculum that is not covered in osteopathic schools. Hint- you can't. More than 50% of osteopathic students sit for both their own licensing exam (the COMLEX) as well as the allopathic exam (USMLE) and as of two or three years ago the majority of graduating D.O.'s do in fact train in ACGME residencies which means that, yes, they do in fact complete the "same" residency. Many more are training in AOA residency positions that are actually part of a dually accredited AOA/ACGME program. When you say that D.O.'s don't get "cream of the crop" residencies what you really mean is that they don't land the most competitive residencies in lucrative specialties like derm and ortho. More D.O.'s do go into primary care which is reflective of the missions of most D.O. schools, however the fact that family practice or pediatrics are less competitive specialties to enter does not mean that the residencies themselves are of inferior quality. In reality all that reflects, is that peds doesn't pay as much as derm, plain and simple. Finally as for this statement:"It seems a certain sector created the title DO to accommodate those who didn't quite qualify for acceptance into an MD program."... you do realize that the osteopathic profession and many of its schools were established way back in the 1800's right? Which makes your claim laughable. In fact, it sounds like what you are describing is actually the glut of offshore (Caribbean) medical schools that began opening in the 1970's/1980's on... schools with indisputably looser admission standards and poorer residency placement track records but schools which award upon their graduates the degree M.D., ironically making them "real"-er doctors in your book than American-educated D.O.'s. Ridiculous.

A simple example of providing poor care to a happy patient who remains oblivious to the consequnces of that poor care: prescribing antibiotics inappropriately. A lot of patients still believe that antibiotics cure colds. These people are happier with the providers who "do something" rather than telling them to wait it out and it will go away on its own. They've been known to doctor-shop or bounce around walk-in clinics until they find a provider who gives them what they want. God, we see these people daily in the ED. Of course, by the time they finish that ten-day amoxicillin prescription, their self-limited viral URI will have run its natural course and gone away on its own, but they will attribute the recovery to the abx and be grateful to the provider who really took their symptoms seriously and did something to help them. Same thing could apply even with some bacterial infections like otitis media in young children. Some people really don't like it when they present with a sore throat or N/V/D and walk out with just a test order for a culture. Its the standard of care, but they just want their drugs. Will it harm anyone in the long run to take an antibiotic for the viral pharyngitis or gastroenteritis that's on its way to getting better in a few days anyway? Of course, but not directly enough that they are likely to recognize the effects anytime soon.

I'm not sure what you mean when you state that some Caribbean schools are accredited. Neither the LCME nor the AOA accredit offshore schools, and given that these are the accreditation bodies under discussion here, your statement is not true. If you are instead conflating the issue and referring to other international accrediting agencies or to the four schools that have a handful of state-specific approvals, then the point is just irrelevent. As for tuition in the Caribbean, it's impossible to keep track of all schools as they are constantly opening/closing, gaining/losing WHO listing status, etc. but I do know that all of the Big 4 (Ross, SGU, AUC and Saba) have tuition on par with US schools, ranging from the mid-20's to low-30's annually. As for who is claiming that the AMA was to blame for high med school tuition, any reasonable reader should infer that to be the intent of your post (319), as you wrote it in direct response to a poster discussing LCME accredidation. Perhaps you were just unclear. You also suggested that med schools sustain high tuition by keeping numbers down, which is revealed to be a flimsy claim given the rich example of the AOA and osteopathic schools. They are expanding seats rapidly, literally quadrupling their enrollments in the last two decades and opening dozens of new schools, and yet their tuitions are not falling and in fact have increased to an even greater level than the LCME schools. DO expansion is a remarkable phenomemom, incidentally. Right now about 5-8% of physicians in the US are DO's, but today 20% of med students are in DO programs and that figure will reach 25% in the next decade. Anyway, clearly the high tuition at DO schools is not resultant of keeping seats limited. Rapid expansion and low(er) admission standards have not made AOA or Big 4 Caribbean schools any cheaper. How do I make the determination that the AOA is "less anti-competitive" in its accredidation policies? Well, first I use the term anti-competitive in the spirit with which is has been used in numerous prior posts- that is, to mean harboring policies which intentionally limit the number of seats in medical schools for the purposes of maintaining artificially low supplies in exchange for among other things the ability to charge higher tuition to students. Obviously there are other, more accurate, interpretations of the word. But the AOA is clearly willing to allow greater (practically out of control, given the limited osteopathic residency slots) expansion and to relax its accredidation standards to the point of approving for-profit status schools (something that the LCME strictly forbids) and so on those two points I find them to be less anti-competitive

Osteopathic medical schools have, on average, higher tuitions than LCME schools despite being regulated by the AOA. And the AOA is certainly less anti-competitive in its accredidation policies; the number of osteopathic seats has rapidly outpaced that of allopathic school, with new schools and expansion branch campuses opening practically every year. They have even allowed the accredidation of a private for-profit school (RVU in Colorado). I would also add that most offshore/Caribbean med schools have similar tuitions despite also not being under LCME regulation. I can't see clear evidence that the restrictive monopolistic accredidation tactics of the "AMA" are to blame for high med school tuition given that most non-LCME schools (ie, those in direct competition for students with the LCME schools) have even higher costs.

There are lots of other reasons European doctors get paid less compared to those in the US. Not only do they go to school for fewer years and have no student loans (higher education essentially free) but they also work fewer hours and have fewer overhead expenses. Most European doctors work the equivalent of a US physician's part-time schedule (35-45 hours per week) and take far more vacation (up to 12 weeks per year). They also have no personal administrative overhead since they work in an NHS and have no malpractice insurance premiums. If you take an average PCP's income in the US, subtract out monthly student loan payments and some kind of opportunity cost calculation for training for more years, and then subtract out the overhead and malpractice premiums, and finally cut the remaining amount by at least 1/3 (to adjust for the hours worked)... it would come darn close to being less than or equal to their European counterparts' incomes.

nice try, but we both know this isn't a stand-alone dnp degree (the kind existing msn/nps get to enhance their clinical expertise, and the kind that is being discussed here) but rather a direct-entry doctoral np training degree for rns. of course it's going to contain all the clinical science that existing msn programs contain. now, here is the link for your school's post-msn dnp program. and yes, it's mostly the kind of "fluff" we've been talking about. how is this transforming msn-prepared nps into more expert clinicians who now have "all the medical knowledge of a physician?" 31 credits total year 1 (6 credits) fall semester biostatistics (3) winter semester no classes spring/summer theoretical perspectives in the discipline of nursing for advanced practice (3) year 2 (6 credits) fall semester* adv. quantitative/qualitative research methods related to capstone project i (1) winter semester adv. quantitative/qualitative research methods related to capstone project ii (1) residency related to capstone project (1) spring/summer adv. quantitative/qualitative research methods related to capstone project iii (1) informatics (2) year 3 (9 credits) fall semester advanced quantitative/qualitative research methods related to capstone project iv (1) residency related to capstone project (1) winter semester organizational & administrative - theory (3) advanced quantitative/qualitative research methods related to capstone project v (1) spring/summer health policy & economics (2) residency related to capstone project (1) year 4 (10 credits) fall semester advanced quantitative/qualitative research methods related to capstone project vi (1) winter semester transcultural care for advanced practice (3) residency related to capstone project (1) spring/summer academic faculty role theory and application (3) residency related to capstone project (2)

A nurse with a PhD has "earned" it in your sense. A DNP, as a professional clinical doctorate like the MD, would not.

Unless you want to post a link to your school's DNP curriculum that is going to be really hard to believe. I haven't seen a DNP program yet that didn't contain at least 50% fluff. Fluff being courses in theory, management, ethics, statistics, business, education, etc. which may or may not be rigorous in nature but have zero to do with advanced clinical practice and knowledge, the stated purpose of the DNP.

Well, just to clarify... medical school graduates who have not passed the USMLE are not allowed to call themselves doctors in the clinical setting. And, also, a residency is not "required to practice" as you claim. Only one year of post-grad training (the internship) is required under law to be licensed to practice. Your argument might make more sense if you propose that only interns not be addressed as doctor. Residents do in fact possess an unrestricted license to practice medicine. However, the residency is required for board certification, hospital priviledges and membership on insurance panels.

Yeah, the guy they quoted for this article with his silly airline allegory is a jerk. However, the DNP degree is still a piece of garbage that fails to rise to the level of academic rigor we associate with a doctoral course of study. With direct-entry/accelerated options (there are schools where degreed non-nurses with no BSN can earn the DNP in just three years, how many of you know that?), online classes, limited hours of clinical training, no standardization of curriculum with heavy variability from program to program, a strong presence of courses having nothing to do with clinical patient care or health science (health administration, statistics, nursing leadership, nursing theory, etc.), and no formal exit examination (the much-hyped optional pilot exam that Mundinger described as being based on the USMLE Step 3 all but disappeared from nursing media when the first cohort of DNPs took it last fall with a 49% passing rate)... how exactly did we all expect physicians to respond to an increased push for authority and scope with this worthless degree backing it up? It probably doesn't help that Mundinger herself has presented Columbia's DNPs as nurses "with all the medical knowledge of a physician." There are a heck of a lot of MSN prepared NPs in the world who neither want nor support this transparent ploy to bringing more cash into nursing schools while artificially enhancing prestige. There is no evidence that current non-DNP NPs are inadequately educated and trained nor that the DNPs will become superior providers. What exactly is the need? Why put this embarassment of a degree out there and give all the anti-NP lobbies more ammunition to criticize nursing education and preparation? It's silly to argue about whether one who has earned a doctoral degree deserves the title of "Dr." Of course they do. But I'm not convinced that someone who finishes this pseudo-doctorate in its present form (which far more closely resembles a MHA/MBA/MPH hybrid) should really claim to have earned a clinical doctorate with a straight face.