Thoughts on Fort Worth's new medical school

Today I went to the TCU Retirees luncheon to hear Dr. Stuart Flynn, the founding dean of the new TCU and UNTHSC medical school. As I listened to him talk about training empathetic students, memories of my own experience with osteopathic medical school came flooding back.

No, I never was a student, and I didn’t marry my husband until a few days after his graduation, so I didn’t really earn that PHT (pushing hubby through) certificate. But my affiliation with osteopathic medicine is lifelong, and my involvement with the Texas College of Osteopathic Medicine was intense in the 1970s. I am the daughter of the president of an osteopathic college, the sister of a former clinical dean of TCOM, the niece and cousin of several (most now passed on), and the aunt of two practicing D.O.s. I take my heritage seriously. My ex- was founding chair of the department of surgery when TCOM opened in 1970, and I was director of communications (and then assistant) in the late seventies. I like to say I grew up at TCOM and its sister hospital, Fort Worth Osteopathic.

I applauded today when Dr. Flynn stressed training empathetic scholars and the importance of the doctor/patient relationship. Patients, he said, want to be seen as people, not “the hip” in Room 215 or “the gallbladder” in 240. He talked about bedside manner, and teaching students to look a patient in the eye. All good stuff, and it took me back to the late ’70s when TCOM developed a whole new approach to the medical school curriculum. Instead of emphasizing the treatment of disease, they designed a curriculum that emphasized wellness and the prevention of disease. I remember my good friend Charles Ogilvie developed a wellness scale, with ten being optimum health and one, miserable illness. If I remember correctly, most people live at about six or seven, and the goal was to raise that number. So what happened? Students did abysmally on state medical exams. They had been taught humanistic medicine, but no one taught them to the test (teaching to the test is a problem with education from kindergarten on up to my mind).

So it’s lovely to see this more humane approach today, but to me it seemed like re-inventing the wheel. Especially with the new school’s close affiliation  with the parent of TCOM, where that philosophy has long prevailed.

My question to Dr. Flynn, had I lingered, would have been, “What does your school bring to the table that isn’t already on the table? Other than the fact that a medical school is a feather in TCU’s cap, what’s the reason for two medical schools in one city? Can Fort Worth, with only one major county/trauma hospital, provide enough clinical opportunities to train these young people? Empathy is major, but so is clinical knowledge and experience.

There is still a crying need for more physicians in Texas, especially in rural areas. This was the case when TCOM opened, with the stated goal of training physicians who would go into rural areas. But one of the arguments for an M.D. school has long been that it would attract heavier research funding. To my mind, research trains specialists who are unlikely to then go to rural areas where family physicians are needed.

I know my knowledge of medical education is woefully out of date. I do know, for instance, that students begin clinical experience in their first year instead of the old system whereby they spent the first two years studying basic sciences and the last two in clinical rotations. A great change that puts that doctor/patient relationship in the foreground immediately. And no more one-year internships, as in my day. Students must do a three- or four-year residency, with slots somehow assigned by some sort of national clearinghouse. Only there aren’t enough slots for the students that attend medical school. Is it fair to enroll a student for whom there might not be the required post-grad slot?

Maybe I’m just defensive about osteopathic medicine—a lifelong habit. But I really wish I could have talked with Dr. Flynn. Maybe he’ll talk to the retirees again in a couple of years and I can send him my questions. Who knows? It may all be clear by then. I wish the new school much success, but I don’t want it to crowd out traditional osteopathic medicine.

A new medical school—shall we rejoice?

I am a child of osteopathic medicine. My father was president of an osteopathic college and administrator of the associated hospital. When my brother and I were young, we could count eighteen D.O.s in the family. My ex-husband was a D.O. Today, my brother (retired) and one nephew and one niece represent the family in the profession. I went to work in an osteopathic hospital at the age of fourteen and worked in D.O. institutions off and on until the early 1980s, doing secretarial and then marketing work. To say I am thoroughly steeped in the osteopathic philosophy is probably an understatement.

To me, ever a lay person, it boils down to one simple contrast. Osteopathic medicine teaches that health is the body’s natural way of life and that dis-ease of any one part of the body affects the entire body. Allopathic medicine—traditional or mainstream western medicine—focuses on the dis-ease and curing it. (Allopathic is a term mostly used by proponents of alternative forms of medicine—like me).

My own health history provides an example. Before my hip surgery, a bone that had gone amuck was protruding through the cap of the hip joint and into the abdominal cavity. In addition to pain, I had wild gastrointestinal and urinary symptoms. I asked my M.D. surgeon (who I pretty much think walks on water) about it, and he said no relation because the offending femur was to the left of the abdomen. Well, sorry, I don’t believe that. I think it caused an imbalance and uproar in the entire system. Now that I am well past surgery, those side effects are gone.

D.O. physicians also believe in minimal use of medication, and as a survivor of an unneeded prescription of digitalis, I can testify to that. It made me so nauseous I could barely function, and to my astonishment, the doctor’s office said, “Just quit taking it.” If it wasn’t crucial why was I taking it in the first place?

But I am not writing to discuss my health history. Since 1966, Fort Worth has been home to the Texas College of Osteopathic Medicine, a school that has grown from very humble beginnings and an entering class of twenty to a multiple-building campus that now graduates at least a hundred physicians annually (sorry I don’t have accurate statistics). It sends over half its graduates to rural areas where physicians are so badly needed.

For years I heard rumors of applying to grant an M.D. degree, but I discounted them. Now it has come to pass. TCU and the UNT Health Sciences Center (umbrella institution for TCOM) have joined forces to enter their first class of M.D. students this month. Shall we rejoice?

I think not, but that’s just my uneducated perspective. Most new M.D.s, after the residencies required today, specialize; they don’t become the family physicians that osteopathic institutions send to underserved communities. I have heard the justification that the M.D. program was needed to secure research grant money—far as I know, way back even in the days when I worked at TCOM there was an active and respected research program. And the college had become an important community participant; for example, it hosts the coroner’s office and labs.

My neighbor, a new young family practice M.D., tells me now that residency is required of all graduates—only internship was required in my day—there are not enough residency slots for new graduates. The new school will only increase that problem. Perhaps the overall health care problem is to create more post-graduate slots rather than more graduates. Maybe those so anxious for a new medical program didn’t think of that. There were already eight M.D. schools in Texas.

But the big loser to me is that the osteopathic program. I fear it will be diminished and disappear. Increasingly there is less difference between the two philosophies. Younger D.O.s rarely use manipulation, once a hall mark of the profession. Now that is left to chiropractic medicine, which is incidentally an offshoot of osteopathic technique.

I don’t know what to say about why an osteopathic institution would not defend its integrity, and I may be proven wrong. Perhaps the D.O. program will flourish, but I am not wildly hopeful. I would like not to believe that the Health Sciences Center saw this as an opportunity to become one of the “big” or “regular” guys (over half the students are female, by the by) and I would like not to believe that TCU saw it as an opportunity to add the prestige of a medical school. Now that a donor has underwritten the tuition for the entering class for the first year, TCU can use that figure to boost its fund-raising stats.

No, I’m not rejoicing, and I’m looking a bit askance at those who hail this as a great advance. May I be proven totally wrong—it would make me happy—as long as the osteopathic component is preserved. And if it flourishes, I’ll really rejoice.