Opinion ID: 419681
Heading Depth: 3
Heading Rank: 2

Heading: Graduates of Foreign Medical Schools

Text: 27 Dr. Brandwein also raises an equal protection claim based on the differences in treatment accorded under state law between osteopaths and graduates of foreign medical schools. Graduates of foreign medical schools who do not have degrees which translate to Doctor of Medicine or Doctor or to similar wording may still be accorded the M.D. designation if licensed by the Medical Board. See Medical Practice Act, Sec. 2055. Because osteopaths fall under the exclusive regulatory jurisdiction of the Osteopathic Board, no similar method allows Dr. Brandwein to qualify for the M.D. title. He asserts that the state has thereby drawn an irrational distinction between domestic osteopaths and foreign medical school graduates. 28 We hold that Dr. Brandwein's equal protection rights have not been violated by the provision for differing licensure procedures for those who attend foreign medical schools. All that is needed for this court to uphold the state regulatory scheme is to find that there are plausible, United States Railroad Retirement Board v. Fritz, 449 U.S. at 179, 101 S.Ct. at 461, arguable, Vance v. Bradley, 440 U.S. 112, 99 S.Ct. at 950, or conceivable, id. at 111, 99 S.Ct. at 949-50, reasons which may have been the basis for the distinction. Whether these reasons in fact underlay the legislative action is constitutionally irrelevant. Flemming v. Nestor, 363 U.S. 603, 612, 80 S.Ct. 1367, 1373, 4 L.Ed.2d 1435 (1960). 29 At the outset, we note that the issue is not whether osteopaths are less competent in the art of healing than M.D.s, whether trained abroad or in the United States. Appellees have not alleged that osteopaths are less competent than M.D.s, and numerous courts faced with the same issue have found that osteopaths are equally qualified as graduates of medical schools to perform the practice of medicine. Maceluch v. Wysong, 680 F.2d 1062, 1065 (5th Cir.1982); Oliver v. Morton, 361 F.Supp. at 1268; D'Amico v. Board of Medical Examiners, 11 Cal.3d at 802, 112 Cal.Rptr. at 22, 520 P.2d 10. In California, the regulatory framework ensures that osteopaths and M.D.s are equally qualified to practice medicine. Defendants conceded that all physicians and surgeons, whether licensed by the Medical Board or the Osteopathic Board must comply with the same examination requirements under the Medical Practice Act. See Medical Practice Act Sec. 2080; Gamble v. Board of Osteopathic Examiners, 21 Cal.2d 215, 217, 130 P.2d 382, 383-84 (Cal.1942). 30 It is also not in dispute that foreign medical graduates often hold degrees which differ from the traditional M.D. or Doctor of Medicine degree in this country, 1 yet are granted the privilege of using the title M.D. See Medical Practice Act Sec. 2100 et seq. Further, the training received by foreign medical graduates may differ substantially from that received by graduates of United States medical schools, and in California this difference is deemed sufficient to warrant extensive regulations governing the premedical and medical education requirements, as well as the clinical training and hospital service requirements of foreign medical school graduates. See Medical Practice Act Sec. 2101; 16 Cal.Adm.Code Secs. 1322-25. 31 We think the central issue is not competency, but rather whether there exists a difference in training or philosophy between medical schools and osteopathic schools which is arguably or plausibly a legitimate basis for the classification made by the legislature. Vance v. Bradley, 440 U.S. at 112, 99 S.Ct. at 950; Flemming v. Nestor, 363 U.S. at 612, 80 S.Ct. at 1373. We believe such a difference exists. Uncontradicted testimony before the district court established that, in addition to testing for competency in all areas of medical practice, the Osteopathic Board also tests the candidate's understanding of osteopathic concepts. This area is not examined by the Medical Board. The additional area of examination reflects the mandatory training in osteopathic techniques and theory at schools of osteopathic medicine, which is not mandatory at allopathic medical schools. Maceluch v. Wysong, 680 F.2d at 1066; Oliver v. Morton, 361 F.Supp. at 1264-65. This difference in curriculum reflects the long history of the separate philosophy associated with osteopathic medicine, and provides the osteopathic physician with a unique and distinct educational training which may affect not only the aggregate of his substantive knowledge of clinical techniques, but also his judgment as to the need for, and nature of, treatment. Maceluch v. Wysong, 680 F.2d at 1066. See also Oliver v. Morton, 361 F.Supp. at 1268; Eatough v. Albano, 673 F.2d 671, 676-77 (3d Cir.), cert. denied, 457 U.S. 1119, 102 S.Ct. 2931, 73 L.Ed.2d 1331 (1982). 2 The fact that D.O.s have been uniquely trained in osteopathic, manipulative techniques, preferred by some members of the public, suggests that the designation of the degree M.D. or D.O. helps the public in selecting a physician. Eatough v. Albano, 673 F.2d at 676; Oliver v. Morton, 361 F.Supp. at 1268. 32 The fact that foreign medical school graduates are permitted to use the M.D. degree in no way undermines the rationality of the legislature's decision that osteopaths be distinguished from graduates of medical schools. There might well be a plausible equal protection claim if graduates of foreign osteopathic schools were permitted to use the M.D. title in California; but in this case, no such showing has been made. 3 The legislative decision to allow foreign medical graduates to use the M.D. title is consistent with the rational conclusion that osteopaths have different training from M.D.'s and should be identified as such. [I]t does not follow that osteopaths and graduates of foreign medical schools must be treated alike simply because foreign graduates, like [the plaintiff], may not have had educational backgrounds identical to those attending American medical schools granting M.D. degrees. Maceluch v. Wysong, 680 F.2d at 1068. It is the differences in general philosophy, manifested by the additional training in osteopathic schools, which motivates the basic distinction between M.D.s, whether foreign or domestic medical school graduates, and osteopathic school graduates. 33 Dr. Brandwein's reliance on Oliver v. Morton, 361 F.Supp. 1262 (N.D.Ga.1974) is unavailing. Oliver involved a successful equal protection challenge to the medical licensing scheme in Georgia. There all physician licenses were issued by a Composite Medical Board and the Board permitted graduates of foreign medical schools to use the term M.D. while denying the same privilege to osteopaths. A three-judge court rejected the two possible rationales suggested by the state for such disparate treatment. The state first argued that the degrees conferred by foreign medical schools were substantially equivalent to the M.D. degree; the court, however, found that the D.O. degree was also substantially equivalent. The state also argued that foreign medical school degrees may confuse the public; the court determined that D.O. degrees suffered the same deficiency. 34 Oliver, however, is distinguishable from this case. First, the regulatory framework is different: while Georgia had no provision explicitly providing for the licensing of foreign medical school graduates, California has extensive educational, clinical, and examination requirements which must be satisfied. See Medical Practice Act Secs. 2101, 2102. Further, the Oliver court chose not to stress the interest the public has in selecting a medical practitioner and of being fully informed of the physician's training and philosophy. We find this to be a valid classification, even if particular individuals such as Dr. Brandwein no longer accept the principles of osteopathy. Massachusetts Board of Retirement v. Murgia, 427 U.S. at 316, 96 S.Ct. at 2568. 35 In short, we cannot say that the district court erred in finding that a rational relationship exists between the separate classifications of D.O.s and M.D.s, and a plausible or conceivable difference between the training received by holders of those degrees which may affect the public's choice of physicians. That is all that is required by the Equal Protection Clause. Minnesota v. Clover Leaf Creamery Co., 449 U.S. at 462, 101 S.Ct. at 723. 36