Getting a secondary MD degree as a DO—is it possible, and what could be the harm?

The osteopathic medical profession is increasingly making a bigger name for itself, and many DOs are prouder than ever to be osteopathic physicians. But surprisingly, in recent years DOs have been targeted by businesses offering to turn their DO degrees into MD degrees. These same businesses are also offering to turn MD degrees into DOs.

DOs have reported receiving robocalls from a company that specializes in connecting DOs with medical schools that will help them earn MD degrees. While this may sound appealing to some, the use of these services isn’t recommended. As the vast majority of large medical groups are accepting of DOs, getting a secondary medical degree isn’t necessary for physicians.

These types of medical ‘diploma mills’ or ‘degree mills,’ often located overseas, are not accredited by the Commission on Osteopathic College Accreditation (COCA), the Liaison Committee on Medical Education (LCME) or by an accrediting agency for foreign medical schools that has received a comparability determination by the U.S. Department of Education’s National Committee on Foreign Medical Education and Accreditation (NCFMEA), according to John Przypyszny, JD, a higher education attorney at Faegre Drinker. They are similarly not recognized by the Educational Commission for Foreign Medical Graduates (ECFMG).

“COCA and the LCME are responsible for accrediting medical education programs leading to DO and MD degrees in the United States, respectively,” said Przypyszny. “International medical graduates must also first receive certification from the ECFMG and take the United States Medical Licensing Examination (USMLE) to become eligible for application to U.S. residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and for state medical licensure.

“Further, claims by certain offshore medical schools that a student can ‘convert’ DO degrees into MD degrees (or vice versa) are incorrect. There is not a recognized mechanism to ‘convert’ a DO degree to an MD degree,” he continued. “Obtaining a ‘diploma’ or ‘certificate of equivalency’ does not in itself confer any legal authority to practice medicine, increase the scope of one’s practice or obtain licensure without following state-level requirements.”

This means that MDs degrees obtained from these institutions could not be used to obtain a license to practice medicine as an MD. Ergo, using the MD designation without a license would not be legal and could lead to fraud charges and disciplinary action from a DO licensing board.

The DO talked with Przypyszny and attorney Jenna Milaeger, JD, to discuss the legalities of these programs, the risks of pursuing an MD degree from a diploma mill and why they don’t recommend using them.

Are these services legal?

Przypyszny: Diploma mills often operate outside U.S. jurisdiction or in offshore locales, complicating the enforcement of state and federal laws. Federal law enforcement against diploma mills has been limited in recent years. However, there is precedent for investigating and charging diploma mills—such as the FBI’s “DipScam” initiative in the 1980s and early 1990s, which led to the closure of nearly 40 diploma mills and multiple arrests and convictions under federal antifraud statutes.

The “DipScam” initiative demonstrates that diploma mills can violate federal fraud and deceptive practices laws, particularly if they misrepresent the extent or nature of their accreditation, or if they issue deceptive diplomas or certificates. Many states have also enacted unfair or deceptive practices statutes that provide consumers with remedies against false, misleading and deceptive business practices—though it is harder to enforce these laws against offshore diploma mills. 

Can non-educational institutes issue diplomas or certificates that can be used for licensure purposes? 

Milaeger: There are organizations that offer physicians certificates or “diplomas” in certain treatment modalities or treatment approaches. These certificates or “diplomas” can be used to demonstrate a physician’s qualification to use or administer specific treatments or modalities; however, such certificates or “diplomas” are not the same as a degree from an accredited/approved college or educational institution, which may be used to show that one is qualified to obtain a license from a state licensing board. State licensing boards are responsible for determining education, training and examination requirements for licensure in the state. Those requirements will specify what education programs or colleges are approved for licensing purposes. 

These institutions are not accredited by bodies recognized by licensing boards, so DOs who obtain MD ‘diplomas’ from them and then use the MD designation would be doing so without appropriate licensure. What are the risks of doing this?

Milaeger: Falsely representing oneself as possessing a degree or credential one does not have is misleading to patients and the public and could result in claims of deceptive or false business practices. It can also result in investigations by state licensing boards for unprofessional conduct. When disciplinary action is taken by a state licensing board against a physician for unprofessional conduct, it often has a domino effect, resulting in reciprocal investigations and/or adverse action by hospitals, employers and certifying organizations.

Przypyszny: Using or presenting false academic credentials to obtain employment, promotions, professional status or licensure can amount to fraud, misrepresentation or credential fraud under federal and state law. Federal mail fraud and wire fraud statutes may be applicable when false documents are used in interstate commerce or in the course of federal employment. Violations of the mail and wire fraud statutes are punishable by fine and/or prison time up to 20 or 30 years, respectively. Separately, the Federal Trade Commission maintains authority to bring federal suits to enforce consumer protection laws that prevent false and misleading advertising.

Falsely presenting oneself as a DO or MD may also trigger liability under various state laws. Many states prohibit the intentional use of diplomas from unaccredited institutions to obtain a professional advantage and impose fines or criminal penalties for doing so. Further, medical practice acts enforced by state medical boards make it unlawful to practice medicine or osteopathic medicine without a license or to make false statements in a licensing application. In these instances, state medical boards may sanction misrepresentation of academic credentials as grounds for denial or revocation of a license.Practicing without a license could also lead to professional discipline or criminal charges, including fines and imprisonment.

For anyone who gets a ‘degree’ this way—is it possible in the future that they can be terminated and/or refused from the industry because of their participation and deceit of diploma?

Przypyszny: Yes. Presenting fraudulent or misrepresented credentials to an employer could lead to termination. Medical boards also generally maintain discretion to deny licensure, revoke licenses or discipline medical providers for misrepresenting their credentials under applicable medical practice acts.

Such actions could also be reported to the National Practitioner Data Bank (NPDB), a repository of information on medical malpractice payments and adverse actions related to healthcare practitioners and providers. The NPDB is specifically intended to prevent practitioners from moving between states without disclosing previous damaging performance. Sanctions or disciplinary actions handed down by state-level medical boards could be documented on the NPDB, raising the risk of reputational damage for practitioners associated with falsifying credentials. Further, individuals might also face civil or criminal penalties under state and federal law associated with fraud and the misrepresentation of professional credentials.

If DOs who are receiving targeted advertisements, robocalls, etc., from these companies have concerns about the propriety of these diplomas and certificates and would like to raise these concerns with regulators, who should they contact and what should they say?

Milaeger: State attorney general offices often have divisions/departments that investigate claims of consumer fraud. I recommend they contact their state attorney general and report that they are receiving unwanted communications from a third party that may be providing misleading information to the public. They should also share this information with their state licensing board so that the licensing board is aware that these companies are contacting licensees and providing potentially false or misleading information to licensees in the state, as it may prompt them to make a public statement on this issue.

Are diploma mills becoming more common?

Przypyszny: The stringent licensure and accreditation requirements associated with the medical field have generally limited the growth of medical education diploma mills. Still, diploma mills in other sectors have proliferated more generally in recent decades as a result of social media and more widespread internet access, sometimes making it more difficult to distinguish between purveyors of fraudulent credentials and legitimate distance learning or “certificate of equivalency” programs. For example, the Council for Higher Education Accreditation (CHEA) has recently cautioned students against engaging with fraudulent higher education websites and fake accrediting organizations, which have surged in recent years.

Moving forward

Przypyszny notes that the U.S. Department of Education and CHEA have also warned against the risks of using unaccredited institutions and degree mills.

“Prospective students who are considering applying to a medical school should review these resources and consider these issues if they receive marketing or outreach from offshore schools offering ‘certificates of equivalency’ or other diplomas that are not DO degrees,” he says.

Milaeger agreed, suggesting that anyone interested in applying to a diploma mill should first reach out to their state licensing board to inquire about whether the institution is an accredited or approved program of medical education, and whether a medical degree or certificate from that institution could be used for licensure purposes.

“They should also consider consulting an attorney experienced in representing healthcare professionals with licensure in the state to help them understand the educational requirements for licensure in that state,” she said.

Through some vague, crafty wording, one of these diploma mills encourages individuals to use “DO, MD” or “MD, DO” when representing themselves publicly—a tactic that, as outlined earlier, could lead to legal and licensure issues and losing patients’ trust.

Your DO degree will never stop you from accomplishing your professional goals. Having an MD “degree” as well is just not necessary.

The AOA also continues to reach out to state regulators to educate them on this issue and continues to advocate in this area to make sure these diploma mills don’t negatively impact the osteopathic medical profession.

If you or someone you know is receiving these robocalls, guidance about actions to take is available in this article on diploma mill robocalls in The DO.

Related reading:

Hands-on care: Why the osteopathic medical profession should encourage MDs to learn to provide OMT

DOs vs. MDs: Do patient outcomes favor a side?