New Beginnings for D.O.s in California

Dr. Donald Krpan, DO, interviewed by Dr. Michael Seffinger, DO

in Palm Springs, California
February 17, 2006

Dr. Seffinger: Dr. Krpan do you want to start off with telling us about where you were born and how you got involved with the profession in the beginning and go on from there. If you want to add some questions as they come to you or a stream of thoughts any way you want to do it is fine. If you get stuck and want me to ask you questions just say what ever questions you have for me. Let’s do it that way, okay.
Dr. Krpan: Well, I am Donald John Krpan, DO, an osteopathic physician. My date of birth was 1936. I was born in Rocks Springs, Wyoming, County of Sweetwater. I was raised in Rock Springs until I was six. My father was a coal miner there. All my grandmothers and grandfathers were immigrants from Croatia as was my father. And they cut coal mine when they got to this country. I went to the first grade in Rock Springs and in a little town called Superior. My uncle was killed in a coal mine in Rocks Springs, Wyoming. My father decided he wanted to get out of coal mining at that time. He was superintendent of a mine. We moved to Long Beach, California and I went through the 8th grade in Long Beach. That’s where I was exposed to osteopathic medicine. Our physician there, I don’t know his first name, but his last name was Toler. He was located in North Long Beach. When I was a child and into my 20’s and 30’s I suffered from migraine headaches and Dr. Toler would treat me and make my headaches better as a matter of fact. The most relief I received from migraines was through him.
Dr. Seffinger: T-o-l-l-e-r?
Dr. Krpan: T-o-l-e-r I believe or a-r, I can’t remember. He was our family physician for a number of years. After that we moved to Sacramento. I went to high school in a little town called Roseville, 18 miles northeast of Sacramento; went to Sierra Junior College and then to the University of Nevada, where I graduated and was accepted in 1963 to College of Osteopathic Medicine in Kansas City, Missouri; matriculated there in ’63; graduated in ’67; did a rotating internship at Phoenix General Hospital; and then went into practice. I practiced my first year in Houston, Texas. I returned to Phoenix where I practiced from ’69 to ’76. I obtained my license to practice in California in 1975. I will have to check that, but I think that’s the date and moved to California in 1976. I established a practice in Yorba Linda, California and practiced there from ’76 to 1987 at which time the Dean at COMP, Dr. Jerry Bayles, recruited me to come to COMP and help him with post-doctoral programs. I was there from 1987 until 2003, 16 years. I served as the Dean and then the Provost. The timeframes I don’t remember exactly, but it was like five or six years as a Dean and the remainder of the time it was Provost and Chief Academic Officer at the Institution.
Dr. Seffinger: Okay. When you came to, well, let’s start before you came to California. When you entered the osteopathic profession, what did you see? What was it like at that time in your eyes?
Dr. Krpan: It was small. We had, I think there were, when I was in school, 17,000 osteopathic physicians in the country. We had five schools. We had an advantage at that time over what we have at this time and that is that we were able to train all of our graduates in osteopathic hospitals. At that time there were over 200 osteopathic hospitals. We had approximately, and I don’t know the exact number, but we had approximately 500 graduates from osteopathic colleges each year and they trained, they had to train as there were no slots available in allopathic hospitals, so all osteopathic graduates trained in osteopathic hospitals. And there were an abundance, a surplus of training slots at that time. Today’s world it’s different because 50% to 60% of all the graduates from osteopathic colleges in this country have to go into allopathic programs to get a residency because we don’t have them in the profession. There are a number of factors involved: number one, the allopathic profession has traditionally had approximately 7,000 slots beyond what they need for allopathic graduates in their schools in this country which traditionally were filled by foreign medical graduates (FMGs) and in the early 1970s they started accepting osteopathic graduates into allopathic residencies and our graduates started going that way; subsequent to that and with the crunch of managed care and cost restraints, we started losing hospitals and it wasn’t just osteopathic hospitals, hospitals across the board were stressed because of finances. A lot of hospitals closed. It impacted us more because we were smaller and had fewer hospitals so our graduates started going more into allopathic programs and it eliminated some of that foreign graduate contingency, but it also started taking people from our profession into the allopathic profession where they were trained, and where they sought membership and certification in allopathic specialties.
Dr. Seffinger: So when you came into the profession it was, it had a certain culture to it. It was very small. It was controlled by the AOA. It owned hospitals. You didn’t have the choice of going to allopathic hospitals at the time. You were barred from that option by the AMA I believe was behind that. You then went into practice in the ‘70s and when you came into California from Phoenix, what did you see at that time? What was your impression of the state of osteopathy in California when you entered it in 1975?
Dr. Krpan: The profession was more or less decimated here. They were close to the critical number of DOs remaining with a DO license for renewal of licenses by the Osteopathic Examining Board. They were close to the point where that number would have been small enough that the Board would have been closed down and then people would have - everyone who practiced medicine would have been licensed by the Medical Board of the State of California. We had no hospitals, privileges were limited, there were hospitals where they would turn you down for privileges, namely, Kaiser. Kaiser wouldn’t hire DOs to work in their programs in their first two or three years. I served as president of the Osteopathic Physicians and Surgeons of California two times. The dates I think are ’81, ‘82 and ’87, ’88 and during my first term as president we had individuals who were trying to hire on with Kaiser. They couldn’t get hired because Kaiser just didn’t hire DOs. The Executive Director of our State Association at the time was Matt Weyuker and he and I went to the capitol. We introduced legislation that passed. Kaiser had to start hiring DOs. Then those same DOs who were hired by Kaiser found that because they were DOs they were unable to participate in the profit sharing and ownership plans that Kaiser had. So we went back to the legislature with another bill; got it introduced, got it passed; and then DOs started getting equal rights under the benefits of being employees of Kaiser. That was early on, that was like my first term as president I believe.
Dr. Seffinger: I wonder why you would move from Phoenix where they had osteopathic hospitals and they had a pretty good, well-established profession there to a place where there wasn’t a well established profession. Why would you start out from scratch like that?
Dr. Krpan: Pioneering spirit. But first of all, I was a resident of California before I left to go to the University of Nevada and then to the Kansas City College of Osteopathic Medicine and I still owned property in California. My father lived in California. I was raised in California. My wife was born and raised in California. We wanted to be back in our home state. I was recruited by a hospital in Yorba Linda which was struggling. I was recruited because I helped start a hospital on North 19th Avenue in Phoenix called Phoenix Community Hospital. When I first started there I was the house doctor and the emergency room doctor and it was me, a nurse and a night watchman at night. We got that hospital going. It was 80 beds. It was running at capacity when I left. The people who owned the hospital in Yorba Linda got wind of that and wanted me to come to Yorba Linda. I worked with those people in Yorba Linda. We got that hospital accredited by the AOA by the way. I got the hospital in Phoenix accredited by the AOA. I’m responsible for six hospitals having accreditation by the Health Facilities Accreditation Bureau of the American Osteopathic Association. First of all my experience with them, having been president of the AOA and been through hospital inspections, the Health Facilities Accreditation Bureau of the AOA is easier to get along with. They are more helpful. They are easier to understand and accreditation by that body is more reasonable than going through JCAHO (Joint Commission on Accreditation of Healthcare Organizations; now simply called “Joint Commission”-ed.). So, more and more hospitals are coming our way for hospital accreditation. There’s my reason for coming to California. I practiced in Yorba Linda from ’76 until ’87 as I said, when I was recruited to the school by Dean, Jerry Bayles who was the founding dean of the school. And I helped them with post-doctoral programs. The programs that they had were less than quality and it was kind of a unique situation. I was recruited as the Director of Post-doctoral Training. I went there in October supposedly on a one-day a-week basis and by November I was spending all my time there. So, I sold my practice in Yorba Linda and went full-time with them at a very nominal reimbursement for the first nine months I might add. In June, when Dr. Bayles retired, I was interviewed. I was hired as the Dean of Osteopathic Medicine at the College of Osteopathic Medicine of the Pacific and served in that capacity for approximately five years and then became the Provost and Executive Vice President for Academic Affairs. The challenge that I identified when I became the Dean was clinical training for students and post-doctoral training for graduates. And as I mentioned, there were two programs that were affiliated with the school when I got there. I shut both of them down after I became the Dean because I just didn’t perceive that the quality was there. I further set about to get more clinical rotations for the students and to start post-doctoral programs. I was relatively successful in both of those endeavors. With the programs at COMP, my perception was that clinical training was the most wanting. We corrected a lot of the issues regarding clinical training for the students. I hired people to come in who had quality and were interested in educating students. They became the clinical component of the faculty. When I got there, I think there was two other osteopathic physicians besides myself on the whole campus; one of them was Dr. Earl Gabriel who was working in the clinics and who left shortly after I got there and the other one was Dr. Bayles who was the Dean and who retired in that first year I was there. That brought in Drs. Anne Musser and Alan Cundari. I hired Mitch Kasovac as the Dean. I went out and sought clinical chairs for the departments. I brought in full-time faculty into the OM&M Department that I felt were quality with John Jones as Chair. And regarding post-doctoral training which I really felt was the most lacking in California for graduates from osteopathic college, I set about developing programs. I recognized that the patient population that most lends itself to training of students is the underserved and the poor and so I started going to the county hospitals in California and Arizona. I established relationships and affiliations and then post- doctoral programs in those hospitals. In particular were an internal medicine program that I started at San Joaquin General in Stockton, an internal medicine program I started in Maricopa County in Phoenix, an internship family medicine program that we started at Highland General in Oakland and San Bernardino County and Riverside County Hospitals where we had multiple post-doctoral programs particularly at San Bernardino. The first one we started there was an internship and then a family medicine program. The family medicine program had 54 residents. It was the second largest family medicine program in the country. We managed to make all of those slots dully accredited by the AOA (American Osteopathic Association) and by ACGME (Accreditation Council on Graduate Medical Education). So in any given year they could all be DOs or they could all be MDs filling those slots. During the time that I was at COMP, after we got that program accredited by the AOA we had upwards of 75% of all the slots filled by graduates from COMP and other osteopathic colleges. Subsequent to that we started an OB-GYN program which has approximately 12 residents now. We started an orthopedic program. I was responsible for a neurosurgical program that exists in that hospital right now, under Dr. Javed Sadiqi. Some of the accreditation issues were that we had MDs heading up osteopathic programs, particularly neurosurgery, where there were few osteopathic programs anywhere across the country even in Michigan, Ohio, and Pennsylvania where they have a lot of DOs and a lot of DO post-op programs. We were able to get him accredited as a program director and he still is. The thing that we did though is after we got the program accredited was to find DOs to come in to help them to run these programs Dr. Sadiqi brought in Dr. Dan Miulli. Dr. Valenzuela at Arrowhead brought in Dennis Carden from Apple Valley, who is a DO, OB-GYN. He came down and helped run that program. Earl Gabriel, God bless him, was kind of in between. He left COMP and was floating around covering ER’s and doing locums. I told the people at San Bernardino County that I needed to have an osteopathic DME and they said fine. I arranged for Earl to become the osteopathic DME at San Bernardino County. The students, the residents and the faculty and staff out there all loved Earl Gabriel. He did a great job for me. But he created that osteopathic presence on that campus that was needed. I got a call even after I left Western from one of my graduates who is the program director for the emergency medicine program there; they were having trouble because there was just one DO trainer, the emergentologist. He felt that there should be two and the hospital wasn’t going to let them start the program, so I got involved at the national level. I talked to the people in emergency medicine and said, “You’ve got to give these guys a break. You know there aren’t many DO emergentologists in California, let them start the program, he’ll be hiring some of his graduates from the program and you will have more than one DO in the program” and they acquiesced to my wishes and so I helped get that ER program going. I helped with an anesthesia program at Riverside General, another county hospital. You know, I feel that we were successful in getting programs started. We started a program at Downey, we started a program at Tempe St. Lukes in Phoenix and I can’t remember all of them right now, but there were other programs we got started for the benefit of the students and the graduates. It benefits the students particularly: If they go to a hospital for clinical rotation they often became interns and residents there because of the interns and the residents who become their role models; interns and residents mentor them; it becomes a better training site for the students who are rotating in those hospitals. We established a relationship with Arrowhead and I was able to guarantee that we would have upwards to 300 rotations a year in that hospital for our students. They had OB-GYN and family medicine residencies. There was an orthopedic program that we started there, which since that time has transferred to Riverside General. They each had residents going around teaching students who were rotating there. We have very good relationship with Arrowhead and if I made a contribution to Western University in the time that I was there that would be the most significant I think because it became our hospital. I don’t know if they still have that relationship or not, but the people I worked with and dealt with were part of my family as the Executive Vice President for Academic Affairs at that institution and did just about anything I asked. The OPTI (Osteopathic Postdoctoral Training Institute) concept came about under AOA President Bill Anderson. I don’t remember his year of presidency at the AOA, but the OPTI concept was his and Dr. Michael Opipari’s brainchild. You needed to have a school, a consortium of hospitals, and a base hospital which was osteopathically approved. At the time the only osteopathic approved hospital in the state of California was Pacific Hospital of Long Beach, and Pacific was in the throws of changes in ownership and what have you, and we weren’t sure they were going to remain accredited by the Health Facilities Accreditation Bureau of the American Osteopathic Association. Recently they dropped it and they are now certified by JCAHO (referred to as “J-ko” for short; now, in 2007, it is simply called “Joint Commission”), but I went to the people in San Bernardino who are part of that family I spoke about and I said, “You have to apply for AOA accreditation for this hospital and they did it and they are still accredited by the AOA. That relationship I developed with Arrowhead was a significant contribution to the profession in this state.
Dr. Seffinger: You mentioned something about when you started working at the school there wasn’t much of a clinical education program, okay. Were you aware of the preceptors involved with that particular problem in that you had a lot of DOs, about a couple of thousand that became MDs before that and they had all the clinical programs from the old school, okay, and then they went to start to work to build MDs in allopathic medicine, right and that’s those faculty that you were talking about did clinical work, but some of them also didn’t they, were some of them interested in also clinically training the DOs coming out of COMP. What happened to those people and did you interact with them and rely upon them at all? What was the relationship there?
Dr. Krpan: There was some of that older contingent, you know, I think the godfather of the profession in this state is Ethan Allen. He always had students with him. He was helpful when we wanted to meet with prior DOs to setup clinical rotations and what-have-you, but the two hospitals that I mentioned that I shut down because of poor quality of training were run by prior DOs, so. But we depended on a lot of the prior guys to take the students on clinical rotations, and what-have-you, but they were MDs, they weren’t DOs. You know, they changed their degree. I think some of them felt that they made a mistake in taking that degree. But not many of them would go on the hook to say, “I’ll help you get a program started.” Most of the people who I was able to work with and get programs started with were allopathic physicians in allopathic hospitals.
Dr. Seffinger: Were they foreign medical-trained doctors or were they home grown so to speak?
Dr. Krpan: No, most of the people I dealt with were home grown.
Dr. Seffinger: So it took awhile to develop clinical faculty?
Interrupted
Dr. Seffinger: We are talking about getting a clinical faculty for rotations and you explained all that through the 1980s and ‘90s and you’re developing a relationship with Arrowhead Regional Medical Center which was crucial to develop a great training site. And we had talked about where that faculty came from. There were some MDs and there were some DOs and there were some people who had exchanged or purchased their degree and became MDs. They were somewhat helpful and some of them were not. It went either way. And could you mention or talk a little bit about any sense of discrimination...you mentioned about Kaiser not allowing DOs, were there other sense of a discrimination going on against DOs in that early 1970, 1980 era that you can recall? You said that you went on to become president of OPSC. You went to work with some legislators to try to change the discrimination against DOs in California. Could you talk in a little more detail on how that occurred so that we can understand the process by which a profession that is not accepted very well then becomes accepted? How did that process actually occurr in the state of California?
Dr. Krpan: It was push comes to shove. They started re-licensing DOs in ’74, as I said I came here in 1976. I got involved with the hospital in Yorba Linda. As I said, I got it accredited by the American Osteopathic Association. Ethan Allen who had this undying interest and love for the profession would come to our staff meetings there. I recruited a number of DOs to come to Yorba Linda and practice out of that hospital. Ethan would come to our meetings in 1978, I guess early in ’78, Ethan asked me if I was interested in serving at the state level and I said, “Sure” and then I got involved politically. The Osteopathic Physicians and Surgeons of California, our state association, has a legislative bent. Our Executive Director for close to 20 years was Matt Weyuker and Matt Weyuker was probably head and shoulders above anybody we’ve had legislatively, but he had been a lobbyist I think for the used car dealers in California before that. He knew the legislative process; he knew legislators because he had been in the capitol for so long so when legislation would come through that looked like it was going to impact us adversely, Matt would call our legislative committee and whoever was president at that time and they would go to the legislature and get a Senator or one of the assemblyman to carry a bill for us and then we would push it to see if we could get it passed. It amounted to trips to Sacramento on the president’s behalf. They were unpaid for. The State Association was down to, I don’t know, maybe a 100 when I got here in ’76. I don’t know the exact numbers. But you know the first few annual conventions that I went to you could have put most of the people who came for dinner in this room we’re setting in, it was small. We are fortunate because we had good people coming into the state. We had people coming to the state who were osteopathically oriented. DOs who recognized the value of their degree and you know Norm Vinn and Gary Graham, of course Earl Gabriel, Gil Roth, and Stu Chesky; they all served on the board while I was there. Joseph Zammuto was on that early board and they were all interested in osteopathic medicine. They had a fervor for osteopathic medicine. They did what they could to support the profession and make it grow. You know, they are good people, good practitioners and they went to various parts of the state to practice and they were able because of their skills and personalities to sell the profession in their area and there was, early on, discrimination. I was in a hospital one time in Orange County getting ready for surgery with an MD surgeon by the way and I heard two guys on the other side of a locker talking and osteopathic medicine came up and one of them said to the other, “Why, I thought we handled that problem a long time ago.” So, you know, that was after I came to this state, probably ’77, 78, ’79, so, there remained a bias and a prejudice regarding osteopathic medicine. I think the people who have done the most for our profession in this state are those physicians who went into those hospitals and applied their skills and practiced good medicine and had a personality - they sold themselves to their patients. Osteopathic physicians I think go the extra mile for their patients and those people helped to break down the barriers that existed. They changed the bias that existed. You know there was flat denial of D.O. privileges by Kaiser at one point and through legislative action we were able to change that to “You [as an osteopathic physician] are going to be judged for privileging and for credentialing on the basis of your training not on the basis of your degree.” Once we got that through a lot of the discrimination went by the wayside. One of our graduates probably is never going to be on the staff at Stanford, but we have to bear in mind that probably 95% of the people that graduate from Stanford’s programs don’t stay at Stanford. They are relatively a closed society. They lead in medicine and everyone can’t get a job there, but we have an untold number of people working for Kaiser, we have a lot of graduates in the U.S. military and all of those old prejudices have gone by. I would add that when I would go to a hospital that I felt would do a good job in training my students, I would tell them that it’s going to keep their staff sharper and that I just want them to take my students for three months and try them. The students and I would select students that I would send to different places, but the students sold our programs. The students were bright and eager and I had a program director at Arrowhead tell me when he decided to try my students for three months...He called me and said, “I want to talk to you. I’ve found that your students are better trained for family medicine, they work harder, and they are easier to get along with.” Well, subsequent to that, he said, “Let’s do this post-doctoral training thing that you are talking about,” and we got that done and that was on the basis of a three month trial with my students to see if they were acceptable to that hospital. You know, the quality of the people that came to this state, and I’ve got to say that all of them were not quality that came to this state. We had people running away from histories in other states. There were a number of them. The people who were serving on the Licensing Board at that time were bending over backwards to give licenses to people if they met the reciprocity requirements to come to California. There were cases in which they were a little reluctant, for example, the ultra-specialists. I think in their eyes, and I’m talking about people who are interviewing people to come to California, the existing resident DOs in California, they, I think, felt that the ultra-specialists might sell them out again. It was just a feeling that I got at the time and that as time passed we started getting younger physicians and the newer breed onto the Boards, onto the Board at OPSC. It was more of an interaction between us and the MDs and a lot of the prejudices went away. Our people can go to just about any hospital in the state now, get privileges. They can go to any hospital in the state that has training programs and take training once they graduate. We have our students in most of the hospitals in the state doing clinical rotations, so a lot of the barriers that existed initially have gone away. I remember when Ethan came to me in 1977 and said, “Don, we are going to start a school in Pomona, will you give us some money?” I said, “Sure!” I said, “Ethan, but where are you going to train these people?” I should have known better than to ask the question because DOs have traditionally given back and I can remember times when Earl Gabriel who was the clinical dean at that time would call me and say, “Don, would you take two students this month?” The DOs who came here from other places made the clinical program go because they were willing to give of themselves in their practice to take students in for training purposes. It’s been a great ride.
Dr. Seffinger: Well, there was tremendous change in that short length of time. You were on a licensing board, okay, can you give us a sense of what that was like rebuilding a licensing board as well. And all these new DOs having come in, there had to be a way to discern which ones were be faithful to the profession, which ones were possibly going to undermine it, ah, how did you discern who were the good DOs and then how did you police them? How was the licensing board set up to regulate the profession to make sure that it would be a strong profession?
Dr. Krpan: The licensing board’s main responsibility is protection of the public. They don’t care whether you are a ‘good’ DO or not. They care whether you are a good practitioner. The body that cares most about whether you are a good DO and remain true to the profession is probably our State Osteopathic Association (OPSC). The licensing board is made up of people who are gubernatorial appointees and some of them are very true to our profession and some of them aren’t. Their job, however, is not to determine whether or not you are a good DO, their job is to determine are you a good practitioner and their job is protection of the public. You know we would nominate people that we thought would be good licensing board members, but it’s all political process. If it is a democrat governor in there you probably are not going to get on that board if you are a republican, and visa versa. Unfortunately that’s the way it is. They don’t always pick the best people to be on the board. It’s based upon political payback I think, a lot of it. Over all the years I’ve been in the state, now 30 years, we’ve been fortunate over all the years that most of the people who had positions on the board were tried and true to the profession and had the profession at heart. Again though, that’s not their job. There job is to assure that a good level of medicine is being practiced by the licentiates of that board.
Dr. Seffinger: The OPSC then had to work on building the culture of the profession, right? How did they do that?
Dr. Krpan: You know I mentioned we had some good people come in who were from other places. In the early days there were no graduates of the schools in California. They hadn’t started a school until 1978, didn’t graduate the first class until 1982, so the people were building the profession in this state prior to that time. Most of the licensees from other states who migrated here between 1974-1982, including DOs from Arizona where I was from, Michigan, Pennsylvania, Ohio, were good people from all over the country, most of whom had been through the same political battles that I’ve been through wherever I was. I know personally that there were political prejudice and bias because I mentioned I practiced in Texas my first year. They would not give privileges in the Hill-Burton funded hospital in a little town 70 miles outside Houston because I was a DO. It was Hill-Burton funded hospital and they were required by the law to give you privileges if you have a license. I didn’t push it; I had three hospitals I worked out of in Houston, but they wouldn’t even allow me to send my patients there for laboratory and x-ray, so, there was prejudice against the profession as late as 1969 because that’s when I was in Texas. In coming here those people who came probably were exposed to a lot of the same prejudices that I was exposed to where I had been and recognized the need to keep this profession together. And we managed to get some really good people on the board initially. There were a lot of good personalities on that board. They helped to generate a viable state association and that state association is the core of the profession in this state. I would mention, however, of that core that we have, we only have a 25% market share of the people who are licensed and practicing in California, because 4500 DOs are licensed here, but they aren’t all practicing here. Some of them are in other states. Of the ones who are practicing here, and I think its more like 3,000, we have 25% as members of our State Association and membership is crucial to the success. I’m going to be talking tomorrow night about that a little bit at the banquet in honor of the inauguration for our new state association (OPSC) president and you know its imperative that those of us who are over the hill now and will be going away shortly impress on these young people the value of having a viable State Association. Their State Association is the responsible body which worked tirelessly until the California State Supreme Court overturned the stifling effect of the1962 proposition 22, restoring the power of the state osteopathic licensing board to license new DOs, got them their privileges at Kaiser and UCLA and at hospitals and institutions throughout the state. There was another time I went to the legislature with Matt Weyuker. There was a chink in our Practice Act which loosely interpreted would have made it possible for MDs, for the Medical Board to give a license to a DO. Matt Weyuker and I went to the Senate subcommittee and had a senator, Bill Green, carry a bill for us to revise our Act to eliminate that component. And we got it passed. You know that could have been another threat to us if disloyal DOs were going to go to another licensing board to get their license. We managed to eliminate that clause. That was probably 1987, somewhere in there.
Dr. Seffinger: So those are the political aspects of what a State Association can do to help with legislative issues. What else does OPSC do for DOs in California?
Dr. Krpan: Oh, interact at the Industrial Commission for the State of California; make sure DOs are included; and make sure DOs are compensated. The same thing with Medi-Cal - they monitor the legislation to see there is no adverse legislation affecting DOs. They interact with third-party payers. They make sure we are included in the managed care plans. The State Association does a lot for these people. We need to impress upon students and new graduates the reason for having a State Association represent them. Whether you are a member or not you reap the benefits of those who are there and on call to meet these crises. It would be better if we had more people to employ in those causes.
Dr. Seffinger: What about the post-graduate education content and quality at OPSC Continuing Medical Education courses?
Dr. Krpan: You know OPSC is not that intimately involved in educating DO students. However, they give continuing medical education to post-doctoral osteopathic physicians, but their continuing medical education component is a requirement. There is a requirement in the state of 50 hours a year or 150 hours in three years and depending on what specialty society you are certified by within the AOA there are varying requirements for continued certification also. OPSC provides that continuing medical education component. The quality of the programs are good across the board and I might add that they are getting better all the time. Part of the reason is we have new people coming out of new programs who know all of the latest advances in medicine. They recognize the newer medicines. I haven’t practiced medicine in 20 years. Some one asked me the other day would I consider going back into practice. Before I could go into practice I would have to take a pharmacology course because I do not know these new medicines. They change so rapidly. I hear about laparoscopic surgery, and I feel like a dinosaur. You know things have changed so much in 20 years. So if I were to want to go back I’d have to take some training and these young people coming out are attuned with all of that and they come to our CME programs and they keep our people who are in practice informed of all the latest developments and that’s the function of the State Association when you talk about continuing medical education. Most of the other state societies do the same thing.
Dr. Seffinger: Are there a lot of specialties in the state, a lot of DOs that are specialist or are they mostly specializing in family practice, primary care or is there a wide variety?
Dr. Krpan: Most of them are in primary care. I’m sure of that because for the longest period of time we didn’t have any residencies in this state besides primary care. We now have orthopedics. We have anesthesia. We have surgery and we have emergency medicine and we have the largest neurosurgical program in the osteopathic profession. Some people are saying it’s as large as Mayo’s program and it’s a good program. The trainer has 12 residents this year I think and I’ve helped him to increase from the sidelines through my contacts at the AOA on an ongoing basis, but he has Riverside General, Arrowhead Regional, and Kaiser-Fontana as sites for these people to train in. They are all big tertiary care hospitals.
Dr. Seffinger: There is also training OB-GYN, ER, Pediatrics, Anesthesia, Surgery, and Internal Medicine.
Dr. Krpan: So, we are going to have a larger percentage of specialists in our contingency as time passes because more people are taking those specialty and sub-specialties and I think another issue and I see it as a concern and that is that I see more of our people going into specialties as time passes and the reason for it is there are people advertising that nurse practitioner’s and PA’s can do 80% of what a family doctor does. It’s far from the truth. If they could do 80% of what a family doctor does then they should be able to pass a test showing that they have knowledge of 80% of what a family doctor does and we know that they couldn’t do that. They just don’t have the educational background for it. But I see this threat because our profession has traditionally been primary care and once we get to where we are not selling that concept anymore are we really a different kind of doctor. That’s my concern, Mick, and I don’t know. That’s just personal. I think it needs to be monitored.
Dr. Seffinger: Okay, let’s take a break to change the tape. When we come back we will focus on your ascension to the presidency of the AOA and the first California DO that became an AOA president since 1951 or so. So let’s take a break.
Dr. Seffinger: Tape 2, Michael Seffinger, DO – interviewing Donald Krpan, DO, Palm Springs, California, February 17, 2006 We are talking about Dr. Krpan becoming the first president of the Osteopathic Association from the state of California since 1951. Could you take us through how that came to be?
Dr. Krpan: Well, I was promoted by California to become a member of the Board of Trustees for the American Osteopathic Association in 1987. The first time I was put up and I did get a seat on the Board of Trustees of the American Osteopathic Association. I served in that capacity as a board member from 1987 until 2000 when I became the president. There were issues that I addressed that some people didn’t want to hear as a board member. One in particular had to do with new colleges and increases in class sizes in existing colleges. And I wrote a paper and documented my findings with the facts and asked to talk to the Board of Trustees of AOA about this issue. In my concern, in 1995, and that’s eleven years ago when I gave this talk to the board, was, “Where are we going to train these people that we’re telling we’re going to train to be a different kind of physician?” And if we are going to train them in an allopathic hospital under allopathic physicians then we are going to lose them to the allopathic world because they don’t come back to us for membership or certification once they are done with their training; I see it for a cause for alarm. I think when those people outnumber the people who are trained within our profession, this profession is going to be at extreme risk because we know what happened in California in 1962 and it could happen again. I can document that 60% of our people are leaving the profession for post-doc training now, most of them because they have to because we don’t have training for them. I do not think that we are creating the loyal, osteopathic physician across the board that we did when all we had was osteopathic hospitals to train in. It’s not the same. It’s a different world now and it creates a cause for alarm in my eyes for our profession. And I have to say when I wanted to give that talk my friend Bill Anderson was President of the AOA and our Executive Director was Bob Draba and our legal council, Jack Campbell said, “You can’t give this talk!” (I showed it to them before I went to give the talk). They said, “You can’t give this in open session. This is like restraint of trade.” We’re saying that, “You are talking about as a board member limiting growth.” And I said, “I’m not talking about limiting growth, I’m talking about structured growth, reasoning growth and so I gave the talk to the board and I have to tell you that most of the members of the Board of Trustees were very supportive and they recognized what it was I was saying. There were some who felt that I was self-serving because I was employed at Western University and I didn’t want any competition from other schools and that was the farthest thing from the truth. By 1997 I already had been through a number of AOA Departments as a Chair. I was appointed to the Department of Education by two successive presidents and moved forward to the Presidency. The highlight of my presidency year was to keep young people in our profession, develop more osteopathic training, and make them believe that we are going to create that different kind of doctor. I submit, I go on record with this, our schools tell applicants and interviewees that we are going to train you to be a different kind of doctor. So they bring them in and for two years they get OM&M in school and then they go into clinical training and they never see it again. They oftentimes never see a DO again; most of the time they never see a DO when they are in post-doctoral training. That’s a significant statement. There are 60% - 70% of our graduates in programs where there are no DOs. How are you going to generate the loyalty that we saw through all the ages in our profession in these young people who don’t come back to us? Of the people who train in allopathic hospitals, this was really a huge cry of my presidency, people who train in allopathic hospitals, 11% of them come back to us for certification and membership and that was the last figure that I heard. That is a significant loss, if you are only getting back 11% of 60% you are losing a lot of people. A profession this size cannot afford that. When I first went on the board, when I first started going to the AOA House of Delegates, which was in 1978, Ethan Allen and I were the two delegates from California, that’s how many delegates we could have. Ethan Allen and I, starting in 1978, going to the AOA House of Delegates, paid our own way, every time. Being a member of the House and getting to know the people from other states, I can remember when I first moved here and I first became a member of the House of Delegates, I was looked at askance – they wanted to know what’s going on in California, and are they going to sell out another time, and there was animosity towards this state. I interacted with physicians from other states, convinced them that my loyalties were to this profession and as time passed I ascended into the president elect position and then the Presidency. I sold myself for the Presidency. They were convinced that I was a loyal, contributing DO and I feel that’s what I am. I moved forward into the Presidency of the American Osteopathic Association. I currently am the leader of our caucus for the Federation of Osteopathic States. We make up 40% of the AOA House of Delegates. We have become a real player. I have already notified Texas that this year I want a seat that they don’t deserve. We are three seats short for the population of dues paying members in our Federation than we should be. Texas is one long. Ohio is one long and Florida is one long and I want those seats for our people. We are all dues paying members and we should have equal representation. So, I already notified Texas that this year I want that seat, and Ohio has agreed to give me that seat next year at this time. So, I’m building our Federation. We are going to get up to the point where we have the 40% of the Board of Trustees we are entitled to. Right now we have 28% of the Board seats and 40% of the dues paying members, so we are correcting that and this year we will have two people from our Federation going onto the Board - one of them to replace Darryl Beehler who is in our Federation and we are entitled to that seat. The other one is the seat that I want Texas to give us, which they don’t deserve in which we do. I think my ascension to the presidency is 99.9% because of who I am and what I did in the House and my interaction with members of the House and Delegations from other states. I pride myself in my integrity. When I tell somebody something I mean it. I don’t say spurious things. I don’t tell lies. If I tell them I’ll do something, I’ll do it. If I tell you that I’m unhappy with something you are doing it’s because I don’t want it to come from somebody else. I tell you personally what I think of you. And I think that integrity came through to the people I was dealing with.
Dr. Seffinger: What did you accomplish as President?
Dr. Krpan: Well, my theme was keeping our people within the profession. I guess there were a couple of other issues. I tell you what, I’m going to get out the speech I gave when I left the Presidency and I’ll share it with you and I will tell you everything I did. I have a document on that. I’ll make that available to you. You know I got up in front of them and said, “I told you I was going to do this and I did it.” The big thing was the Patient’s Bill of Rights and I actually met with President Clinton for ten minutes in the White House on that and the big disappointment to me during that year was we couldn’t get it through the Congress of the United States; that Norwood-Dingle bill because managed care was taking advantage of patients and physicians and we went to Capitol Hill to get the Patient’s Bill of Rights passed. It didn’t happen and ultimately they did pass some legislation, but it wasn’t the Norwood-Dingle bill and it didn’t have the clauses, all of the clauses, that we’d like to see in a Patient’s Bill of Rights.
Dr. Seffinger: Is the AOA now interacting along side with the AMA and is the OPSC interacting along side now with the California Medical Association? Is there a bury-the-hatchet type attitude now in terms of these two...?
Dr. Krpan: It’s significantly better than it ever was. It’s getting better all the time. Medicine’s changed, you know, it’s us as physicians against all the rest of them out there: Medicare; Medicaid; Third-party payers; hospitals; and physicians are taking it upon the chin. They are paying you less and expecting you to do more. And so we are finding that as physicians, MD or DO, that we have the same plights and we are supporting each other in a lot of those and you know the Patient’s Bill of Rights is one of them. They were very supportive of that also. Reimbursement issues, we are working together on credentialing and privileging issues, we are working on, and particularly when you talk about third-party payers you know they really had their way at one time. They had gag clauses regarding physicians. If you said anything contrary to the policies of the company they would take away your patient population. They did that to a number of physicians, left them broke and wondering what happened. A lot of that’s gone away now and it’s because we are working together with the allopathic physicians for the betterment of all physicians. There are still threats, you know, I alluded to one of them, I’m sure that at the allopathic level they would like to still see one medical profession in this country. They made it clear to us a number of times at the Federation of State Medical Licensing Boards that most of them would like to see one examination for licensure of physicians in the United States and that’s the USMLE (United States Medical Licensing Exam) and we have steadfastly declined to allow that to happen. We want our own National Board of Osteopathic Medical Examiners giving exams to our graduates and students. And there are still some threats, but they are less noxious than they were in the old days. A lot of the prejudice has gone away. I was before the legislature one time, I told you we went up there because we had that chink in our Practice Act. Matt Weyeuker and I were sitting in front of this panel and this one Senator said, “Doctor,” he said, ‘Isn’t it true that your students train with allopathic students in hospitals?” I said, “Yes, Senator, that’s true.” He said, “Well, isn’t it true, doctor, that when they graduate they go into residencies and internships together?” I said, “That’s true Senator.” And then he said, “Isn’t it true, when they are all done with their training they go into practice together?” I said, “That’s true.” He said, “Tell me doctor,” he said, “Why do we need two licensing boards in this state.” I said, “We don’t Senator. When the allopathic physician becomes competent in everything that we do, we will be happy to license them.” He said, “That’s it, pass the bill.” And they passed the bill and changed our Act. There was another time when I was before them and he said, it was regarding this same thing, you know, the issue was the CMA told us that they would not fight us on this and then when we got to the Senate Subcommittee a representative of the CMA said, “Well, why shouldn’t they be allowed to take an MD degree if that’s what they want?” And I said, “I have an answer for that.” And he said, “What’s that doctor?” I said, “Well, the gentlemen who is standing in the back of the room saying now that you would give a DO a license if he requested it, I think that’s what I’m hearing him say, and you know what, I graduated from medical school in 1967. I came here and I asked for a license, and that was during the blackout years, and they told me I had to be a graduate of an accredited medical school to get a license in California.” I said, “I am a graduate of an accredited medical school.” My question to that man in the back of the room was, “What’s different about me today from what I was then? When I was a graduate of the same school he wouldn’t give me a license now he is saying he will give me a license? Tell me what is different about me.” Senator Green, who was carrying the bill for us said, “I move this bill...” and there was another Senator sitting in front of me who said, “I move this bill, you owe me a vote and I want it right now” and of course it went through, but you know there were threats. The CMA was present and told us they wouldn’t fight our bill, but they still said, “Well, if they wanted an MD degree why shouldn’t they be able to get it.” You know a lot of things happened over the years. I don’t think it’s as overt anymore. I think that because younger people are training together, they’re working together, there’s less of a prejudice and bias against our profession that existed before, but, you know, I couldn’t get licenses and practice privileges in a hospital in Texas. And I have to tell you that when I went through that hospital, there were only three patients. I was the only doctor in the County and I had 16,000 patients. I averaged 30 patients cared for in a hospital in Houston all the time because I was the only doctor there and I had to transport them 70 miles to go to that hospital [that accepted me on staff]. It was an exciting year for me. It was a big decision to leave there and fortunately there was a young fellow who had just finished his training...I told the hospital I wouldn’t leave there if I didn’t find a doctor to come in, and there was a young fellow from Beaumont, Texas, which is not that far away, who came through and asked me if there is a chance he could work for me and I said, “How would you like to have the practice?” and I gave it to him. He’s still there, a little town called Shepard, Texas.
Dr. Seffinger: Okay. So obviously you still think that there is a need for a separate profession that the osteopathic profession has something to offer that the medical or the allopathic profession does not have. Can you articulate that in a short paragraph that says what does the osteopath profession have to offer to the American public and why it should continue to exist?
Dr. Krpan: You know that question was a lot easier to answer when 70% of our people went into primary care, because we were offering something that the other side did not offer - 95% of their people are in specialties and there is a need for that primary care physician. We are seeing a change in that now. We are seeing more and more of the patients being transferred to Pas (Physician Assistants) and nurse practitioners for that primary care component. I think that there’s still the majority of DOs in primary care. I think we do train them to be more touchy-feely caring physicians than they have in the allopathic world. I believe that with all my heart and I think even the ones who leave our schools and go into allopathic programs are imbued with that philosophy because we really hit them hard on it within the first two years. Hopefully they are not losing it, but I think as long as we are espousing that patient-centered care in our schools that there’s a need for that second profession extension.
Dr. Seffinger: What advice do you have for future allopathic physicians in training?
Dr. Krpan: I’m not qualified to advise them.
Dr. Seffinger: Anything about osteopathic medicine that they should know about?
Dr. Krpan: Oh I think we are seeing a trend in allopathic physicians in this country and abroad; they have become more interested in our hands-on techniques and I’d like to see more of them take advantage of that component. I think it develops a couple of things. Number one – a more touchy-feely physician on their behalf and number two – a respect for what it is that we do as physicians when we have more MDs out there learning some of our skills. It’s going to eliminate some of that bias that exists.
Dr. Seffinger: Should allopathic students think about practicing and working with osteopathic physicians?
Dr. Krpan: Oh, you know that situation is here. Our physicians and their physicians are working side by side everywhere right now. The Chairman of the Department of Anesthesia and a past President of the College of Anesthesiologists, I’m talking about the American...the Allopathic College of Anesthesiology, chaired the department for Mayo Clinic, in Rochester, is a classmate of mine. My best friend in school was an anesthesiologist at Ohio State University. Our physicians are working side by side with their physicians. We have our philosophy and our hands-on care to offer. I think as long as we have that there’s a reason for us to remain separate. Beyond that a lot of what they do in those settings that they are in is identical. It’s a tight rope or walk as a profession and we need to maintain our people, loyal stances within the profession and protect the privileges that we have to practice as DOs.
Dr. Seffinger: One final question, who else do you think we should contact that you think was instrumental in the historical development of osteopathy in California?
Dr. Krpan: There were a lot of people that came about the time I did, of course. I think Phil Pumerantz is someone you should interview because he has a school, has a lot of graduates. Norm Vinn and Gary Graham were early on. You know they came after me, but they are early contributors to the growth. Gary Graham is very knowledgeable. Norm Vinn is smart as a whip and I think they can contribute something. Norm was involved with a post-doc program at Pacific Hospital in Long Beach, had students in his office all the time. Gary was our Executive Director for the State Association two different times. Really helped us out when we got financially embarrassed. If you could, I think a lot of legislative stuff and the inner professional stuff, the industrial commission, the legislature aspects, if you can get Matt Weyuker’s input, I think it’s critical and that’s about it.
Dr. Seffinger: Great. Thank you very much. Anything else you want to add or have we covered everything we could?
Dr. Krpan: No. I think what you are doing is a great thing. I’d like to see the final product when it’s done.
Dr. Seffinger: And you will. One of the things that we will do is when we put it all together, we will give it back to all the people that were involved who wants to see it, will be approved again by everybody so that you will have a chance to see not only your transcript and change it in any way you feel you need to before you approve it; and then again when we will edit that down and give everyone a chance to work with it. That will all be within this year, so...