Conversion of all DO degrees to MD, and ending separation of medicine

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Conversion of all DO degrees to MD, and ending separation of medicine


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Brany

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As long as medicine has existed, it has had one main focus and that has been summarized in enhancing the well-being of humans. Undoubtedly, AT Still had the same exact intention, and put his efforts in every way based on his abilities to contribute to the well-being of his patients at the time. As we all know, medicine since its inception has been growing based on the contributions of many dedicated physicians such as AT Still; nevertheless, not every new discovery and precious idea in medicine has lead into a new branch, title, and/or “philosophy” in medicine. The rationale behind this trend has been due to the sole intention of medicine as aforementioned, the enhancement of one’s quality of life positively; therefore, new ideas and discoveries that can contribute to this goal are welcomed to be incorporated into the everyday practice of medicine by ALL doctors and not as sporadic branches of healing clubs that may be seen in traditional practices of medicine in various cultural societies or tribes.
The organizations representing osteopathic physicians speak of “distinct philosophy” of holistic approach to patient care that can contribute a lot more to the overall well-being of patients; well this is an excellent discovery that should be now taught at every medical school in the world, so doctors regardless of their choice of specialty would be able to learn the exact protocols organized in this patient-centered approach of practicing medicine for the well-being of their patients. It would be unfair that only those patients that visit the 5% of all physicians in the US can get such “especial treatment” based on this valuable “philosophy”.
Furthermore, I would not like to get into the discussions of the validity of OMM as I have already expressed my genuine opinion pertaining to this matter elsewhere on the SDN. However, let’s say that OMM is an excellent tool in practicing medicine that can be incorporated into every physician’s practice. Well, shouldn’t this precious tool also be offered to all future doctors in every medical school, so all patients in the future can benefit from what this practice can do for them? Do you think that it would have been a good idea that every new tool and treatment in medicine that was creatively invented would have lead to a new branch of medicine, title or philosophy? I would say no, even if an approach in medicine is not initially welcome in the filed whether because of the lack of understanding of the healthcare professionals at the time or the lack of evidence in the benefits of this new approach, it doest not necessitate a professional practicing physician to isolate himself from the medical community and create a new institution of medicine with his own philosophies and practices. Perhaps, a better approach that can eventually contribute to all patients is to put even more efforts to convince the medical community of the valuable benefits of this new practice/ treatment as many other great scientist and physicians have done so in the history.
I hope you do not misinterpret my personal opinion on the subject as I do not intent to insult any of you and your sincere efforts in helping people in the future. All physicians regardless of their title are in this profession for the meanings found way beyond a two letter title after one’s name. DO’s alongside MD’s have been working very hard for the valuable goals that medicine has been offering to the well-being of all patients. DO’s are undoubtedly very competent physicians in every field of practice in medicine. Subsequently, my above proposal is not to compare the competency of practicing DO’s and MD’s, whereas, I am truly concerned whether this separation is really necessary.
My proposal:
1) All schools in the US offer the same degree, MD, that has been offered globally for centuries in the past
2) Patient-centered and holistic approach in medicine should be more emphasized at all medical schools
3) Some techniques of OMM that have been scientifically proved to be beneficial to patients start being offered at all medical schools, and for those who are TRULY interested in learning all techniques of OMM, a year of fellowship should be offered at some schools, so students can actually learn all the techniques more thoroughly without being under pressure of coursework while in school.

Please feel free to express your opinion professionally without intending to insult anyone or any profession. The main intent of this thread is to have a constructive exchange of ideas on a very sensitive subject, as I am sure that as future physicians we would have to deal with many sensitive subjects which may necessitate us to express our opinion. This may be a good practice!

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why not convert all MD degrees to DO?
 
why not convert all MD degrees to DO?

cause MD stands for medical doctor.. that is a doctor that practices Medicine. now some smart a$$ is going to jump in and give me the right latin term.

Not to mention they are the majority... not to mention people will get more confused... not to mention who cares
 
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By the Brany.. definitely doesn't stand for BRAINY.

Its suppose to be a private poll not one that shows peoples individual VOTES. :smuggrin:
 
Im not exactly for an DO to MD change but rather a DO to MDO. Which would make since. we do not become "doctors of osteopathy" anymore, but "doctors of osteopathic medicine"
 
Based on BRANYs argument (which I largely agree with) it doesnt seem that changing the DO title to MD is the answer, but rather spreading the education of the osteopathic philosophy (OMT included) to our MD counterparts.

Why change the degree if the fundamental issue is lack of comprehensive medical care being taught uniquitously? The letters at the end of the name is not what separates us.

If all MD school started learning these treatments then, it seems, they are conforming to the osteopathic model. So you suggest that WE change OUR titles? Seems counterintuitive.

As it stands now any DO will have a comparable education in the way of standard medical practice as any MD, but we are learning additional treatment mdoalities.

I feel the future of medicine will be a more patient-involved and comprehensive model (I hate the word holistic), but again...the problem is in the education of physicians as a group, not in the letters behind the name.

Besides...as it stands now I get more positive feedback from patients than I used to. I am finding less and less "what is a DO?" and finding more and more "oh...youre a DO" followed by only positive reaction. I imagine this comes from weaning away from the pre-med bias and realizing the real world doesnt share the same reservations as wannabe docs.
 
Based on BRANYs argument (which I largely agree with) it doesnt seem that changing the DO title to MD is the answer, but rather spreading the education of the osteopathic philosophy (OMT included) to our MD counterparts.

Why change the degree if the fundamental issue is lack of comprehensive medical care being taught uniquitously? The letters at the end of the name is not what separates us.

If all MD school started learning these treatments then, it seems, they are conforming to the osteopathic model. So you suggest that WE change OUR titles? Seems counterintuitive.

As it stands now any DO will have a comparable education in the way of standard medical practice as any MD, but we are learning additional treatment mdoalities.

I feel the future of medicine will be a more patient-involved and comprehensive model (I hate the word holistic), but again...the problem is in the education of physicians as a group, not in the letters behind the name.

Besides...as it stands now I get more positive feedback from patients than I used to. I am finding less and less "what is a DO?" and finding more and more "oh...youre a DO" followed by only positive reaction. I imagine this comes from weaning away from the pre-med bias and realizing the real world doesnt share the same reservations as wannabe docs.

MD's are superior because they don't have to do cranial

then again, they don't get to feel up their female classmates for 2 years.

Palpating old people during third year makes DO's and MD's equal again...
 
Im not exactly for an DO to MD change but rather a DO to MDO. Which would make since. we do not become "doctors of osteopathy" anymore, but "doctors of osteopathic medicine"

The DO to MDO (or OMD) is currently being debating by the students at my school. Not to actually change, but assesing interest in a change. So far it has been a split vote with a small margin in favor of changing.
 
The DO to MDO (or OMD) is currently being debating by the students at my school. Not to actually change, but assesing interest in a change. So far it has been a split vote with a small margin in favor of changing.

I only stated this because the original DO (Doctor of Osteopathy) is no longer trained in this country but in England. So maybe a change to distinguish us from that.
 
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I wouldn't necessarily be opposed to the change, but only because "DO" nowadays doesn't mean anything more than confusion if the patient looks at your ID badge or insignia and sees you're not an MD. I don't know HOW many times I've been asked, "what is osteopathic?" or "what's a DO?", and I've only been on rotations a few months.
Not beacuase I have a problem with the initials of "DO", but because DO--on the national level--doesn't MEAN anything more or less than "Doctor", so who cares if it's 'osteopathic' or 'medical'. "Osteopathic" implies the basis of our practice--our medical skills--resides in osteopathy, in dx and tx that are based on osteopathic principles, which--as I've said before--are common knowledge talking points in medicine. The only difference is the accrediting agencies that license our schools and standardized exams.

Unless, of course, you're the AOA president and you want to lower the standards of DO school admissions as long as they're TRULY interested in osteopathy...

Bottom line: yes, we get some valuable musculoskeletal training / education, but does that mean we should have a monopoly on musculoskeletal educaiton, or that MDs need to better theirs? Two years of didactics do not make for a lifelong distinction.
 
If youre any good at OMT it does.

Oh bull crap.
There's nothing that OMT provides that a combination of chiro and PT couldn't.
And again, I'll mention that any MD has the POTENTIAL to learn and consequently bill for OMT if he / she so chooses.
 
why should you have to seek two seperate treatment modalities (chiro and pt) when it seems that the counter to that argument is that a DO can proverbially kill two birds with one stone.

and about cranial. get over it already. you are in an osteopathic school, its going to be taught, suffer through it and then when you do whatever it is you practice then dont ever touch cranial again.

what is the big f'ing deal?
 
Yea, I'm like Vonage: one rational voice among many many stupid ones.

If you say so. No use arguing with you. Better to just nod, smile and move on.

:D
 
My only question is how will we be able to distinguish ourself from the MDs if all of the allopathic schools started teaching OMM. Some of the allopathic schools have already started teaching OMM.
 
why should you have to seek two seperate treatment modalities (chiro and pt) when it seems that the counter to that argument is that a DO can proverbially kill two birds with one stone.

and about cranial. get over it already. you are in an osteopathic school, its going to be taught, suffer through it and then when you do whatever it is you practice then dont ever touch cranial again.

what is the big f'ing deal?

well, chief, some of us have principles (and complacency--which is what you have if you would just as soon accept something than have an informed position--isn't a principle).
 
My only question is how will we be able to distinguish ourself from the MDs if all of the allopathic schools started teaching OMM. Some of the allopathic schools have already started teaching OMM.

few patients will seek you out because you're a DO, and if they do, they're seeing you for the wrong reason, visiting you on some false pretenses that you're a better doctor because you're a DO. Your patients should want to see you because you're a good doctor, not because your initials are different.
 
And your answer: who cares. few patients will seek you out because you're a DO, and if they do, they're seeing you for the wrong reason, visiting you on some false pretenses that you're a better doctor because you're a DO. Your patients should want to see you because you're a good doctor, not because your initials are different.

What I meant to say is that the difference between a DO and an MD is the teaching of OMM, but if allopathic schools started teaching it, then we are all the same. I never meant to say that DOs are better than MDs or visa versa. And you are correct. Pateints should be seeing me because I am good doctor, not because of my initials. :)
 
Oh bull crap.
There's nothing that OMT provides that a combination of chiro and PT couldn't.

OMT provides ME with revenue...rather than send the $$ to the chiro or the PT.

Why should I send back pain patients elsewhere for treatment when I can do some effective OMT in under 5 minutes. Then have the insurance pay me the additional $62 for my 5 minutes of work. Not to mention the added qualifiers because now I can take the time to instruct the patient on proper exercise and stretching.

So I can bill an additional $100...instead of the patients insurance paying twice that for a single chiro visit or PT session.

Seems like it helps me ($), patient (effective, immediate, convenient, safe treatment) and the insurance company (less $$ spent).

A typical FP can make an additional $20,000/year by doing ONE technique on only THREE patients per day (~ 1 hour/week of time). So youre not "shotgunning" and doing OMT on everyone...just a few patients here and there when it is most appropriate.

I dunno...seems like NOT using your OMT skills is the dumber of the two options.
 
just when i thought pre-osteopath couldn't get sink any lower...

thank you, folks, for this thread. it's a great reminder.
 
just when i thought pre-osteopath couldn't get sink any lower...

thank you, folks, for this thread. it's a great reminder.

:confused: :confused: :confused:
 
OMT provides ME with revenue...rather than send the $$ to the chiro or the PT.

Why should I send back pain patients elsewhere for treatment when I can do some effective OMT in under 5 minutes. Then have the insurance pay me the additional $62 for my 5 minutes of work. Not to mention the added qualifiers because now I can take the time to instruct the patient on proper exercise and stretching.

So I can bill an additional $100...instead of the patients insurance paying twice that for a single chiro visit or PT session.

Seems like it helps me ($), patient (effective, immediate, convenient, safe treatment) and the insurance company (less $$ spent).

A typical FP can make an additional $20,000/year by doing ONE technique on only THREE patients per day (~ 1 hour/week of time). So youre not "shotgunning" and doing OMT on everyone...just a few patients here and there when it is most appropriate.

I dunno...seems like NOT using your OMT skills is the dumber of the two options.
well, let’s do an experiment (seeing as you want to make this about money): you see as many patients as you can in a day and do OMM on 1/3 of them (on top of their presenting problems), and I’ll see as many patients as I can without doing OMM. I can guarantee you who will come out ahead.

1. that’s the reason many patients come to you for OMT, because they don’t want to pay out of pocket for chiro or massage therapy; I fail to see how that’s a good thing from the standpoint of the current problems with medicine / insurance.
2. what actual BENEFIT are you doing to those additional 3 patients per day, other than lining your pockets with more cash? so every kid who has resp problems should get some rib raising? The whole “it can net you more income” argument is rather pathetic. first off, it doesn’t look good; second, are you really providing something other than temporary relief of symptoms, particularly when studies show that OMT is no more efficacious (if not less) than Tylenol for temporarily relieving pain?
I always loved the “it will boost your income” argument…really provides a great argument for incorporating OMT into your practice.
 
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well, let’s do an experiment (seeing as you want to make this about money):

Unfortunately the one thing that medical school does NOT do well is teeach young physicians about the financial aspect of things. As altruistic as you want to be, you need to pay back loans and make a living. I never turned this into a pissing contest about who can make more, but yes...I did point out the financial benefit to providing additional care to your patient.

you see as many patients as you can in a day and do OMM on 1/3 of them (on top of their presenting problems), and I’ll see as many patients as I can without doing OMM. I can guarantee you who will come out ahead.

Not you. What are the most common complaints to a FP office? Because you are only a third year let me help you out. MSK pain, URI, HA top the list.

Now...how long does it take the average DO to do OMT? FOREVER. Why? Because they arent good at it. I can diagnose and treat a segment in 15 seconds. I can provide OMT for URI in less than 2 minutes and treat LBP (lumbars and innominates) in under 5. All while I am gathering more information about the patient. Im not doing cranial ro any techniques that will slow me down. I have worked in offices that run through 40 patients a day where 80% of the patients get some form of OMT whether it be lumbar HVLA or cervical ME. It only slows those DOs who arent good at it. Those of us who are proficient make it part of the visit, not make it "extra time".

1. that’s the reason many patients come to you for OMT, because they don’t want to pay out of pocket for chiro or massage therapy; I fail to see how that’s a good thing from the standpoint of the current problems with medicine / insurance.

Chiro and PT are indeed covered by insurance. Massage for non-therapeutic reasons isnt. So when are they going to pay out-of-pocket? When they want their backs rubbed. When they present with LBP or other complaints where manual therapy is indicated their insurance will pay the bill regardless of who does it. It might as well be me...a licensed, trained physician who can integrate other aspects of their medical care into my treatment plan in order to prevent certain conditions from being chalked up to "just back pain". Seems like I'm looking out for my patients...not just turfing them to a PT or chiro.

2. what actual BENEFIT are you doing to those additional 3 patients per day, other than lining your pockets with more cash?

Run a few keywords through OSTMED and take a look at the research yourself. I dont need to hold you hand with that one.

so every kid who has resp problems should get some rib raising?

Rib raising, thoracic pump, thoracic HVLA, cervical HVLA...along with their regular regimen of inhalers and oral meds (albuterol, singulair, zyrtec). I can treat the child while talking to the parents. The child feels better right away and the parents have a better sense that I know what I am doing and that I care about my patient.

The whole “it can net you more income” argument is rather pathetic. first off, it doesn’t look good;

Who am I trying to "look good" for? I am sure every person who enters medicine has at least SOME altruism, but the reality is that medicine is still a career and that we as physicians must get paid for our services. Have I mentioned anything about taking advantage of the system, false billing or charging patients for serviced non rendered? Nope. Have I mentioned anything about the almighty dollar being more important than the benefit of OMT? Nope. Have I said once that I do OMT on my patients simply for the financial benefit? Not at all.

Quite simply the more common reasons that many DOs dont do OMT is because they say there is lack of time (untrue if you are well trained as I stated above) and they dont know how to get paid for it.

second, are you really providing something other than temporary relief of symptoms, particularly when studies show that OMT is no more efficacious (if not less) than Tylenol for temporarily relieving pain?

True...there are some studies which show that OMT is no more beneficial than NSAIDs for certain types of MSK complaints. There are also studies that show quite the opposite. There are quite a few studies that show OMT being beneficial in decreasing hospital stay, increasing ambulation postoperatively and decreasing postoperative pain. So OMT is not just an out patient modality. If you do a thorough search of the literature, which I am quite sure you havent (most DO students are unaware of the literature...if its not shoved in their face, they dont look for it. typical medical student attitude regardless of the topic), you will see that not only has OMT been shown effective in MSK complaints and in outpatient settings, but has had benefits in the surgical, orthopedic, obstetric, pediatric and pain management fields.

Again...you have to look at ALL the literature. Not just the 3 studies posted at quackwatch.org. Also be sure to look at journals from Britain, Sweden, Germany and Australia regarding manual therapy...thsoe countries have great government funding for clinical trials.

I always loved the “it will boost your income” argument…really provides a great argument for incorporating OMT into your practice.

In my experience this is often the only way to get some of the students in OMM lab interested in learning it. And if I can get them practicing and reading by peaking their financial interest, then hopefully when they go out into practice (or at least on rotations) they will have spent enough time learning it in lab to not hurt someone.

I make no apologies for promoting the financial benefits to providing OMT. It would be irresponsible of me NOT to be financial prudent and have a practice with 2,000 patients who depend on me to keep my doors open and 5 employees who depend on me to pay their salaries...not to mention pay back government issued loans and provide for my family. Its not selfish, is self preserving.
 
I don't always agree with your arguments JPHazelton, but I love that you know your stuff and can convey it in a level headed and logical way. Much respect sir! :thumbup:
 
The organizations representing osteopathic physicians speak of “distinct philosophy” of holistic approach to patient care that can contribute a lot more to the overall well-being of patients; well this is an excellent discovery that should be now taught at every medical school in the world, so doctors regardless of their choice of specialty would be able to learn the exact protocols organized in this patient-centered approach of practicing medicine for the well-being of their patients. It would be unfair that only those patients that visit the 5% of all physicians in the US can get such “especial treatment” based on this valuable “philosophy”.

Excellent point! Everyone should become a DO!

The way I see it is something similar to the California Merger, but in reverse. For example, the American Academy of Osteopathy can set up courses across the nation (based mainly at the individual DO schools, but also at physicians's clinics in the event schools are not available nearby). Every licensed US MD is welcome to register for OPP courses. The MDs will be taught how to talk to patients for more than 5 seconds, how to be nice to nurses and staff, osteopathic manipulation techniques, and clinical medicine (how to integrate all above aspects in a clinical setting).

After a year or so, if successfully completed, the MD will qualify to receive a DO degree. Like in the Shaolin temple, where you burned a dragon on your forearm after graduating, when MDs graduate from the course they must tattoo the "Ram of Reason" on their chest and a portrait of A.T. Still on their calf.

OK, it's almost 6:30 AM. Time to go vote! Remember, No on issue 4, Yes on issue 5!! (for those of you in Ohio)
 
I don’t always agree with your arguments JPHazelton, but I love that you know your stuff and can convey it in a level headed and logical way. Much respect sir! :thumbup:

You have to know what you are talking about...from personal experience...before you can have an intelligent debate. There is a difference between an informed person and a person with just an opinion. Unfortunately opinionated people are difficult to interact with because they wont back down and are usually looking to push buttons. Even when presented with evidence contradicting their statements and ramblings, they find ways to manipulate anothers words to make it seem like THEY are the correct ones...or they take the conversation in an entirely new directed based on one or two words you use (like above...any mention of money spurs an entire new response centered around that one word :rolleyes: ). Opinionated people are like the media...they will run with whatever they feel they can spin into the best story, regardless of what their experience with said topic is.

Again...if you are going to have a good debate that will bring about insightful information you have to know your topic...moreso than just labwork and readings. You need to have personal experience.

I dont know anything about Cataract surgery more than what I have seen in videos...so I stay out of the Optho forums. :p

Shinken...I like your idea. :thumbup:
 
...but isn't it not fair that DOs get to take the COMLEX instead of the USMLE? So, maybe a fair system would be to make all DOs who wanted to be MDs have to take and pass all USMLE steps and do an allopathic residency.
 
...but isn't it not fair that DOs get to take the COMLEX instead of the USMLE? So, maybe a fair system would be to make all DOs who wanted to be MDs have to take and pass all USMLE steps and do an allopathic residency.

Many DOs do take USMLE and a majority of DO grads go into allopathic residencies.

I took USMLE and I hope to enter a dually accredited residency (AOA and ACGME).

I dont see how that affects anything.

If you wanted to have the "MD" degree then you should have attended an Allopathic school. Simple as that.

Also...how is it "not fair"? I could see it being "unfair" if DOs were REQUIRED to take both tests, but they arent. Personally I think there should be only one set of board exams anyway...make everyone take the same test. As long as DO students achieved a certain "minimally competent" score on their OMM lab grades then there is no need to test OMM...I dont think you can test OMM well with written exam questions anyway.
 
well, let’s do an experiment (seeing as you want to make this about money): you see as many patients as you can in a day and do OMM on 1/3 of them (on top of their presenting problems), and I’ll see as many patients as I can without doing OMM. I can guarantee you who will come out ahead.

No reason for a new experiment because it's already been done, over and over. One of our OMT instructors is in family practice with a group of MD's. He's the only DO, AND he makes more than anyone in the group because of the OMT he does. He sees the same number of patients as anyone else, yet makes more-- a good bit more.
 
No reason for a new experiment because it's already been done, over and over. One of our OMT instructors is in family practice with a group of MD's. He's the only DO, AND he makes more than anyone in the group because of the OMT he does. He sees the same number of patients as anyone else, yet makes more-- a good bit more.

Exactly. This is not an uncommon occurrence.

What some DO FPs do is have a striclty OMM day every other week where they have their MSK patients come in on the same day.
 
You have to know what you are talking about...from personal experience...before you can have an intelligent debate. There is a difference between an informed person and a person with just an opinion. Unfortunately opinionated people are difficult to interact with because they wont back down and are usually looking to push buttons. Even when presented with evidence contradicting their statements and ramblings, they find ways to manipulate anothers words to make it seem like THEY are the correct ones...or they take the conversation in an entirely new directed based on one or two words you use (like above...any mention of money spurs an entire new response centered around that one word :rolleyes: ). Opinionated people are like the media...they will run with whatever they feel they can spin into the best story, regardless of what their experience with said topic is.

Again...if you are going to have a good debate that will bring about insightful information you have to know your topic...moreso than just labwork and readings. You need to have personal experience.

I dont know anything about Cataract surgery more than what I have seen in videos...so I stay out of the Optho forums. :p

Shinken...I like your idea. :thumbup:


Precisely. The only problem is that there seem to be an infinite number of the individuals that are ill informed and attempt to perpetuate their ignorance.

I also wanted to chime in with some more evidence of the financial advantage of OMT, even though it is anecdotal. I just want to preface that with whoever thinks that doctors shouldn't be concerned with money and purely driven by altruistic principals is a *****. If you're truly working to help alleviate your pts.' pains/illness/whatever, then why on earth wouldn't you take advantage of the skills that you have obtained??? These physicians are utilizing their skills and knowledge to better the lives of their pts., and if they make additional money (rather than outsource it to PTs or Chiros) via this skill base, then what is wrong with that?

That being said, the DO that I shadowed back home worked alongside a few other MDs, and they routinely referred their own pts. to him for OMT. I honestly don't know how much I'll end up using OMT (depends on what field I go into) in the future, but how can you say that he is not at the advantage there???

Sorry for the length.
 
Based on BRANYs argument (which I largely agree with) it doesnt seem that changing the DO title to MD is the answer, but rather spreading the education of the osteopathic philosophy (OMT included) to our MD counterparts.

could you imagine what MDs would think of osteopathy if they had some of our cooky OMM instructors...............
 
well, let's do an experiment (seeing as you want to make this about money): you see as many patients as you can in a day and do OMM on 1/3 of them (on top of their presenting problems), and I'll see as many patients as I can without doing OMM. I can guarantee you who will come out ahead.

Let's say you both take 15 minutes per patient. You have scheduled 20 regular appointments (checkups) and 10 sick visits. (a typical non-hectic day for a PCP).

For the sake of argument, let's say all 20 regular appointments were similar, all level 3 established patient visits with no modifiers, so you all get paid the same (let's say you get paid $80 per patient, so 20 x $80 = $1600).

*fee for a level 3 established patient visit with no modifier (99213) was made up ... it differs from insurance to insurance.

Now, with the 10 sick visit, Josh does OMM for 3 of them (1/3 of the patients he sees). We are going to assume Josh didn't do OMM on his 20 regular checkup patients which he could have. For you, its 10 x $80 = $800 from the sick patient visit.

For Josh, 3 of his patients will get OMM so he codes 98925 for OMM on 1-2 body regions along with a -25 E/M modifier to his sick visit code. Let's say because of that, he gets an extra $40 (most insurance in Philly area pay more than that but it's a nice round number). So for him, it's 7 x $80 + 3 x $120 = $920

So net income for the day is
Josh with 3 OMM (only 1-2 body region per patient) and 27 regular patients = $2520
An MD who doesn't do OMM but sees 30 patients = $2400

Net difference of $120. In a 5 day workweek, that's $600. In 1 month (4 weeks), that's $2400. Assuming no work on weekend. So 1 month difference of income is $2400, which makes 1 year difference of income $28,800 (48 work week in a year). All for just doing OMM on 3 of his 30 patients that day.

*there are a lot of variables in determining net income, and a lot of assumptions were made ... the business of medicine is very very complex. Not only that but ICD-9 and CPT codes, reimbursement issues, chart audits, medicare/medicaid requirements, etc all factor into this debate. But as you can see, if insurance only pays $40 for OMM and you only do it on 1/10 of your patients a day, the extra income adds up.
 
Let's say you both take 15 minutes per patient. You have scheduled 20 regular appointments (checkups) and 10 sick visits. (a typical non-hectic day for a PCP).

For the sake of argument, let's say all 20 regular appointments were similar, all level 3 established patient visits with no modifiers, so you all get paid the same (let's say you get paid $80 per patient, so 20 x $80 = $1600).

*fee for a level 3 established patient visit with no modifier (99213) was made up ... it differs from insurance to insurance.

Now, with the 10 sick visit, Josh does OMM for 3 of them (1/3 of the patients he sees). We are going to assume Josh didn't do OMM on his 20 regular checkup patients which he could have. For you, its 10 x $80 = $800 from the sick patient visit.

For Josh, 3 of his patients will get OMM so he codes 98925 for OMM on 1-2 body regions along with a -25 E/M modifier to his sick visit code. Let's say because of that, he gets an extra $40 (most insurance in Philly area pay more than that but it's a nice round number). So for him, it's 7 x $80 + 3 x $120 = $920

So net income for the day is
Josh with 3 OMM (only 1-2 body region per patient) and 27 regular patients = $2520
An MD who doesn't do OMM but sees 30 patients = $2400

Net difference of $120. In a 5 day workweek, that's $600. In 1 month (4 weeks), that's $2400. Assuming no work on weekend. So 1 month difference of income is $2400, which makes 1 year difference of income $28,800 (48 work week in a year). All for just doing OMM on 3 of his 30 patients that day.

*there are a lot of variables in determining net income, and a lot of assumptions were made ... the business of medicine is very very complex. Not only that but ICD-9 and CPT codes, reimbursement issues, chart audits, medicare/medicaid requirements, etc all factor into this debate. But as you can see, if insurance only pays $40 for OMM and you only do it on 1/10 of your patients a day, the extra income adds up.

Exactly. This is a fairly realistic example. Now, you take a DO who did an additional +1 year in OMM, someone who was an OMM Fellow like myself or a DO who really put in the time and effort to learn OMM...your ability to treat quickly and effectively goes up. You ability to recognize the number of patients who can benefit from OMT goes up. And, of course, your reimbursement goes up.

It is not uncommon for a DO who uses OMT in his/her practice on a semi-regular basis (daily but not on every patient) and uses it appropriately...to make an additional $60,000/year over their non OMT counterparts.

As demonstrated with the above example all it would take would be an additioanl 2.5 hours PER WEEK of treating patients with OMT. Come in 30 minutes earlier every day of the week for $60,000/year? No problem!

One final word on the "money" issue that some people get upset with.

More revenue coming into an office means:

1. You can hire better trained office staff
2. You can purchase better medical equipment
3. You can afford larger accomodations to see more patients
4. You can afford to take much needed vacations ;)
5. You can afford to take time off from your regular office to do missionary work, volunteer, community work, etc

Lots of benefits...not simply lining the pockets of the "evil OMM doc". :D :D :D
 
Say someone comes to your office with a plain old cold. You spend 10-15 minutes getting a hx and doing an exam, making notes, writing scripts, being an amiable physician, dictating, and because you know you can milk an extra few bucks out of this visit (and because OMM tells you it’s warranted), you do some soft tissue, feel-good techniques. Now, that person gets over the cold in a week or so, used the cough syrup you rx'd, got some sleep, kept hydrated, and felt better. Convince me the OMT you did helped the patient get better compared to the 37 other times in his / her life he / she has had a URI and did just fine without the OMT…convince me that if the patient had to actually pay for the OMT (rather that just billing it to insurance), you still would have done it. The only one that benefits from such an example is you, coming out a few bucks ahead. Don't give me that Rube Goldberg "more money is better equipment is better patient care" crap.

Now something doesn't make sense: if all those DOs could be making more money and helping our patients more (as the past few posts seem to profess), why aren’t they? Why isn’t OMT utilized to a greater extent?

And don't give me this "medicine is a business" and "we've got loans to pay back" bull****. I’m as stressed as you that I’ll be paying back a quarter mil, but it's not like you'll be living in a cardboard box unless you bring home the extra 'ching' from OMT.

JP, your “come in 30 minutes extra per week for an extra $60k a year" is a far-stretched hypothetical. According to all your examples, EVERY FP doing minimal OMT should be making 200k a year minimum.
 
Now something doesn't make sense: if all those DOs could be making more money and helping our patients more (as the past few posts seem to profess), why aren't they? Why isn't OMT utilized to a greater extent?.

Because they're not good at it. Like any procedure, OMT takes practice-- hands-on practice. Those people who bitched, moaned, and complained about it all the way through med school and never really learned anything at all are not likely to practice it. They simply choose not to.

Just because they could be making more money at it is not a good enough incentive for them to really learn it. They could all be making a crapload of money by doing Botox injections, but they simply choose not to do that either. I know a few MD's making a killing off of Botox, though.

...your "come in 30 minutes extra per week for an extra $60k a year" is a far-stretched hypothetical.

No...it's not. There are DO's actually doing this right now. It's a very few, but there are some doing it and they are well compensated. But, these guys are good at it. They can make a diagnosis and finish a treatment before you or I can correctly adjust the table height. They spend some serious time perfecting their practice and it has paid off.
 
Say someone comes to your office with a plain old cold. You spend 10-15 minutes getting a hx and doing an exam, making notes, writing scripts, being an amiable physician, dictating, and because you know you can milk an extra few bucks out of this visit (and because OMM tells you it's warranted), you do some soft tissue, feel-good techniques. Now, that person gets over the cold in a week or so, used the cough syrup you rx'd, got some sleep, kept hydrated, and felt better. Convince me the OMT you did helped the patient get better compared to the 37 other times in his / her life he / she has had a URI and did just fine without the OMT&#8230;convince me that if the patient had to actually pay for the OMT (rather that just billing it to insurance), you still would have done it.
The only one that benefits from such an example is you, coming out a few bucks ahead. Don't give me that Rube Goldberg "more money is better equipment is better patient care" crap.

The patient benefits as well. According to the literature my patient WILL get better quicker and WILL likely leave my office feeling better. Just because you dont believe this to be true does not make it so.


Now something doesn't make sense: if all those DOs could be making more money and helping our patients more (as the past few posts seem to profess), why aren't they? Why isn't OMT utilized to a greater extent?

PCOM FPs held a summitt on this very matter. 2 major reasons were brought up...
1. Lack of confidence in their OMT skills
2. Lack of knowledge on how to bill for the OMT

We are currently working with PCOM docs to rememdy both of these issues.

And don't give me this "medicine is a business" and "we've got loans to pay back" bull****. I'm as stressed as you that I'll be paying back a quarter mil, but it's not like you'll be living in a cardboard box unless you bring home the extra 'ching' from OMT.

Very true. Now take that same attitude to any other discipline and see how it flies...oops...it doesnt! Tell the owner of a car dealership "you dont have to sell more cars...youre not poor" or a lawyer "dont take on any more clients because you already have a nice house." Are you kidding me? If I can help patients MORE than docs who dont use OMT AND get paid more as well? No brainer.

JP, your "come in 30 minutes extra per week for an extra $60k a year" is a far-stretched hypothetical. According to all your examples, EVERY FP doing minimal OMT should be making 200k a year minimum.

Here is where you are wrong and where you are making assumptions.

I KNOW FPs doing this. My numbers above albeit hypothetical are modeled on real situations. My experiences with FPs who use OMT are just as stated above. This really is how things work.

You are ASSUMING that this isnt the case but I guarantee you havent spoken with any FPs who are actually doing this to see if I am indeed right. You are just telling me I am wrong, wiping your hands of it and waiting for me to write back.

Go out there and talk to these docs using OMT in their practice. Ask them if they bill for it. Ask them if they make more money. You will see that they do.

Dont just tell me I am wrong because it doesnt sound believable to you...thats no basis for an argument.

Time and time again I have provided solid examples. I have told you to view the literature. I have given you cases where FPs using OMT can benefit their practice. I have shown you the numbers. ALL based on clinical trials, anectdotal scenarios and numbers straight from the coding books yet you still try to argue against these points WITHOUT providing anything but your opinions and doubts.

You consistently deny what more experienced people have to say regarding the topic. You dismiss the facts about the numbers without having any knowledge of whether it is true or not and you continue to make the same bland factless statements.

I dont see how any competent medical student can have all of these things displayed in front of them and NOT say "gee...maybe I dont know as much about this as I thought."

When I dont know about a topic I take the time to research it...talking to people who know more and reading what I can find. You obviously havent done that, and until you do your responses will be your opinion and nothing more. The facts have been laid out. If you chose not to believe them then that is your issue and yours alone.

So stop running your mouth about your opinions and bring some numbers and facts to the table. Maybe then you will get more respect and credibility around here.
 
And by the way...it wouldnt take me 15 minutes to diagnose a cold. ;)
 
1.) I'm not saying there aren't people out there billing for OMT and making money off it...I'm saying it's not the norm, and that it's wrong (one of the many things wrong with this profession’s leadership).

2.) "You consistently deny what more experienced people have to say regarding the topic." ?
--Because you're a fellow and a few months ahead of me doesn’t make your logic any more valid. I'm not denying anyone's personal experiences, but there's no general truth to personal experience, only relativity, and your relativity is no more valid than mine. I'm talking as a matter of principle.

3.) "You dismiss the facts about the numbers without having any knowledge of whether it is true or not and you continue to make the same bland factless statements."
--What facts and numbers are you talking about?? For every pseudo-fact (I say pseudo because an AOA publication doesn't mean squat...the "official scientific journal of the AOA" is a joke) you can conjure up, there's a fact or pseudo-fact contradictory to it. The only "numbers" you've given me are the "I know a guy who makes X dollars" or hypothetical situations using 9th grade math to project potential income. Big deal. I can find an article in a CAM journal saying immunizations cause autism, but it doesn’t mean anything if their logic / methods / sample size / results / etc… are flawed, or—as is the case with many AOA ‘journal articles’—the discussion / conclusion is ambiguous.

4.) "I dont see how any competent medical student can have all of these things displayed in front of them and NOT say "gee...maybe I dont know as much about this as I thought."
-- Talk about arrogant. And mature...the 4th year starting a pissing contest with the 3rd year because he's got 1 year on him. I'm impressed.

5.) "When I dont know about a topic I take the time to research it...talking to people who know more and reading what I can find. You obviously havent done that, and until you do your responses will be your opinion and nothing more. The facts have been laid out. If you chose not to believe them then that is your issue and yours alone."
--WHAT FACTS???!?!? All you've given is hypothetical situations and personal stories about a doc you know. BIG DEAL! Saying "there are studies that say ..blah..." doesn't mean anything, particularly if it's one single study in a BIASED publication like the JAOA. Now, you go right on ahead and do your little rebuttal with journal references you spent a little too much time and effort researching, but it’s going to amount to nothing more than wasted energy (as I said in 3).

I don't particularly care about gaining 'respect' or 'credibility' to your standards, nor do I give a flying fart what loonies like yourself think… I tend to steer clear of complacent snobs. Using big words and talking down to people like you're some sort of omniscient osteopathic guru not only makes you look foolish and arrogant, it is a waste of time (as was the time I spent typing this response…but I’m a sucker for blog-battles).

How about I repost the meat of my last post, seeing as it was ignored:

Say someone comes to your office with a plain old cold. You spend 10-15 minutes (or in JPs case, about 5 minutes because he’s some sort of super student…) getting a hx and doing an exam, making notes, writing scripts, being an amiable physician, dictating, and because you know you can milk an extra few bucks out of this visit (and because OMM tells you it’s warranted), you do some soft tissue, feel-good techniques. Now, that person gets over the cold in a week or so, used the cough syrup you rx'd, got some sleep, kept hydrated, and felt better. Convince me the OMT you did helped the patient get better compared to the 37 other times in his / her life he / she has had a URI and did just fine without the OMT.
 
A 4th year knows TONS more than a 3rd year just starting in the hospitals. Remember this post a year from now. Take a look at how inexperienced you are with medicine now and compare it to how much knowledge you have gained as you start your 4th year. Take into account that JP is (was?) an OMM fellow and I'll take his well informed opinion based on experience over an average 3rd year's opinion any day (I'm just a 2nd year, but this is what all the 4th years have told me).

Oh, and there's nothing wrong with billing for OMM. It's a service a DO is providing. The fact that you don't believe in it means nothing to the rest of the world. There are patients who swear by it. Some of it is bs (cranial), other manuevers with a rational theory behind them can be effective (counterstrain, muscle energy). Even if you think it's effectiveness is due to a placebo effect (which i don't believe it is) - so what? It makes the patient feel better, has a medical/scientific theory behind it, so use it if you're good at it.

JP wasn't bragging - it takes a good experienced doctor 5 minutes or less to diagnose a cold.

Prove to me that the patient who had a URI for a week, started a Z-pack, and started feeling better 2 days later had a bacterial infection that resolved due to antibiotic therapy as opposed to a viral infection that took longer than normal to clear. Just because you don't have clear cut evidence written in stone doesn't mean you should withhold treatments that can potentially help, especially OMM, which in the hands of a good doctor has virtually zero risk of negative effects.
 
I'm a 5th year.

It has been proven time and time again that debting with homeboy is useless. He turns everything into personal attacks and namecalling.

I've brought the evidence and experience.

He has brought the bitching and moaning.

In the end your opinion means nothing to anyone but yourself.

I truly hope that someday you ascend to the level that you can be a mature, responsible physician and ask questions rather than force opinion. I hope you treat your patients with better respect and dignity than you treat people here. That, of course, will be more important as you cant hide behind the annonimity of a screen name.

I think the intelligent people reading this thread can see you for what you are...no sense in calling more attention to it.

Thats all I have to say here. See you all in another post.

:thumbup:
 
I like your strategy: throw, duck and run.
Again, you haven't given me any facts other than personal experience and hypothetical situations. I've repeated this about 3 times to no answer.
Don't give me this "i've proven it time and time again" garbage. Geez, this is ridiculous.

J15...the '5 minute' reference was to a hx, PE, dictation, rx writing, etc...no doc does all that in 5 minutes. Sure you can rush and prob'ly get it done in 5 min, not on avg. Gosh who cares...it's a mute point. You're focusing on 1 unimportant detail.

Critical dissent is differentiated from 'whining and bitching'; and I'm not namecalling--I'm defending myself from personal cuts by using personal cuts.

Arguing with me is no more pointless than arguing with you, or anyone else on this forum for that matter. It's a freakin blog--people express their opinions, not try to win hearts and minds.
 
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