Doing OMT on the side for extra income

[CanAmPremed]

So I'm in med school but was thinking about some ways to offload expenses during residency. I love OMT and am really good at it. So to all the DO residents out there do you know if its considered legal to practice OMT only, like at say gyms or what have you, and charge people for it during residency? Or do I have to wait until I'm boarded and licensed to charge for OMT.

I just figured there are osteopaths out there who are only trained in osteopathy doing that.

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[Shinken]

So I'm in med school but was thinking about some ways to offload expenses during residency. I love OMT and am really good at it. So to all the DO residents out there do you know if its considered legal to practice OMT only, like at say gyms or what have you, and charge people for it during residency? Or do I have to wait until I'm boarded and licensed to charge for OMT.

I just figured there are osteopaths out there who are only trained in osteopathy doing that.

You need a license to practice osteopathic manipulation in the US. I'm not aware of any "osteopaths" that are trained only in OMT (e.g. European DOs) doing just that in the US, although I'm sure they're out there.

So, bottom line: once you're a DO resident, after satisfying the requirements for a medical license of your particular state, you can obtain a medical license and moonlight. Moonlighting could involve urgent care work, nursing homes, OMT, etc. You must adhere to your program's rules for moonlighting. As a DO resident, if you perform OMT for pay on the side without a license that's illegal.

 

[heyjack70]

I haven't heard of any DO's doing this, but theoretically I don't see any reason you couldn't except your residency program might not approve it.

From a practical standpoint though it would probably be challenging to setup your own moonlighting clinic. You have to get insurance (malpractice, business, etc), office space, possibly staff, and business license. You are also obligated to be available for your patients in the off hours by telephone. Will you be taking call alone? And all this is on top of your residency obligations.

The concept off doing OMT in a gym makes it sound like your planning on treating people in with single treatment sessions and no followup. I've seen practice similar to this done by massage therapists in the local mall. But this sounds extremely atypical of an OMT clinic, and would potentially put you at risk for malpractice related to patient abandonment. Where you see a patient, which establishes a professional relationship, but then you are unavailable for followup care (what if you end your practice at the gym? You are responsible for referring your patients to other providers, laws vary by state). I would worry about being an innovator in this type of practice model while in residency.

If you could find a local DO in practice who would take you on as an employee that would probably be best. It would be much less complicated.

 

[Law2Doc]

...

The concept off doing OMT in a gym makes it sound like your planning on treating people in with single treatment sessions and no followup. I've seen practice similar to this done by massage therapists in the local mall. But this sounds extremely atypical of an OMT clinic, and would potentially put you at risk for malpractice related to patient abandonment. Where you see a patient, which establishes a professional relationship, but then you are unavailable for followup care (what if you end your practice at the gym? You are responsible for referring your patients to other providers, laws vary by state)...

the liability risk is a lot greater than just not providing follow up, actually. If you see a patient in a medical capacity, you are liable for everything a reasonable licnsed practitioner would have seen or realized. You may be looking at it as just doing a little OMT on the side, but the patients see it as getting a check up from a physician, and when you don't send every suspicious set of symptoms running to the ER or to get additional workup, you are committing malpractice. It would be hard, if not impossible for a non licensed person to get malpractice insurance. Additionally, doing procedures generally accepted as medical exposes you to liability for practicing medicine without a license, so doing OMT before being licensed or working outside of a hospitals training license umbrella might be illegal.

 

[Flopotomist]

when you don't send every suspicious set of symptoms ... to the ER or to get additional workup, you are committing malpractice. .

Uhm... as an EM resident, I hate this attitude. If your patient comes to you with a medical complaint, and you are a doctor, if it is not an emergency - work it up your darn self. I now return you to this thread...

 

[J-Rad]

the liability risk is a lot greater than just not providing follow up, actually. If you see a patient in a medical capacity, you are liable for everything a reasonable licnsed practitioner would have seen or realized. You may be looking at it as just doing a little OMT on the side, but the patients see it as getting a check up from a physician, and when you don't send every suspicious set of symptoms running to the ER or to get additional workup, you are committing malpractice. It would be hard, if not impossible for a non licensed person to get malpractice insurance. Additionally, doing procedures generally accepted as medical exposes you to liability for practicing medicine without a license, so doing OMT before being licensed or working outside of a hospitals training license umbrella might be illegal.

I disagree with this. While I think there are multiple factors not making the OP's OMT-on-the-side business all that viable, this isn't really one. If they were to set up some kind of OMT practice after acquiring a medical license (just to avoid that problem in this hypothetical) they are functioning as a subspecialist, not necessarily a primary care doctor (as long as they are not advertising themselves as such). While, yes, they would be required to send a person to the ED for emergent conditions (and would likely be liable for missing an emergent condition that should have otherwise been obvious), the OP would not have to work up every little suspect condition the patient might have if not related to the reason that the patient presented. For example, if they noted a suspicious mole on the patient's skin, OP would not have to work this up/refer it. They can merely tell the patient to follow up with their primary care provider.

I see a bigger problem being record keeping. Outside an established infrastructure (like setting up an OMT clinic in your residency hospital) how are you going to make, keep, and maintain medical records while also accounting for privacy concerns and other medico-legal issues surrounding record keeping (not saying this is an insurmountable obstacle, but may be an onerous process). As a subspecialist without any direct link to the PCP (such as being in the same hospital system using the same EMR, etc) you also should communicate your findings and treatment to the PCP-another possibly onerous aspect.

Uhm... as an EM resident, I hate this attitude. If your patient comes to you with a medical complaint, and you are a doctor, if it is not an emergency - work it up your darn self. I now return you to this thread...

See above.

 

[Law2Doc]

I disagree with this. While I think there are multiple factors not making the OP's OMT-on-the-side business all that viable, this isn't really one. If they were to set up some kind of OMT practice after acquiring a medical license (just to avoid that problem in this hypothetical) they are functioning as a subspecialist, not necessarily a primary care doctor (as long as they are not advertising themselves as such). While, yes, they would be required to send a person to the ED for emergent conditions (and would likely be liable for missing an emergent condition that should have otherwise been obvious), the OP would not have to work up every little suspect condition the patient might have if not related to the reason that the patient presented. For example, if they noted a suspicious mole on the patient's skin, OP would not have to work this up/refer it. They can merely tell the patient to follow up with their primary care provider.

I see a bigger problem being record keeping. Outside an established infrastructure (like setting up an OMT clinic in your residency hospital) how are you going to make, keep, and maintain medical records while also accounting for privacy concerns and other medico-legal issues surrounding record keeping (not saying this is an insurmountable obstacle, but may be an onerous process). As a subspecialist without any direct link to the PCP (such as being in the same hospital system using the same EMR, etc) you also should communicate your findings and treatment to the PCP-another possibly onerous aspect.



See above.

I think you guys misunderstood my post. I said the OP would need to work things up, or if he wasnt qualified, send them elsewhere. Elsewhere can be a primary care doctor or the ER. Ideally the former, but in cases where folks are going to be seeking out nonlicensed OMT at a gym or other non medical venue, they are less likely to be plugged in with a PCP. But if they are, sure, send them there after you ensure that they understand they have a problem and that they need to see a real doctor, not just some guy at the gym. I wasn't saying flood the ER with non emergent things, I was saying that as a non licensed individual you have no ability to work this up yourself, but have the duty to see it get worked up once you assume some semblance of care in a way they reasonably believe you have some qualifications. In cases where folks are looking for OMT at a gym as an alternative to actual healthcare they aren't going to have a PCP, and the ER is going to be the only place you can be assured an actual physician is going to work up the problem and thereby get you off the hook. Until someone does, you are basically F'ed. So yeah, you have the duty to send them "someplace" where they will get care, even for a concerning looking mole, if they reasonably believe they are obtaining some form of osteopathic healthcare by seeing you. In the screwed up US health system in most cases that's going to be the ED, even if we both agree that's an inappropriate place to work up non emergent things. To the OP its less about whether that's the right place and more about getting off the hook.

I disagree that the OP would be setting himself up as a sub specialist in a case where he is neither licensed nor boarded and is providing a service that is mostly performed by primary care generalist DOs -- it is reasonable for individuals familiar with OMT to believe you are seeing them in a generalist osteopath capacity. OMT is not the hallmark of any subspecialty. Nor can someone not boarded claim to be a practicing member of a subspecialty. Patients aren't going to have a good idea of where you draw the line in terms of what problems you are going to help them with and what you are going to willfully ignore. Patients would be understandably confused, and would have expectations in excess to what the OP would legally be allowed to provide. Which a judge and jury would be quick to find were reasonable expectations. The OP lacks the diagnostic skills of a full fledged licensed practitioner and is going down a route that will hold him to higher standards. Again he's not holding himself out as a fancy masseuse, he's holding himself out as someone practicing a form of osteopathic medicine. Along with that comes the concept that some portion of his patients are going to come out of that appointment thinking they just saw a doctor and that he would have mentioned to them if he had any concerns. Which is problematic until he is license and insured and adequately trained to do so.

 

[heyjack70]

If you are interested in moonlighting as a resident, there are lots of other options than doing OMT. You will probably make more money doing something else too. Make sure to ask the residents about moonlighting when you go on interviews because it varies significantly from place to place. Some places have absolutely none.

@Law2Doc. I think the OP was asking about moonlighting in residency, presumably after intern year and getting a full medical license. Without the full license it would be illegal to do OMT and get paid for it. And there are manipulation-only DO practices that do function as specialists and do not manage any primary care issues.

 

[Law2Doc]

...Without the full license it would be illegal to do OMT and get paid for it...

This.

 

[Sneezing]

This is a great idea.
1) get your full license
2) know your program's rules for moonlighting.
3) if there is no mention about opening your own practice, then ask and find out if they approve it. There are several residency programs that permit residents to open their own practices.
One example at MGH psych for PGY4s: http://www2.massgeneral.org/allpsych/adultresidency/program.htm
"Moonlighting opportunities and the ability to start a private practice are available to PGY-4 residents."
4) It is easier as others pointed out to use another docs place/practice, etc.
5) You won't be able to hold yourself as the specialty you are training in because you haven't completed the residency yet. So you will only be able to advertise as a general practitioner who is focusing on OMT.
6) you can easily say you will only do OMT and not be a primary care physician. However, as others pointed out above your medical background will hold you to greater expectations of working up a back pain that could be prostate CA mets...
7) EMR is easy. Use microsoft word or adobe. Have your fax be an internet based company and your phone be through skype. Then all you need is a good lap tap with mobile internet and a few hard drives to back up the medical charts. Even after you complete the residency you would still need to keep the hard drives with the charts for a certain amount of years. Different states have different requirements for how long records need to be kept.


That's a great idea, very doable, but contingent on your program directors approval. Best of luck.

 

[nitemagi]

This is a great idea.
1) get your full license
2) know your program's rules for moonlighting.
3) if there is no mention about opening your own practice, then ask and find out if they approve it. There are several residency programs that permit residents to open their own practices.
One example at MGH psych for PGY4s: http://www2.massgeneral.org/allpsych/adultresidency/program.htm
"Moonlighting opportunities and the ability to start a private practice are available to PGY-4 residents."
4) It is easier as others pointed out to use another docs place/practice, etc.
5) You won't be able to hold yourself as the specialty you are training in because you haven't completed the residency yet. So you will only be able to advertise as a general practitioner who is focusing on OMT.
6) you can easily say you will only do OMT and not be a primary care physician. However, as others pointed out above your medical background will hold you to greater expectations of working up a back pain that could be prostate CA mets...
7) EMR is easy. Use microsoft word or adobe. Have your fax be an internet based company and your phone be through skype. Then all you need is a good lap tap with mobile internet and a few hard drives to back up the medical charts. Even after you complete the residency you would still need to keep the hard drives with the charts for a certain amount of years. Different states have different requirements for how long records need to be kept.


That's a great idea, very doable, but contingent on your program directors approval. Best of luck.

I knew several residents in my old program (UCSD) who also opened their practice during 4th year. Sneezing makes good recommendations overall.