Future of Osteopathy

[Hedwig]

This morning, I heard an interesting opinion regarding the future of osteopathic medicine and I thought it would spark an interesting debate.

I'm a post-bacc student at NYIT, the school that NYCOM's part of. I was talking to a DO administrator there, told her I'm thinking of going DO, and asked for her impressions of the future of the field.

I found her opinion interesting. She told me that she predicts that by the end of the decade there will be no distinction between MD and DO. As you all know, the National Institutes of Health (NIH) is setting up the first ever federal OMM research center at TCOM. In light of this, I was given two scenarios:

1. The NIH will say, "Hey, OMM works great!" in which case all the allopathic schools will integrate it into their curricula; or

2. The NIH will say, "No, OMM doesn't work at all, it's just a placebo, it's about as helpful for neuromusculoskeletal problems as aromatherapy or those massage pads you can buy for $35.00 at The Sharper Image," in which case the osteopathic medical schools will stop teaching it.

Either way, she predicted that the major distinction between MDs and DOs will disappear.

So what do you think? I thought this was really interesting.

What I want to know is, If this indeed happens, will the DO schools still award the DO degree since MDs would, in effect, be doctors of osteopathic medicine as we now know them?

---

Members don't see this ad.

 

[pags]

As long as US allopathic medical schools stay competitive and keep their admission standards high, there will always be filled seats in osteopathic schools, no matter if OMM is scientifically proved beneficial or not.
The cold hard truth.

 

[Stillfocused]

I hope this does not turn into another one of those awful "Why not change the initials D.O. to M.D.?" threads that pops up here every few months.

This question has been settled by 125 years of history. A couple million bucks in NIH/AOA grant money is not going to change this either way.

If an individual is uncomfortable with the discipline's philosphy, principles, practice or degree, then he or she should not go to school for it.

 

[Fooman]

Well, I think she may be right. Seeing how the current trend is, that most DOs do not practice OMM in their field. Of course, this may be an ignorant statement based on the DOs in my area that I've come acrossed.

But if you think about it, if OMM gains more light, then it would make sense for allopathic schools to incorporate it into their training.

 

[einey]

Hedwig, there is more to osteopathic medicine than OMM, there is the whole philosophy difference in how the healing capacity of the human body works, it's a whole mind set that is different than allopathic medicine. Besides, the AMA already tried to take over the DO's several years back offering to convert the DO degree to MD, but the AOA said no, that they were seperate and distint. Maybe in the future we will be know as either MDA's or MDO's

 

[Stillfocused]

Here we go again.

This is silly!

Still being quite deliberate when he created the degree "Doctor of Osteopathy."

It is proud title and needs no revision.

Besides, any confusion that the public might have will certainly not be lessend by creating a whole new title. M.D.A.??????????????????????????

 

[einey]

Well actually StillFocused, MDA vs MDO might be a very workable solution. As DO's we are medical doctors. The title Medical Doctor of Osteopathy would focus the attention on the division of osteopathic medicine vs Medical Doctor of Allopathy. Most certainly it promotes the distintion and pride that is osteopathic medicine. In other words, it would raise people's awareness of osteopthic medicine.

 

[tlh908]

I knew very little about osteopathic medicine until August when I met a surgeon who was a DO. Since then I have been more impressed with osteopathy than MD's. What signifagance is there in the fact that DO schools continue to open and expand while the class size at MD schools stay the same. Could DO's some day overtake MD's? I am from Detroit and there was a day when the big three American car companies thought they had a lock forever on the American market. Could this same thing happen in medicine????

 

[pags]

Of course, I am not speaking for the AOA. However, I truly believe that one way to get DO notoriety is by flooding the market; so we have to be noticed by the sheer number. I believe there are somewhere around 650,000 MD's and 45,000 DO's in the US. A huge margin. The problem is that the AOA GME cannot keep up with the increasing number of DO graduates; thus keeping the relative number of residencies and open spots limited.

 

[boston DO]

i think the future of osteopathic medicine is very bright. i recently read that by the year 2010 the number of DOs will be doubled from the current level of 50,000. also we have two new schools being added and the possibility of more in the future. i do think it's a shame that more DOs don't use omm in their practice, but omm is only one component of osteopathy. it's the philosophy behind it that's key. the holistic philosophy provides the framework for how you practice medicine. so even though you don't use omm in your practice you still can be considered a true DO if you believe in the philosophy. the philosophy is what's going to ultimately distinguish us from md's considering there are already md's learning omm as we speak.

 

[gasrx]

The main question is where does the AOA plan to train this increase in osteopathic medical grads. The AOA barely has enough positions for half their graduates. Most of their training programs are small community based programs. I can not see how they can increase the number of graduates without increasing the number of quality GME. The key word being QUALITY Graduate medical education. Sound very irresponsible.

 

[Hedwig]

GME is, of course, an issue in and of itself, which will have to be addressed sometime soon. However, the fact is that MD growth is stagnant, and thanks to AMA accreditation rules, the prospect of there ever being another MD school is highly unlikely. DO growth is tremendous. The class sizes are increasing, the new VCOM is opening in 2003, and several new schools are in the works. Remember, in many parts of the country there is a severe physician shortage. Osteopathic medical schools are a great solution. Virginia, for example, needs primary care docs really badly, hence VCOM.

No, DOs will not "overtake" MDs anytime soon. There are still 16,500 new MDs graduating every year. At the same time, though, the number of MDs practicing medicine is shrinking as the baby boomers retire, while the number of DOs is going up. What is certain is that DOs will become increasingly known to the general public. Slowly but surely, osteopathic physicians are making quite a name for themselves. And despite the false MD premed objection, "It's easier to get into DO school, so they must not be as good," tons and tons of patients who don't believe that BS and who know firsthand the difference a DO makes are visiting DOs for every kind of medical care. The public doesn't buy into any of that prestige propaganda--the public just wants to get well--so I agree that the future looks very bright for DOs.

Anyone who's spent some considerable amount of time around osteopathic physicians knows that there's something very special there. My DO FP is every bit as good as my MD FP, but he's a much cooler guy and explains things to me in ways that I've never seen a MD bother to do. He treats me like a person, not a claim number, and actually involves me in the process of getting well! I really hope that there will always be a DO degree, seperate and distinct from an MD.

 

[deleted6669]

Hedwig- you rock dude!
ditto to all of the above.
if you end up attending pcom make sure you do an elective with milton soiferman, DO in south phily. he is a pcom graduate working in FP and uses OMM with many of his patients. I did a 3 month FP rotation with him in PA school and learned a great deal about FP in general and osteopathy in particular. best of luck-E

 

[pags]

Hedwig:
I agree and appreciate your last post except for one point. I've experienced on many occasions, even outside the medical setting, the public's uncertainty of DO's training and knowledge base. This understanding of "easier to get in phenomena" is more widespread than you think. Just recently in Self magazine, there was an article written by a lay person stating something like that it's ok to see a DO for something routine, but when it something serious or complicated, go see an MD. Now, I didn't read the article myself, but I've heard tons about it in the DO community here. It's statements like this we have to overcome for everything you said to ring true.

 

[gasrx]

I don't think you are getting the point. How can you graduate more DO's without placing them into proper post graduate training? If the number of graduates is out pacing the number out residency spots (which is the case already) where are you going to train the graduates? Medical graduates are no good without proper post graduate training. Unless the AOA will continue to uses ACGME accredited training programs as a crutch to place DO graduates. What if ACGME decides to only take MD graduates into their program? Half of all DO graduates would not have a residency. That is a fact. The AOA needs to have some forsight and start creating proper post graduate medical training and become self sufficent. Plus half of DO grads who go into more competitive residencys (rad, anesthesia, even IM) go into ACGME programs because a lot of the DO programs are very low quality.

 

[Hedwig]

Gasrx,

Again, I cannot offer a solution to the osteopathic GME problem. I predict, however, that as the need for better osteopathic GME becomes more severe, schools will begin to follow the PCOM model, creating very-high-quality DO GME at high-quality allopathic institutions. For instance, PCOM's major clinical affiliate is Medical College of Pennsylvania Hospital, a large allopathic institution affiliated with MCP-Hahnemann medical school. The problem is real, but the solution might not be as difficult to come by as you imply. JMHO, though.

Secondly, ACGME programs will never stop taking DOs. This is more than a MD vs. DO issue. Medicare pays for ALL GME, which is supervised at all levels by the federal government. The only way DOs could be excluded from allopathic GME is if the feds gave the ok. Why would they do that? What possible justification could be used to cajole the government into excluding 1,500 doctors from graduate medical training? There's no shortage of allopathic GME, and the number of new MDs in the US is stagnant. Thus, this will never, ever happen.

Again, the need for PCOM-like osteopathic GME is very real. But I'd be more optimistic. If PCOM can do it, why can't the other schools? NYCOM seems to be following this trend, in my opinion, with programs at NUMC (neurosurgery, I believe) and LIJ. There's the quality for you. Now all that's missing is quantity. Lots of quantity. PCOM has enough internship and residency spots for only about 1/3 of its grads.

 

[Sweaty Paul]

The AOA's response to the shortage of residencies is to be found in their OPTIK program. I can't begin to tell you what OPTIK stands for, however, it essentially means that each osteopathic medical school must convince training sites to join their OPTIK to provide guaranteed post-graduate training positions for their graduates.

As gasrx pointed out correctly, the osteopathic profession currently can provide rotating internships and residencies for only 46% of the students that are graduated each year. This number will only decrease with additional schools being opened and the increasing number of graduates will outstrip those internships and residencies that are currently being developed.

That said, I am curious as to why everyone thinks that in order to be a successful D.O. they must only participate in a D.O. residency. ACGME residencies are hardly "Fall-Back" placements. Most of these residencies are better funded, larger, and pay you more (though not much considering your hours) than their osteopathic counterparts. You might not get all of the exposure to OMM in an ACGME residency that you might in an osteopathic residency, however, there is more to osteopathy than OTM and much of that comes from the individual practioner.

Sweaty

 

[gasrx]

If you do an ACGME residency without doing a AOA intership, the AOA penalizes you. Without an AOA intership you can not practice in 6 states (Okl, West Vir., Florida, Pen, Michigan, one more). Also you can not become a Dean of a Osteopathic Medical School or a DME. Simply put you fall out of the good graces of the AOA. The AOA's OPTI plan is realy not that good. There is no quality assurance (from the AOA pres himself), their goal is just to have places to put bodies. The AOA president himself was bragging to us how the trained at a 50 bed hospital in Alabama. Which was satisfactory in his eyes. NYCOM has no real strong residency programs in their OPTI besides FP and Neurosurg at LIJ. IM at NUMC is like working in a third world country.

Before the AOA increase the number of grads they need to improve GME. As you can see from this year, top DO candidates are being squeezed out of ACGME programs for less competitve MD candidates. Take Rads for example. ACGME may not shut DO's out, but we get shut out from top programs no matter how good you are.

 

[Hedwig]

Okay. So what exactly are the ADVANTAGES of being an osteopathic physician as opposed to a MD? I've yet to hear this addressed.

 

[Teufelhunden]

Okay. So what exactly are the ADVANTAGES of being an osteopathic physician as opposed to a MD? I've yet to hear this addressed

1. OMM -- now that I've started some of my early clinicals, it has become increasingly apparent how many people are in pain, and how efficacious OMM treatment can be in treating that pain.
2. Opportunities to match into either AMA or AOA residencies.
3. Extra training in the musculoskeletal system is an advantage going into certain fields, e.g. radiology, PMR, ortho (it may not necessarily enhance your competitiveness in procuring a spot in those programs, but it definitely gives you a stronger foundation which could help you succeed in those fields).

 

[Sweaty Paul]

gasrx,

You don't have to do an AOA approved internship, you can get the AOA, through the filling of forms, to approve your residency and still get all of the benefits of AOA'dom. That said, it isn't all that easy getting the approval, but, it won't get easier unless we make the AOA understand that their current policies aren't fair and are alienating students. No you can't practice in some states, however, if you think you will live, or might want to live in one of those states plan accordingly. Also, if you think that you want to practice in one of the 5 states then you can also try to get them to change their legislation. The AOA doesn't control what the requirements are to practice in a state the State Board of Medical Examiners and the state legislature makes those decisions.
No you won't be able to be the Dean at an Osteopathic medical school, but, there are only 19 COM's. Again, if that is a career goal plan now and work to change the problem.

Yes, the OPTI programs are a stop-gap, however, we have to have something until quality, well-funded programs can be developed.

Lastly, to say that top D.O. are getting squeezed out of ACGME residencies is a bit reactionary. KCOM sent grads to RAD in the Cleavland Clinic, PM&R to Baylor and Johns Hopkins,etc .

Does something need to change in the AOA...yes. The only way that will happen is if we let them know what is wrong and have constructive ideas on how to help fix it.

Sweaty

 

[DocHahn]

IMHO, I don't think PCOM is setting a model for future GME's. The major reason PCOM is affiliated with MCP is out of necessity because PCOM's hospital closed a few years back. For as large of an institution as we are, I think we're just keeping our heads above water as far as GME and clinical rotations are concerned.

Doc Hahn
PCOM MSII

 

[Hedwig]

DocHahn,

I respectfully disagree. City Avenue Hospital, that big mess you see as you walk to class everyday, was a crappy hospital (despite the revisionist historical spin some professors put on the place) and never served as a true major clinical affiliate. Unless I'm mistake, PCOM students only had one mandatory rotation.

MCP hospital isn't an affiliate-by-default. The Tenet corporation asked PCOM to come, not vice versa.

PCOM is the only osteopathic medical school I know of that uses major allopathic teaching hospitals for the vast majority of its GME: Temple, Children's Hospital of Philadelphia, MCP, Jefferson Hospital, Graduate Hospital, Abington, Lehigh Valley, Memorial Sloan-Kettering, Deborah Heart and Lung, Einstein, St. Christopher's Hospital for Children, etc.

I'm not sure what you mean when you say that PCOM is barely "keeping its head above water" when it comes to rotations and residencies, but I'm pretty sure that it's not the case. It's not a medical school's responsibility to have an internship and residency for everyone in the graduating class. Also, I've never heard complaints about any rotations except the rural medicine month in Laporte, PA. In fact, PCOM's clinical education has the highest level of student satisfaction of any of the osteopathic medical schools. Go to the PCOM website and get a copy of the Annual Report, which touts (and cites) this statistic.

 

[drchrislareau]

Osteopathic medicine is alive and well as a separate and distinctive school of medicine. D.O.s are the only physicians trained to deliver comprehensive medical care. They were the only physicians who could actually help out at the scene during 911 giving treatment to rescuers and workers. Also, see <a href="http://www.dohealthnet.com/article1171.html" target="_blank">statement by the U.S. Federation of State Medical Boards</a> and more recently an account of <a href="http://www.dohealthnet.com/article1228.html" target="_blank">how osteopathic medicine is used to enhance performance of top athletes</a>. Considering the great number of iatrogenic cases of morbidity and mortality in the U.S., the real question should be can allopathic medicine survive without incorporating OMT and the osteopathic philosophy into its curricula?

 

[med student]

•••quote:••• D.O.s are the only physicians trained to deliver comprehensive medical care. They were the only physicians who could actually help out at the scene during 911 giving treatment to rescuers and workers. ••••I have to believe you are kidding but I suspect that you are not. So I would love to see what evidence you have that says only DOs could help at the scene of the accident. I do not believe this is possible and I would love to hear a reason why only DOs could respond to the scene.

•••quote:••• Considering the great number of iatrogenic cases of morbidity and mortality in the U.S., the real question should be can allopathic medicine survive without incorporating OMT and the osteopathic philosophy into its curricula?
••••See once I again I would have to disagree because if and when OMT is proven effective it will become just like any other another specialty. If I used your logic I could also say that since the population is getting older and there will be more cardiovascular disease all physicians should be trained as cardiologists or they will be at a competitive disadvantage and they not be able to get patients. Obviously this is not the case. Also in the whole OMT for athletes thing I think this is a good thing but it sounds like they are filling a role that was traditionally done by a physical therapist. So it is nothing new to use these techniques to help athletes before they compete.

 

[njdocDO]

•••quote:••• Also in the whole OMT for athletes thing I think this is a good thing but it sounds like they are filling a role that was traditionally done by a physical therapist. So it is nothing new to use these techniques to help athletes before they compete.
••••True, physical therapists have worked on many athletes before, but much of what PTs do has its foundations and practices rooted in OMT. Look it up. Many of the techniques are very similar, if not the same.

•••quote:••• I would have to disagree because if and when OMT is proven effective it will become just like any other another specialty ••••It's funny how people think physical therapy is effective but OMT is not. OMT is just as effective and goes much further as to the conditions it can treat. Does DO=MD+PT? Maybe, maybe not, but I'll take it over just the plain MD anyday. The more tools in my bag, the better.

I do agree that the above poster is nuts if he says DOs are the ONLY ones who could provide care on 9/11. I go to school in NY. They had school nurses out there helping. If you were able, you helped. Period. I believe some of my professors helped at the scene by using OMT to relieve back pain and muscle soreness from rescue workers.

 

[drchrislareau]

Glad you asked. See <a href="http://www.efamilypracticenews.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=aqf010312301" target="_blank">Family Practice News</a> as well as <a href="http://www.dohealthnet.com/article1228.html" target="_blank">article on treating olympic gold medalist</a> and <a href="http://www.dohealthnet.com/article1171.html" target="_blank">Statement by the United States Federation of State Medical Boards</a>. If you are interested in studying current research in OMT you may want to read <a href="http://www.dohealthnet.com/article1018.html" target="_blank">about research published in the New England Journal of Medicine</a> and even <a href="http://www.dohealthnet.com/article1040.html" target="_blank">an article published in the Journal of the American Academy of Osteopathy</a>. You are right that OMT for athletes is nothing new. Actors, dancers, and athletes have been using OMT for decades. The recognition for D.O.s is something new, though.

 

[drchrislareau]

•••quote:•••I do agree that the above poster is nuts if he says DOs are the ONLY ones who could provide care on 9/11.••••I was preparing to leave for New York to help out when I heard that physicians were being turned away. Everyone on the scene helped each other, providing care. I was glad to hear that D.O.s were able to do something for the heroic workers. The point I was trying to make is that the use of OMT in assisting disaster relief workers filled a need. I apoligize if I have injured any one's sensibility.

 

[med student]

•••quote:••• True, physical therapists have worked on many athletes before, but much of what PTs do has its foundations and practices rooted in OMT. Look it up. Many of the techniques are very similar, if not the same. ••••I realize this so I am sorry if it was not clear and also I am not one of those people who believe that PT is effective while OMT is not. I think once the research is done many OMT practices will be proven effective but others will not (the one about cranial adjustment pops into mind). But this is the way medicine works because we are constantly changing what we do as more evidence becomes available.

 

[njdocDO]

Yeah, cranial adjustment does sound like it has a lot to prove. I agree. But, remember, there's tons of mainstream medical practices that work and the experts arent sure why they work, both procedures and drugs. For example, many psych drugs work but the biochemistry as to how they work is inconclusive. Many arent even fully convinced how the birth control works. In some minds, science-wise, on paper, things dont add up to provide the efficacy they do in practice.

I was one who was OMT doubtful awhile ago too. But, after being taught the science behind it and actually seeing it work on patients, it really is only a matter of time until the public accepts it. If publications in journals is what it takes, fine. I'm happy to see it "proved officially" finally. I guess DOs would officially be the more comprehensively trained physicians out there then? Not necessarily. Too much of a generalization. But, DOs will have an extra tool which the public is very much starting to demand. The allopathic community will have to catch up.

IMO, the AOA does a really, really bad job at marketing OMT and the DO philosophy and profession in general. They are making attempts to improve though and actually just hired the "Got Milk?" ad agency to bring the DO more into the medical limelight. We'll see what happens.

Just food for thought.