I want to become a DO

[Dr.Inviz]

I didn't realize you have matriculated (or even been accepted) at a med school already

Aww, poor Kuba didn't know? Poor Kuba wants to know? LOL, Kuba, I don't have to announce much on SDN to get a tickle of joy, I get enough on here with the responses I receive out of posters like you.

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[DoctorMom78]

there have been some stupid MD vs DO threads, but man, this one is probably the stupidest.

 

[DoctorMom78]

BLAH BLAH BLAH BLAH....

OK, now everyone kiss and make-up!!!

 

[scpod]

there isn't necessarily a difference in philosophy...as what we say is basically just plain, common sense that any good doc should follow....the difference is that all DO schools come out and "state" that those are our tenets.....no where does it ever state that the philosophy is unique to DO's only ...

No, there's not really a difference now...but there used to be. Traditionally, MD schools were very physician oriented and not very patient-oriented. They were taught to be the stern, distant father figure. Medical students were taught not to get involved with thier patient's emotional or spiritual life-- just treat the symptoms.

OTOH, DOs have had a patient-centered philosophy since inception. They were charged with "treat[ing] the whole person" and using "rational treatments...[that] include all scientifically proven therapies." They were taught to consider the emotional and spiritual being of their patients.

As the years have passed, MD schools have come to embrace that same philosophy (although they do not engrave it deeply into the walls of their inner sanctum) as studies have shown that patients respond better when the "whole person" is treated. Call him a quack if you will, but it didn't take Andrew Still, MD a whole lot of double-blind studies to realize that patients should be treated like people, not like a collection of diseased body parts.

Yes, today the lines are blurred, and there is little difference in the philosophies being taught...but there once was. A lot of people have claimed that DO schools are becoming more and more like MD schools. However, the truth is the reverse of that.

 

[spicedmanna]

I agree with Taus. I'm tired of talking about statistics. Once you are accepted, they mean jack and s**t. My stats don't say everything about my person; in fact, it's my belief that they say the least about me. But I'm going to apply smartly. DO represents the smart choice for me for a variety of reasons. Even if the lines are blurred at this stage, and schools teach very similar principles (effective pt care is effective pt care, regardless of perceived style), DO's have a long tradition of teaching these priniciple that are now supposedly universal. Commitments matter to me. I'd rather build my foundation on a school that has been practicing patient-centered care since the beginning and whose curriculum is well-known for producing great primary care doctors. It's a bonus to have OMM, too, in my opinion. While numerically, some DO schools might be lacking in comparison with their allopathic cousins, there are definitely advantages. I think the DO curriculum produces excellent clinicians and have a demonstrated commitment to the things I care about. So I'm happy with my choice.

 

[ruck]

What I don't understand is that why some of you guys go crazy over someone saying they like OMM and osteopathic philosophy. I don't think they are saying that OMM makes DO superior to MD. Everyone has his/her own interestes and preferences. It's a free country for god's sakes. People have freedom of choice and I think all of us should be thankful for that and respect it. I personally think most people go to osteopathic medicine because they wanna be physicians period. I think alot of people who go to osteopathic medical schools are very dedicated to medical profession. As some of you say those people did not have good enough statistics to get into MD medical schools. But that is not important what matters is that those people did not quit and go after other career paths because they are too passionate about medicine and they can't see themselves doing anything else. At the end of the day it is the passion and love for medicine and humanity that make someone a respectable and competent physicain not numbers nor two letters.

 

[DoctorMom78]

DR. INVIZ?!?! ACCOUNT ON HOLD?!?!? What happened?!?!?

As cranky as he can be, I don't see that he did anything worse than anyone else in this thread...another casualty of the MD vs DO debate.

Whether we are going to be MDs or DOs, we are all going to be doctors. We are going to be working with each other one day. Everyone has their own opinions on this topic, but we should really all just agree to disagree and worry about more important things...like who is Anna Nicole's baby daddy.

Behave everyone!

 

[DragonWell]

DR. INVIZ?!?! ACCOUNT ON HOLD?!?!? What happened?!?!?

As cranky as he can be, I don't see that he did anything worse than anyone else in this thread...another casualty of the MD vs DO debate.

Whether we are going to be MDs or DOs, we are all going to be doctors. We are going to be working with each other one day. Everyone has their own opinions on this topic, but we should really all just agree to disagree and worry about more important things...like who is Anna Nicole's baby daddy.

Behave everyone!

Newer folks may not remember good old OSUdoc08, but Inviz's postings remind me much of his style. OSUdoc08 could turn any thread into a pissing contest, and while he actually occasionally had some good points, somebody must have gotten tired of his $hit, since he is no longer with us. Disagreement is fine, disrespect is not.

 

[Dr__Robert]

My definition of a middle of the road MD school is ANY med school that is not elite. There are several MD schools that are middle of the road (aka good, but not elite) .. and you can get in with a 28. Don't cover up your misunderstanding. 30 is the golden number for most MD schools, but 28 in most cases is good enough, as well.

No, no it is not. As I stated earlier the average US MD-granting school has a 30.4 MCAT average, the SD is roughly 1.73.

This means that a 28.0 is at the 8.27th percentile.

Let me say that again... less than 9 percent of people scored less than a 28 and got into an MD school... this means that (roughly...though it won't work out exactly this way) 9% of schools... that would be the bottom 9%... have an MCAT average of 28.0.

Please learn some understanding of statistics.

 

[Doctor Bagel]

Newer folks may not remember good old OSUdoc08, but Inviz's postings remind me much of his style. OSUdoc08 could turn any thread into a pissing contest, and while he actually occasionally had some good points, somebody must have gotten tired of his $hit, since he is no longer with us. Disagreement is fine, disrespect is not.

Yep, he's permanently banned. He got about 5k posts in before his banning, though. Of course, Inviz and OSUdoc would get into a pissing contest with each other, so they wouldn't be buddies.

As for DKM, he's been on sdn forever, but I don't think he's yet to have actually applied to medical school. I'm confused as to why anyone takes his opinions seriously. Not to say he doesn't have a right to them, but it's not like he has any more insight than anyone here.

 

[Doctor Bagel]

No, no it is not. As I stated earlier the average US MD-granting school has a 30.4 MCAT average, the SD is roughly 1.73.

This means that a 28.0 is at the 8.27th percentile.

Let me say that again... less than 9 percent of people scored less than a 28 and got into an MD school... this means that (roughly...though it won't work out exactly this way) 9% of schools... that would be the bottom 9%... have an MCAT average of 28.0.

Please learn some understanding of statistics.

Sort of, but state schools throw the statistics off because they're limited in who they can admit. Your odds of getting into my school with a 28 aren't small. In fact, our average MCAT for my class was a 9.7 in each section, so the people with 28s aren't in the bottom 8.7% of my class. The same is true is these southern states that Invez is talking about.

 

[supersash]

instead of sitting on SDN for hours crying, maybe those who feel insecure with the DO title, should spend this time getting their GPA up, or studying to retake the MCAT.

i'm sick of all the bitching!! kiss and make up before someone gets banned for something silly

 

[Dr JPH]

DR. INVIZ?!?! ACCOUNT ON HOLD?!?!? What happened?!?!?

Not his first warning, but it could be his last.

 

[DoctorMom78]

i'm sick of all the bitching!! kiss and make up before someone gets banned for something silly

I agree! Someone close this thread.

 

[Dr__Robert]

Sort of, but state schools throw the statistics off because they're limited in who they can admit. Your odds of getting into my school with a 28 aren't small. In fact, our average MCAT for my class was a 9.7 in each section, so the people with 28s aren't in the bottom 8.7% of my class. The same is true is these southern states that Invez is talking about.

Again, I think you have a lack of understanding of the statistics presented. Somebody with a 28 MCAT might not be in the bottom 8.7% of the 2006 entering class at a certain school... but they are at the bottom 8.7% of the entire country's entering classes.

From this you can somewhat extrapolate... now, what I'm about to say is not 100% accurate... but I bet it's accurate to +/- 3%.

This means that the bottom 8.7% (+/- 3% means from about 6%ile to 12%ile among medical school classes) of schools have an AVERAGE of 28. Again... individual cases will vary... but were looking at AVERAGES.

 

[Kuba]

Again, I think you have a lack of understanding of the statistics presented. Somebody with a 28 MCAT might not be in the bottom 8.7% of the 2006 entering class at a certain school... but they are at the bottom 8.7% of the entire country's entering classes.

From this you can somewhat extrapolate... now, what I'm about to say is not 100% accurate... but I bet it's accurate to +/- 3%.

This means that the bottom 8.7% (+/- 3% means from about 6%ile to 12%ile among medical school classes) of schools have an AVERAGE of 28. Again... individual cases will vary... but were looking at AVERAGES.

congratulations on passing statistics 101. If you read the post again, you will see the poster was not referring to national averages, but rather the discrepency that exists between state schools (particularly in the south) and the other upper level and pricate schools. A 28 at a state school in the south is not in the bottom 8%.

 

[DropkickMurphy]

As for DKM, he's been on sdn forever, but I don't think he's yet to have actually applied to medical school. I'm confused as to why anyone takes his opinions seriously. Not to say he doesn't have a right to them, but it's not like he has any more insight than anyone here.

No, I won't be applying for another couple of years, and you're right- what I say here (unless I provide evidence to back it up) is simply my opinion. The same as what DGriss, Kuba, Inviz, or anyone else states here. Personally I'm not claiming any more insight, it's just that I don't temper my opinions out of fear of appearing less than "worthy" of being a physician in the eyes of a bunch of premeds and a few med students. My concern is simply for the ability to be able to deliver quality and timely care to my patients today and for years into the future....anything beyond that is secondary.

 

[Doctor Bagel]

Again, I think you have a lack of understanding of the statistics presented. Somebody with a 28 MCAT might not be in the bottom 8.7% of the 2006 entering class at a certain school... but they are at the bottom 8.7% of the entire country's entering classes.

From this you can somewhat extrapolate... now, what I'm about to say is not 100% accurate... but I bet it's accurate to +/- 3%.

This means that the bottom 8.7% (+/- 3% means from about 6%ile to 12%ile among medical school classes) of schools have an AVERAGE of 28. Again... individual cases will vary... but were looking at AVERAGES.

Who cares if you're in the bottom nationwide? There are tons of schools where the average mcat is around 29. If you're lucky enough to have one of those as your state school, a 28 is a perfectly good score. I understand your statistics, but I don't think they're as valuable as you're making them out to be. If we lived in a country without state supported school where residency was never a factor, they might be useful.

 

[peppy]

Let's try to keep some perspective. The majority of people in this country don't even finish college (I think the stat I read recently was that only 25% of the American population has a bachelor's degree), much less get into any sort of doctoral degree program. Getting into medical school is an accomplishment that should be celebrated, regardless of whether it's a DO or an MD program.
Even though getting accepted to a Carribean school is seen as "easy" from a GPA/MCAT viewpoint, I respect Carribean MDs for having the courage to take such a difficult and risky path to follow their dream rather than looking down on them for having lower stats than I do.

Since I scored a 34 on the MCAT myself, I don't have any sour grapes issue with the test.
But, nonetheless, I feel that actual med school classes really don't have much to do with what you learn on the MCAT.
I think you could teach someone all the background knowledge of physics/chem/bio they truly need to know to understand med school classes in about a week.
The reason that criteria like the MCAT and years of classes like o-chem exist in this process is because the adcoms need *some* objective way of ranking people when there are so many applicants fighting to get in. Just because it takes a 30 to get into an MD program right now, based on the current competition, doesn't mean that you actually need a 30 on the MCAT to be an awesome doc.
Having a 45 on the MCAT and graduating from the greatest school won't help you much if you're so lacking in empathy/interpersonal skills that all your patients dislike you and decide to sue you.

So, my fellow DOs, don't be ashamed of our degree. Med school is more about what you put into it than about the school itself.
And before you MDs get too cocky, let me remind you that it's harder to get into veterinary school than to get into MD school, so a lot of you would be considered unfit to even neuter a dog by your own criteria.

 

[spicedmanna]

And before you MDs get too cocky, let me remind you that it's harder to get into veterinary school than to get into MD school, so a lot of you would be considered unfit to even neuter a dog by your own criteria.

LOL

Oh man, that's a good one.

 

[t-funk]

Peppy, great post. I really don't understand the bickering that goes on about MD vs DO. And it's not bc I'm trying to rationalize my poor stats. Anyone who makes it to a doctoral program has made a great accomplishment. Any little unforeseen circumstance such as a disability, life threatening illness, death of a mother, etc, and an individual could easily find themselves in that 75% without a bachelor's degree. It's a combination of natural ability, hard work and determination, and as little as people like to admit it, luck and good fortune. Any one who makes it through a doctoral program should be commended.

My best friend was one of the smartest people I have ever known with an IQ of about 165. Her mother died of cancer during our senior year. She lived in a kind of a hippie commune where they believed in that macrobiotic stuff and refused medical help. My best friend had a full ride scholarship but basically fell out of life bc she believed her own mother didn't care enough about her to get medical help. She got into drugs and other types of debauchery really bad. I am just thankful that I have been able to achieve the things that I have and I don't sit around thinking that I am better than other people or worse than other people. You never, ever know what they have been through.

Anyway, I am in agreement with Doctor Bagel. Who cares if 7% of the medical schools in this country have MCAT averages less than 28. So what! At my state allopathic school, a large majority of people will have a 28-30 MCAT. That score makes them a doctor and that's all that really matters. As always, Doctor Bagel is the sound voice of reasonable judgement. Thanks Doctor Bagel !

 

[DoctorMom78]

Peppy, great post. I really don't understand the bickering that goes on about MD vs DO. And it's not bc I'm trying to rationalize my poor stats. Anyone who makes it to a doctoral program has made a great accomplishment. Any little unforeseen circumstance such as a disability, life threatening illness, death of a mother, etc, and an individual could easily find themselves in that 75% without a bachelor's degree. It's a combination of natural ability, hard work and determination, and as little as people like to admit it, luck and good fortune. Any one who makes it through a doctoral program should be commended.

My best friend was one of the smartest people I have ever known with an IQ of about 165. Her mother died of cancer during our senior year. She lived in a kind of a hippie commune where they believed in that macrobiotic stuff and refused medical help. My best friend had a full ride scholarship but basically fell out of life bc she believed her own mother didn't care enough about her to get medical help. She got into drugs and other types of debauchery really bad. I am just thankful that I have been able to achieve the things that I have and I don't sit around thinking that I am better than other people or worse than other people. You never, ever know what they have been through.

Anyway, I am in agreement with Doctor Bagel. Who cares if 7% of the medical schools in this country have MCAT averages less than 28. So what! At my state allopathic school, a large majority of people will have a 28-30 MCAT. That score makes them a doctor and that's all that really matters. As always, Doctor Bagel is the sound voice of reasonable judgement. Thanks Doctor Bagel !

I wholeheartedly agree with both of you!

I think that there is way too much emphasis put on the MCAT anyway. A lot of great people with otherwise strong stats miss out on opportunities because of their MCAT score. There are plenty of people that graduate from schools (MD or DO) who had lower MCATs that go on to become wonderful doctors.

 

[J1515]

It may be something that is difficult in the state I reside in, as I shadowed 1 DO physician and spoke with another, and both made the statements that OMM is difficult to bill for, which is why they do not do it. In addition to the time consuming aspects of it. They also probably were not even into it while in med school and may have pursued DO school as a means to an end -- being a physician.

This is my favorite line that pre-meds use..."Well I spoke with many _______s and they told me ________"

The truth of the matter is, there are some insurance companies that will reimburse for it, and there are some that won't. The companies that do reimburse will usually only give a very small % of what the osteopathic physician actually bills. The big money in OMM is in small private practices that don't accept insurance and only take out of pocket payments. Naturally you'd expect to find these practices in the more wealthy areas and these are the DOs that people are referring to when they say "OMM can be very profitable"

 

[scpod]

The truth of the matter is, there are some insurance companies that will reimburse for it, and there are some that won't. The companies that do reimburse will usually only give a very small % of what the osteopathic physician actually bills...

That isn't the way it works. The reason why OMT isn't reimbursed correctly is that not many people seem to know how to bill for it. OMT codes (98925-29) are paid on a regular basis when the exam code uses a 25 modifier. There are lots of DOs making great money, and being reimbursed by insurance companies, because they use OMT on a regular basis and know how to bill for it. The reason why most DOs don't use OMT, I believe, is that they don't practice it and they don't feel comfortable with it. Like any other procedure, if you don't practice it, you'll never get good at it.

 

[bigdog8829]

DKM, wow. over 7K posts and you still have yet to apply to medical school... you have one heck of an opinion.

I wonder how your words will change once you actually go through the process. (That means don't worry, you'll read up on the d.o. philosophy and tell all the schools what you like about it...)

 

[Krazykritter]

That isn't the way it works. The reason why OMT isn't reimbursed correctly is that not many people seem to know how to bill for it. OMT codes (98925-29) are paid on a regular basis when the exam code uses a 25 modifier. There are lots of DOs making great money, and being reimbursed by insurance companies, because they use OMT on a regular basis and know how to bill for it. The reason why most DOs don't use OMT, I believe, is that they don't practice it and they don't feel comfortable with it. Like any other procedure, if you don't practice it, you'll never get good at it.

Very good post, scpod. I agree 100% & will add one thing; Just b/c you write down a billing code, doesn't mean you will get paid for it. It is all about justifying your work to insurance companies. Gotta document to get paid...

 

[J1515]

That isn't the way it works. The reason why OMT isn't reimbursed correctly is that not many people seem to know how to bill for it. OMT codes (98925-29) are paid on a regular basis when the exam code uses a 25 modifier. There are lots of DOs making great money, and being reimbursed by insurance companies, because they use OMT on a regular basis and know how to bill for it. The reason why most DOs don't use OMT, I believe, is that they don't practice it and they don't feel comfortable with it. Like any other procedure, if you don't practice it, you'll never get good at it.

How much do you bill for it and how much does the average insurance company reimburse you, if you don't mind telling me?

 

[DropkickMurphy]

That means don't worry, you'll read up on the d.o. philosophy and tell all the schools what you like about it.

Not about the philosophy I won't......

Nun lieber Kinder, gebt fein acht....I've read what I can find about it and still think it's a load of BS used to artificially seperate the two camps in medicine. Now granted, will I pander somewhat to the ADCOMs when the time comes? You bet your ass, but then again I'll be doing the same thing to every school I interview- MD or DO. I will keep my negative opinions to myself for that time and focus on the benefits of each school (location, etc). Trust me.....I was in the Air Force and that is the best training in the world for telling people what they want to hear whilst lying through your teeth and seeming to be telling the truth.

 

[Vox Animo]

They took our jobs!"

"Dey turk ma jugh!"

"Derka der!"

 

[spicedmanna]

Nun lieber Kinder, gebt fein acht...

"Kinder, liebe Kinder, das hat mir Spaß gemacht.
Nun schnell ins Bett und schlaft recht schön.
Dann darf auch ich zur Ruhe gehn. Ich wünsch euch gute Nacht."

(Children, dear children, that was fun.
Now, quick, to bed and sleep tight.
Then I can also go and rest. I wish you a good night.)

 

[DropkickMurphy]

"Kinder, liebe Kinder, das hat mir Spaß gemacht.
Nun schnell ins Bett und schlaft recht schön.
Dann darf auch ich zur Ruhe gehn. Ich wünsch euch gute Nacht."

(Children, dear children, that was fun.
Now, quick, to bed and sleep tight.
Then I can also go and rest. I wish you a good night.)

Nice......I was just trying to tell everyone to pay attention, but I didn't figure anyone would catch it.

 

[toothless rufus]

How much do you bill for it and how much does the average insurance company reimburse you, if you don't mind telling me?

I have been looking up physician reimbursement online, and I still can't find how insurance companies got out of paying the full amount, and how they took the choice away from physicians to accept less than what they bill for? How did that happen? That's gotta stop!! Anyone know of a good resource?

 

[NickRiviera]

Not about the philosophy I won't......

Nun lieber Kinder, gebt fein acht....I've read what I can find about it and still think it's a load of BS used to artificially seperate the two camps in medicine. Now granted, will I pander somewhat to the ADCOMs when the time comes? You bet your ass, but then again I'll be doing the same thing to every school I interview- MD or DO. I will keep my negative opinions to myself for that time and focus on the benefits of each school (location, etc). Trust me.....I was in the Air Force and that is the best training in the world for telling people what they want to hear whilst lying through your teeth and seeming to be telling the truth.

You don't think they can tell you are just saying what you think they want to hear? It's usually pretty obvious to when people are doing that. Good luck BSing though.

 

[Dr JPH]

OMT is billed based on number of body areas treated

1-2
3-4
5-6
7-8
9 or more

Typical reimbursement would pay $18 per each level, but I have seen as much as $28 per level.

Many of the DOs who charge cash do so on an hourly or half hour payment level.

Some insurance companies will pay you to do EITHER medical OR OMT. So, if you come in for a BP check and medication refill and then get OMT, the doctor cannot bill the insurance for both. So in this case they usually only bill for the more complete visit.

What many docs do is have one day per week where they have their patients come in and they have a designated OMT day. This way they can provide both services to their patients and still get the maximum reimbursement.

So there are more DOs doing OMT than you would think, but most arent getting paid for it.

 

[scpod]

Some insurance companies will pay you to do EITHER medical OR OMT. So, if you come in for a BP check and medication refill and then get OMT, the doctor cannot bill the insurance for both. So in this case they usually only bill for the more complete visit.
...

Obviously, though, your practice may differ depending on the type of patients you have. Medicare, for instance, in Texas pays 30 to 60 dollars for OMT, depending on the code, for participants and slightly less for nonparticipants. You can, though, charge for both the office visit and OMT in the same day if you use the appropriate office visit modifier indicating they are two separate issues. For instance, if you are doing a routine physical and the patient complains of low back pain, you are justified in performing a separate treatment. OTOH, if you are performing a physical that normally is included in a surgical billing, then you cannot bill separately for the office visit.

Of course, many claims are routinely denied on a regular basis. That's why a full-time staff person is needed just to argue wth insurers daily. It sucks, but if you don't have someone to do that, you'll be getting regularly ripped off.

 

[GwinnettPreMed]

No, no it is not. As I stated earlier the average US MD-granting school has a 30.4 MCAT average, the SD is roughly 1.73.

This means that a 28.0 is at the 8.27th percentile.

Let me say that again... less than 9 percent of people scored less than a 28 and got into an MD school... this means that (roughly...though it won't work out exactly this way) 9% of schools... that would be the bottom 9%... have an MCAT average of 28.0.

Please learn some understanding of statistics.

Dr__Robert,

Based on my conversations with other students (I understand that studies > anecdotes), that SD is way too small. It's like 5% of the mean, so they'd have to accept almost no outliers (above or below) for it to be accurate. What am I missing?

I checked using the data from here: http://www.aamc.org/data/facts/2006/2006mcatgpa.htm, and it appears to me that 1.73 is the SD for each section, not across all sections. The SD for all sections combined is 5.2. Since we don't know if the distribution is normal and a 30.4-28=2.4 or about 1/2 a std deviation, the Chebychev rule would put a 28 score at >>25%, wouldn't it?

If my reasoning is off, I'm happy to be corrected - my intent here is not to start/continue an argument , but to make sure I understand the stats. It has been >12 years since I took the class and I didn't use them too much in my previous career. If you or anyone gets a chance to help I'd appreciate it...thx

Edit: After re-reading some of your earlier posts, I now get that the conversation was about average scores at med schools, but based on the above, the statement "less than 9 percent of people scored less than a 28 and got into an MD school..." does not seem accurate to me. Any help you can give is appreciated...

 

[Dr JPH]

Obviously, though, your practice may differ depending on the type of patients you have. Medicare, for instance, in Texas pays 30 to 60 dollars for OMT, depending on the code, for participants and slightly less for nonparticipants. You can, though, charge for both the office visit and OMT in the same day if you use the appropriate office visit modifier indicating they are two separate issues. For instance, if you are doing a routine physical and the patient complains of low back pain, you are justified in performing a separate treatment. OTOH, if you are performing a physical that normally is included in a surgical billing, then you cannot bill separately for the office visit.

Of course, many claims are routinely denied on a regular basis. That's why a full-time staff person is needed just to argue wth insurers daily. It sucks, but if you don't have someone to do that, you'll be getting regularly ripped off.

True

Medicare is much nicer with reimbursing for OMT than other plans.

Again, thats why many DOs do a cash OMT business.

 

[DropkickMurphy]

You don't think they can tell you are just saying what you think they want to hear? It's usually pretty obvious to when people are doing that. Good luck BSing though.

Hell, if the DO programs weaned out everyone who lied or BSed about their reasoning for wanting to attend, they would not be able to have a class of more than about 20 people per school. Anyhow, it's not outright lying that I'm suggesting, more like just biting my tongue about how the programs are backups.

Of course, people BS almost as much to get into MD programs- "No, I'm not in it for the money!", "I want to work in rural primary care!", etc

 

[J1515]

OMT is billed based on number of body areas treated

1-2
3-4
5-6
7-8
9 or more

Typical reimbursement would pay $18 per each level, but I have seen as much as $28 per level.

Many of the DOs who charge cash do so on an hourly or half hour payment level.

Some insurance companies will pay you to do EITHER medical OR OMT. So, if you come in for a BP check and medication refill and then get OMT, the doctor cannot bill the insurance for both. So in this case they usually only bill for the more complete visit.

Exactly. I've seen physicians here (NY) charge $40 to $50 for OMM treatment in addition to the medical. They get reimbursed $14 to $18 depending on the plan. Not worth it for the amount of time required to perform OMM properly. I can't say this is how it works all over the country or for every insurance plan though. Like others have said, if you dedicate a practice to OMT that's a different story.

 

[Dr JPH]

Not worth it for the amount of time required to perform OMM properly.

Speak for yourself.

3 areas in 3 minutes

If you cant adequately treat a body area in a minute then either you arent doing it correctly or you dont know what you are doing.

Dont be fooled by the second year medical student fumbling around trying to figure out which way to HVLA someones neck.

I can HVLA the entire C-spine, treat the first ribs bilaterally and then fix the upper thoracics in under 2 minutes.

You need to learn high yield OMT techniques. What is going to get you the best patient response in the shortest amount of time and in the safest manner. Like when someone comes into the ER. CT scan vs Ultrasound vs MRI. What will give me the most information and the correct information in the shortest amount of time, while still being cost effective based on patient presentation.

I would say $50.00 for 3-5 minutes of OMT is fair reimbursement.

 

[J1515]

Speak for yourself.

3 areas in 3 minutes

If you cant adequately treat a body area in a minute then either you arent doing it correctly or you dont know what you are doing.

Dont be fooled by the second year medical student fumbling around trying to figure out which way to HVLA someones neck.

I can HVLA the entire C-spine, treat the first ribs bilaterally and then fix the upper thoracics in under 2 minutes.

You need to learn high yield OMT techniques. What is going to get you the best patient response in the shortest amount of time and in the safest manner. Like when someone comes into the ER. CT scan vs Ultrasound vs MRI. What will give me the most information and the correct information in the shortest amount of time, while still being cost effective based on patient presentation.

I would say $50.00 for 3-5 minutes of OMT is fair reimbursement.

You misunderstood me. They CHARGE $50. The insurance company(ies) reimburse for $18 when they bill for a medical visit as well. Again, I can't comment on every area and every company. When you mention the time required for those 3 treatments in under 2 minutes including HVLA, I'm assuming you're not including the time spent on myofascial. What about the treatments that traditionally require a minute and a half for "release"? While I'm not huge on OMM, I have enough knowledge to know that some treatments should and will take more than 60 seconds when performed properly.

 

[DropkickMurphy]

Hell......even I will admit $18 for a few minutes of work is fair.

 

[mecute]

And before you MDs get too cocky, let me remind you that it's harder to get into veterinary school than to get into MD school, so a lot of you would be considered unfit to even neuter a dog by your own criteria.

I hate when people use vet school as a justification to detract from the competitiveness of allopathic (MD) medical schools. The main point that many on this pre-osteo board fails to realize is that it is the # of applicants to seats ratio is only one factor to determine competitiveness. The other MAJOR factor is the QUALITY of applicants. Just like how certain DO schools have 5,000+ applicants and after picking the best of that applicant pool, the average stats of the incoming class is still significantly lower than the average stats of an incoming state medical school class that selected from 1,000 applicants. You can argue all day about DO schools looking at other factors besides the MCAT and GPA but the bottom line is GPA and MCAT are the two most objective criteria that can be used to judge applicants and it weighs heavily in DO school admissions just as it does in MD school admissions. In fact, I got pre-secondary interview invites from some DO schools just because of my numbers so don't think DO schools are any different in caring about numbers. The facts speak for themselves.

 

[112258]

Whether we are going to be MDs or DOs, we are all going to be doctors. We are going to be working with each other one day.

Agreed. Where do these people get these opinions about DOs being inferior. I can understand the viewpoint from an average person who maybe hasn't interacted with DOs or heard of them, then sure I'd probably think that too. But as future DOCTORS....well you will work with them one day, and if you're both figuring out something TOGETHER are you going to think they are inferior? Will you not take orders from them if they are in a position superior to you??? If you ask doctors (MDs) their opinions, I am pretty sure most if not all will say "we're all doctors, pretty much exactly the same". That is the response I got, in a state where there is no DO school, when I was asking many, various doctors their opinions of DOs, because I had none. Every single one said go DO, we work with them all the time, they are the same. For goodness sake, there are DOs that work in shock trauma at Maryland!!!! Will you future MDs ignore them one day?? When we are doctors, we will all be part of a team of equals....get over it!!!

 

[spicedmanna]

Agreed. Where do these people get these opinions about DOs being inferior. I can understand the viewpoint from an average person who maybe hasn't interacted with DOs or heard of them, then sure I'd probably think that too. But as future DOCTORS....well you will work with them one day, and if you're both figuring out something TOGETHER are you going to think they are inferior? Will you not take orders from them if they are in a position superior to you??? If you ask doctors (MDs) their opinions, I am pretty sure most if not all will say "we're all doctors, pretty much exactly the same". That is the response I got, in a state where there is no DO school, when I was asking many, various doctors their opinions of DOs, because I had none. Every single one said go DO, we work with them all the time, they are the same. For goodness sake, there are DOs that work in shock trauma at Maryland!!!! Will you future MDs ignore them one day?? When we are doctors, we will all be part of a team of equals....get over it!!!

It's not a problem of MD or DO, but one of a stupid game of oneupmanship, in which there is no winning. It's the idiocy of people in general to try to discriminate and prejudge, instead of finding the common ground and celebrating the unique gifts each of us have. More specifically, it's a problem with pre-meds, because some of us lack a fundamental security in which to realize that it's pretty much an individual game, where one is essentially competing against one's self. Sometimes we feel compelled to make others less than rather than elevating ourselves. There is no argument except the one that resides in us.

 

[supersash]

well said!

Agreed. Where do these people get these opinions about DOs being inferior. I can understand the viewpoint from an average person who maybe hasn't interacted with DOs or heard of them, then sure I'd probably think that too. But as future DOCTORS....well you will work with them one day, and if you're both figuring out something TOGETHER are you going to think they are inferior? Will you not take orders from them if they are in a position superior to you??? If you ask doctors (MDs) their opinions, I am pretty sure most if not all will say "we're all doctors, pretty much exactly the same". That is the response I got, in a state where there is no DO school, when I was asking many, various doctors their opinions of DOs, because I had none. Every single one said go DO, we work with them all the time, they are the same. For goodness sake, there are DOs that work in shock trauma at Maryland!!!! Will you future MDs ignore them one day?? When we are doctors, we will all be part of a team of equals....get over it!!!

 

[Dr JPH]

You misunderstood me. They CHARGE $50. The insurance company(ies) reimburse for $18 when they bill for a medical visit as well. Again, I can't comment on every area and every company. When you mention the time required for those 3 treatments in under 2 minutes including HVLA, I'm assuming you're not including the time spent on myofascial. What about the treatments that traditionally require a minute and a half for "release"? While I'm not huge on OMM, I have enough knowledge to know that some treatments should and will take more than 60 seconds when performed properly.

Again...time spent is in direct propotion to the skill of the physician.

Am I going to sit with a patient in a position for 90 seconds for a counterstrain technique? No way. But I WILL do FPR or LAS and get the same result in under 10 seconds, all with a myofascial release built in.

Am I going to do very involved ME with precision positioning? Nope. HVLA all the way.

What can be done quickly?

Still
HVLA
FPR/LAS
Balanced tension
Muscle energy (some)


If I spend 2-3 minutes per patient and only get $18 on top of my regular fee, thats pretty good.

What does a typical FP get reimbursed for a complete visit (not a new patient, no procedures, no blood draws, etc)?

Maybe $48-$65

So if I can make 25-35% MORE by adding OMT and not adding a whole lot of time to each visit...well, that seems to make sense to me.

And pick just one day per week...or a few days per month...and do a cash only OMT clinic and youre set.

So lets think for a minute...

If a typical family doc does OMT on ONE patient PER DAY and only gets reimbursed $18 (meaning they are likely doing minimal OMT anyway), they can make an additional $4500 a year.

Seems like remembering your musculoskeletal exam and OMT can pay for a nice vacation.

 

[bigdog8829]

More specifically, it's a problem with pre-meds, because some of us lack a fundamental security in which to realize that it's pretty much an individual game, where one is essentially competing against one's self. Sometimes we feel compelled to make others less than rather than elevating ourselves. There is no argument except the one that resides in us.

I wish there was an appluase icon.
I will be one to admit that I fall under this.

 

[J1515]

Again...time spent is in direct propotion to the skill of the physician.

Am I going to sit with a patient in a position for 90 seconds for a counterstrain technique? No way. But I WILL do FPR or LAS and get the same result in under 10 seconds, all with a myofascial release built in.

And what do you do if the pt has no relief of their symptoms with FPR? Would you just apologize, circle the billing code, and give them the boot? The issue I have with OMM as a whole is that some things don't work for some people and I have a problem performing a 10 second technique that might not work and then sending them on their way and billing for it. For example, you're placing the pt into completely opposite positions for ME vs. FPR. Theoretically speaking, how can they both have a theraputic effect? I understand the anatomical reasons for both treatments but it seems like almost a crapshoot when trying to choose which treatments to use in 2 minutes.

If I spend 2-3 minutes per patient and only get $18 on top of my regular fee, thats pretty good.

Just out of curiosity, how many of your patients come to you specifically with musculoskeletal problems? If a patient comes to you with a sinus infection or pneumonia, would you perform a lymphatic technique and have no problem billing for it? Ethically speaking, would you perform a pedal pump and bill for it? Or would you tell the patient to walk on a treadmill for 10 minutes once a day?

So if I can make 25-35% MORE by adding OMT and not adding a whole lot of time to each visit...well, that seems to make sense to me.

Again, this is assuming that there is a justification for performing these OMM techniques on the patients. History has shown that there is an osteopathic manipulative treatment for just about every type of disease or dysfunction out there. While I don't consider myself to have nearly as much experience as you do, I can tell you right now I don't buy into some of it. It's not due to closed mindedness, but rather a lack of evidence supporting it AND proposed mechanisms that seem unbelieveable to me. For example, to bring up the issue most commonly bashed here, I find it hard to believe anyone can feel CSF moving under skull bones. Until there is a way to measure these pulsations from contact outside the skull with a computer and then compare it to the sensitivity of the human finger tip I will refuse to perform this in a practice.

 

[Taus]

And what do you do if the pt has no relief of their symptoms with FPR? Would you just apologize, circle the billing code, and give them the boot? The issue I have with OMM as a whole is that some things don't work for some people and I have a problem performing a 10 second technique that might not work and then sending them on their way and billing for it. For example, you're placing the pt into completely opposite positions for ME vs. FPR. Theoretically speaking, how can they both have a theraputic effect? I understand the anatomical reasons for both treatments but it seems like almost a crapshoot when trying to choose which treatments to use in 2 minutes.



Just out of curiosity, how many of your patients come to you specifically with musculoskeletal problems? If a patient comes to you with a sinus infection or pneumonia, would you perform a lymphatic technique and have no problem billing for it? Ethically speaking, would you perform a pedal pump and bill for it? Or would you tell the patient to walk on a treadmill for 10 minutes once a day?



Again, this is assuming that there is a justification for performing these OMM techniques on the patients. History has shown that there is an osteopathic manipulative treatment for just about every type of disease or dysfunction out there. While I don't consider myself to have nearly as much experience as you do, I can tell you right now I don't buy into some of it. It's not due to closed mindedness, but rather a lack of evidence supporting it AND proposed mechanisms that seem unbelieveable to me. For example, to bring up the issue most commonly bashed here, I find it hard to believe anyone can feel CSF moving under skull bones. Until there is a way to measure these pulsations from contact outside the skull with a computer and then compare it to the sensitivity of the human finger tip I will refuse to perform this in a practice.

ok a few quick things here...

1. you're going to be prescribing drugs that work by many different and sometimes opposing mechanisms....and they can all be for the same goal.....some drugs don't work the same in all people for the various reasons that you have learned (or will learn)

2. Knowing exactly which treatment to use is something that comes with more experience and practice....something I don't claim to have yet either and none of us likely will unless you practice and continue using OMM after your pre-clinical years. For now, concentrate on acute vs. chronic and just learning how to do the various types well

3. you can't just lump all of OMM together and judge it by looking at one modality (cranial)