Interesting!!!

[AustinFinklea]

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I read this article; many of you may have already. I thought it was interesting.

http://www.jaoa.org/cgi/content/full/106/5/250

Do you think allopaths should be able to place into AOA approved residencies/internships????

 

[SamaraMorgan]

.

 

[Depakote]

I read this article; many of you may have already. I thought it was interesting.

http://www.jaoa.org/cgi/content/full/106/5/250

Do you think allopaths should be able to place into AOA approved residencies/internships????

Interesting indeed.

I did always think that was a bit of a double standard that DO's could enter MD residencies but not vice versa.

I guess my quesiton is not should they be able to, but could they?

I would assume any AOA approved residency/internship would have at least a minimal emphasis on OMM. The vast majority of MD graduates will have zero exposure to the practice, those that do (as an elective) would be at a substantial disadvantage compared to DO graduates who have spent 4 (or 5 years in the case of OMM fellows) mastering the skills.

Now OMM aside, would it be a bad idea? No.

If I recall correctly. A substantial number of AOA approved primary care residencies went unfilled last year. If this could help fill some of those spots, especially in underserved areas, then I would definitely support that.

And a large number of DO students still seek allopathic residencies. If this would aid in blurring the line between MD and DO, help eliminate some of the stigma that still exists and make it easier for osteopathic physicians to specialize in a broken system that has them starting a step back. I'm all for it.

 

[medmom]

My issue is that if theywant us to do osteopathic residencies than maybe they shoulld put them where we would want to go. I live in Colorado and although I am going to go to shcool in the east I want to return to the mountain states. What do I want to practice? The all dreaded primary care ( family practice). But when I look at residency programs there are NONE in MOntana, Idaho, Oregon or Washington and there is only one in Wyoming and one in Colorado, both in the desert of the east sides. So, I will probably do an allo residency simply because I want to be in the mountains where I plan to stay and practice.

 

[MaximusD]

My issue is that if theywant us to do osteopathic residencies than maybe they shoulld put them where we would want to go. I live in Colorado and although I am going to go to shcool in the east I want to return to the mountain states. What do I want to practice? The all dreaded primary care ( family practice). But when I look at residency programs there are NONE in MOntana, Idaho, Oregon or Washington and there is only one in Wyoming and one in Colorado, both in the desert of the east sides. So, I will probably do an allo residency simply because I want to be in the mountains where I plan to stay and practice.

it's a good thing that you didn't tell them u wanted to move back in your interview

 

[DoctorMom78]

Interesting indeed.

I did always think that was a bit of a double standard that DO's could enter MD residencies but not vice versa.

I guess my quesiton is not should they be able to, but could they?

I would assume any AOA approved residency/internship would have at least a minimal emphasis on OMM. The vast majority of MD graduates will have zero exposure to the practice, those that do (as an elective) would be at a substantial disadvantage compared to DO graduates who have spent 4 (or 5 years in the case of OMM fellows) mastering the skills.

Now OMM aside, would it be a bad idea? No.

If I recall correctly. A substantial number of AOA approved primary care residencies went unfilled last year. If this could help fill some of those spots, especially in underserved areas, then I would definitely support that.

And a large number of DO students still seek allopathic residencies. If this would aid in blurring the line between MD and DO, help eliminate some of the stigma that still exists and make it easier for osteopathic physicians to specialize in a broken system that has them starting a step back. I'm all for it.

I hope to fill one of those AOA primary care/underserved spots. I really want to do an osteopathic residency. I wonder how many MDs would want to do an AOA residency anyway. I don't know if I want the "line blurred" between the DO and MD. I personally really like osteopathic medicine and all it has to offer and it would be a shame for it to lose its identity. A.T. Still founded osteopathic medicine because he felt that traditional allopathic medicine was lacking. I think that an osteopathic physician in an allopathic residency and vice versa goes against everything that he believed in. I would like to see the two fields stay separate but equal. 😀

 

[DrMom]

I spent time on an AOA committee that was discussing this possibility. There are MD grads who have expressed interest in DO residencies. Much of the time this has more to do with them liking the location of the program rather than an interest in Osteopathic medicine, although I'm sure there's a bit of both.

The programs that don't fill are definitely interested in having US MD graduates. Everyone I've discussed this with has stated that they'd have to "catch up" on OMM in some manner. Obviously some specialties use more OMM in their training than others, but all AOA residencies have *some* kind of OMM requirement, so everyone would have to learn at least some OMM.

Personally, I don't have any problem with MDs applying to our programs as long as they do the OMM.

 

[MJB]

Interesting indeed...especially after having just finished my first reading of "The DO's" a couple of weeks ago.

 

[112258]

I have a question, what's the deal if you apply to allo and osteo residencies? Is it true that if you get into an osteo you have to accept it? So does that mean if you want some competitive specialty you only apply to allo programs? Or am I TOTALLY off...someone correct me 🙂

 

[bkpa2med]

The thing with that is that Osteo residencies match first, so if you match osteo that's what you get. Someone correct me if I am wrong.

 

[DropkickMurphy]

Personally, IF I go to an osteopathic program, I plan to not apply to any osteopathic residencies. Once I'm done with school, I'm done with OMM unless someone in my family pulls a muscle. 👍

 

[jkhamlin]

I spent time on an AOA committee that was discussing this possibility. There are MD grads who have expressed interest in DO residencies. Much of the time this has more to do with them liking the location of the program rather than an interest in Osteopathic medicine, although I'm sure there's a bit of both.

The programs that don't fill are definitely interested in having US MD graduates. Everyone I've discussed this with has stated that they'd have to "catch up" on OMM in some manner. Obviously some specialties use more OMM in their training than others, but all AOA residencies have *some* kind of OMM requirement, so everyone would have to learn at least some OMM.

Personally, I don't have any problem with MDs applying to our programs as long as they do the OMM.

Agreed.

Just for fun, and contribution to this topic with a related concept, take a look at the following (I'm sure you're aware of this, DrMom, but others aren't):

http://www.jaoa.org/cgi/reprint/101/2/68

 

[jkhamlin]

Personally, IF I go to an osteopathic program, I plan to not apply to any osteopathic residencies. Once I'm done with school, I'm done with OMM unless someone in my family pulls a muscle. 👍

🙄 🙄 🙄 🙄

 

[Doc2007]

Honestly speaking, we DOs are allowed apply to MD residencies, then we should allow them to get training in the Osteopathic program. It would seem fair. Of course, MDs will get to get some sort of training in the OMM.

 

[DrMom]

I have a question, what's the deal if you apply to allo and osteo residencies? Is it true that if you get into an osteo you have to accept it? So does that mean if you want some competitive specialty you only apply to allo programs? Or am I TOTALLY off...someone correct me 🙂

There are osteo residencies in competitive specialties, too, so your scenario isn't necesarily accurate. People just have to decide for themselves which programs they are most interested in and then decide if they're going to participate in the DO match. If you participate in the DO match and succesfully match to a program, you are pulled from the MD match because you already have a residency spot.

Whether you match via MD or DO, you are stuck with whichever program you match at...that isn't just a DO thing.

 

[DropkickMurphy]

🙄 🙄 🙄 🙄

What? I'm sure we all learn things in school (osteopathic and allopathic) that we have no intention of using ever again....even you.

 

[jkhamlin]

What? I'm sure we all learn things in school (osteopathic and allopathic) that we have no intention of using ever again....even you.

I don't go into things assuming I will never use what I learn. I learned that lesson this semester. I assumed that I would never use matrix algebra, and was pretty sure there was no use for it. Boy was I wrong. It is quite useful in regression analysis.

So, if you have a patient with a musculoskeletal injury that can be fixed with OMM, and you are a DO, you would prefer to drug them up with narcotics and tell them to stay out of work for 4-6 weeks (which you know they cannot and will not do) and possibly prescribe unnecessary surgery instead of doing the least invasive and most effective thing?

 

[Dr JPH]

I spent time on an AOA committee that was discussing this possibility. There are MD grads who have expressed interest in DO residencies. Much of the time this has more to do with them liking the location of the program rather than an interest in Osteopathic medicine, although I'm sure there's a bit of both.

The programs that don't fill are definitely interested in having US MD graduates. Everyone I've discussed this with has stated that they'd have to "catch up" on OMM in some manner. Obviously some specialties use more OMM in their training than others, but all AOA residencies have *some* kind of OMM requirement, so everyone would have to learn at least some OMM.

Personally, I don't have any problem with MDs applying to our programs as long as they do the OMM.

👍

Also, look at dually accredited programs.

In order for them to maintain the AOA portion of the accredidation there needs to be a certain amount of OP&P training throughout the course of the year.

I have been involved in this training for several different residency programs.

Much of it is lecture based regarding OMT, but there is indeed a laboratory portion to it.

In my experience working with MD residents in certain fields (Rehab, FP, Peds) they are VERY open to the idea of learning OMT and welcome it with open arms...often with more enthusiasm than the DOs in the same program.

So do I think MDs should be allowed access to DO programs? Yes.

Will MDs be interested in DO programs? Yes.

History tells us this...look at DO programs that gain dual accreditation and see the number of MD applicants who apply the following year...there is usually a fair amount.

I think all programs should work to gain dual accreditation...larger applicant pool, fewer restraints on graduates continued training and stricter guidelines to follow as far as strength of program.

 

[Dr JPH]

I don't go into things assuming I will never use what I learn. I learned that lesson this semester. I assumed that I would never use matrix algebra, and was pretty sure there was no use for it. Boy was I wrong. It is quite useful in regression analysis.

So, if you have a patient with a musculoskeletal injury that can be fixed with OMM, and you are a DO, you would prefer to drug them up with narcotics and tell them to stay out of work for 4-6 weeks (which you know they cannot and will not do) and possibly prescribe unnecessary surgery instead of doing the least invasive and most effective thing?

Not worth feeding DKM anything...he will turn it into a fight. Better to let it go.

 

[DropkickMurphy]

I don't go into things assuming I will never use what I learn. I learned that lesson this semester. I assumed that I would never use matrix algebra, and was pretty sure there was no use for it. Boy was I wrong. It is quite useful in regression analysis.

So, if you have a patient with a musculoskeletal injury that can be fixed with OMM, and you are a DO, you would prefer to drug them up with narcotics and tell them to stay out of work for 4-6 weeks (which you know they cannot and will not do) and possibly prescribe unnecessary surgery instead of doing the least invasive and most effective thing?

Well, let's assume I get into my dream residency- neurosurgery, or even my back up- critical care medicine. I don't imagine I'll be seeing too many people with minor musculoskeletal injuries at least that won't be superceded by other concerns.

While I see your point... but remember, I'll be a physician first and an osteopathic physician second. Not doing OMM is not going to get me sued. Failing to follow an accepted standard of care (even if it is not the best choice in the opinion of the OMM gurus) could hang my ass if I were taken to court.

Not worth feeding DKM anything...he will turn it into a fight

Nope, I've made my point. No desire for a fight.

 

[Dr JPH]

Well, let's assume I get into my dream residency- neurosurgery, or even my back up- critical care medicine. I don't imagine I'll be seeing too many people with minor musculoskeletal injuries at least that won't be superceded by other concerns.

While I see your point... but remember, I'll be a physician first and an osteopathic physician second. Not doing OMM is not going to get me sued. Failing to follow an accepted standard of care (even if it is not the best choice in the opinion of the OMM gurus) could hang my ass if I were taken to court.

Again, I think youre missing the point of using OMM as an adjunct. No one is telling you to do cranial instead of surgery for an uncal herniation.

But your postop patient can surely benefit from some OMT.

And no one is telling you to do a lymphatic pump instead of aggressive fluid management.

But your patient just off the ventilator can decrease their chances of post-op/post vent atelectasis with OMT.

Again...plenty of research to back both of those things up.

True...not doing OMM wont get you sued...but a patient who develops a gnarly post op pneumonia can get you sued if they die. Why not offer every possible chance for that patient to get healthier quicker?

If it came in pill form you would be all over it. But because its OMM you dismiss it.

 

[jkhamlin]

Again, I think youre missing the point of using OMM as an adjunct. No one is telling you to do cranial instead of surgery for an uncal herniation.

But your postop patient can surely benefit from some OMT.

And no one is telling you to do a lymphatic pump instead of aggressive fluid management.

But your patient just off the ventilator can decrease their chances of post-op/post vent atelectasis with OMT.

Again...plenty of research to back both of those things up.

True...not doing OMM wont get you sued...but a patient who develops a gnarly post op pneumonia can get you sued if they die. Why not offer every possible chance for that patient to get healthier quicker?

If it came in pill form you would be all over it. But because its OMM you dismiss it.

👍

 

[DropkickMurphy]

But your patient just off the ventilator can decrease their chances of post-op/post vent atelectasis with OMT.

So does:
-Getting them out of bed and into a chair, or walking
-Incentive spirometry
-PEP
-IPPB

If it came in pill form you would be all over it. But because its OMM you dismiss it.

No, if I could have my RT's do it or it were feasible from a standpoint of time, I'd be all over it. Several vent patients and a couple of them are unstable, I have a couple of bronchs to do, etc, etc. Figure I'm the only CCM doc (since I don't want to work in a huge hospital).....I don't exactly have time to be spend minutes massaging and manipulating each patient....

But yes, my burden of proof is going to be higher because it's OMM. It's just like if someone walks up to me claiming they have proof of the existence of sasquatch. The crackpots in the field have made anything in the realm of that topic suspect in the minds of the established "authorities" (mainstream medicine and the science community respective to each topic)

 

[Dr JPH]

So does:
-Getting them out of bed and into a chair, or walking
-Incentive spirometry
-PEP
-IPPB

Transferring pt OOB has its own risks, especially if its a neurosurg patient.

Research by Slyzewksi (sp???) showed OMT more effective than IS. 2 mins pedal pump vs IS use 4x/day.

I dont know why Im even trying to explain this to you...you have yet to attend one class in medical school...havent even been accepted to a medical school yet.

Why not go allopathic if your convictions are so strong against OMT?

I cannot understand how someone who has never learned or even tried OMT can have such a negative impression of it despite the research put in front of him.

You dont think I have ever done OMT on a neurosurgery patient or in the ICU?

Im going into general surgery...Ive spent the majority of my time in SICUs and ORs. I have seen first hand what OMT can do. I have had surgeons, orthos and neurosurgeons ask me to do OMT.

Again...Im not making the argument AGAINST what you list above, but offering OMT as an adjunct.

You are on the defensive like I am telling you OMT will cure what it cannot cure. Im simply telling you that those who have come before you have shown it to benefit the types of patients that the situations you describe entail.

If you ever get into medical school I hope you have a more open minded approach, because your patients are going to want you to do everything to save their ass. They will ask you to pray with them, they will ask you to respect their cultural and religious beliefs...what will you tell them? "No research, not wasting my time."

If 2 minutes of my time doing OMT can improve my patients chance of fighting or fending off pneumonia or post-op atelactasis, then its 2 minutes well spent IMO.

I will never be "too busy" to do everything I can for my patient.

 

[Dr JPH]

The crackpots in the field have made anything in the realm of that topic suspect in the minds of the established "authorities" (mainstream medicine and the science community respective to each topic)

So I would hope you would be smart enough and critical enough to REALIZE they are crackpots and discount what they say. I do.

Just the fact you are hanging your opinion of OMT on what a few "way out" people claim shows me you are too easily influenced by that.

Stay away from those who preach the extremes and look to the research and evidence for the rest of the field.

If a neurosurgeon told you he could give someone the powers of ESP by tinkering with the occipital lobe you would call them a crackpot and move on...but it wouldnt discredit the entire field of neurosurgery.

 

[DropkickMurphy]

If I get into an allopathic program, I will chose it over an osteopathic program, simply because I will have more than enough to learn without adding OMM to the mix.

I'm not doubting your experiences, or the evidence you've presented (as I have read most of what you've suggested), but I simply choose to stick with what I know works. You are at least reasonable and able to argue your points with something more than "You're a sellout". That I appreciate and wish that there were more people like you involved with OMM and fewer people that make osteopathy look like glorified chiropractic medicine because they cling to the "DO difference" simply for whatever reason......

 

[DropkickMurphy]

So I would hope you would be smart enough and critical enough to REALIZE they are crackpots and discount what they say. I do.

Just the fact you are hanging your opinion of OMT on what a few "way out" people claim shows me you are too easily influenced by that.

Stay away from those who preach the extremes and look to the research and evidence for the rest of the field.

If a neurosurgeon told you he could give someone the powers of ESP by tinkering with the occipital lobe you would call them a crackpot and move on...but it wouldnt discredit the entire field of neurosurgery.

Point taken......

 

[jkhamlin]

If I get into an allopathic program, I will chose it over an osteopathic program, simply because I will have more than enough to learn without adding OMM to the mix.

I'm not doubting your experiences, or the evidence you've presented (as I have read most of what you've suggested), but I simply choose to stick with what I know works. You are at least reasonable and able to argue your points with something more than "You're a sellout". That I appreciate and wish that there were more people like you involved with OMM and fewer people that make osteopathy look like glorified chiropractic medicine because they cling to the "DO difference" simply for whatever reason......

Those of us who "cling to the 'DO difference'" do so because we have seen it work, numerous times. I just think it is absurd to discount any useful knowledge before you have even learned it. It would be like someone saying "Yeah, all that stuff about antibiotics, sure I'll learn it, but really I won't use it after I graduate, I'll just tell my patients to wash their hands really well."

 

[Dr JPH]

If I get into an allopathic program, I will chose it over an osteopathic program, simply because I will have more than enough to learn without adding OMM to the mix.

I'm not doubting your experiences, or the evidence you've presented (as I have read most of what you've suggested), but I simply choose to stick with what I know works. You are at least reasonable and able to argue your points with something more than "You're a sellout". That I appreciate and wish that there were more people like you involved with OMM and fewer people that make osteopathy look like glorified chiropractic medicine because they cling to the "DO difference" simply for whatever reason......

And I wish you the best of luck wherever you get accepted.

I dont believe in the "youre a sellout" line....I look at it simply as people who have not had the opportunities that I have had in using OMT.

Regardless of where you go to medical school you need to keep an open mind...collective "you", not just you in particular.

Do those other things work? Sure.

But I have seen patients fall from a chair after getting OOB and I have seen IS sit at the bedside for a week unused.

Knowing that 2 minutes of my day can be MORE effective than either of those things means I will be spending 2 extra minutes with each patient. Hell...OMT can often be done on rounds while everyone is standing around yapping about the patient. It takes more time to pimp a 3rd year than it does to deliver an effective OMT treatment.

"3 areas, 3 minutes" should be the goal.

Those who know me know I am not a cranial, biodynamic or "voodoo" person.

The musculoskeletal system is just as vital as cardiac and pulmonary in providing health and stability to a patient. One delivers blood, the other oxygen and the final supports the interconnecting structures.

OMT simply takes the MSK system and gives it the same level of attention and respect as anything else. No more, no less.

Again...OMT wont cure an MI or stroke.

But I have seen it help with many, many things.

Maybe later I can list all of the conditions I have encountered where I have had PERSONAL experience in using OMT (not "i once heard a guy...")

Again...is it the end-all-be-all? No.

But neither is medication, radiation or surgery.

Well...maybe surgery. 😉