Making it as OMM DO

[zoner]

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I was wondering, can a physician really make it financially as OMM practicing family or sports med doc?

I am into it, but am I kidding myself into thinking that I will be able to pay off all my 300k to 600k debt doing this?


Thanks

 

[Darthberghen]

It's an applicability issue. Don't know of anyone doing OMM all day for a living. OMM is not the only thing taught in DO school, as you know.

 

[cel2016]

Not sure exactly what you mean by your question - are you wondering about treating with ONLY OMM?

Many DOs don't end up using OMM in practice at all (including the two I've shadowed who are family practice docs). However some (I know of one) choose to "specialize" in OMM, but still utilize other modalities of treatment as necessary.

I'd guess to "make it" financially with only OMM you'd need to be in an area where you have a patient base that really buys into it (large city/progressive area)... of course that's just my gut feeling, I have no data to back it up.

 

[zoner]

I guess what I really meant was that how do you practice OMM as a family physician if you can only have 10-15 minutes at a time with a patient? Also, i heard that a lot of family doc declare bankruptcy and can't make much money. If so, how would I ever pay off my loan or let alone practice OMM on top of that?

 

[Cinclus]

I guess what I really meant was that how do you practice OMM as a family physician if you can only have 10-15 minutes at a time with a patient? Also, i heard that a lot of family doc declare bankruptcy and can't make much money. If so, how would I ever pay off my loan or let alone practice OMM on top of that?

If I'm not mistaken, you can bill for OMM as a procedure. So even if the amount of time spent with a patient is lengthened by OMM, they will be billed for it on top of the bill for the appointment.

 

[Darthberghen]

Keep in mind the vast majority of FM issues are not amenable to OMM, and most people go in expecting a pill.

 

[donkeykong1]

I guess what I really meant was that how do you practice OMM as a family physician if you can only have 10-15 minutes at a time with a patient? Also, i heard that a lot of family doc declare bankruptcy and can't make much money. If so, how would I ever pay off my loan or let alone practice OMM on top of that?

oh really? 🙄

yes, it is financially lucrative to run an FM+OMM practice

 

[oms2]

some doctors are plain ignorant when it comes to running a business, there are plastic surgeons and dentists that have gone bankrupt in this recession

 

[SpecterGT260]

I guess what I really meant was that how do you practice OMM as a family physician if you can only have 10-15 minutes at a time with a patient? Also, i heard that a lot of family doc declare bankruptcy and can't make much money. If so, how would I ever pay off my loan or let alone practice OMM on top of that?

It will be up to you if you go the DO route as to how much OMM you include in your practice. I suspect, though, even if you went into an OMM friendly field (because not much OMM goes on in things like radiology, for example) it will depend on 1) your patient population - how much do they ascribe to non-pharm treatments vs "expecting a pill" and 2) your particular scope of practice and is practicality - you may find that it is more financially savvy to provide other treatments, and since you will be trained to do so... why not?

 

[zoner]

so on average, can a family physician make enough to pay of all the med school loan debt?

 

[SpecterGT260]

so on average, can a family physician make enough to pay of all the med school loan debt?

yes.

 

[oms2]

the average fp is doing fine. if you're willing to live a little away from the big cities, you can have a good life, revered by everyone and the cops will never give you a ticket. and if you can set up your own lab and hire a couple of techs maybe even a pt, you can rake in very decent dough. it's not a bad gig.

 

[dozitgetchahi]

I know of a couple docs affiliated with UMDNJ-SOM that do nothing but OMM and are cash-only to boot. These guys are supposedly doing very well (i.e., making $300-400k/year).

 

[3dee]

I know an OMM only doctor that does really well (but doesnt accept insurance)

 

[oms2]

i worked in a clinic. yeah the overhead involved with insurance is significant. that's a problem with the business side of medicine vs dentistry.

 

[peppy]

While I'm not a big OMM fan myself, I have worked with Family Medicine docs who did OMM as part of their practice. Even if it's not a major city, you can find patients with chronic pain issues who are willing to try OMM (after all, consider how many people out there go to chiropractors), especially if you're in a state with a DO-friendly atmosphere. Visits for OMM are indeed billed differently than normal office visits are. I definitely think if you are interested in OMM that it's quite possible to incorporate into a primary care practice. I think the main reason most DOs don't do it these days is because many of us go into allopathic residencies where OMM skills atrophy and/or many of us just are not that interested in continuing to do it.

 

[zoner]

While I'm not a big OMM fan myself, I have worked with Family Medicine docs who did OMM as part of their practice. Even if it's not a major city, you can find patients with chronic pain issues who are willing to try OMM (after all, consider how many people out there go to chiropractors), especially if you're in a state with a DO-friendly atmosphere. Visits for OMM are indeed billed differently than normal office visits are. I definitely think if you are interested in OMM that it's quite possible to incorporate into a primary care practice. I think the main reason most DOs don't do it these days is because many of us go into allopathic residencies where OMM skills atrophy and/or many of us just are not that interested in continuing to do it.

are you in OMM residency?

 

[peppy]

are you in OMM residency?

No. I'm in allopathic residency myself and never use OMM anymore (by choice). I just happened to work with some people who were really into OMM when I was doing family medicine as an intern and a student.

 

[cabinbuilder]

If I'm not mistaken, you can bill for OMM as a procedure. So even if the amount of time spent with a patient is lengthened by OMM, they will be billed for it on top of the bill for the appointment.

Yes, you bill OMM as a procedure. You bill based on how many regions you treat and their are 9 regions that are coded for.

If you get good at HVLA which is really what I use most of the time then I can do the C-spine, T-spine, L-spine, and Sacrum in about 3 mintues.

So I would do my A/P

back pain 724.5
Somatic Dysfunction of Cspine Tspine Lspine Sacrum 739.1, 739.2, 739.3, 739.4


Bill the office visit 99213 + modifier 25 for OMM procedure 98925

Of course you can always add a trigger point injection or a joint injection, etc to the visit. plus whatever laundry list of stuff the patient comes up with.

 

[cabinbuilder]

It's an applicability issue. Don't know of anyone doing OMM all day for a living. OMM is not the only thing taught in DO school, as you know.

I have multiple physician friends who only do OMM for their entire practice.
They do not use insurance and are cash only. They do well but they are very very good at what they do.

 

[zoner]

how did they establish their practice? do they advertise or what?

and how do they make patients cover all that expenses in cash? assuming that bills for the procedures you mentioned will come out to be near 500$

 

[group_theory]

Yes, you bill OMM as a procedure. You bill based on how many regions you treat and their are 9 regions that are coded for.

If you get good at HVLA which is really what I use most of the time then I can do the C-spine, T-spine, L-spine, and Sacrum in about 3 mintues.

So I would do my A/P

back pain 724.5
Somatic Dysfunction of Cspine Tspine Lspine Sacrum 739.1, 739.2, 739.3, 739.4


Bill the office visit 99213 + modifier 25 for OMM procedure 98925

Of course you can always add a trigger point injection or a joint injection, etc to the visit. plus whatever laundry list of stuff the patient comes up with.

I have multiple physician friends who only do OMM for their entire practice.
They do not use insurance and are cash only. They do well but they are very very good at what they do.

Yup. You can choose to bill medicare/insurance or take cash only (and can bill by the hour or submit the same bill as you would have for insurance)

It has been years since I dealt with OMT reimbursement (since med school) but I believe reimbursement ranges from $18-30 per level/region.

If you do C-spine HVLA, then treat bilateral first rib, and then work on the upper thoracic, you can probably get $50 for 3-5 minutes of work

Or you can bill by the half hour. Some places bill $50-$150/hr, but some places (with long wait list) bill up to $200/hr.


*you have to be real good and usually people learn about you through word of mouth (and not advertisement). People are willing to pay cash in stuff they see value. And there are a lot of people with money willing to spend (think of all the people with money in NYC+suburbs of NJ/CT, SF, LA, DC, Boston, etc)


Disclaimer - it has been years since I dealt with OMT reimbursement (my Family Medicine preceptor introduced me to this during my FM rotation). My residency did not deal with OMM at all (obviously, since it was an ACGME university program) and I don't do OMT in my fellowship so the information that I just posted may be outdated.


Check out this post (an oldie but goodie)
http://forums.studentdoctor.net/showpost.php?p=4772647&postcount=197

 

[costales]

FYI - There is a JAOA write-up on OMT billing and coding:
http://www.jaoa.org/content/109/8/409.full.pdf+html

 

[cabinbuilder]

how did they establish their practice? do they advertise or what?

and how do they make patients cover all that expenses in cash? assuming that bills for the procedures you mentioned will come out to be near 500$

Well, my friends have an OMM only practice and/or accupuncture. They have a flat rate office visit. I know the one charges $100/visit, and the other $150/vist.

Their clientele are referred from colleagues. They don't do any other family practice visits. Just like folks who go to massage or accupuncture, they know it's cash up front.

 

[zoner]

well, i just don't think its a "letgit" medical treatment . How is it any different than going to get a really good body work?

 

[SpecterGT260]

well, i just don't think its a "letgit" medical treatment . How is it any different than going to get a really good body work?

Wtf is letgit?

 

[zoner]

Wtf is letgit?

well, maybe legit was a poor choice of words... how is it any different than getting a massage or other body works whose practitioners always spew that their work cures? DO gets what around 500 hours training in OMM? Acupuncturist gets what like 2000 hours in what they do and some massage therapist gets about 1000 hours for their licenses as well, then who is to say DO can do those body works better than other therapist like an acupuncturists or a massage therapist?

 

[oms2]

so you went from

I am into it

to

i just don't think its a "letgit" medical treatment

to

DO gets what around 500 hours training in OMM? Acupuncturist gets what like 2000 hours in what they do and some massage therapist gets about 1000 hours

what's your real question?

 

[zoner]

i guess my question is how do you practice OMM with only 500 hours of training in it? Or am I wrong in thinking that

 

[Styria]

well, maybe legit was a poor choice of words... how is it any different than getting a massage or other body works whose practitioners always spew that their work cures? DO gets what around 500 hours training in OMM? Acupuncturist gets what like 2000 hours in what they do and some massage therapist gets about 1000 hours for their licenses as well, then who is to say DO can do those body works better than other therapist like an acupuncturists or a massage therapist?

You're begging the question that the content of those hours is equivalent. DO schools average 180 hours for OPP. But in them we learn much more variety of techniques and principles, at a faster pace. We also learn more anatomy, more physiology, etc. Everything will help your OMM if you're interested, even histology and pharmacology. By the end of second year students can innovate and apply what they've learned in new ways. And if you don't know what to do, you consider the anatomy and go from there.

I've been in courses with massage therapists, physical therapists, bodyworkers, etc. DOs are better.

 

[Prncssbuttercup]

Because we're trained to do more than one thing. The people you listed are only trained to do ONE thing...

Either way, I think it is letgit (hehe-legit) and am hoping that I will be able to incorporate it into my practice some day... I aspire to be like CB in many ways... she's inspiring 🙂 (I'm serious)

 

[dsoz]

Back to the original question. I shadowed a DO in Portland that has an OMM only practice. Very successful, in an office that is considered fairly high rent district near the river. He had a partner, but the partner split to start his own practice. Now the first guy is hiring another partner.

He has DO med students from two different schools scheduled to do rotations through his office.

I shadowed two days, and there were a constant stream of people coming through the door for OMM treatment.

If something works for someone, they will refer their friends, who refer their friends, etc.

dsoz

 

[zoner]

So I have a question.

I am very familiar with one of other bodywork since I used to do them professionally. Sure I learned a lot of techniques, but honestly, I thought most of the techniques were kinda bogus. They do make people feel better, rested and just overall good, but can't say I ever cured anyone with what I used. With that said, I have shadowed some DOs and I do agree that people like them a lot. But I saw a lot of similarities between what DOs do and what other therapists do. Ok, they know more about health and physiology since they are physcians , but if they are applying similar techniques such as HSL, soft tissues, joints, trigger points, all therapies used by other practictioners such as chiros, accus and mass therapists, who is to say their method of execution is science based and not something based on say their instinct or other hoky poky purely based on just some common sense such as stretching, strength training and good old placebo effect. Sure, its the result that matters, but it sound awfully like the treatment is not totally scientific based. I reject the notion that being a doctor has art to it. I think it should be science based. Is it also ethical to charge so much for their treatments when similar things could be done by other practitioners for a much cheaper price? This is where I am confused. How scientific are all the OMM treatments? How accurate are OMM diagnosis? How much is it really treating the patient when an OMM doc does one trigger point release for a whole hour and charge several hundred dollors?

To clarify myself further, lets say someone has a really bad plantar fasciitis, how would the method of treatment be different if they were to go to DO, PT, MT or Acupuncturist? They would all probably release all the muscles around the lower extremes starting from the lower back down, no? Maybe DO would probably do cranial work, but that method is controversial as to its effectiveness.

 

[zoner]

You're begging the question that the content of those hours is equivalent. DO schools average 180 hours for OPP. But in them we learn much more variety of techniques and principles, at a faster pace. We also learn more anatomy, more physiology, etc. Everything will help your OMM if you're interested, even histology and pharmacology. By the end of second year students can innovate and apply what they've learned in new ways. And if you don't know what to do, you consider the anatomy and go from there.

I've been in courses with massage therapists, physical therapists, bodyworkers, etc. DOs are better.

Can you elaborate on that please? When I shadowed a DO, I was already familiar with most of visible techniques s/he was using except of course, they knew all the correct medical terms that made them (seem) more knowledgeable. And of course, they take physical history and etc but you know what surprised me was that one DO would use similar techniques and procedure for all the patients. Their techiniques didn't vary all that much from patients to patients. And this is very similar to other body work practitioners as well.

 

[zoner]

It's an applicability issue. Don't know of anyone doing OMM all day for a living. OMM is not the only thing taught in DO school, as you know.

Yeah, I know that, but I am talking if I were to do my residency or fellowship in OMM.

 

[Prncssbuttercup]

I guess I fail to see how massage and OMM aren't giving a medical benefit?? I don't think you're accepting that stress and muscle/joint pain cause people daily pain which affects their life. It interrupts sleep, causes all sorts of other issues, and rectifying them DOES show medical benefit. I don't see what you're missing...

 

[Dharma]

I reject the notion that being a doctor has art to it. I think it should be science based.

I feel that "art" comes through in approach and delivery. There is an art in the way one practices any profession, i.e. how he deals with people and practices/refines the skills of his trade. In terms of a physician's approach and delivery, mastering one's art could only help a patient's overall well-being, even if eliciting a placebo effect. In this regards, art is very much a part of the practice of medicine.

That said, the validity and efficacy of all therapies and procedures should be sought through scientific inquiry and attempting to arrive at a deeper understanding behind any mechanisms at play. Lack of concrete understanding does not necessarily mean that said therapy/procedure is ineffective or just the result of placebo effect though.

 

[zoner]

I guess I fail to see how massage and OMM aren't giving a medical benefit?? I don't think you're accepting that stress and muscle/joint pain cause people daily pain which affects their life. It interrupts sleep, causes all sorts of other issues, and rectifying them DOES show medical benefit. I don't see what you're missing...

I wasn't saying that there is no benefit, but just saying what makes OMM's techinques for releasing stress and muscle/joint pain different than going to a really well trained/intuitive massage therapist or other body workers for a lot cheaper?

 

[zoner]

but without a concrete scientific proof to go by, bodywork practice that deals heavily with placebo effect is bordering on being unethical since we are asking to be paid well for it.

for example, how body workers define normal is problematic. sure, there is normal (insert whatever) level in your blood serum, pee or whatever that can be concretely measured, but how do you really define what is normal stance, normal posture, normal muscle tone, normal flexibility, normal balance? These are the mainways I think a lot of body-workers use to execute their techniques, but what is normal/healthy for one is not the same for the other, and if b/w apply this certain standard to everyone, how are we going to know the real benefit of what is being done? its all rather too subjective and it becomes like what a painter does. what looks good to one viewer isn't for another.


another example is this.. lets say a patient comes in with years of "bad" posture due to some childhood injury. A muscle is really tight on one side of the body. How does say one, two or three treatment going to really "cure" that? sure, the pain can be alleviated for a day or a few days at max, but it can't cured unless the patient does serious therapies, strength training and other self care. going to see a doc for that condition is probably be the least effective way to "cure" his issues.

 

[Dharma]

but without a concrete scientific proof to go by, bodywork practice that deals heavily with placebo effect is bordering on being unethical since we are asking to be paid well for it.

for example, how body workers define normal is problematic. sure, there is normal (insert whatever) level in your blood serum, pee or whatever that can be concretely measured, but how do you really define what is normal stance, normal posture, normal muscle tone, normal flexibility, normal balance? These are the mainways I think a lot of body-workers use to execute their techniques, but what is normal/healthy for one is not the same for the other, and if b/w apply this certain standard to everyone, how are we going to know the real benefit of what is being done? its all rather too subjective and it becomes like what a painter does. what looks good to one viewer isn't for another.


another example is this.. lets say a patient comes in with years of "bad" posture due to some childhood injury. A muscle is really tight on one side of the body. How does say one, two or three treatment going to really "cure" that? sure, the pain can be alleviated for a day or a few days at max, but it can't cured unless the patient does serious therapies, strength training and other self care. going to see a doc for that condition is probably be the least effective way to "cure" his issues.

and therein lies the problem of developing decent OMM studies. the field does need more who are willing to develop competent research and studies.

then again, you are focusing here on the topic of pain as well, which is very subjective. This issue is not exclusive to OMM and will definitely be seen in the realm of pain medicine as well (where other, possibly more dangerous modalities are utilized without much evidence either).

To add to all of this, your typical D.O. will have a much deeper knowledge and understanding of human anatomy and physiology as compared to the average body work therapist.

 

[Dharma]

another example is this.. lets say a patient comes in with years of "bad" posture due to some childhood injury. A muscle is really tight on one side of the body. How does say one, two or three treatment going to really "cure" that? sure, the pain can be alleviated for a day or a few days at max, but it can't cured unless the patient does serious therapies, strength training and other self care. going to see a doc for that condition is probably be the least effective way to "cure" his issues.

This sounds like something a PM&R doc would handle, who may employ OMM, and will most likely determine the most effective means of treatment. This could include a referral for longterm physical therapy administered by a DPT. The physician's understanding of MSK is exactly what is needed to direct competent care in such a case. His involvement in such process, even if only as the individual who directs the course of treatment, would be quite effective. Go ask the folks over at PM&R what they think about such a scenario.

 

[zoner]

To add to all of this, your typical D.O. will have a much deeper knowledge and understanding of human anatomy and physiology as compared to the average body work therapist.

yeah, of course,

 

[zoner]

This sounds like something a PM&R doc would handle, who may employ OMM, and will most likely determine the most effective means of treatment. This could include a referral for longterm physical therapy administered by a DPT. The physician's understanding of MSK is exactly what is needed to direct competent care in such a case.

is that pain management and rehabilitation?

what's MSK?

 

[Prncssbuttercup]

Just a wild guess
Musculo-skeletal Kinetics/kinesis...

 

[oms2]

is that pain management and rehabilitation?

what's MSK?

musculoskeletal
betcha they don't teach medical terminology in massage school

 

[zoner]

musculoskeletal
betcha they don't teach medical terminology in massage school

um. i beg to differ. they teach that in all bodywork school such as in acupuncture schools and massage schools and what not. it also depends on what school.

 

[SpecterGT260]

um. i beg to differ. they teach that in all bodywork school such as in acupuncture schools and massage schools and what not. it also depends on what school.

knowing "musculoskeletal" does not mean knowing medical terminology. Ive heard some pretty interesting and creative uses of medical terminology by such people

 

[zoner]

knowing "musculoskeletal" does not mean knowing medical terminology. Ive heard some pretty interesting and creative uses of medical terminology by such people

man, dudes, stop being so condescending to other professions

 

[SpecterGT260]

man, dudes, stop being so condescending to other professions

You should learn the difference between statements of fact and condescension.
Saying "xxxx does not possess yyyy skill" is not condescending. The problem arises when xxxx wishes they had yyyy and any statement to the contrary just pings an insecurity. But again, this should not be confused as condescending.

 

[zoner]

You should learn the difference between statements of fact and condescension.
Saying "xxxx does not possess yyyy skill" is not condescending. The problem arises when xxxx wishes they had yyyy and any statement to the contrary just pings an insecurity. But again, this should not be confused as condescending.

oh yeah, your right, i should learn to read and understand simple statement. gosh you are so smart and well knowing. ead again the way you phrased your statement! by such people. Anyways, I wasn't going on this direction with this thread.