Number of DOs "growing exponentially"

[bones]

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I am legitimately wondering if there remains a practical difference in the style of medicine between the osteopathic medical school graduates and the allopathic graduates? If the last survey I saw is any indication, an exceedingly small and continuously dwindling number of practitioners incorporate OMM into their practice, and that being the case, is there a point to having two separate structures for producing physicians?

Very good question. There is a huge difference for those who are truly trained as osteopathic physicians, but most DO's have only a bare bones education in osteopathic philosophy and manipulation, and many are taught by MD's in 3rd and 4th year. New schools will dilute the quality DO educators even further.

I see three ways this can go.
1) Continue making dozens of new DO schools and dilute qualified and skillful OMM instructors even farther. The DO title is then a mark you didn't get into MD school. This is easy to do, and very profitable, and the AOA would remain powerful, but the quality of DO's will continue to decline.
2) Stop new schools and improve DO education such that DO's are indeed different in thinking and practice. There may then be many proud DO's, but this would potentially cost many powerful people a lot of income. The AOA would remain powerful.
3) Award MD's to all graduates except those who do extensive training in manipulation and choose to integrate it in their practice. This would be cost neutral, but the AOA would resist as it would take away all of their power.

If anyone has other ideas i'm all ears. To me the growth of new schools is a disaster, but without new legislation blocking it finances will continue to push us this way.

 

[TriagePreMed]

Very good question. There is a huge difference for those who are truly trained as osteopathic physicians, but most DO's have only a bare bones education in osteopathic philosophy and manipulation, and many are taught by MD's in 3rd and 4th year. New schools will dilute the quality DO educators even further.

I see three ways this can go.
1) Continue making dozens of new DO schools and dilute qualified and skillful OMM instructors even farther. The DO title is then a mark you didn't get into MD school. This is easy to do, and very profitable, and the AOA would remain powerful, but the quality of DO's will continue to decline.
2) Stop new schools and improve DO education such that DO's are indeed different in thinking and practice. There may then be many proud DO's, but this would potentially cost many powerful people a lot of income. The AOA would remain powerful.
3) Award MD's to all graduates except those who do extensive training in manipulation and choose to integrate it in their practice. This would be cost neutral, but the AOA would resist as it would take away all of their power.

If anyone has other ideas i'm all ears. To me the growth of new schools is a disaster, but without new legislation blocking it finances will continue to push us this way.

I doubt the DO degree will just be a marker that you didn't get into MD school. If anything, the standards for DO will grow and it will become like the DDS/DMD where nobody thinks one is better than the other.

Explain to me one thing. As a novice pre-med thinking about DO school, what is there about osteopathic medicine that's being "diluted" or "necessary" for the future generation of doctors?

 

[Limvostov]

I doubt the DO degree will just be a marker that you didn't get into MD school. If anything, the standards for DO will grow and it will become like the DDS/DMD where nobody thinks one is better than the other.

Explain to me one thing. As a novice pre-med thinking about DO school, what is there about osteopathic medicine that's being "diluted" or "necessary" for the future generation of doctors?

I could be wrong here but from what I understand at this point our third and fourth year rotations may or may not be with a DO. When you do not rotate with a DO you lose the "osteopathic" portion of the training because the person you're rotating with does not have that education. Thus, when you finish your education you are weakly trained more and more in osteopathic medicine depending on how many rotations you had with an actual DO physician.

For example: At my last job I worked at a new AOA residency site. A 1st year resident was on the phone calling up the hospitalist for some advice on a new admit and mentioned doing some form of OMT for the patient. The reply from the other end was obvious confusion as the resident had to explain what she was going to do step by step and add in "it's something we were trained to do as osteopathic physicians." The attending had no clue what she was talking about and voted down doing the OMT. Granted he was the on call hospitalist who only picked up about one shift at the hospital every two weeks, but that was a prime example of the future of osteopathic physicians being trained my MD's. That particular AOA site (also the only AOA site I have to compare too so n=1 here) has about 10% DO's and 90% MD's which is a decent ratio, but it's easy to see how things could get "diluted".

However, on the flip side of this. All the newly opening schools are not opening equal amounts of residency positions. This will cause many DO students who in the past would have attended an ACGME residency to need to look more toward AOA residency positions that are usually left unfilled. This will increase the number of osteopathic physicians getting a "true" osteopathic education.

 

[bones]

I doubt the DO degree will just be a marker that you didn't get into MD school. If anything, the standards for DO will grow and it will become like the DDS/DMD where nobody thinks one is better than the other.

Explain to me one thing. As a novice pre-med thinking about DO school, what is there about osteopathic medicine that's being "diluted" or "necessary" for the future generation of doctors?

What would be diluted is the quality and quantity of well trained DO's that integrate osteopathic philosophy and manipulation into their practice, relative to the number of incoming DO students. Think about student-faculty ratio of lab. If you double the number of students and the number of skilled OMM specialists remains the same, quality of training will suffer. I would argue that if the ratio is less than 1 teacher to 4 students you will be hard pressed to deeply understand the material. Even the best schools now are operating at a 1/6 to 1/8 ratio and many are operating at 1/10 ratio to 1/20 ratio. You can imagine what will happen to quality of education if you drop to a 1/40 ratio or a 1/80 ratio- which is what may be happening at some of the new schools.


Some of the older schools like KCOM and MSU-COM and PCOM will still have 5+ full time OMM faculty, but some of the new schools will have 1-2, or no full time faculty at all- opting instead for one or two part time faculty from the community to teach their 100+ student class. As new schools open, faculty are drawn away from established schools so even at these older schools faculty spots are left open. Most DO schools in the country has at least one OMM faculty spot open at this time.


My point in all of this is--- if quality of osteopathic education suffers, how skilled will the new graduates be as a whole? Will they truly be different than MD's, or will they simply have gone through the motions for a variety of techniques and memorized a few osteopathic terms for boards? how likely would it be that such a person would forget everything once they enter practice, and what does the DO degree then signify in this group of individuals? The few who invest their own personal effort will track down excellent mentors and will find a way to develop their skills, but the majority will not and that is who I am concerned about.


For those in DO school now- I am not trying to discourage you- find mentors, shadow OMM specialists, and practice outside of class. Ideally find a DO residency that incorporates Osteopathic principles into the specialty of your choosing.

For those applying to DO school to learn to be "osteopathic" physicians instead of just physicians- your job will be easier if you find a school with at least 5 full time OMM faculty and a faculty/student ratio in OMM class of at least 1 per 10 students. If you can find this at a new school than great, but otherwise look to the established ones.


and for everyone- vote to stop the mass production of new DO schools until we can fill faculty spots at the existing ones!

 

[Flushot]

bones, as a current 2nd year, the least of my concerns is the faculty to student ratio for OMM. Statistically speaking, the majority of my classmates won't use it in practice either, so this is not as big of a problem as securing sites for 3rd and 4th year and of course, residencies.

Also, why do you recommend searching for a DO residency with osteo principles? What if my specialty has little use for it?

I remember the residency director for Arrowhead EM residency in Colton, CA talking to us about having to do OMT to keep accreditation, even if it wasn't really applicable. Diagnosing wasn't enough and he honestly said it was a hindrance. That said, I would be thrilled to train there, due to the volume and pathology they see. It'll train excellent EM docs for sure.

I'll leave it at that since I think I know what seems to be important to you, but I personally find other issues more urgent.

 

[DOtoCanada]

Consequently, they tolerate the office with the ultra-rude desk staff, jerk doctors that never are on time, etc. because "insurance is paying for it" and they don't feel compelled to search for anything better. Would these same people tolerate that piss-poor level of service if they were paying out of pocket? I doubt it. (I could go on and on about this, but I digress. Needless to say, one of the things that frustrates me the most about health care in America today is that the concept of "customer service" has totally vanished only to be replaced by ridiculous MBA-inspired mumbo jumbo about "patient management". Given this, many doctor's offices frankly treat patients like dirt and seem to get away with it. I wouldn't mind being treated a little more like a "customer" by today's medical profession, and a little less like a "patient".)

This same issue exists with healthcare cost allocation etc. You wanna bring costs in line and balance compensation more equitably among specialties? Dump insurance and make everyone pay out of pocket. (This will never happen, of course, and it's not the only solution...but one can dream.)

Seriously? You obviously have NO CLUE as to how medicine works. So, if your doctor is late coming to your appointment it's HIS fault? Heaven forbid that the physician may have had an emergency. I'll remember that patients should be treated with a first come, first serve, you-only-get-your-allocated-timeslot-for-your-visit mentality when your loved one shows up with an MI. I'll make sure to tell them to wait as I promptly remove the hangnail that was scheduled to take place.

 

[bones]

bones, as a current 2nd year, the least of my concerns is the faculty to student ratio for OMM. Statistically speaking, the majority of my classmates won't use it in practice either, so this is not as big of a problem as securing sites for 3rd and 4th year and of course, residencies.

Also, why do you recommend searching for a DO residency with osteo principles? What if my specialty has little use for it?

I remember the residency director for Arrowhead EM residency in Colton, CA talking to us about having to do OMT to keep accreditation, even if it wasn't really applicable. Diagnosing wasn't enough and he honestly said it was a hindrance. That said, I would be thrilled to train there, due to the volume and pathology they see. It'll train excellent EM docs for sure.

I'll leave it at that since I think I know what seems to be important to you, but I personally find other issues more urgent.

You make my point exactly... I dont blame you as most likely you just haven't had the right exposure going through school so you dont see what I'm saying. You are making a practical argument about your personal concerns and opportunities for yourself and others, while I am making a argument of principle- why even call ourselves DO's if we have no intention of being different than MD's?

My argument is that most people who have no interest in using osteopathic philosophy and OMM would be better off as M.Ds... there is little point in them wearing the DO degree. This way you dont feel embarrassed by your degree, and those who are excited to be DO's dont have to keep explaining how they are different to puzzled audiences... "exactly the same only compassionate" doesn't fly- just ask any MD. If your idea of OMM is a few random techniques to address pain issues and you have no attending physicians to show you how to apply OMM during 3rd and 4th year its no wonder you dont see how it could be used in various specialties. So yes I agree we need better 3rd and 4th year coverage- but I would argue we need 3rd and 4th year DO attendings that can actually teach osteopathic principles.

When done right and with depth osteopathic principles are relevant to the vast majority of specialties. This means understanding functional anatomy in depth, and pathophysiology in depth- far more than most students leave their first two years with. This also means having a number of skillful specialists in your chosen field (or at least OMM specialists) to teach you how to use osteopathic principles and mechanics in the clinic setting for your specialty.

If a DO Emergency department doc could quickly and reliably tell who is a drug seeker and who has real pain would this be relevant? what about if they knew almost immediately what chest pain cases are cardiogenic vs pulmonary vs musculoskeletal vs GI? what if they could in a few minutes fix many of the patients that keep bouncing back for the same complaint which seems very vague to most MD and untrained DO attendings?

I have done 3 ER rotations in my training and all of the above is very easy to do even at a student and intern level if your hands are reasonably good.

I see applications like these for the vast majority of specialties-Anesthesiology (esp pain clinic), PMR, IM, FP, Peds, Neuro, Psych, OB, ortho and general surgery are the most obvious. These are probably around of 90% of DO's.

The exceptions may be path, optho and radiology, and derm but most DO's that go into these would be happy with an MD degree right... or an MD residency if they are competitive enough to get in?


I'm not here to fight you, just to lay out the problem. I believe that osteopathy is something worth saving and fighting for- and I have hundreds of patients that would stand by me and say the same... some who have failed treatment at major well known medical centers such as mayos... some have failed extensive surgery before coming to me, and some had been suffering for decades on a pile of medicines before they saw me- simply because their docs didn't have the right kind of training to understand what was really wrong with them. In many more I have prevented years of suffering and unnecessary surgeries, including for patients already on the chopping block (scheduled for the surgery we prevented).

Until more people know what osteopathy really is and what it is capable of, its gonna be a hard sell and I know this, but because i know whats possible I am going to keep pestering this message board. I am hoping those on the fence who read this learn something. Anyone with genuine interest who wants specific cases, PM me with specific questions- going into details here would be off topic. Anyone in Kirksville that wants to learn what exactly I'm doing or would like to see a demo, you're welcome to shadow me or join our weekly advanced applied osteopathy class- PM me for details.

thanks

 

[bones]

Thank you for your first reply. Could you explain how OMM/OMT applies to Psychiatry? I'm truly curious because I worked in a mental health clinic with only MDs and the most touching I ever saw them do was a handshake.

as psychiatry stands in the MD community, its strictly hands-off. Most DO psychiatrists have been trained by MD's in residency and mirror this. I have worked with a psychiatrist named Dr. Lovy- the first DO in the army to serve as a military doc (2nd in armed forces) who spends most of his visits with patients reading subtle musculoskeletal cues and changes when he talks about different topics with his patients- his skill here makes him like a human lie detector and almost a mind reader. He works closely with OMM fellows and students at various levels of training using manipulation on patients simultaneous as he goes through his psychiatric routine. He does extensive manipulation himself in the context of sports medicine and marathons- which he does for fun, but he is pretty much hands-off with his own hands on his psychiatry patients- mostly for fear of litigation. A strong DO psychiatry presence could change this fear. I am not a psychiatrist but I myself use osteopathic principles to treat sleep disturbance in psychiatric patients (both quality and quantity of sleep) which i believe is at the heart of many cases of depression, bipolar, ADD/ADHD, and schizophrenia (just ask a schizophrenic how well they sleep sometime, and ask what the symptoms are of a normal person who has no sleep x3 days, much less 10 years). I have seen unbelievable improvement in many of these cases, and complete remission of many (off meds)- especially children with ADD/ADHD.

 

[bones]

Thank you for your first reply. Could you explain how OMM/OMT applies to Psychiatry? I'm truly curious because I worked in a mental health clinic with only MDs and the most touching I ever saw them do was a handshake.

You might be interested to know that there was a Osteopathic Sanitarium in Macon Missouri back in the day, and they reported excellent patient outcomes relative to all other sanitariums in the state at that time- and the interventions used were OMM, sunlight (vitamin D) and exercise. Eventually it was bought out and they switched to a conventional psychiatric model for higher reimbursement and that was the last truly DO psych facility that I've heard of.

 

[TriagePreMed]

Thanks, Bones. I'm very much interested in going to DO over MD these days. I wish there was more information for those of us interested in doing so. I'm starting the Pre-Student Osteopathic Medical Association club at my school. I hope nationals will be able to provide us with these kind of resources.

 

[Flushot]

bones, thank you for the detailed response. I meant no animosity in my post; I just wanted to know what you thought about the reality of it.

It's unfortunate, but there are many reasons why OMM seems like a burden in the face of classes like path and micro. For example, Cranial is a hard sell and for them to grind it out in 3 weeks and somehow get us to care more about it than our Pharm test that same week is near impossible.

I have to run now, but I do appreciate your post. I like your sincerity in the validity of OMM but I don't really know what it will take to keep it with students beyond more professors.