Osteopathic Medical Evolution

[proudtobeDO]

This is just my opinion!
Prediction:

Once the efficacy of OMT for many musculoskeletal and some visceral illnesses has been researched and proven (which I believe will occur), and the osteopathic profession has garnered all the respect it truly deserves (from both the medical world as well as the public), I foresee a change. As manual medicine techniques and some of the osteopathic philosophy are slowly integrated into the allopathic educational curriculum, and osteopathic medicine opens up its doors to more health professionals desiring to augment their education (MDs, allied health workers, MSc), I predict a change.

Osteopathic medical schools will no longer have that amiable feeling of warmth and
support. But rather, in achieving success and recognition, they will have adopted an
atmosphere of arrogance and smugness. The schools and their students will no longer
collaborate and uphold one another, but more willing will compete and struggle to be
better than the other.

I'd appreciate any comments!

[This message has been edited by proudtobeDO (edited July 08, 1999).]

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[Ponyboy]

I don't think that OMM will soon recieve the reception that you think that it will at allopathic schools and centers. I think that OMM will eventually be recognized as a valid form of treatment like chiropractic treatments but it will not be incorporated into allopathic medical schools. If anything, I think that as the AOA and the osteopathic schools strive to become more widely recognized, they will try to shed their image as second class medical schools and will try to encourage applicants with more competitive stats. This will lead to more competition within the individual schools. However, I don' think that there will be alot of competition between schools. There isn't any real competition between allopathic schools right now and many schools collaborate with one another on research projects. Generally, while students may compete with one another in their own school, they don't compete with other schools and their respective students. BTW, what exactly are the osteopathic schools competing for? Prestige? Research money?

 

[drusso]

A recent book on manual medicine published by the Academy of Physical Medicine and Rehabilitation was edited by a MD. Strangely, DO's wrote most of the chapters. People are watching. In Europe, manipulation is a larger part of medicine. Many european orthopaedists practice at least some manipulation.

 

[Ponyboy]

People are watching. But there are many other distractions. Do you remember the historical article in NEJM about the uses and benefits of chiropracting? Where was OMT and the AOA? People have realized the benefits of manual medicine in certain aspects of life. However, they are more likely to look for this manipulative treatment in chiropracters, massage therapists and physical therapists (because these professions have had a much better advertising campaign than the AOA). They aren't looking for it in their physicians, they're looking for it in their allied health professionals. That's why manipulative medicine isn't likely to be incorporated into allopathic schools. If anything, in the future, OMM training will be made available to those in PM&R and other specialties where it may be useful, not to all medical students.

 

[drusso]

I see your point, but it is fine line between educating patients and doing the disgusting kind of advertising that chiropractors do. If I had a choice, I'd prefer that the AOA not be *too* aggressive in emphasing manipulation; afterall, manipulation is only part of being a DO. I think that in the long run the profession will be best served by advancing OMM on its scientific merits. This is difficult because there are no huge profits to be made in OMM like in the drug industry.

By the way, OMM has been validated in many different ways. What is frustrating is that the field of OMM doesn't cumulate like other areas of medicine does. For example, someone does a pilot study of OMM for the treatment of adhesive capsulitis, finds positive results, and then the whole topic drifts off into obscurity. Compare this to the way other kinds of research in medicine gets done: A scientist discovers that drug X lowers cholesterol, other researchers do confirmatory studies, others do studies comparing different doses of medication, then they look at the effects stratified by gender, patient population, age, co-morbid conditions, etc. You see my point? At the end of the day, there is whole lot to say about drug X and cholesterol while OMM still only has a single positive study on its subject.

There is probably more evidence for the efficacy of manual medicine than most other areas of medicine, but it is scattered all over the map. To see the big picture, the trick is to not get too caught up in the minor differences between "brands" of manipulation and look more broadly at the whole field of manual medicine which includes physical therapy, massage, scientific (as opposed to professional) chiropractic, etc. We need to do more meta-analyses and we need to cumulate manual medicine's effects better. Then, we need to publish review articles and consensus statements.

Finally, what DO's bring to the table that is unique is that we are fully trained physicians *and* manual medicine practitioners, "full-boat, one-stop shopping" so to speak. Gee, what a concept...how cost-effective in these cost-conscious times.

[This message has been edited by drusso (edited July 11, 1999).]

 

[proudtobeDO]

My initial intention for posting was to spark up a discussion. I respect drusso?s opinion,
as well as ponyboy?s. They are both viable arguments.

This post is in regard to ponyboy?s first post.

Ponyboy,

You forecast that with recognition, osteopathic schools will strive for, and have the opportunity to admit applicants with more competitive stats. But does that necessarily
correlate to more competition within the schools? Or is that atmosphere more dependent
on the school and the environment it cultivates and fosters (this is what I was leaning toward in my original post).

In addition, you mention chiropractic treatment as if it were an accepted and well
researched art of medicine. I would have to disagree, I don?t think chiropractic therapy is an acknowledged form of medical care, as I believe OMT will be. Furthermore, to the
best of my knowledge, I don?t think chiropractic treatments have been well researched (I checked Medline etc.). And even if the treatments, in the future, are thoroughly researched, they will not be performed by complete physicians. In support, I excerpt from Eugene A. Oliveri?s, DO (AOA) statement when he discusses political issues on manual medicine in Europe(from Current challenges to MDs and DOs sponsored by the
Josiah Macy Jr Foundation, a book I became aware of thanks to an earlier thread). An agrument which I believe can be applied to the US as well. He alludes to a group of German physicians who practice manual medicine and had asked the European economic community to recognize only full physicians as praticioners of manual medicine ...because they felt that manipulation should only be performed by complete physicians.

Contrary to chiropractors, osteopathic physicians are complete doctors with a profound wealth of knowledge in medicine. Moreover, there are a number of scientifically researched projects on the effectiveness of OMT and back pain. And a number of projects currently underway to test the effectiveness (or efficacy) of OMT for other musculoskeletal disorders.

In regards to integration into the allopathic curriculum, I again take excerpts from the
above mentioned book:
Jordan J. Cohen, MD (AAMC) responds to Fredrerick Humphrey?s, DO (UMDNJ-COM)
question about the implications for the allopathic profession if the efficacy of OMT
should be proven. Cohen states ?I think OMT will be embraced and included in the
curriculum and added to the armamentarium ... it would be my view that anything that
was proven to be advantageous would be embraced enthusiastically and then adopted and used.? Furhtermore, Robert Graham, MD (American Family of Family Physicians)stated that ?If OMT were found effective, the allopathic profession would adopt it.?

The impetus for the integration would, in large part (I believe), be due to the
unsatisfaction the allopathic world feels about their current arsenal of treatment, especially for chronic illnesses. Enrique S. Fernandez, MD (HR & SA BHP) states ?I?ve become increasingly frustrated as an allopathic physician by the limitations of what my training has offered me in terms of being able to evaluate certain conditions and to treat them ... my armamentarium has failed me miserably [in some cases].?

In regards to the reception of OMT in the allopathic world (which you disagree with) I
mention the following: Gunnar B.J. Anderson, MD,PhD (Rush Presbyterian-St. Luke?s Medical Center) comments on the scientific study of OMT ?One study will not convince anybody, but once you get up to quite a few studies (DRUSSO?S POINT

), and they all point in the same direction, then people begin to believe. And Once they begin to believe they begin to study why, and they begin to incorporate these methods into their own treatment arsenal, and then finally we?ve made a step in the right direction?.In support Mary charelson, MD (Cornell University Medical College added ?Dr. Anderson is absolutely correct ... Really studying the efficacy of an intervention that is believed to be particularly efficacious in the osteopathic world, in a condition which is common and we commonly confront, is very important at this stage.?

Currently, MD physicians are requesting fellowships in osteopathic manual medicine,
which are approved by the AOA and allow the MDs to receive certificates in manual
medicine. OMT is also being incorporated into physical medicine and rehabilitation
training progams(I believe they offer OMT in Johns Hopkins? PM&R CME courses). Most obvious is OMT usefulness in Family
practice (e.g. Maine-Dartmouth http://www.dartmouth.edu/dms/mdfpr/PMMDFPR/Osteopathicmed.html)

I apologize for the length and dullness of this post. But I didn?t want to make claims
without any support. I also want to reiterate that my reason for these comments are for
discussion purposes only.

PS I believe osteopathic schools will compete for all of the above (prestige, research, grants) and more. I also believe allopathic schools are competing (however subtle it may appear to some). In regards to collaborated research projects, my understanding is that they are among individual researchers and not the schools themselves.

 

[Ponyboy]

proudtobeDO,
if DO schools do begin to rely more heavily upon stats and if more academically "elite" students begin entering into osteopathic medicine, you will see a new population of students at osteopathic medical schools. these people are ambitious and goal oriented and will strive to get high marks and honors in all that they do. this will invariably lead to competition regardless of where they study. they all have the same goal, to land a good residency, and as such, will work very hard. i believe that competition will be derived from this. there are some ways of remedying this: pass/fail classes etc. but there is still bound to be competition.

as for the research backing up chiropracting, i cannot recall the NEJM article as i only briefly skimmed over it. however, i do remember the large media work up about it and all the attention that it received. it received so much attention because chiropracting is a commonly accepted form of treatment among the public. many people have heard of chiropracters and are knowledgeable as to what they perform. whether there is research backing it up or not is irrelevant to the public (unless it is actually harmful). people will still flock to these bone-crackers because they have heard of them and believe that the treatment is effective. the question as to whether manual medicine should be performed by complete physicians is a minor one (a propos, it's interesting that the support you used was by physicians who practices manual medicine. let's see, if we made it illegal for anyone who is not a physician to practice manual medicine, then only DO's and specially trained MD's could practice manual medicine. hmmm, that seems kinda like a monopoly

)(also, another irony is that chiropracters are now thinking about campaigning to be referred to as "primary care physicians". pretty interesting.). massage therapists, physical therapists and chiropracters are specifically trained for manual medicine and i would be perfectly happy to let them treat my patients who needed it. i believe that they have sufficient training to do what they have to do. the alternative to these health professionals is a complete physician who specializes in manual medicine. in other words, a SPECIALIST. in the mind of an HMO (or patient for that matter) what would cost more, someone with about 4-6 years of training and a bachelor's degree (or at least a non-physician degree) or a PHYSICIAN with around 10 years of training. most people would pick the massage therapist because it would be cheaper for them (either the HMO or the patient seeking private services).

as for whether OMM will be introduced into allopathic schools, there are always people who have supporting opinions. OMM is useful in only certain conditions. have you asked the local pathologist, psychiatrist, ID specialist or public health physician when they last used OMM? more than likely you will get an answer of "in my fourth year of med school." a very small percentage of DO's actually use OMM in their practice (wasn't it something like 20% use OMM more than ten hours a week?). they have found that it is uneconomical for them to use OMM in their practice because it takes too much time. OMM is most useful and cost-effective in PM&R cases. outside of that, it is a rarity. that is why, i believe that if OMM will be incorporated into allopathic education, it will be incorporated at the post-graduate level for those who wish to learn it, not the undergraduate level.

anyways, you have to remember that DO's make up about 5% of the physician population. if they make changes into the curriculum of allopathic schools it will be at a much later date, when they have amassed enough support in numbers and public popularity (including being very well received from all of their MD counterparts). i think that by the time i begin to wind down my career, the changes will start to occur.

if DO schools compete for prestige they will have a long way to go. DO schools first have to overcome being seen as a "second rate med school" before they can start to compete, reputation-wise, with JHU, harvard and upenn. as for research money, everyone competes for research money, that's the nature of the beast. yes, allopathic schools do compete for research money but they are quite congenial to one another otherwise. if schools did compete, and i mean really compete, with one another, do you think that they would allow individual researchers to collaborate? there would be pressure to work with someone with in the school system over someone without.


BTW, i should tell you that i have been playing devil's advocate and that i am all for OMM and any other treatments that could help my future patients.

 

[edgar]

I want to follow up on a comment Dave Russo made about DO's being a "one-stop shop". According to a DO I know (hospitalist), this is correct. In his opinion, he feels that HMOs, especially in California where they reign supreme, love DOs because since they do manipulation they can keep billing "in house". He further explained that if an MD had a patient that required manipulative therapy, reimbursement would have to go out of the HMO/group practice to a chiropractor or massage therapist. With a DO, provided he/she practices manipulation, can perform manual medicine on the patient and keep the reimbursement within the HMO/group practice. The only problem he sees right now is what Ponyboy mentioned, OMT takes a lot of time and with managed care you don't have that kind of time when patients are lining up outside your door. And another problem is that HMOs/health plans don't always reimburse DOs for manipulative therapy so there might be little incentive for a DO to spend a lot of time on OMT and not get paid for it. Just parroting back what I've heard.......


EDGAR