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Osteopathic medicine as limited to primary care medicine

Discussion in 'Medical Students - DO' started by prolixless, May 30, 2001.

  1. prolixless

    prolixless Senior Member

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    I recently finished reading "Osteopathic Medicine: A Reformation in Progress" and the authors noted an interesting possibility for the future of osteopathic medicine. We all know the two most common scenarios for the future of osteopathic medicine, namely, that it either merge with allopathic medicine or that it remain a distinct field. But what if the osteopathic field was limited to the role of primary care medicine while the allopathic field was limited to the role of specialty medicine? After all, how many DO surgeons, for example, incorporate the use of OMT (either directly or by referal) in their practice? Do the surgeons at osteopathic hospitals still refer an OMT specialist as part of post-op care like they used to once upon a time? Post your thoughts on this topic.
     
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  3. muonwhiz

    muonwhiz Senior Member

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    I'd be surprized if there was an agreement for osteopathy to be limited to primary care and allopathy to the specialties. Most of the schools (of both) are advertising that they are great producers of primary care physicians. I'm not sure, but there may be some funding issues attached to it, especially from state legislatures for schools instates where more primaries are needed. Interesting question, though!
     
  4. turtleboard

    turtleboard SDN Advisor

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    I think this is something that's come up time and again in medical education. According to my school's archives, Columbia University considered taking over the institution and make it a generalist school producing only "general practitioners" (family physicians).

    The plans for it fell through, but it gives you the impression that some schools produced only primary care physicians in years past and it'll likely be the case in the future. It makes sense. Most DO schools' mission statements include "training of primary care physicians" somewhere in there, but as someone else pointed out, it'd be difficult to have the allopathic institutions give up on producing primary care physicians.
     
  5. kidterrific

    kidterrific Senior Member

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    I know it's illegal, but do you think you could repost the article here?
     
  6. Popoy

    Popoy SDN Super Moderator

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    "Osteopathic Medicine: A Reformation in Progress."

    Is not just an article, it is a small book.... The authors tackle issues of Osteopathic medicine from "The Beginning, The Present, and the Future"
     
  7. prolixless

    prolixless Senior Member

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    I think you guys are most likely right in that it would be too difficult for many allopathic schools to severe their ties to produce primary care physicians.

    However, if the trend twoard specialization continues like it has over the past decades, I could forsee state governments and the medical community limiting certain schools to produce only primary care physicians in an effort to create more pc physicans. It makes sense that osteopathic schools would be these chosen schools.

    Furthermore, since there is a correlation between physicians who specialize and physicians who train at large academic hospitals, I could forsee them limiting those medical schools which are linked closely with large academic hospitals to producing only specialty physicians. A move like this would cause fewer students to pursue the MD degree for pc medicine and eventually most of the pc physicans would be DO's. I could even see some allopathic schools (perhaps those ones that are not as closely affiliated with large university or academic hospitals) becoming dual training institutions where they train both MD's for specialization and DO's for pc.

    But like I said before, state governments and the medical communit would have to believe that a tend toward specialization is creating a detrimental effect from a shortage of pc physicians. After all, who's to say that they might not believe that a trend toward specialization is a good and natural thing, given the increasing complexity and technology of medicine. Or who's to say that they might come to believe that we don't need as many pc physicians as long as we have an abundant supply of PA's and NP's.
     
  8. stuDOc

    stuDOc Member

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    Where did the primary care focus of osteopathic medicine originate? Since "primary care" is a neologism created by the managed care community, I was wondering if it was a strategic political move on behalf of the osteopathic money makers to address the rapidly growing need for gatekeeper physicians while at the same time providing themselves a very marketable slogan to keep the class rooms filled with students (I Never new I was so cynical ;)). Any ideas?
     
  9. Brennan

    Brennan Senior Member

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    Yes thats what we need to do...think about placing restrictions on both sides....so both would have fewer choices..DUMB, DUMB, DUMB.....i cant even think of any state or federal system that would do something so stupid......this is something that i would help nip in the bud if it ever got past being a joke
     
  10. muonwhiz

    muonwhiz Senior Member

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    Popoy: please give the publication info for the Osteopathic book that you have cited above. Please give the name of the author and ISBN number to allow us to track it down. Where did you get the book? Is it paperback or (expensive) hardback? Thanks!
     
  11. prolixless

    prolixless Senior Member

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    I think you're partially right. We'd be naive to believe that the present-day osteopathic profession is not at some level exploiting the governments' and medical community's pull to produce more primary care physicians. Nevertheless, historically the osteopathic profession has had a propensity to produce primary care (or generalist) physicians both because of its guiding philosophy and because it didn't have much resources to do otherwise. The osteopathic philosophy has always emphasized a global approach to veiwing health and the human body, so it makes sense that it would emphasize it's physicians to have a general understanding of medicine--hence the production of generalist trained DO's. Also, historically osteopathic training has for the most part occurred in community hospitals and clinics. Thus it had little exposure to research medicine, large academic hospitals and expensive technology, all of which strongly contribute to training specialized physicans--hence the lack of specialty trained DO's. Check out Gevitz's book for a stronger analysis.
     
  12. prolixless

    prolixless Senior Member

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    Brennan,
    I'm in general agreement with you on this one. Still, whether we like it or not, forcing boundaries around a profession focusses it to practice only within those boundaries. If governments and the medical community actually believed our health care system was in a desperate situation due to lack of pc physcians, I could see them drawing those boundaries in order to force the production of pc physicians. Truly it would be no joke.
     
  13. Frosty

    Frosty Junior Member

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    I have to say that this has been an interesting topic and I have enjoyed reading different people's views. From my perspective, I would have to agree with those who are against suppressing the choices available to those who graduate with a D.O. or M.D. There are 4 years of learning and experiencing the different avenues of medicine between entering medical school with a premature idea of what direction you want your career to take you and applying for residency. I have heard from friends that they had changed their minds 3 or 4 times during their clinical rotations (including between general and specialty). I, personally, would be uncomfortable being forced to making a decision on my future career (deciding on general or specialty) without the knowledge you gain as part of your medical education. To me, applying these limitations would be like placing yourself in a glass box and not being able to extent beyond those glass walls. Finally, I think that this segregation between D.O./General and M.D./Specialty would weaken the medical profession as a whole. It is the combining of philosophies and knowledge that help us grow as medical care providers.

    *Limitations are only goals to be surpassed* ; )
     
  14. HomerJ

    HomerJ Senior Member

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    The question of allopaths serving as specialists and osteopaths serving as FPs is interesting but their is one flaw that is being overlooked. Since DOs make up less then 10% of the physician population, the need for FPs could not be met. You would see an even greater shift of MDs "overcrowding" larger cities, while small communities struggle to find enough DOs to meet their needs. Also, I think that it would be difficult to force people to choose what to practice before they even get a taste of what they are doing. I believe that the only way to generate more FPs is with government incentives. For example, paying for med school or paying off loans, and providing cheaper malpractice insurance through gov't subsidies. There are already programs through the military or the National Health Corps, so I don't know what more could be done.
     
  15. prolixless

    prolixless Senior Member

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    I also would hate to see medicine split up it's training between DO's and MD's. I think it would make for a greater bunch of physicians who are forced into certain fields and who are unhappy with their jobs. We already have too many unhappy physicians as it stands.

    Yet if there was a tremendous need for pc physicians, I don't think my opinion would hold much weight in the eyes of governments and other medical proponents of pc training. Let's face it folks. Medicine is one of the rare fields that gives it's students numerous avenues of practice to choose from, but the majority of career fields in life are not this convenient. Podiatrists, for example, have freedom within their boundaries of practice, but whether they like it or not, they must do work pertaining to feet. The same goes for other medical fields such as nursing and optometry. And somehow these people are able to jump into these limiting careers and yet still enjoy their work. The same would have to go for DO generalists and MD specialists. Who knows, maybe DO schools would require all it's admits to have shadowed pc physicians and MD schools would require it's admits to have shadowed specialty physicians, so that they could get a "taste" of these fields. I don't really know. But if push came to shove, the convenience of choice in medical school could take a backseet for the sake of producing more pc physicians.

    Regarding the notion that the DO population is too small to make this sort of split in medicine, I think you are right--as it stands now. Like most everything else, this would not be a change that occurs over night. DO's would have to earn the reputation of pc leaders and perhaps pc experts, given their whole-person philosophy. Somehow the idea would have to be inflated, by the government and medical community, that if you want to learn pc medicine, DO schools are the best place to do it. Like said before, some MD schools might become DO schools or dual MD and DO schools. Anyway, it would have to be governments and the medical community who guide this process and not DO's themselves.

    With all of that said, I think a bigger flaw in this whole idea is that there is not always a distinct separation between generalist and specialists. What fields would we consider pc and what fields specialties? There seems to be too big of an overlap or difference of opinion as to what counts as pc or specialty. Too many specialists have to do deal with pc related issues, and too many generalists have to deal with specialty related issues. Medicine is not a black and white field.
     
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  17. muonwhiz

    muonwhiz Senior Member

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    As far as incentives to practice primary care or in an underserved area, other that the National Health Corps, what else is there? I'm not including the military because that is its own animal. I've heard that there are large numbers of med students that apply for those scholarships, far more than there are slots (i.e. funding). I've also heard that the Bush administration wants to cut this program farther. I say that program should be expanded so that every med student that wants to do it could do so. And it wouldn't take a rocket scientist to come up with other kinds of programs for med student loan forgiveness bboth to practice primary care and also to work in underserved areas.
     

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