Osteopathic Medicine

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Andrew Taylor Still

Mentor - Osteopathic Med.
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Hello!

I would like to introduce myself. My name is Andrew Taylor Still and I am the founder of Osteopathic Medicine.

I have been invited to The Student Doctor Network by Dr. Lee Burnett to help answer any questions about osteopathic medicine.

I will be checking in regularly to be of service here. Just remember, I am 178 years old to please be sure to speak up and make the title of your post very clear so that I can recognize it!

:)

BEFORE ASKING YOUR QUESTION, PLEASE READ THIS!

I have included some links that might help you out a bit. Please be sure to read and research before you look to me for help. It is very difficult for me to answer ALL of your questions in a timely manner. If you cannot find the answer you are looking for or want more information, then please post your question.

Thank you!

OMM / OMT
http://forums.studentdoctor.net/showpost.php?p=5019417&postcount=21
http://forums.studentdoctor.net/showpost.php?p=5021754&postcount=22
http://forums.studentdoctor.net/showpost.php?p=5022704&postcount=24
http://forums.studentdoctor.net/showpost.php?p=5044439&postcount=42
http://forums.studentdoctor.net/showpost.php?p=5044518&postcount=45

MD vs DO
http://forums.studentdoctor.net/showpost.php?p=5002483&postcount=4
http://forums.studentdoctor.net/showpost.php?p=5002657&postcount=9
http://forums.studentdoctor.net/showpost.php?p=5032354&postcount=30
http://forums.studentdoctor.net/showpost.php?p=5043124&postcount=40

DOs in Residency / Internship / Residency Matching
http://forums.studentdoctor.net/showpost.php?p=5002498&postcount=5
http://forums.studentdoctor.net/showpost.php?p=5002612&postcount=8
http://forums.studentdoctor.net/showpost.php?p=5006380&postcount=11
http://forums.studentdoctor.net/showpost.php?p=5009529&postcount=12
http://forums.studentdoctor.net/showpost.php?p=5010023&postcount=13
http://forums.studentdoctor.net/showpost.php?p=5017084&postcount=18
http://forums.studentdoctor.net/showpost.php?p=5027115&postcount=26
http://forums.studentdoctor.net/showpost.php?p=5028550&postcount=27
http://forums.studentdoctor.net/showpost.php?p=5033952&postcount=31
http://forums.studentdoctor.net/showpost.php?p=5034865&postcount=34
http://forums.studentdoctor.net/showpost.php?p=5038784&postcount=35
http://forums.studentdoctor.net/showpost.php?p=5039717&postcount=36
http://forums.studentdoctor.net/showpost.php?p=5042774&postcount=39
http://forums.studentdoctor.net/showpost.php?p=5059813&postcount=50

Dual Degree Programs
http://forums.studentdoctor.net/showpost.php?p=5042712&postcount=38


MDs and OMT
http://forums.studentdoctor.net/showpost.php?p=5031187&postcount=29


OMT in Clinical Practice
http://forums.studentdoctor.net/showpost.php?p=5002529&postcount=6
http://forums.studentdoctor.net/showpost.php?p=5002704&postcount=10
http://forums.studentdoctor.net/showpost.php?p=5011496&postcount=15
http://forums.studentdoctor.net/showpost.php?p=5034704&postcount=32
http://forums.studentdoctor.net/showpost.php?p=5034732&postcount=33


Applying to Osteopathic Medical School
http://forums.studentdoctor.net/showpost.php?p=5011513&postcount=16
http://forums.studentdoctor.net/showpost.php?p=5044497&postcount=44
http://forums.studentdoctor.net/showpost.php?p=5048710&postcount=47
http://forums.studentdoctor.net/showpost.php?p=5054692&postcount=49

Growth of Osteopathic Medicine
http://forums.studentdoctor.net/showpost.php?p=5002583&postcount=7

International Practice Rights
http://forums.studentdoctor.net/showpost.php?p=5017145&postcount=20




Helpful Links:

American Association of Colleges of Osteopathic Medicine
http://www.aacom.org/

AOA
https://www.do-online.org/

Osteopathic Internship & Residency Search
http://opportunities.osteopathic.org/index.htm

Find a D.O.
http://www.osteopathic.org/directory.cfm

DO SCHOOLS
collegemap-big.gif


Q: What are the average MCATs & GPAs for DO schools?
A: http://pegasus.cc.ucf.edu/~amsa/links/medmcat.html




=======================================

OK, so I'm not the REAL A.T. Still, but I do have a lot in common with him.

Like Dr. Still I wanted to find complementary methods to treating my patients and not just rely on the "conventional" medical therapeutics. I wanted to offer comprehensive healthcare to those who came under my care. Does this mean I don't prescribe necessary medications or refuse to perform surgery? Absolutely not.

The beauty of osteopathic medicine is that it is a completely integrative field and philosophy. True, medicine has changed significantly in the last 125 years so some of the early uses of osteopathy may be a bit clouded when viewed by todays standards. But the concepts remain true. We have the ability to offer something additional to our patients. Osteopathic manipulative medicine is a unique form of treatment that can be used to diagnose, treat and sometimes cure a patient of certain ailments. The most important thing to remember is that there are indeed limitations of what OMT can do, but there are few scenarios where OMT cannot offer SOME benefit to your patients.

SO...who am I really?

Well, I am an osteopathic physician. I also have advanced training in Osteopathic Manipulative Medicine. I have experience treating patients in an OMT-only practice, I have been published in the osteopathic medical literature and I have academic responsibilities as well. Like all of you, I too am still learning. I am currently a Resident in an osteopathic program and hope to someday be heavily involved in osteopathic medical education.

I look forward to hearing your questions and will meet the challenge to answer them as best I can.

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The Osteopathic Medicine Mentor thread is officially open for business!

Feel free to post here with any questions you have regarding osteopathic medicine and I will answer them to the best of my ability.
 
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Hi Dr. Still;)! Thank you for helping us neurotic pre-meds and med students by joining SDN. I'm sure your advice will be greatly appreciated.

You're welcome!

I just came back from an interview this week where they demonstrated a "back cracking" technique in the OMM lab. I was wondering if you could tell me what makes the poping sound when you "crack" someones back or neck and why that action relieves pain/tension?

The actual "pop" sound, believe it or not, comes from the release of nitrogen gas into the joint cavity. The nitrogen is usually dissolved in the synovial fluid but comes out of solution when there is a large change in pressure. In this case the HVLA maneuver, or back cracking, results in a decrease in pressure and "POP" goes the gas!

ATS
 
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I think the DO medical schools have done medical students a disservice by not integrating their medical schools into the MD system.

I don't think this is an issue of integration, but rather an issue of a once separate field (osteopathy) incorporating current medical education into its curriculum.

Having a separate DO residency system which excludes MDs hurts medical students as well as when certain MD residency programs don't favor DOs.

Interesting thought. I don't think many people have looked at this and said "why can't an MD apply to that osteopathic program?"

A separate system also breeds potential resentment among DO, some of whom try to "prove" themselves their entire careers.

Well, DOs seem to be a DOs own worst enemy! But I think the great majority of osteopathic physicians don't feel the need to prove anything as most of the sterotypes end at the last college Pre Med Society meeting.

Having an integrated system would not prevent DOs from continuing to do manipulations.

True.

Is there a good reason for a separate system? Or are the not so good DO schools not capable of getting accreditation?


From my understanding the requirement for accredidation for a US allopathic and osteopathic medical school are nearly identical. In fact, there is at least one DO school which has the licensure to confer the "MD" degree upon graduation if it so choses (it does not).

I think the reason for a separate system lies mainly in the historical aspects of osteopathic medicine and does not have any indication on the different quality of medical education.

For the most part you cannot tell the difference between an MD and a DO (or an MD student vs a DO student for that matter) other than the use of OMT. It is unfortunate that most DOs chose NOT to use OMT in their practices.

Will there ever be a true merging? I dont think so. I think enough people want to see osteopathy as its own true focus of medicine, though the lines may be blurred quite frequently.

Thank you for your comments..


ATS
 
Hello, I currently am a premed, going to be a junior,

Action time! This is where you need to push yourself!

I would like to know about DO residencies, because I am extremely interested in that, what type of residencies do DO's usually get, also if you don't mind me asking what are you doing your residency in, thanks...hope to hear from you soon:laugh:

There are separate Osteopathic (DO) residencies in nearly every field. The only exceptions are some of the very subspecialty areas (pediatric neurosurgery, for example).

A good number of DOs chose to do residencies in primary care areas (Internal medicine, family practice, OB/GYN, Pediatrics) though many still opt for specialties.

The percentage of DO graduates entering primary care vs specialty fields varies from school to school and class to class, but an overall estimate puts about 55% of DO graduates into primary care and the other 45% into specialty fields.

Of course, of that 55% into primary care, some will go on and complete further training in subspecialty areas.


ATS
 
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Based on your experience what fields of medicine would be able to utilize OMM the most. (ie. Family practice, Emergency medicine….ect).?

GREAT question!

Family Practice
Internal Medicine
Surgery (post op care mostly)
Sports Medicine
Physical Medicine/Rehabilitation
OB/GYN

In my experience those have been the most popular areas for people to incoporate OMT. However, there are uses in just about ANY specialty. In fact, I recently listened to a great lecture about OMT in Psychiatry!

I think the difficult part is finding ways to use OMT appropriately and within certain time contraints.

Does having OMM as a tool in your practice help extend the time that you can designate to each patient?

Extending time with a patient is something every physician wants to be able to do. Unfortunately the business aspect of medicine often doesnt allow that to be the case. Adding OMT can not only add the amount of time per patient, but because you can bill for OMT you are utilizing that time appropriately for your practice. NO patient will complain about their doctor taking "too much time" with them!

Could you give examples of the most common ailments that OMM can successfully treat?


Where to start!!

Back pain
Neck pain
Headaches
Upper respiratory ailments

Those seem to be the most common things I have seen with patients, but the uses of OMT extend into other areas.

Post operative uses (abdominal to orthopedic)
Pregnant patients
Asthmatics
Post injury (ankle sprain, knee injuries)

There are many conditions where OMT can be curative, and even more where it can be used as a valuable adjunct. The most important thing to learn is when OMT is indicated...and when it is not.


ATS
 
What is your interpretation of all the new osteopathic medical schools opening up?

Hmmm. Interesting.

I am always a supporter of increasing awareness about osteopathic medicine, and this country sure does need more primary care physicians, but I sometimes think the AOA is moving too quickly. Tuition is very high at many DO schools yet these schools are creating branch campuses.

Post Doctoral education for the DO is limited in some areas...that needs to be expanded.

I think the AOA is reacting to the increased number of applications and the increasing demands of the healthcare system. My sources tell me that the larger DO schools exceeded 5,000 applications EACH this year.

I think the thought is a noble one, the execution may not be as well thought out.

What are some new and current break throughs in Osteopathic medical research?

This can be a forum of its own.

Parkinsons and multiple sclerosis are hot topics right now in the OMT research world. There is plenty of research being done at osteopathic schools but OMT research is not as prevelant...mainly because they are difficult trials to conduct.

Let me do some research of my own. Ask this question again in a few weeks and I will have a more thorough answer!

What in your opinion needs to be worked on in regards to the AOA and the osteopathic profession in the near future?

Not sure what you mean. I think the AOA is making strides to be a more "user friendly" organization. The revamping of the internship year is an example.

Personally I think the AOA needs to do a better job of listening to its students and residents ( ;) ). It relies heavily on a group of rotating leaders who are cultivated "within the system".

How as an osteopathic medical student can we start initiating these changes?

AOA Convention. Become a leader in your local chapter of ANY professional organization, but particularly those within the osteopathic community. Awareness of the frustration by DO students about the AOAs direction WILL bring about change, I promise you. But remember to always be professional and diplomatic.

Some have said in other threads that there isn't much scientific based evidence to support cranial osteopathic manipulation do you agree to this claim?

Yes and No.

There are some articles that support cranial as a valid treatment modality and others that show very poor inter-examiner reliability.

Much of this research is done in small groups and most is done outside the US where immediate criticism of things doesnt occur as frequently.

I think that in order for cranial to ever be considered a "mainstream" osteopathic treatment there needs to be a LOT more research...good research. I also think there needs to be a change in attitude about cranial osteopathy. Too many regard it as an "exercise in perception" rather than a true, palpable, physical dysfunction. I think you walk on thin ice when you do that.

So is the evidence for cranial weak? Well, its not widely distributed to say the least.

ATS
 
What do you think are the biggest reasons why the Doctor of Osteopathic Medicine degree hasn't been accepted as a full medical practice degree every where in the world yet? When do you think this will happen?

The countries that are most resistant to accepting DOs as fully licensed physicians are those that have "osteopaths" (similar to our chiropractors). These places allow DOs to practice manipulation only.

Some countries are just plain OFF LIMITS to ANY foreign trained physician.

If the US states that a DO degree is equivalent to and MD degree than why do some residency programs not accept the COMLEX?

Familiarity with the exam. It would be very difficult for XYZ Allopathic Hospital to adequately compare 50 MD applicants with USMLE scores to one DO applicant with a COMLEX.

Many places that are familiar with DO graduates (Chicago, Philadelphia, NYC) do indeed accept the COMLEX in lieu of the USMLE.

Again, if a program doesnt know how to interpret a score, they cant use it.

I dont see the COMLEX changing its scoring system any time soon so the best alternative is for a DO to take the USMLE in order to provide potential programs with a score that is understood.

Is the reasoning that it's the only way to maintain a standard score from applicants a fair analysis?

I believe so. See above.

ATS
 
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Despite researching the "DO vs. MD" debate on my own, I think it would be valuable to hear your opinion on the matter. So, as an open-ended question, what are your thoughts about pursuing a DO vs. an MD and vice-versa?

I think that for the typical student wishing to become a physician the choices are practically interchangable.

If you aspire to travel and work abroad or have a difficult time with the concept of OMT perhaps pursuing MD school would be more appropriate.

Also, what do you think are some aspects where osteopathic medicine is stronger (and weaker) than "traditional" medicine?

I dont see it in terms of "stronger" but rather I see osteopathic medicine, OMT specifically, as a valuable adjunct that I am glad to have.

So PRO would be OMT

I dont see any negatives to learning OMT.

Again, we DOs learn all the "traditional" medicine plus the addition of OMT. If you are asking if I feel there are any shortcomings in the education I would say no. There are, however, shortcomings with the postgraduate opportunities for many DOs. I think there needs to be more (and better) post graduate training sites/programs for DO graduates. I think there needs to be more integration of DOs into MD training sites WITHOUT the relative black-balling from the osteopathic community.

And finally, why do you think a person should pursue osteopathic medicine over the "traditional" degree.

1. Cant get into MD school. Sounds weird, but its true. Most DO students applied to and were rejected from the MD school application process.
2. If you have a desire to learn OMT.
3. If you feel that a particular DO school that you were accepted to outperforms an MD school that you were accepted to (cost, location, quality of education, size, whatever)

I dont think you need to necessarily look at it as a "different path", but perhaps as the same path...youre just looking at a little different scenery.

Thank you in advance.

You are welcome. Hope I could answer some of your questions.

I will admit, it is easier to answer less general questions...you folks have got me thinking!

ATS
 
Thanks for your time!

Youre welcome!

One very large reason I am interested in OM is I have read it may allow the physician to diagnose some musculoskeletal problems without the need of x-rays or CTs.

We still use these modalities as well.

I'm interested in what your opinion is because I'd rather not expose patients to radiation if at all possible (although this may be difficult because of liability) as well as the fact that I'd like to do rural/mission type work where these machines aren't available.

ALWAYS use the xray machine, CT scanner or MRI if you have it and it is indicated! Many a time I have examined a patient and had a very strong idea of the pathology...and every time I have attained the appropriate tests to show that. In this day and age of liability there is little excuse not to. Plus, these machines are getting faster, cheaper and expose patients to far less radiation that one would think. (A pregnant women can have 2 CT scans while pregnant)

In RURAL areas or places where you dont have these machines then your heightened palpatory skills will be astoundingly helpful.

Many pathologic conditions give us clues that we can palpate as musculoskeletal changes.

Example...appendicitis often causes a viscerosomatic reflex point that can be palpated near the end of the 12th rib on the right side. I can recall one case where a patient was seen in the ER for abdominal pain but because the location of the pain was midline and very low (almost pelvic) and shiften to the LEFT side no one thought appendicitis as the top cause. My musculoskeltal exam guided me more towards appendicitis.

On CT scan she had a very low appendix that was crossing the midline.

Did my physical findings change the diagnosis or treatment? Not necessarily, but it did help narrow my differential diagnosis and alter my therapy as necessary. She still had surgery and recovered well...with the help of some post of OMT too!


How beneficial is OM in diagnosing?

Very beneficial.

Is that pain musculoskeletal, visceral or fake?

Your hands can tell you, and they dont lie. Not to imply patients lie, but your hands can become a valuable tool for making a diagnosis or supporting a diagnosis.


Youre welcome!

ATS
 
Is it true that MD Internal Medicine Residencies require a total of 3 years of pg training, while DO IM residencies require 4?

No.

What you may be referring to are cases where a DO completes an osteopathic traditional rotating internship (TRI) prior to their IM residency. In 5 states (PA, WV, OK, FL, MI) a DO must have completed this TRI requirement in order to gain licensure in that state. So if a DO intends on completing their training at an allopathic institution in a 3-year IM residency, they will need to do the extra year to fulfill the AOA requirement for practice in those states.

If you look at Osteopathic IM Residencies they are 3 years long, just like the allopathic programs.

You can get more information on osteopathic post graduate programs here

http://opportunities.osteopathic.org/search/search.cfm

Why the difference?

Osteopathic internship requirement as listed above.

Is this extra year common for most DO specialties and residency programs?

Not at all. Again, the extra year is simply the addition of TRI year that not all DOs complete.

As mentioned above, some programs incoporate this into their first year of training as well.

So the only time a DO has to do an additional year is if he/she decides to complete an allopathic residency program and wants to practice in the 5 states listed above. OR if the osteopathic program they are matched into does not have a built-in internship year but has a "specialty track" or "special emphasis" internship.

My best advice would be to speak to the programs you are considering and find out if their program fulfills the AOA internship requirement. If you dont intend to practice in PA, WV, MI, OK or FL or plan on completing only allopathic training then it wont matter.

ATS
 
Dr. Still,
I am currently a first year so residencies and match process is far away for me for now.

It approaches faster than you think!

I heard that since the osteo-match day is earlier than allo-match day,

One month earlier. Osteopathic in mid February, Allopathic mid March.

if a D.O. wants to apply to both allopathic and osteopathic programs, they need to do two different match applications and if they match into a D.O. program first, then they automatically get thrown out of the M.D. one.

Correct. Once an applicant matches in the AOA match their application is electronically withdrawn from the allopathic match.

Is this true as of today and do you see this changing in the near future??

It is true and no, I have not heard any rumors of a change in this procedure in the forseeable future.

Also, I am considering a subspecialty in gastroeneterology.

Great field.

Since there's no osteopathic fellowship program in that field,

There are 8 osteopathic GI fellowships:

173185
NSUCOM/Sun Coast Hospital - Gastroenterology Residency
Gastroenterology
Largo
FL​

126354
St James Hosp & Health Centers - Gastroenterology Residency
Gastroenterology
Olympia Fields
IL​

162644
KCOM/St John-Detroit Riverview Hosp - Gastroenterology Residency
Gastroenterology
Detroit
MI
(Dual AOA/ACGME accredited Program)​

131400
Botsford General Hospital - Gastroenterology Residency
Gastroenterology
Farmington Hills
MI​

128269
Genesys Regional Med Ctr-Health Park - Gastroenterology Residency
Gastroenterology
Grand Blanc
MI​

129654
St John - Oakland Hospital - Gastroenterology Residency
Gastroenterology
Madison Heights
MI​

126289
UMDNJ/SOM/Kennedy Mem Hsp/Our Lady of Lourdes - Gastroenterology Residency
Gastroenterology
Stratford
NJ​

152953
Millcreek Community Hospital - Gastroenterology Residency
Gastroenterology
Erie
PA​


if I do an osteopathic IM residency will I still stand a chance of getting the fellowship or would you suggest an allo- residency?? Thanks a lot.

You can certainly continue into an allopathic GI fellowship from an osteopathic IM residency. Is it likely tougher to match? Yes. Many fellowship programs are affiliated with an IM residency priogram, and most of these programs do tend to take their own.

There are osteopathic GI fellowships as I have listed above, and I would think their policy of "taking our own" is the same.

GI is a competitive field so you need to take advantage of every opportunity that comes along. 3 yeas of IM training may change your mind as to which field you want to pursue (subspecialty), but planning ahead to target IM programs with a strong, well developed GI fellowship is a good idea.

I think the level of training at many of the strong DO programs is more than adequate to get you to match into an allopathic GI program, but again, you will need to make yourself knows to the fellowship.

Another option would be to find an IM residency that allows "out-of-system" electives so that you can visit some of these GI fellowships that are at other hospitals.

ATS
 
Hello, are there transplant fellowships for DOs or if I want to become a transpalnt surgeon I should have my general surgery residency from allo school and after apply for fellowship from allo school?

I am unaware of any accredited osteopathic transplant surgery fellowships.

As mentioned above, this is an area that due to the lack of post graduate training opporunities in the osteopathic world, we are forced to go to the allopathic sites to complete our training.

For more information on fellowship programs and transplant surgery in general, you should visit here:

http://www.asts.org/

ATS
 
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Thank you for your reply!!! :)

No problem!

Do you know any DOs who went to transplant surgery fellowships,

Not off the top of my head. Let me ask around and see what I can come up with.

or how difficult for DO to get accepted to transplant surgery fellowship?

Hard to say. I dont know how difficult it is for ANYONE to get a transplant fellowship. I dont know how competitive it is. Surgical subspecialties go through highs and lows. Plastic surgery and breast surgery are hot right now. Big money, lots of cases and lots of applicants. CT surgery has slowed, where 10 years ago CT was the moola maker.

But suffice to say that it will likely be a bit more difficult to get a transplant spot if you are applying from outside the program. You need to be familair with the program and they NEED to know you!

ATS
 
Hi there Dr. Still

Hi

I am a first year medical student at your school

KCOM? Not mine any more! ;)

and since I can't seem to find your office anywhere on campus anymore I thought I would just post this.

My office is in the hearts of all DO students! :laugh:

My office is now here at SDN

I have a strong interest in the use of osteopathic medicine within the pediatric field.

Kids respond AMAZINGLY well to OMT, and they like it...they think its fun!

As of yet I have seen very little training in this area and know there is not much planned into the curriculum.

Take what you do for adults and down size it.

Some great techniques for kids:

Visceral techniques
Ear/Nose/Throat techniques
Mandibular, auricular, thoraci techniques
Lymphatic
Myofascial
Counterstrain

What are some good resources available for someone who wants to learn more about this special part of osteopathic medicine?

Honestly? Your OMM professors. Find out how many of they have worked on kids. Unfortunately most DO Pediatricians dont use OMT. Probably because like you, they dont know where to look for information.

Also, if someone wanted to go into pediatrics and do a +1 year afterwards are there any programs that would gear it more towards peds so I didn't have to spend the other nine months treating adults (not that I don't like them, they just would not be my focus)?

As above, most of what you do with adults is perfectly applicable to kids.

Now, will I take a 5 year old and do a supine thoracic HVLA maneuver? No.

But that doesnt mean I cant treat that segment with a variety of other OMT techniques.

The best way to become adept at treating kids with OMT is to treat adults, find out what works for you as far as your "style" of treatment and then make it work with kids. Often having parents help out or even teaching parents some of the simple ENT techniques. Demonstrating on big brother or big sister can help build confidence. Make the OMT treatment FUN for the kids. Make it a game.

A child who is ill doesnt want to get out of bed, let alone be at the doctors office. But if you are willing to get on their level (not talk like a child, but sit on the table and play with the cars/dolls/blocks) you can easily do OMT as you examine the child.

You can do an auricular drainage technique to a child with otitis media immediately after you look in their ear...or during the ear exam to help distract them. Kids think the miller/dalrymple pump is funny because they (as one child once told me) feel all "jiggly".

OA release for newborns with a diminished or absent suckle reflex (compression of the hypoglossal nerve) is an easy technique that works wonders with malnourished newborns.

Children with Cystic Fibrosis. Now that is an area where OMT can improve the quality of life exponentially. You sometimes hear this called "Chest Physical Therapy." Perhaps a GOOGLE search can bring up some hits on that.

Thanks for the help and thanks for the great learning institution.

You are very welcome.

As a recap...kids are little adults, with a few special considerations. But for the most part anatomy is the same (after a certain age when things decide to shift) and you can use your knowledge and experience with OMT to treat the little members of our society.

I would also direct you to a chapter in Foundations for Osteopathic Medicine by Stephen Sheldon, DO who is affiliated with CCOM.

ATS
 
i took summer school last summer...didnt do to well (i had no time to study, big mistake on my part to take the school..but i did and got 2 F's)

Any way you can do grade replacement to get the F's removed?

my university transcript is really good, when i apply to medical school, do i have to show my summer school transcript from the community college even if i didnt transfer the credits to my university...and if i do have to show them, what if i just said i didnt take any summer school at the community college, could i get away with it?

Hmm.

You took these classes, failed them and never had the credits transferred?

Reporting all of your grades is always the best policy. You dont want to start off with an interview that says "so why did you report the Fs from ___ college?"

I hate to "turf" a question but this one would likely be better answered by my counterpart in the Medical School Application area of the Mentor forum.

ATS
 
Unfortunately I cannot offer medical advice in this forum.

ATS
 
Thanks for replying to my previous question, but I am still a bit confused.

Uh-Oh! :)

Say I go to PCOM (yes yes im still a pre-med), since that is the closest DO school to me right now. I dont want to practice in Pa, but I will probably end up doing a residency there because I dont want to go to far from home in MD. How long would a residency take if I were to do IM? 3 years? or 4?

If you complete an Osteopathic IM Residency it will be 3 years.
If you complete an Allopathic IM Residency it will be 3 years (however, you may not be able to get full icensure in PA due to Pennsylvanias requirement that all DOs complete an AOA approved Traditional Rotating Internship). This will make it 4 years as you will do a TRI BEFORE starting your Allopathic IM residency.

What if I did a specialty? Say Opthamology or PM&R? Would those end up being 4 years also?

Same as above. If they are (1) Osteopathic programs (2) Dually accredited AOA/ACGME programs or (3) you can get the AOA to approve the internship after the fact (not always easy) then you will not be doing an additional year of training.

So its possible to have an IM residency, and Opth/PM&R residency take the same amount of time?

It is possible to complete these training programs without doing an additional year, yes.

Optho and PM&R are not subspecialties of IM...not sure if you are confused over that.

There are, however, benefits to the internship year other than the additional experience.

When you are applying to these residency programs you are going to be applying as an intern against 4th year medical students. A solid letter of recommendation from someone who oversees you as an intern is far more impressive than a letter from someone who oversees you as a medical student. Trust me! :thumbup:

ATS
 
Hi A-STill!

Hi!

I want to go to a osteopathic PCP that does OMM for my final check up before I start med school. I want to try an OMM technique? Is there any techniques that the doc can do for a fairly healthy 22-year old? My knees hurt often, so maybe I can use that as a way to have OMM performed on me.

Having OMT done is a great experience. It allows you to see what you are in for as a student. I would field any medical questions to your PCP and let them decide if and how OMT is appropriate for you.

Also, aside from the AOA-certified DOs that can be found through AOA.org, is there a resource that will allow you to find all DO's in your area, not just the ones that did the TRI?

Good question. The Yellow Pages or www.yellowpages.com

There is also a book the AOA puts out that has a census of the practicing DOs and there are also books that each state puts out that list practicing physicians in different areas of that state. But as far as an easy to search online resource, I do not know of any others.

ATS
 
Dear Dr. ATS

I have a question regarding a previous answer of yours. Some one asked about why one should pick a MD ver Do (or something similar to this) and one of the reasons that you gave was if someone wants to travel.

Yes.

Are you saying that a Osteopathic physician can't travel around the world and practice? or its difficult for them compared to the MD's?


Osteopathic physicians can certainly travel and practice in other countries, but yes it can be more difficult for a DO than an MD for a number of reasons.

#1. Not all countries recognize the DO degree as a fully licensed physician and therfore some countries will allow US trained DOs to only practice manipulation

#2. Some of the Departments of Health seem to be slower and more reluctant to approve a working visa for a DO over an MD. There are a few reasons for this: First of all, they do not have an official policy for osteopathic physicians where they may have them for MD and second, they may not have had many (or any) DOs petition for practice rights

#3. Gaining licensure to practice in many foreign countries can be very, very difficult regardless of your degree or place of training. On the other hand, getting practice rights in the US for a foreign trained doc is much easier!

Hope that has helped

ATS
 
Dear Andy, :p
What is the real world practice of setting up an OMM only world like... aka how do you get starred, and, umm, how do you reimbursed if you do omt only. If possible answer in detail with examples and numbers
thanks
Brooklyn

Interesting question Brooklyn. Let me see if I can help you out.

First of all, lets briefly talk about training. Many people who set up an "OMM ONLY" type practice do one of three things.

1. Complete an OMM/NMM residency (Internship + 2 years = 3 total)
2. Complete an FP or IM residency and then do a +1 OMM year (4 total)
3. Complete an FP or IM residency and go right into practice (3 total)

I would recommend option 1 or 2. Being board certified in OMM is the way to go, in my opinion.

Most of the people who run OMM practices are affiliated with DO schools in some way. Getting an academic spot drastically changes how your practice will run. These are salaried positions and you maintain a certain quota as far number of patients you need to see in a month.

Private practice can be far more lucrative but you work a lot harder as well.

Billing for OMT is not terribly difficult. As with everything else in medicine there are billing codes for OMT. You bill the insurance company just as you would if you did an EKG, drew blood, collected urine, removed a skin lesion, etc. Its a procedure in a way.

You bill based on the number of body areas that you treat and the reimbursement increases for each billing code.

1-2 areas, 3-4, 5-6, 7-8, 9 or more

Again, as with everything in medicine some insurance companies pay more and some pay less. So you may bill for $100 and only get a percentage. What percentage is dependant upon that insurance company. Unfortunately this is why many docs dont accept most insurances. Its hard to justify working an hour and only making $40. You cant keep a practice open on $40 an hour.

The more popular method is for the doc to charge a patient cash for service, billed as a half hour or hour appointment, and then the patient can submit and get partial, full or no reimbursement from the insurance company. Some also bill a flat fee "per visit" which the typical doc seeing 2-3 patients per hour.

In this situtation is when the physician needs to be aware of the financial burden on some patients.

The hourly fee charged is dependant on the area, type of practice (OMT only vs OMT + FP services) and other personal factors. Most of the DOs I know in private practice are quite reasonable in their fees, often charging less than chiropractors in the area. In fact, I know of a few who charge less than massage therapists!

I am hesitant to give out exact numbers, but a DO who does an OMM only practice can make around $150,000 - $175,000/year or more in a lucrative practice. That may not sound like much, but those numbers are in a moderately priced practice AFTER overhead costs for the office.

Another way to look at this situation is to examine what they physician must pay out of pocket:

1. office rental fees/maintenance fees
2. equipment rental fees, if any
3. office staff
4. insurance

I knew of one DO who made an even $100,000 in his practice and then earned a little more from being affiliated with a DO school and being an assistant professor. That was a nice set up because the doc knew there was money coming in so if it was a slow week in the office, there was still a paycheck.

One final consideration is supply vs demand. The demand for OMT specialists is so high that many patients give up the search for an "osteopath". A 6 month waiting list is not uncommon for many of these docs and for those who do FP/OMM, their practices are nearly closed within a year of being out in the community. (closed meaning not taking new patients)

Bad for patients but good for business. So you want to take advantage of the situation WITHOUT taking advantage of your patients.

As far as people I have worked with I know of salaries ranging from $120,000/year to around $400,000/year. There are so many variables to consider and like any specialty, you need to be smart about how you practice in order to be successful.

So in closing...as one colleague told me "I make more than my internist but I cant afford the car my cardiologist drives."
 
This forum thread is GREAT.

Agreed. ;)

A quick question,

Quick answer.

who are the shining stars around the country in OMM academia
right now?

Stiles, Kuchera, Schiowitz, Nicholas, John Jones, Lockwood, Capobianco, Carreiro to name a few.

Could you give us a breakdown of where we should
consider particularly carefully when deciding on a Osteopathy school
with OMM as our central passion in mind?

Each DO schools has its own "flavor" on how they teach and integrate OMT into their curriculum. Some schools more heavily stress OMT as a stand alone while other try to integrate it better into the course curriculum.

Perhaps the best way to find out what you are looking for would be to contact students at different schools and find out what they think of their own OMM Curriculum.

There are a few DO schools who are doing more OMM research than others: NYCOM, PCOM, MSUCOM, UMDNJSOM

You can also look to see where certain esteemed members of the OMT community are practicing. The names listed above, for example.

If you are looking for probably the most recognized name in Osteopathy it would be Michael Kuchera who is at PCOM and heads up the OMM research department there.

ATS
 
Have you come accross DO´s who are intersecting their OMM/NMM
residency training with psychonueroimmunology studies? It seems like a particularly appealing marriage of studies and full of creative potential.

Try doing a search for David A. Baron, DO

Unfortunately there isnt much in this area as of yet, but I do know of a few early studies. I cant go into details on those at this point. :)

ATS
 

Right here!

How difficult are dual programs such as the MPH/DO program PCOM and Temple offer? Is it TWICE THE WORK or is it properly spaced out over the extra year's time? :eek:

From what I know of these programs they do have some overlap in coursework, but I believe most of the classes for the dual degree occur during a separate year where you devote your time solely to the 2nd degree and have little or no medical school courses.

----------
PCOM has a MPH dual program and a undergraduate fellowship in OMM.

My sources agree.

Aside from the fact that it'd be a 6 year program, what's the word on the street, has it been done?

I dont know if anyone has done both programs. There may be some difficulty with student loans as well as with scheduling problems. Has it been done? I do not know. Can it be done? Again, not sure. I would think it would depend on the school and the policies surrounding these dual degree.

Thanks Sincerely.

Youre welcome.


Uh oh...more!

Great response to my earlier question.

Thanks! :)

I'm excited as hell about PCOM for a lot of reasons, but Dr. Kuchera is one of the top.

Fantastic researcher and educator. Very personable as well.

I've been getting mixed signals from the students there about how OMM is presented... they say the Nicholas brothers have difficulty staying on topic, whatever that means.

You will find critics of every class at every school...and everyone has their own opinion. The most important thing is that each school presents the information that is necessary to be competent in OMM and to pass National Boards.

As far as Nicholas goes, he must be doing something right. My sources tell me he is the longest acting chair of an OMM department in the country. He has been teaching for 30+ years.

Everything in its proper context, a good majority of students taking OMM, I suspect, do so because it's compulsory, not for the edification. -Cheers!
)

Again...diffrnt strokes for diffrnt folks.
FYI, also, we just started up a pre-student osteopathic medical association chapter here in philadelphia, Temple University.

Fantastic! Temple is a great school. Bill Cosby, right?

If you have any suggestions on activities to prepare students for osteopathy, I'd love to hear them!!!!
:thumbup::thumbup::thumbup:

Try trips to DO schools...especially PCOM and UMDNJSOM. No excuse as they are right in your back yard.

Also try getting DOs and DO students to come speak at your meetings.

Perhaps you could try to get Nicholas or Kuchera to come speak...or better yet, plan a trip to PCOM and see if you can schedule a meeting with them.

Let me know if I can be of further assistance.

ATS
 
Dr. Still,

I was wondering if you had any suggestions to shadowing a DO? I dunno how to go about finding one.

http://www.osteopathic.org/index.cfm?PageID=findado_main


After I do, would I simply cold call him and speak to the secretary? That doesnt seem like it will accomplish much since the DO's are usually much too busy to speak with students.

I would call the office staff and ask them if you could leave a message for the doctor. Tell the office staff you are a premedical student and you are interested in shadowing. Leave as much contact info as possible...phone, email, address...and be patient with a response.

ATS
 
First off, thanks for doing this.

Glad to be here.

And secondly, my apologies in advance, I probably will be posting here a lot.

Apology accepted.

I had a question about orthopedic surgery and the differnce between an AOA spot and AMA spot. I don't think I have ever seen an osteopathic student match into an AMA spot for orthopedics...is this because they know they can get an AOA spot so why bother?

You havent been looking in the right places! Is it difficult, absolutely. Orthopedics is a very competitive field to begin with. Add on top of that a DO student coming from an outside school who may or may not have had ample rotation and "face time" at that program. Makes it difficult.

Or is it because no AMA programs accept osteopathic students for an ortho spot.

This is not true at all.

Going on with this, if one was to pursue an AOA spot in orthopedics...are there career limitations with this--meaning will they be forced to practice in osteopathic hospital or rural area?

Not at all. A DO who completes and AOA Orthopedic residency will not be limited in scope or place of practice. Just like with getting the residency spot, however, getting that Chief or Ortho spot at a large allopathic institution might not be easily attainable.

Thanks again.

Any time.

ATS
 
As a soon to be DO student at KCUMB, what would you recommend to a DO student who is interested in neurosurgery?

Top of your class, very strong board scores, early "Face time" with residency program directors, research in neurosciences and well planned clinical rotations at programs you will be applying to.

Is it possibly to incorporate OMT into a ns practice, espcially if one spends a lot of time on spine cases?

I think the most benefit one could do with OMT on these types of patients is in the post operative recovery time. Gentle OMT techniques can help alleviate pain, improve respiratory function and help the patient ambulate sooner following surgery.

Or is it better to leave that to the PT's?

I have always found that working with PTs who know my style of treatment and know how I work are more beneficial than either myself alone or them alone. We seem to have a synergistic effect when working together.

There are 9 programs for residency, 3 of which I am seriously interested in and think are strong programs.

I count 11 programs. I am familiar with 6 of them and I wouldnt hesitate to recommend an applicant to any. In any given group there are "weaker" and "Better" programs. What you want to look for in a neurosurgical residency is: 1. Am I going to get cases? You dont want to be in a program that doesnt have exposure to the cases you need in order to complete your training. 2. Am I going to get to use technology? You dont want to be in a program that has little or no access to some of the newest surgical equipment. 3. Am I going to get research time? Very important in the surgical community, especially the NS community.

I really want to be a Osteopathic physician and go the AOA route, but feel that applying to 3-4 programs won't give me a huge cushion.

I would consider applying to all or almost all of the DO NS programs. Or at least the ones you are familiar with. It is very difficult to get an idea on the quality of a program until you have spent clinical time there during your rotations. Many people hear things and "know a guy who knows a guy" and thats not really a good way to make a decision on a residency program. I am sure if you rotate at the right places you will find more than you would be happy being in.

Also, the DO NS world is incredibly small (12-15 spots per year on average). Word travels fast on the top candidates and best applicants. Make sure you are one of them and you might find yourself being recruited rather than being pimped during an interview. NS is definately competitive but just the fact that it IS neurosurgery, many applicants are scared away right off the bat.

Would you recommend one to also look into AMA programs?

Absolutely. Just realize that the AMA programs are far more competitive than the AOA programs. The ALL require research and many of them are at large academic institutions so it might be difficult getting in unless you yourself are part of that large academic institutions.

I dont want to discourage you because if you are at the top of your class in everything and take the USMLE you definately have a shot.

Good luck.

ATS
 
Hey AT Still, thanks for answering my questions.

Youre welcome

Sorry the 9 programs I saw was the outdated listed posted on http://www.aoaneurosurgery.com/.

Always important to seek the most updated information!

I forgot the VCOM program and the one in Chicago at Cook County, which I heard might not be around next year?

I have not heard any specifics on that. I am watching closely as you are.

What were the 6 programs that you mentioned you knew something about?

NYCOM St Barnabas
NYCOM LI Jewish
PCOM
OUCOM Doctors
OUCOM Grandview
BroMenn
I know it is still early, but I really like the Providence, Bromenn, PCOM, and the Columbus programs.

:thumbup:
Any other programs that I should consider when I get to the point of doing sub-i's?

I would focus on the programs you will be applying to. You only get a limited number of electives and you want to offer as much time as possible to your top choices.

Would you recommend doing month long sub-i's, or more 2 week sub-i's to be familiar with more programs?

Even though it will limit the number of places you can see, I think a month is far better in allowing a program to see you and for you to see a program. It takes a week just to find the cafeteria, learn how to look up labs and figure out which staircase to take! 4 weeks at a site is a must in my opinion.


Youre welcome

ATS
 
Do you know of any way allopathic students can learn osteopathic manipulation, either during seminar courses or during residency (preferably residency)?
Thanks!

Great question!

Many of the CME courses and weekend seminars offered by DO schools are open to ANY physician, MD or DO.

Some of the courses require a certain level of proficiency so you may need to start with some of the more basic courses, but you can certainly participate in them.

DOs are not trying to place a strangle hold on OMT. In fact, we are looking for any physician to embrace and use these techniques...so much so that much of our teaching is done in Europe. Its dissapointing that we can easily amass a classroom of 50 European Orthopedic Surgeons to take an OMT course yet have to scrape together 10-12 DOs to take a 4 hour class.

I know several MDs who are very involved in the OMT community. Most are in Canada and Europe, but there are a good number here in the US as well.

My advice would be to call the Osteopathic Association of the state where you are completing your residency and ask for a complete listing of the CME courses in the future. Then simply contact the person listed for that CME and explain that you are an MD looking to learn. You may not get the CME credits but you will (most of the time) be allowed to participate in the course.

Another option might be to call the DO school closest to you and ask to speak with the OMM Department Chair. Most of the Chairpersons I know would be more than happy to give you more information on local courses and educational experiences.

One DO school I know of has had MD residents (PM&R) sit in on OMM lab.

Another DO school has been considering having MD residents audit the OMT course given to the 1st & 2nd years and work towards a master degree.

I have been involved in teaching courses and seminars for several residency programs, all of which have been mixed MD and DO residents.

The opportunities are indeed out there and as I said above, most people in the OMT community would be more than happy to embrace an MD looking to learn a bit about what we do.

I wish you luck and please keep me updated!

ATS
 
Dr. Still, thanks for all your great input!

My pleasure.

Those of us interested in DO progrmas have heard that the only people who worry about the DO versus MD after their name are the pre-med students and once you're out there working, your professional colleages don't really make a distinction.

PreMeds run the "DO vs MD" debate circles!

Have you found that to be true?

Is there professional discrimination against DOs? Yes.

Is it as commonplace and blatant as it is here on SDN? No way.

Some residency programs are closed to DOs or are a tough match for DOs.

I have found there are 2 groups of physicians who seem to have some animosity towards DOs.

1. Older physicians...these are the docs who trained when DOs were "osteopaths" and not physicians. There are few of these docs still around.

2. Very young physicians. Residents mostly who have never worked with any DOs. I think their animosity spills over from the PreMed days. Only a few have ever been blatant about their "problems" with DOs, and none of them continued that attitude once all the facts were on the table and once they found out which of their attendings are DOs! This seems to be a "phase" more than anything.

I have been very suprised at the number of MDs I have worked with that are pushing for change in the medical community regarding DOs. Many of them want DOs in their own fields because they have seen the level of competency our graduates have. In fact, the way a few MDs talk about advancement of the osteopathic community, you would think they went to a DO school.

I am sure a premed or MD student is going to read this and have doubts or think I am lying. Well, thats because we all "know a guy" who hates DOs...and he is an MD...and he says DOs are only family doctors...etc. Sure, thats the truth. And I have stories that are the other way. I "know a guy" (a DO) who was able to help a woman with headaches that 4 MDs couldnt.

Its useless to swap anectdotal jibberish and declare it as law as to the state of MD/DO relations in the real work.

99% of the time no one knows, cares, asks or can even tell the difference between an MD or DO as far as clinical competency.

You may be suprised to know that doctors dont sit around and ask eachother about MCATs, medical school of their choice, board scores and other things. We ususally talk about anything EXCEPT medicine!!!

I have a passion for emergency medicine as well as internal med (at least right now I do). What is your view of the "shared" residencies between EM/IM I've heard about lately?

These are very strong programs. 5 years if I am not mistaken. They are becoming increasingly popular as well. One outlook is because EM has a high "burnout rate". I suppose that is true to an extent, but I think the dual certification allows for a greater scope of practice in some settings. Rural settings, academic settings and administrative roles will appreciate the additional training.

If you enjoy both EM and IM then consider a dual residency. The worst that can happen is that you extend your training by a few years...and thats not a bad thing at all!

Is there ever a time that OMM would be appropriate for use while seeing patients in the ER?

Absolutely. There has been research on OMT in the ER for diagnostic purposes as well as treatment of acute musculoskeletal problems. Ankle sprains is the first that comes to mind.

Search for an article by Eisenhart on ankle sprains done at St Barnabas in NYC. Probably 2003 or 2004 in the Journal of the American Osteopathic Association.

Also, think about the types of patients you see most frequently in the ER.

Its not trauma, GSW, stabbing, etc.

Its URI, SOB, CP, cough, Peds illnesses, etc.

One concern that some people have about OMT done in the ER setting is that you will end up getting patients coming in for "just OMT". Has happened in a few cases, but with proper patient education hopefully that wont be an issue.

Thank you again!

Youre welcome!

ATS
 
Hello, Im going to be an oms1 this year and Im interested in emergency medicine.

Congratulations and good luck!

I know its a little early and things always change but its never too early to start thinking about the future...

I wholeheartedly agree. Thought most people change their minds on specialty choice from MS1 to graduation, planning is the #1 key in gaining a competitive residency spot.

My question is that Ive noticed that theres about 37 osteopathic emergency medicine residencies however, there seems to be only single programs in large metropolitan areas and states such as in California and Chicagoland compared to mutlitple programs in rural areas why is this?

Like with many osteopathic residency programs they are more commonly found affiliated with community hospitals, as the larger allopathic hospitals and schools have their own programs.

I count 40 AOA approved EM residencies, 3 of which are dual ACGME/AOA accredited.

There are also numerous dual EM/FM, EM/IM programs.

How often are residency locations opened up?

Not often. Maybe a new program every few years. But with the opening of all the new DO schools those numbers might increase in the next 5-7 years.

And whats the likelyhood of more er residencies opening up in larger more metropolitan areas within the next couple of years?

As above.

Also remember that each EM program has to meet certain standards as far as resident exposure to cases, including level 1 trauma.

Also realize that EM is one of the areas where DOs are very much on a level playing field with MDs come application time.

ATS
 
Dear ATS
Thank you for your earlier reply.

No problem.

Does your cardiologist drive a daewoo???
just checking
:)

Nope. ;)

My real question is not really how much one can make etc.... I know its all about how you run a practice

Ahh.

My real question is how do you get started, logistics-wise.
hang up a shingle? advertise? etc

Well, its a lot like starting a family practice from the ground up. You will obviously need financial support right off the bat in order to get office space, equipment, etc.

Advertising is an absolute must. So it becoming acquainted with the other resources in your area. Much of your business is going to come from referalls, at least at first. Having a strong relationship with the primary docs in the area as well as PT centers will help you get started.

Luckily with OMT the practices tend to grow quickly by word of mouth. I know some docs who offer discounts to patients who refer other patients. Almost like "refer a patient and get a free treatment."

I am going to be a PM&R doc who does omm and probably will get certified through which ever vehicle will be most efficient at the time of graduation of my rehab residency.
What i am asking, is how you start a practice. most of what you previously described had to do with an established practice from what I understood.
So, essentially, how does one start a practice? Do your primary training (FP or in my case rehab, and then start one day a week omm clinic, or just jump right in, or what?)
please elaborate.

If you are going into PM&R a smart thing to do might be to get a job at a hospital that has steady hours and income. Then find an FP in the area that is willing to take you on as a one-day-per-week partner who provides OMT. The doc will obviously take a cut. I know a few FPs who earned a lot of money through OMT and never touched any of the patients...they simply rented out their extra space to DOs looking for a chance to set up shop and make a name for themselves in the community.

The other good thing is that most DOs who do OMT are quick to refer to other DOs in the OMT specialty. This is simply because there are more patients than there are appointments. At least once per week I am on the phone with colleagues from the surrounding areas that are closer to a patients home or are working where a patient may be moving to. Finding who is in your area can only help. And finding an area that doesnt have an OMT specialist (not that difficult) will help as well.

I hope that helped to answer some of your questions. Setting up a practice is not an easy task, and I am far from an expert on that. Like starting any business it takes money, time and being prepared for a few tough months until things get rolling.


btw, I am SO going to grow myself that beard

Girls like it.

ATS
 
Hello Dr. Still,
Im back again with more questions.

Bring it on.

I just read that you are familiar with OMT "only" practices.

True.

How hard would it be to start an OMT only practice in a state that doesnt have a DO school? Such as MD or NC/SC/GA?

Hmmm...

I guess it would depend on how receptive the community (and the primary care physicians in the area) are to OMT.

Also, I from what you said NMM/OMM residency is 3 years long total?

Internship + 2 years. Correct.

Is that enough?

In order to be proficient in OMT, yes. FPs, internists and Pediatricians all work with only 3 years of postgraduate training.

or would a combined FP/OMM residency be best?

That depends. Do you want to see patients for medical reasons? Or do you just want to see them for manual medicine?

Regardless of your training you need to be able to recognize when your practice cannot deal with a particular medical issue. If you are seeing a patient in your OMT-only office for headaches and you suspect they are secondary to hypertension, having your patient follow with their PCP is an absolute must. You, as the OMT specialist, dont want to have a patient with a serious medical issue go unchecked because you "dont do that kind of medicine."

You are still a physician, regardless of your specialty.

So if you want to be the doc who writes BP meds, manages diabetes AND does OMT then you will most certainly need FP training at the very least.

If you want to be the manual medicine doctor only, then the 3 year NMM is the way to go.

How many hours can a Dr. working in OMM only practice work?

As many as you want. I know a doc who does Monday through Friday 8a-6p, Saturday 8a-12noon.

How bout salary range?

I talked about this above, but you can expect to make a decent living. In some larger metropolitan areas OMT specialists are charging up to $200/hour

How easy/hard/reasonable is it to expect to be able to open a practice immediately after completetion of the residency?

I spoke about this above as well. Ease of opening a practice is dependant upon a number of issues from community size, need for the services you offer, advertising ability, etc.

Thanks again!

Youre welcome

ATS
 
I'm really interested in Preventive medicine, Internal Medicine, and Emergency medicine... haha I know...

Its good to have a lot of interests early on. Keep your options open.

I will be an OMS1 at TCOM this coming year

Good school.

and I was wondering if you know of any dual accredited combined residency programs in IM/PH, EM/PH.

I do not know of any dually accredited programs with Public Health/Preventive Medicine.

There are, however, a number of dual programs in EM/IM and EM/FP.

Depending on what type of practice you would like to have you may not need to complete a Preventive Health postgraduate program.

I believe Texas has an MPH dual degree option. This will likely mean 5 years of medical school but it will prepare you well for a career in primary care or EMED with a focus on preventive health.

Or even just AOA accredited I tried to find something on http://opportunities.osteopathic.org/search/search.cfm but couldn't find anything regarding combined residency programs.

There are AOA approved dual residency programs in several different fields. There are also many ACGME programs that lead to dual board eligibility.
Thanks again.. I literally check this forum every night for new questions this is very helpful.

Glad I could help. Always here to answer your questions so keep them coming!

ATS
 
A Few Questions

Hopefully a few answers!

Are there any disadvantages to attending one of the newer osteopathic medical schools?

No upper classmen to give advice. No residency programs. No precendent of students at clinical sites. Possibly untested curriculum (unless a branch campus). No precedent of graduates at residency programs.

I dont think you need to worry about getting a good education. The above things can be considered more of a hurdle rather than a roadbloack.

I begin in the Fall at a school that's first graduating class is 2008.

So there are a few people ahead of you. Thats good.

How do you get into Radiology as a DO?

Top of your class, absolutely nail the COMLEX and USMLE, strong ECs, RESEARCH can only help and get to know people in the Radiology field at places you are thinking of applying.

Radiology is a tough match no matter who you are.

I am considering going into Pediatric Radiology, and have heard a plethora of information on matching into radiology-mostly from inexperienced people.

Everyone I know who went into Radiology did very well in school and on boards. They worked very hard in school, made connections, attended conferences and did something that set them apart from other medical students. Every year a few people get lucky and scramble into an unmatched spot, but thats not the norm. Money and lifestyle will continue to drive the number of applicants to radiology.

What are the issues you face if you go into a non-AOA approved residency?

1. You cannot practice in PA, MI, OK, FL, WV unless you do an AOA approved internship.

2. You may have difficulty in academic settings at DO schools.

3. You may be barred from certain osteopathic professional societies.

It wont affect your practicing career though.

I believe you have to do an internship anyway for Radiology. So you could always do an AOA internship that knock out #1 above.

ATS
 
Hello Again Dr. Still, I come bearing questions.

Lets hear them.

I was reading on opportunities website about residencies, and I saw these 5 things
Family Practice/OMM
Family Practice/OMT
Fam Prac/IntegratedOMM Res Plus One Modified Option
Neuromusculoskeletal Med + 1
Neuromusculoskeletal Med/OMT

What is the biggest diff. between these 5 things?

FP/OMM and FP/OMT are the same thing. Combined residencies leading to a dual board eligibility in both FP and OMM.

FP/Integrated modified option is like the programs above, but there is simply an option for staying on to complete an additional year in OMM.

NMM+1 is an additional year that a resident will complete following the completion of a separate residency program. This will lead to board eligibiity in OMM.

NMM/OMT is a 2 year residency in osteopathic manipulative medicine.

Now this may seem like a stupid question but whats the diff. between OMM and OMT?

OMM = Osteopathic Manipulative Medicine
OMT = Osteopathic Manipulative Therapy/Treatment

These terms are sometimes used interchangably. Really OMM is the specialty whereas OMT is the actual hands on therapy.

Because when you think about it, you dont "do OMM". You dont offer "osteopathic manipulative medicine" to your patients...you offer "osteopathic manipulative treatments or therapy".

Which of these would be best for private practice?

That depends on what type of practice you want. If you want to do just OMM then you can do with the NMM/OMM residency only.

If you want to do FP as well as OMM then one of the other pathways is necessary.

If you want to do IM, Peds, ER, OB/GYN, etc AND do OMM, then you should look into the +1 year in NMM/OMM.

How competative are these programs?

These vary year to year and program to program. For the most part, if you want a spot in an OMM/NMM residency, there will likely be a spot SOMEWHERE for you. Now, some programs have become increasingly competitive while others consistently go unfilled. Its not a matter of quality IMO, but rather location and exposure.

Also, how long are they?

FP/OMM is 2 years long but you must complete an AOA rotating internship first.

NMM/OMM is also 2 years, again you need to complete an AOA rotating internship first.

The +1 year is just that...an additional year AFTER completion of a separate residency program.

and do these lengths include an internship year?

See above.

Thanks again!:thumbup:

Youre welcome

ATS
 
With several osteopathic medical schools now offering the DO/MBA, do we know what most of these students end up going into?

Thats a good question. The strong number end up going into practice just like any other physician, but perhaps with a strong sense and knowledge of the complex financial aspects of the medical field.

Are there any DO/MBA's that have become a CEO of a hospital/healthcare system?

My guess would be that somewhere there is a DO who is running a hospital, but I havent heard of any big promotions...at least none where the fact that the physician was a DO was highlighted. It might be tough to know...there are a lot of hospitals out there!

Would one expect a DO/MBA to me involved with admin. work at mostly osteopathic hospitals/medical schools, or could we expect them to end up in allopathic university medical centers as well?

All of the above.

There are actually quite a few physicians and other healthcare professionals who have MBAs. They are in all aspects of medicine from the practitioner to the president. I dont know of any statistics regarding DO/MBAs or MD/MBAs, but I know they do command a bit more salarywise for administrative positions. Plus it puts you a bit ahead of some other applicants.

These are great questions...I wish there was a resource I could direct you to in order to get more information. Perhaps asking a question to the Physician Recruiter might help...see what sort of market there is for physicians specifically with an MBA

ATS
 

Hi

Thanks for founding osteopathy!

No problem.

I will be MS1 at AZCOM this fall, and my background is Asian studies, computer programming, muscial performance, and (most recently) massage therapy.

Wow!

I'm a generalist, in other words.

Sure are.

It seems as though family practice medicine combined with OMM is the best choice for me--it gives me the general training as a physician plus a chance to get good at neuromuscular manipulation which is why I chose osteopathy in the first place.

Excellent. Grass roots osteopathy! :)

The 3-year combined program at UNECOM caught my eye.

One of the better programs IMO.

Do you see this type of combined program as the wave of the future for us hard-core OMM types?

Yes I do. I think our patients as a whole are demanding more from their doctors...not by being pushy, but by wanting their trusted osteopath to give them feedback on their BP meds or their glucose control options. I see it all the time. I think that becoming a more complete physician by adding the medical aspect to the manipulation aspect is the way to go.

Are these programs on the increase, or are they merely a continuing niche for the minority (or small majority?) of D.O. students that actually believes in osteopathy?

Well, I think more students "believe" in osteopathy than the matriculation into OMM residencies show. But they seem to be in place for the hardcore OMMites. Like with any specialty their popularity waxes and wanes from year to year. Regardless of their popularity, there are no shortage of jobs for OMM Specialists both in private practice and academia.

Also, I'm curious as to your opinion about TRI.

My father once said "there is no such thing as too much education."

Too much tuition perhaps, but the fact that you will be spending time as a DOCTOR in different areas of medicine means a whole lot. Your education will grow exponentially from 3rd to 4th year...your confidence, abilities, etc. Only because as a 4th year medical student you are DOING much more. Well, the same holds true for internship. Now you are the DOCTOR. One month in FP (even as a surgery intern) may not seem like a logical choice looking at it from the outside, but I can tell you that the docs I have worked with who did that internship seem to be more confident in managing all aspects of their patients, at least early on in their career.

To my mind, it's a good idea to be exposed to several facets of medical care at the graduate level.

Agreed.

My father, an old time MD radiologist, thinks it was a mistake for the AMA to discontinue their version of the rotating internship.

Many people feel this way. But with the length of postgraduate training progams and the constant growth of medical technology, the push to streamline training is great. Now there are streamlined programs in most of the surgical specialties. No longer are you going through general surgery training THEN cardiothoracic...now you are streamlined into CT surgery. Good to become a CT surgeon, but I think you lose something. Some will agree with that and some wont.

Yet, most voices I hear among medical students (admittedly, only on SDN) are against the TRI and feel the AOA is backwards, or stupid, or unfair, or driving people away from osteopathic residency, etc.

I am aware of that attitude and I dont know why they feel that way. And when asked they dont seem to have any good answers. I think because its "required" some places people take issue with it. Certain specialties require an internship prior to beginning their program. I dont know of any doctor who did an internship who is worse off from it. Most, if not all, have benefitted.

As an older student in a career change, I have fewer years ahead of me to practice medicine, yet I would treasure the TRI if it achieves the goal of making me a more well rounded physician with a broader and deeper perspective.

My thoughts exactly. I think it is difficult to appreciate this fact as a premed or medical student...or even as the intern on medicine rounds when they want to be in the OR or delivery suite. The AOA has the right intentions with a lot of things...they dont always get the implementation just right, but they try. I think the TRI is a strong testament to the design of osteopathic medicine to produce well rounded physicians.

What's your take on all this?

Thanks!
-Theraball

I think you are going to make a fine physician. Tell your father the founder of osteopathy said so!

ATS
 
Hey I am a junior in college and I am considering he osteopathic way. I may not be able to get into an allopathic school due to my mcat score. My question is why do you think a D.O. is better than an M.D. from the carribean like St. Georges University.

I get this question all the time.

I would refer you to the match statistics for non-US MD schools...not just the match RATE, but WHERE the graduates are matching.

In an effort to avoid any and all DO v MD conflict in this thread I dont feel it prudent to go into a lot of detail.

From my experience in speaking to program directors of residencies of all types (MD, DO...specialty, primary care...academic, community) the overall feeling toward Caribbean medical schools is poor. Significantly poorer than the attitude towards DO schools.

DO schools were created to offer something different to patients.

Caribbean MD schools were created to offer MD degrees to students not able to gain admission to the US medical schools.

ATS
 
Hello ATS,

Hello.

I'm an osteopathic student about to finish my first year and am in love with the idea of using OMM in the future.

Thats what I like to hear.

I love the immediate gratification aspect and simplicity of the techniques.

Dont get caught up in thinking OMT is a miracle cure. There are many patients who only maintain a certain level of functionality despite OMT, PT, meds, etc. The quick cures are nice but thats not every patients.

The thing is, I'm also interested in surgery/procedures (currently thinking about orthopedics or pain management). What kinds of unique opportunities are there in the use of OMM in these specialties?

There is some pretty solid research on OMT being a great post operative modality. Studies that show decreased pain, improved mobility and shortened hospital stay are in the literature. Easily searchable with your favorite journal search engine.

As far as pain management, the cross over is strong. OMT + pain meds can have a synergistic effect (1 + 1 = 3). I dont know of any studies, but I have seen this with my own patients.

Much of OMT is very orthopedic in nature as well. Having an additional modality to treat your patients can not only help the post op people, but also prevent or delay surgery for other people. Orthopedic surgeons arent hurting for work so a few people helped with OMT wont bankrupt them. Now imagine if YOU are the orthopedic surgeon doing both. :thumbup:

Also, do you know of any surgeons or pain specialists that use OMM extensively in their practices?

Surgeons...extensively? No. Fairly regularly, a few yes.

Pain management...I know a lot of people in the pain management field who use OMT quite often...daily in fact.

If so, what percentage of their time is spent using OMM?

Tough to say. For surgeons it can be a few minutes per day while on rounds. For pain docs it can be on several patients per day in their office. All depends on the types of patients and pathology you see.

I forsee myself spending some time in OMM-only practices and also practicing pain or orthopedics.

All fields with patients lining up to see you. You can do some great things if you can integrate them.

Thank you very much! (Sorry for all the questions!)


Youre welcome, anytime. Good luck.

ATS
 
So NYCOM is affiliated with LI Jewish? Does it help to have worked, shadowed or volunteered at LI Jewish?

One of the most important things in securing a residency spot is to become familiar with the residency program, residents and the residency director. Face time is a MUST, especially at competitive programs.

ATS
 
Hi ATS, thanks for all your information; I've enjoyed reading your thread and found it very helpful.

Glad I could help

My plans are to apply to both allopathic and osteopathic schools.

Godo plan. More options. :thumbup:

I do like the osteopathic philosophy.

Thank you. :)

I have a few questions for you concerning my application to DO schools.

Go for it.

Right now, I have about a 3.65 overall gpa and right now have a 4.0 this semester. This includes a horrible D+ in orgo 1 which I am retaking in the summer. Will AMCOOS replace that grade with my new one?

Dont know what AMCOOS is. AMCAS or AACOMAS? I dont know if grades are replaced. I think ALL grades from ALL colleges are reported.

Without it I'd have a 3.9 science gpa and hope to improve it with this semester's grades. I did take a few pre-reqs at a nearby CC due to timing and the cost and I plan to retake orgo 1 and take orgo 2 this summer after graduating. Do DO schools look down upon CCs for pre-reqs?

I dont think any school really "looks down" upon community college courses...but sometimes they look at two applicants with similar scores. One got a B in Organic while taking it over the summer. The other got a B in Organic while taking 14 other credits. Perception I guess.

But if you ask me does an A from a community college look better than a B from your regular school? I would say yes.

I really need to save money so I can afford this application process and eventually for med school.

Dont underestimate the money factor. Save as much as you can. Student loan interest rates are climbing.

I've visited NYCOM at their Open House and fell in love with it so I definitely intend to apply there.

Good school.

I'm a NY resident.

Sorry to hear that. ;)

I have done some volunteer work in a hospital, some clinical, some as a research assistant doing a clinical study and I've shadowed a DO. I am taking a year off before applying, so I hope to get some sort of research job after I finish with med school. I'm also working on another independent medically related project but can not post it to retain anonymity.

All things to put on your CV and application. Dont spread yourself too thin, but stay involved and make connections early.

I plan to take the MCAT in Jan if I'm ready. What do you recommend me doing to improve my application?

Retake the D. Bring that up.

Do well on the MCAT. Magic number seems to be 35...that will open many, many doors. 30 is strong as well. 27 is where you start thinking about retaking it, depending on where you apply.

Doing the research as you mentioned would be great. I would spend more time working with physicians so you can really build a strong rapport and get a great letter. Try to find graduates from the schools you are interested in.

Apply early!

Your grades are solid, you are planning ahead and from the limited explanation of your ECs you seem to be in the right frame of mind. Nail the MCAT and I think you will be OK.

ATS
 
Master Still,

Pupil Delicate Genius...

In my previous life (before wanting to pursue medicine) I was strongly interested in a career in Physical Therapy. One of the aspects that drew me to the profession was (and currently is) my love for the musculoskeletal system, and the opportunity to work manually with patients.

It can be very rewarding.

If asked in an interview "Why DO?" would it be a bad idea to mention this. I see some parallels between PT and OMM, but I am unsure if this will go over well with DO schools.

Absolutely mention it! You love hands on, right?

You love seeing the improvement in a patient because of something tangible you did to them, or with them, by working with your hands. You help ease back pain, stiff joints. You help people walk again following knee replacement surgery. These are all things that PTs and DOs experience every day.

Any DO who uses a lot of OMT works closely with PTs. They are very important for a number of reasons.

1. We cant see everyone! Many OMM practices have significant waiting lists.
2. Some patients need training in exercise therapy, aquatic therapy, machines, therapy devices...things that we dont always have access to or time to go through with all our patients.
3. Referalls! Goes both ways. I get and send people to PTs that I know and trust.

Your opinion is much appreciated.

No problem.

ATS
 
Oh, maybe I misunderstood, or I sort of changed the question around. I meant to ask if it would help to get into NYCOM med school if you've done volunteer work, etc at LIJ and get a strong letter from a DO who works there?

Yes.

And even better if the DO graduated from NYCOM.

ATS
 
Hi again, ATS!

Hi!

Thanks so much for answering my questions. You're terrific!:thumbup:

Thank you!

Opps I guess my brain stopped functioning for a minute;:oops: I meant to ask if AACOMAS drops the bad grade and just averages in the retaken course grade?

I dont believe so.

I've heard that is true, but even so, surely they see the original grade, so does that still hurt an otherwise very good science gpa?

Perhaps the medical school application Mentor would be of more help.

Yikes a 35 on the MCAT?!:scared: I mean I'll shoot for a 45; I can't ever understand anyone trying for less :p but I'm not expecting anything near that.

Expect the best from yourself.

I bought examkracker materials and have access to lots of the tests. How would you suggest I prepare? :scared: I'm really really very nervous about it.

Been a long time since I took the MCAT. Im afraid my best advice is study...but that was obvious.

When you say to make connections early, do you mean with someone important who can write me a good LOR?

Yes. The more people you know, the better.

How many letters do most DO schools expect and from whom?

Usually 3, one from a DO.

Is it better to shadow or work with several physicians so I can get multiple letters, or should I spend all my time with one so he or she sees my dedication?

One solid letter from a DO is likely better than multiple mediocre letters.

So far, I'm pretty sure I can get a strong letter from the DO I've worked with. But as a minimum I want to spend more time with him so I can then ask for the letter. Should I then try to shadow more doctors?

Above.

Should it be in a totally different field, type of practice or can it be from the same department?

Cant hurt to see different things.

What's a good amount of time to shadow each doctor?

2-3 times is usually more than enough. Unless the doc keeps inviting you back.

Do DO schools like people who have certain qualities/qualifications or do they like to see people who have a more unusual background: major, ECs, etc?

Every medical school is looking for the same thing. Good MCAT, strong grades, volunteer work, familiarity with medicine, good ECs.

What will make a candidate stand out to get an interview if they have the average MCAT and gpa for the school? (Surely, not that I'm from NY:rolleyes: )

What makes YOU stand out? No one can answer that question except yourself. You cant make something up or put on an act. You need to be yourself and hopefully you bring something special to the interview.

Thanking you in advance.

Youre welcome

ATS
 
Wow, that was a quick response! Thanks!

No problem

Just shadowing a doctor 2-3 full days is all that's needed? Wow, that's not bad to do multiple physicians then.

I'm not going to make up anything; I guess I was asking if there's any kinds of ECs or something that adcoms really like to see; something I can improve upon now since I have a year off? I'm just so afraid i won't be able to get a research or medically related job in my time off. And then what..?

Most applicants dont have research experience.

ATS
 

Hi.

I am currently a student at the University of Michigan.

Wolverines!

I do not have the best academic record, however. I have transferred schools 3 times (however, before coming to U of M I had a 4.0).

Transferring could come up in an interview.

Since then, I have received a D in physics (retook and got a B, but it still shows on my transcripts) and failed Genetics, and received a C in my other physics class. Obviously, I had a terrible semester.

:oops:

I am currently retaking Genetics. If I recieve all A's in my last year here in college, is my future for admissions into DO school still compromised?

I think most schools will look at your transcript as a whole before passing judgement. Continual low Bs and Cs doesnt look great, but mostly As with a few blemishes are easier to pass over. Hopefully there is a good reason why you had such a bad semester, not just you got lazy. Varsity sports, studying abroad or heavy research committments are excuses, but make lower grades look a bit nicer.

Be prepared to explain every single grade on your transcript whether it be an F or an A.

Thank you!


Youre welcome

ATS
 
Hi Dr. Still,

Hi

I haven't had any research experience thus far, and I am worried it isn't going to interest me, even in med schools.

A lot of people arent interested in research...mostly because they right projects hasnt come along yet.

Right now, I am thinking about specialties like EM & anesthesiology, are these fields where research is a must during med school?

EM likely no...at least not for many programs. Anesthesiology, it depends.

More and more fields are becoming research oriented in that they like their residents to complete at least one project before completion of their residency program. Some programs are adding a year or incorporating a mandatory research year ("bench year" some call it) in order to get their residents published. It also looks great for the program/hospital.


I think applicants with strong research projects in the areas they are interested in are looked more favorably upon than those without. The exceptions might be community programs that arent affiliated with a large university or academic center.

Most importantly, the project has to be something you are interested in doing rather than just being a lab rat.

With that said, I know many people who matched all over the country in many different fields WITHOUT medical school research.

ATS
 
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