Osteopathic physicians make more than Allopathic physicians?

[darktooth]

I was in clinic with a family med D.O. and we saw a patient coming in for a routine visit, but she also had some neck pain. The doctor did a few different OMT techniques and the patient's pain was gone. She was so happy and actually hugged the doc lol.


Anyways, afterwards we were talking and he told me that the visit itself was billable at about $50, but the techniques he used would likely be billable at $90, landing the total for the visit at around $140. He almost tripled what he made with OMT!

So then I started wondering if D.O.'s make more than M.D.'s in fields where OMT is applicable, like family medicine? The averages I'm sure include both DO and MD salaries, but being that there are more MDs out there currently, I wonder if it the averages are lower than average DO salaries due to our potential to make more through OMT?

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[BurghStudent]

This might be difficult to parse out. I can imagine that there is a tendency for DOs to practice in more rural areas (not generalizing here), and in private practice than MDs, leading to an increase in reimbursement.

 

[darktooth]

OMT visits also generally take more time per patient.

The techniques he used took about 3 minutes. Her questions about other non-OMT related issues took way longer.

I'm sure they generally do though.

 

[cabinbuilder]

OMT visits also generally take more time per patient.

Since when? HVLA takes five minutes if you know what you are doing.

 

[GUH]

Since when? HVLA takes five minutes if you know what you are doing.

Is five minutes additional direct patient contact time per patient insignificant? Honest question; you would know better than I do.

 

[metopic]

Is five minutes additional direct patient contact time per patient insignificant? Honest question; you would know better than I do.

Well if the example from the OP is actually true (and insurance actually pays out that much) then you are probably increasing the length of the office visit by 20-25% for a 180% increase in revenue. Typical routine follow up office visit is 15 minutes. Seems worth it ;p

I doubt most insurance companies would actually pay face value for OMT. On the other hand cash practices for that stuff rake it in as far as I can tell.

As for the OP, MD's have a higher probably of going into higher paying specialties, so that skews the numbers pretty significantly. No matter how much OMT a FP doc does, they aren't making neurosurgery money. That said, I wouldn't be surprised at all if the average DO FP made more than the average MD FP by a substantial margin, especially once you consider other things like MD academia for family medicine paying poorly and DO school academia paying very well (OMT clinic type FP guys that teach OMM make good money).

 

[Otto of the Silver-Hand]

Well if the example from the OP is actually true (and insurance actually pays out that much) then you are probably increasing the length of the office visit by 20-25% for a 180% increase in revenue. Typical routine follow up office visit is 15 minutes. Seems worth it ;p

I doubt most insurance companies would actually pay face value for OMT. On the other hand cash practices for that stuff rake it in as far as I can tell.

As for the OP, MD's have a higher probably of going into higher paying specialties, so that skews the numbers pretty significantly. No matter how much OMT a FP doc does, they aren't making neurosurgery money. That said, I wouldn't be surprised at all if the average DO FP made more than the average MD FP by a substantial margin, especially once you consider other things like MD academia for family medicine paying poorly and DO school academia paying very well (OMT clinic type FP guys that teach OMM make good money).

Some insurance companies are capitated... so it doesn't matter how much time you spend w/ the patient. Other companies have a set fee. So for a 5 minute visit, you get 25 bucks, but for visits that are 15, 25, 45, 60 minutes you get $50. And still others determine reimbursement based on the complexity of the case. So if the company feels that a person w/sniffles and back pain isn't complex enough they pay you at a rate they feel is justified. A big mistake that new attendings make is that they think billable services = reimbursement, when in reality billable services <<<<<< reimbursement. The take home message: insurance companies are looking for ways to cut payments to doctors, not give doctors more $$$. A cash practice is actually quite good, but you have to set up in a pretty influential neighborhood. I know a couple of OMT guys who are doing quite well around Wall Street. That's also why some docs are doing concierge. As for DO FP academics making more than MD FP academics, that's debatable. You have to remember that most academic centers/ clinics provide services in poor neighborhoods. In addition, The salary of an MD -affilliated Academic regardless of their specialty or degree (MD/DO) is heavily dependent on grants. Another take home message: the vast majority of physician employees know very little about billing and reimbursement.

 

[cabinbuilder]

Is five minutes additional direct patient contact time per patient insignificant? Honest question; you would know better than I do.

For me (and I am ONLY speaking for what I do) that 5 minutes extra doesn't change anything since I get paid by the hour. The site I am at can bill for the OMT- I generally do the coding for them so they can but it doesn't affect my pocket. Plus, it's not like you do OMT on every patient. I may do it 2-3 times a day.

 

[Otto of the Silver-Hand]

Is five minutes additional direct patient contact time per patient insignificant? Honest question; you would know better than I do.

Yes and no. If you are billing by time and if you spent 20 minute w/ a pt you could only bill for 15 minutes. If you spent another 5 minutes (so increases by 25 minutes) you could bill for a 25 minute visit. There are caveats: you have to put both the start and end times on the progress note.
However, to reiterate billable hours do not equal reimbursement.

 

[Seth Joo]

I was in clinic with a family med D.O. and we saw a patient coming in for a routine visit, but she also had some neck pain. The doctor did a few different OMT techniques and the patient's pain was gone. She was so happy and actually hugged the doc lol.


Anyways, afterwards we were talking and he told me that the visit itself was billable at about $50, but the techniques he used would likely be billable at $90, landing the total for the visit at around $140. He almost tripled what he made with OMT!

So then I started wondering if D.O.'s make more than M.D.'s in fields where OMT is applicable, like family medicine? The averages I'm sure include both DO and MD salaries, but being that there are more MDs out there currently, I wonder if it the averages are lower than average DO salaries due to our potential to make more through OMT?

MDs have better chances at fields like Orthopedics, Dermatology, etc, a much larger percent of MDs become specialists, so MDs earn more than DOs.

 

[cabinbuilder]

MDs have better chances at fields like Orthopedics, Dermatology, etc, a much larger percent of MDs become specialists, so MDs earn more than DOs.

NO NO NO NO NO NO NO. An MD derm and a DO derm WILL MAKE THE SAME $$$$. Please do NOT THINK that just because you are an MD you will make more. I make the SAME $$ as my MD FP counterpart. I currently am MAKING MORE working in ER.

 

[darktooth]

MDs have better chances at fields like Orthopedics, Dermatology, etc, a much larger percent of MDs become specialists, so MDs earn more than DOs.

You misunderstood me.

I'm suggesting the DOs make more than MD in the SAME specialty as a result of OMT. This would be most pronounced in fields where OMT is most applicable like family med

 

[BigSib]

... So then I started wondering if D.O.'s make more than M.D.'s in fields where OMT is applicable, like family medicine? The averages I'm sure include both DO and MD salaries, but being that there are more MDs out there currently, I wonder if it the averages are lower than average DO salaries due to our potential to make more through OMT?

Long story short: yes you can make more as a DO in fields where OMT is applicable (most primary care) if you use it correctly and if your contract allows you to be paid based upon its usage in some form. It depends on your contract, how you're paid, how the clinic bills, and a multitude of other factors.

You can easily bump a level 3 office visit to a level 4 and therefore get more RVU's out of the visit (3.14 vs. 2.14). The 2013 numbers are roughly 1 RVU (Relative Value Unit) = $34 in medicare reimbursement (depends upon state/location). Some contracts have that you may be paid up to %150+ of the Medicare rate, depending upon insurance population.

 

[Dharma]

Since when? HVLA takes five minutes if you know what you are doing.

maybe even less. could probably hit up 5 different locations in 5 minutes!

 

[dyspareunia]

You misunderstood me.

I'm suggesting the DOs make more than MD in the SAME specialty as a result of OMT. This would be most pronounced in fields where OMT is most applicable like family med

DOs also average $40k more debt than MDs do (http://www.amednews.com/article/20120827/profession/308279940/6/). Do the math (because I don't want to) and see if the handful of OMM a DO does per week cancels out the $40k (pre-interest) debt they have that their MD counterpart does not.

I'm sure it does though if it's an extra $90 for a 3minute procedure... even though that seems like an insane reimbursement.

 

[NontradCA]

DOs also average $40k more debt than MDs do (http://www.amednews.com/article/20120827/profession/308279940/6/). Do the math (because I don't want to) and see if the handful of OMM a DO does per week cancels out the $40k (pre-interest) debt they have that their MD counterpart does not.

I'm sure it does though if it's an extra $90 for a 3minute procedure... even though that seems like an insane reimbursement.

Not very relevant to the thread but ok. Lol@ 2011 though. For 2016 it's probably closer to $300k.

 

[dyspareunia]

Not very relevant to the thread but ok. Lol@ 2011 though. For 2016 it's probably closer to $300k.

Why is the additional cost to become a DO not relevant to a thread about the additional income (potential) of a DO? What are you talking about $300k? The average debtload of MD students only went up about 2% from 2011-2013. I would guess that the DO debtload also increased by about that amount too. I doubt it's going to go from $170k to $300k in the next 2-3 years.

 

[NontradCA]

Why is the additional cost to become a DO not relevant to a thread about the additional income (potential) of a DO? What are you talking about $300k? The average debtload of MD students only went up about 2% from 2011-2013. I would guess that the DO debtload also increased by about that amount too. I doubt it's going to go from $170k to $300k in the next 2-3 years.

It's irrelevant because OP is asking a specific question on revenue generated from OMT in those specific fields and not an overall income equality picture.

And considering tuition has risen every year and the elimination of subsidized loans I'm willing to bet that a lot people are going to be 300k in debt or more.

 

[dyspareunia]

It's irrelevant because OP is asking a specific question on revenue generated from OMT in those specific fields and not an overall income equality picture.

And considering tuition has risen every year and the elimination of subsidized loans I'm willing to bet that a lot people are going to be 300k in debt or more.

I see. The point was the difference between debt in DOs and MDs, which will not change much just because subsidized loans were eliminated. Also, the averages include people with 0 debt and are left-skewed.. this is common knowledge. Many students are already >$300k in debt.

 

[NontradCA]

I see. The point was the difference between debt in DOs and MDs, which will not change much just because subsidized loans were eliminated. Also, the averages include people with 0 debt and are left-skewed.. this is common knowledge. Many students are already >$300k in debt.

Nothing to do with OP

 

[dyspareunia]

Not very relevant to the thread but ok. Lol@ 2011 though. For 2016 it's probably closer to $300k.

Nothing to do with OP

Because your original post was more relevant.

 

[darktooth]

DOs also average $40k more debt than MDs do (http://www.amednews.com/article/20120827/profession/308279940/6/). Do the math (because I don't want to) and see if the handful of OMM a DO does per week cancels out the $40k (pre-interest) debt they have that their MD counterpart does not.

I'm sure it does though if it's an extra $90 for a 3minute procedure... even though that seems like an insane reimbursement.

lol...Are you an allopathic student trying to make yourself feel better or something?

If you are...imagine this.... patient presents to your office with acute back pain. Patient is a beautiful 24 yr old female. The one-dimensional MD throws pills at her, she complains they only cover up the issue and give her side effects. - Suddenly - Captain DO flys in, fixes her back in 5 minutes, gets reimbursed handsomely, and flys out the office, girl on arm.

If I was the MD I'd feel a bit inadequate too. "at least I have less debt (on average) than captain DO" I'd say to comfort myself.

 

[cabinbuilder]

You misunderstood me.

I'm suggesting the DOs make more than MD in the SAME specialty as a result of OMT. This would be most pronounced in fields where OMT is most applicable like family med

Apparently so because your original statement was not even close to this new one.

 

[cabinbuilder]

lol...Are you an allopathic student trying to make yourself feel better or something?

If you are...imagine this.... patient presents to your office with acute back pain. Patient is a beautiful 24 yr old female. The one-dimensional MD throws pills at her, she complains they only cover up the issue and give her side effects. - Suddenly - Captain DO flys in, fixes her back in 5 minutes, gets reimbursed handsomely, and flys out the office, girl on arm.

If I was the MD I'd feel a bit inadequate too. "at least I have less debt (on average) than captain DO" I'd say to comfort myself.

HAHA, happens every week. Nice being the hero.

 

[Osteotastic]

No, on average, they do not.

 

[BobBarker]

I don't think you can bill for a procedure and an office visit at the same time, with the one exception being if it is your first time to see that patient.

 

[metopic]

I don't think you can bill for a procedure and an office visit at the same time, with the one exception being if it is your first time to see that patient.

You sure you are actually a resident? Wrong wrong wrong wrong

 

[group_theory]

I don't think you can bill for a procedure and an office visit at the same time, with the one exception being if it is your first time to see that patient.

You can bill for OMT and an office visit if you use modifier 25 with your E/M code ... but be careful of the rules because there are times when you cannot bill for both visit and OMT (only one or the other)

http://www.osteopathic.org/inside-a...coding-and-billing/Pages/billing-for-omt.aspx

 

[TheWeeIceMan]

lol...Are you an allopathic student trying to make yourself feel better or something?

If you are...imagine this.... patient presents to your office with acute back pain. Patient is a beautiful 24 yr old female. The one-dimensional MD throws pills at her, she complains they only cover up the issue and give her side effects. - Suddenly - Captain DO flys in, fixes her back in 5 minutes, gets reimbursed handsomely, and flys out the office, girl on arm.

If I was the MD I'd feel a bit inadequate too. "at least I have less debt (on average) than captain DO" I'd say to comfort myself.

Wait, who is trying to make themselves feel better......?

 

[BobBarker]

You sure you are actually a resident? Wrong wrong wrong wrong

Of course, I am sure you must be THAT med student. I am a senior anesthesiology resident going into a pain fellowship next year. Just retelling what I have been taught/told in pain clinic.

 

[cabinbuilder]

You can bill for OMT and an office visit if you use modifier 25 with your E/M code ... but be careful of the rules because there are times when you cannot bill for both visit and OMT (only one or the other)

http://www.osteopathic.org/inside-a...coding-and-billing/Pages/billing-for-omt.aspx

Yes, this is absolutely the correct way to code for OMT during an office visit.

 

[Seth Joo]

You misunderstood me.

I'm suggesting the DOs make more than MD in the SAME specialty as a result of OMT. This would be most pronounced in fields where OMT is most applicable like family med

Well a DO FM with OMT services will earn more than an MD FM who does not offer OMT. Family Medicine is the setting where OMT can be applied. There are some DOs who are OMT only.

 

[Seth Joo]

NO NO NO NO NO NO NO. An MD derm and a DO derm WILL MAKE THE SAME $$$$. Please do NOT THINK that just because you are an MD you will make more. I make the SAME $$ as my MD FP counterpart. I currently am MAKING MORE working in ER.

That might be the case, but an MD will have greater chances of landing a Dermatology residency or any other highly competitive field. Most MDs tend to specialize while most DOs tend to enter primary care. So when you look at it from a macroscopic view, MDs are likely to earn more than DOs.

 

[cabinbuilder]

That might be the case, but an MD will have greater chances of landing a Dermatology residency or any other highly competitive field. Most MDs tend to specialize while most DOs tend to enter primary care. So when you look at it from a macroscopic view, MDs are likely to earn more than DOs.

WTF???? That wasn't the point of my reply. I'm talking about equality within the same specialty. Gimme a break already. Totally HATE hair splitters. Go join the pharmacists, they are the worst offenders and make life miserable every single day.

 

[darktooth]

Apparently so because your original statement was not even close to this new one.

I intentionally wrote the title of this thread in such a way to draw more attention to it, however, I clearly stated it was with regards to family med with use of OMT.

If that was not clearly stated I apologize as English is not my first language.


(English is my first language, but that sounded like a perfect response)

 

[Dharma]

Someone in this thread has chosen a very accurate name. It should be enjoyable... REALLY enjoyable... but for some reason, it hurts, and that's a bummer. Buzzkill. No one likes a buzzkill. Deep down, the buzzkill doesn't even like itself.

 

[bionerd89]

Wow I can't tell if some people were genuinely confused about OP's question or if they were just over-thinking it.

 

[SurgeDO]

lol...Are you an allopathic student trying to make yourself feel better or something?

If you are...imagine this.... patient presents to your office with acute back pain. Patient is a beautiful 24 yr old female. The one-dimensional MD throws pills at her, she complains they only cover up the issue and give her side effects. - Suddenly - Captain DO flys in, fixes her back in 5 minutes, gets reimbursed handsomely, and flys out the office, girl on arm.

If I was the MD I'd feel a bit inadequate too. "at least I have less debt (on average) than captain DO" I'd say to comfort myself.

if a pt. presented with acute low back pain, i would probably be more inclined to put her on an NSAID and get her to an MRI. performing HVLA on a pt. with acute lower back pain would probably be one of the worst things you could do.

i get the point you were trying to make, but brining up such immature, petty differences between MDs and DOs does nothing but fuel the fire. quit that ****.

 

[dyspareunia]

lol...Are you an allopathic student trying to make yourself feel better or something?

If you are...imagine this.... patient presents to your office with acute back pain. Patient is a beautiful 24 yr old female. The one-dimensional MD throws pills at her, she complains they only cover up the issue and give her side effects. - Suddenly - Captain DO flys in, fixes her back in 5 minutes, gets reimbursed handsomely, and flys out the office, girl on arm.

If I was the MD I'd feel a bit inadequate too. "at least I have less debt (on average) than captain DO" I'd say to comfort myself.

No it was a legitimate question. I'm curious how much more a DO makes from OMM.

But I'm glad you think it's cool to fraternize with patients. Good for you.

 

[darktooth]

But I'm glad you think it's cool to fraternize with patients. Good for you.

I plan to have a heart shaped loveseat in every room in my office. Barry white soft playing in the background. Gowns replaced with silky, deep maroon robes.

i get the point you were trying to make, but brining up such immature, petty differences between MDs and DOs does nothing but fuel the fire. quit that ****.

I was not trying to drive a wedge between DO and MD. That was being done by other forces at large. Captain DO is not about hate, captain DO loves MD's, even if they look down on him. A superhero's job is to be whatever society needs us to be.
In fact, I propose every DO perform BLT of the sacrum on every MD. I can't think of a better way for us to bond with them than with our unparalleled palpation skills at work between their legs.

 

[dyspareunia]

I plan to have a heart shaped loveseat in every room in my office. Barry white soft playing in the background. Gowns replaced with silky, deep maroon robes.



I was not trying to drive a wedge between DO and MD. That was being done by other forces at large. Captain DO is not about hate, captain DO loves MD's, even if they look down on him. A superhero's job is to be whatever society needs us to be.
In fact, I propose every DO perform BLT of the sacrum on every MD. I can't think of a better way for us to bond with them than with our unparalleled palpation skills at work between their legs.

I wasn't trying to drive a wedge between anyone.

If NPs make $90k and a FP makes $150k, but the NP has way less debt from school and is in practice for longer than the FP, the NP has the potential to come out ahead. That's all I was getting at.. That DOs on average tend to come out of school with more debt so how much OMM do they need to do before they really start coming out ahead of their MD counterparts?

Not sure why you all got so defensive.

 

[Seth Joo]

WTF???? That wasn't the point of my reply. I'm talking about equality within the same specialty. Gimme a break already. Totally HATE hair splitters. Got join the pharmacists, they are the worst offenders and make life miserable every single day. Totally HATE hairsplitters. Go join the pharmacists, they are the best at it. Make life miserable every day.

The title of this thread is asking if DOs earn more than MDs, I am asking the question in terms of both populations, US trained MDs vs DOs, a US trained MD is more likely to be in a specialty, and therefore make more money than a DO. That is just the way things are.

Many DOs who are primary care doctors, provide OMT to increase their incomes, so there are cases where DOs can earn more than an MD in the same field of medicine.

A lot of my classmates came to medical school hoping to get into specialty field, but many wind up in primary care.

 

[cabinbuilder]

I wasn't trying to drive a wedge between anyone.

If NPs make $90k and a FP makes $150k, but the NP has way less debt from school and is in practice for longer than the FP, the NP has the potential to come out ahead. That's all I was getting at.. That DOs on average tend to come out of school with more debt so how much OMM do they need to do before they really start coming out ahead of their MD counterparts?

Not sure why you all got so defensive.

Any FP who lays down for a 150K contract either doesn't have that much debt or just is doing it wrong. Need to add another 100K to that figure I know I do.

 

[cabinbuilder]

The title of this thread is asking if DOs earn more than MDs, I am asking the question in terms of both populations, US trained MDs vs DOs, a US trained MD is more likely to be in a specialty, and therefore make more money than a DO. That is just the way things are.

Many DOs who are primary care doctors, provide OMT to increase their incomes, so there are cases where DOs can earn more than an MD in the same field of medicine.

A lot of my classmates came to medical school hoping to get into specialty field, but many wind up in primary care.

Excuse me as I run screaming through the woods naked as the mosquitoes bite me.

 

[Oo Cipher oO]

if a pt. presented with acute low back pain, i would probably be more inclined to put her on an NSAID and get her to an MRI. performing HVLA on a pt. with acute lower back pain would probably be one of the worst things you could do.

You would really order imaging on a pt with acute low back with no neurological defects? Even when such imaging in contraindicated by ACP clinical guidelines? If the back pain could be improved with OMT without the prescription of NSAIDS is this not preferable? I don't understand your fear of using OMT in this situation. This is exactly the kind of situation where we have lots of evidence of OMT working pretty well.

 

[Seth Joo]

I wasn't trying to drive a wedge between anyone.

If NPs make $90k and a FP makes $150k, but the NP has way less debt from school and is in practice for longer than the FP, the NP has the potential to come out ahead. That's all I was getting at.. That DOs on average tend to come out of school with more debt so how much OMM do they need to do before they really start coming out ahead of their MD counterparts?

Not sure why you all got so defensive.

Unfortunately this is a sad reality. As DO students we are taking up debt levels that are often higher than our colleagues at MD schools, and this is so when there are many who go to public MD schools.

But the saying is that life is a beach and then you die.

 

[cabinbuilder]

You would really order imaging on a pt with acute low back with no neurological defects? Even when such imaging in contraindicated by ACP clinical guidelines? If the back pain could be improved with OMT without the prescription of NSAIDS is this not preferable? I don't understand your fear of using OMT in this situation. This is exactly the kind of situation where we have lots of evidence of OMT working pretty well.

I agree, I would get an MRI if they complain of numbness and tingling down the legs into the feet. If not, HVLA is your friend. Plus, MRI is not always available in an area (I work where they have travelling MRI's on a semi van that comes weekly). Most times OMT will fix the problem.

 

[SurgeDO]

You would really order imaging on a pt with acute low back with no neurological defects? Even when such imaging in contraindicated by ACP clinical guidelines? If the back pain could be improved with OMT without the prescription of NSAIDS is this not preferable? I don't understand your fear of using OMT in this situation. This is exactly the kind of situation where we have lots of evidence of OMT working pretty well.

Are you by chance mixing up acute back pain for chronic back pain? I believe the evidence supports the use of OMT for chronic lower back pain.

A patient with a severe spondylolysis or spondylolisthesis would present with acute back pain. These would be a little obvious as the patient would be in excruciating pain. Lesions such as a pars interarticularis could be a little more subtle. Could you imagine putting all your body weight through HVLA into somebody with a fractured vertebrae? Ouch. What about a pt with a radiculopathy due to a slipped IVD?

I personally would not ever feel comfortable performing OMT (especially HVLA) on a patient until an MRI clears him/her. I am sure others will disagree...but you could really **** up a patient 'a life if OMT is performed on the wrong injury.

 

[Oo Cipher oO]

Are you by chance mixing up acute back pain for chronic back pain? I believe the evidence supports the use of OMT for chronic lower back pain.

A patient with a severe spondylolysis or spondylolisthesis would present with acute back pain. These would be a little obvious as the patient would be in excruciating pain. Lesions such as a pars interarticularis could be a little more subtle. Could you imagine putting all your body weight through HVLA into somebody with a fractured vertebrae? Ouch. What about a pt with a radiculopathy due to a slipped IVD?

I personally would not ever feel comfortable performing OMT (especially HVLA) on a patient until an MRI clears him/her. I am sure others will disagree...but you could really **** up a patient 'a life if OMT is performed on the wrong injury.

The ACP guidelines for low back pain are here: http://annals.org/article.aspx?articleid=736814 . Clinical evidence points to withholding any imaging upon initial presentation unless there are progressing neurological defects or there is strong clinical suspicion of underlying pathology. This includes acute or chronic. Treatment options include self care, medications, or spinal manipulation. This is not an just an osteopathic recommendation, these are the guidelines all physicians use.

So yes you should feel comfortable performing OMT, even HVLA, on that acute or chronic low back pain patient if you have done a good history and physical. The evidence backs you up.

 

[SurgeDO]

The ACP guidelines for low back pain are here: http://annals.org/article.aspx?articleid=736814 . Clinical evidence points to withholding any imaging upon initial presentation unless there are progressing neurological defects or there is strong clinical suspicion of underlying pathology. This includes acute or chronic. Treatment options include self care, medications, or spinal manipulation. This is not an just an osteopathic recommendation, these are the guidelines all physicians use.

i agree.

these guidelines do not contradict what i have been saying. you are implying that i think every patient who walks through the door needs an MRI. i do not think this.

a patient who is brought to the ER with sudden, debilitating back pain leads to a "strong clinical suspicion of underlying pathology" especially if there is known trauma involved. the ACP guidelines support MRI for this under recommendation 3. these guidelines also support MRI for suspected radiculopathies under recommendation 4.

So yes you should feel comfortable performing OMT, even HVLA, on that acute or chronic low back pain patient if you have done a good history and physical. The evidence backs you up.

these guidelines do say spinal manipulation is of small to moderate benefit to the patient. i agree manipulation can be beneficial for back pain...as long as other serious pathologies are ruled out. you could damage the spinal cord if you perform manipulation on a patient with vertebral fractures. vertebral fractures present as acute back pain. you need a radiograph to rule out a vertebral fracture. if you can rule out pathologies like this, manipulate all you want...but it is dangerous and irresponsible to start crackin' on a patient presenting with acute back pain without thinking of these pathologies.