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Physical Therapists as DOs?

Discussion in 'Pre-Medical - DO' started by DrCookie, Dec 29, 2000.

  1. DrCookie

    DrCookie Junior Member

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    Dec 29, 2000
    NY
    Hello all... I am currently a year away from my BS in Physical Therapy. I want to pursue medical school, and am most intrigued by osteopathy... Can anyone offer any advice?? I love the hands on approach that osteopathy takes to healing people, a lot of which I am learning in PT school... Feel free to email me!

     
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  3. ewagner

    ewagner Senior Member 10+ Year Member

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    Nov 22, 1998
    Well there cookie,
    I practiced in PT for three years in indianapolis, I got my PT degree at IU, and served as a CI for three universities. I then went back to med school, UHS, and only applied to DO programs. Now, I am in the middle of my third year.
    First things first, one must get past the PR of the AOA. "Osteopathy" as a hands on approach has NOT changed in 50 years. PT is far more researched and far better researched than ANY bit of manipulative medicine paper that comes from DO programs. And that is probably a good thing. DO's as a medical profession MUST learn the fields of Pathology, Pharmacology, Microbiology, Internal Medicine and Surgery best. They must also learn when to refer OUT for manual medicine (PT, OT, and RT). PT's etc practice rehab medicine and that is it. Who better to treat a patient complaints needing hands on care?? I know, I have seen and practiced with both professions! This is in no way knocking my own profession...my school prepared me wonderfully for medicine and I did well on both the USMLE and COMLEX.
    But once you get past rhetoric, and the isolated school lab experience...MANAGEMENT of musculoskeletal complaints is what DO's should master and NOT the manual treatment. We are best suited for ruling out medical disorders and medical management of the patient.
    I hope this does not make you disillusioned...I am just being honest. If you wish to practice manual medicine and wish to do research and to be taken seriously, continue PT. If you wish to practice medicine with an slightly orthopedic emphasis, enter medical school (DO programs).
     
  4. DrCookie

    DrCookie Junior Member

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    Dec 29, 2000
    NY
    Hello ewagner

    I have to thank you for your input on this subject... To clarify myself a little more. I love PT and what it has to offer people. However I know that osteopathy isnt some alternative healing voodoo weirdo nonmainstream approach to medicine... In fact its quite mainstream. I am just very interested in pursuing medicine, and i think that PT and osteopathy dovetail more than allopathic medicine does. I dont know that I would be happy practicing PT for the rest of my life either...I do think it will offer a lot for me, giving me a solid foundation of anatomy, kinesiology, neurobiology and such, which is why I am sticking with it instead of switching to a more traditional bio major. I just hope that the MCAT isnt as intimidating as it seems and that my 3.6 is good enough... well see! Any more advice you can send my way is much appreciated!
     
  5. fiatslug

    fiatslug Senior Member Physician 10+ Year Member

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    May 8, 2000
    Hey ewagner & others--how about a little clarification of the roles of PTs, DOs, & chiropractors in treating musculoskeletal injuries? I worked as a PT/OT aide for 2 years, and God knows most docs don't know 1/10th of the capabilities of rehab therapy. What kinds of patients/injuries are best treated by each practicioner? (I'm an allopathic MS 1)
     
  6. DrCookie

    DrCookie Junior Member

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    Dec 29, 2000
    NY
    Hi

    Im a 3rd year PT student, and I dont know everythign there is to know but I will offer my best insight as to what it is. PT is of great benefit to people in need of musculoskeletal rehabilitaion, pathologies of muscle or bone, some vestibular problems (prevalent in geriatric pops) PTs have an expertise at diagnosing beyond what a physician can at times, ie: a dx of LBP might arise and a PT needs to know the etiology of that so he uses his ability to tell if its a muscle, tendon, or neural in origin, all treatable by the therapist. Sometimes it could be a kidney infection, which is why PMH is so important to know.

    Getting off track here...PT is truly the crux of rehab. Sports injuries, pediatric cases of CP, joint replacements, post surgery pt's, a whole slew of patients can be seen and treated by a PT... OT, as i understand deals more with retraining a patient in ADL's...dressing, eating, coordination, etc. chiropracting is a little gray area, but to my understanding, deals with people who have chronic 'aches and pains' and go for an adjustment of their spine and neck. Heavy into manipulations. PT is the most well supported via research and outcomes data... Hope this helps! Please feel free to email me at [email protected] or [email protected]
     
  7. ewagner

    ewagner Senior Member 10+ Year Member

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    Nov 22, 1998
    This has become an interesting discussion.
    Regarding whether the basic tenet of osteopathy and physical therapy match, well, you would think that they would. But, where are the roots of both arts? In the realm of physical therapy, todays practitioner is in need of outcome related research and must prove functional gains by the use of objective data (that is what you are learning now Cookie) the use of manual muscle testing(ala Kendall) gait analysis (ala Donatelli) and the systematic analysis of movement patters and their treatment (ala Sahrmann). Each of these practitioners have published research, written text, and have served as clinical professors at respected universities (Emory and Washington U).
    But...the original "osteopaths" (a term somewhat out of vogue...well VERY out of vogue) practiced an art not based on research and not based on clinical data or objective measurements. Double blind studies are NOT used in osteopathic manual medicine. Outcome studies are NOT done in osteopathic manual medicine...and if they are, you had better HOPE they show favorable data! If not, don't expect publication!!
    Most young students see this poor research design, it is presented in OMT class. And this lack of objective proof, and well researched techniques and data turns almost ALL young DO students off to manual medicine.

    In fact, I came into the program as a big supporter of manual medicine, and left as the biggest opponent. They don't teach true kinesiology in OMT class. They don't teach objective measurements in OMT class. THey don't have outcome studies in OMT class. They don't have algorithms for treatment of common disorders in OMT class. You see, OMT is a cash based business, not a reimbursable charge from managed care or most private insurance...therefore, the strict rules for functional outcomes needed in PT are not needed by the old school DO's that practice manual medicine!

    OK, regarding the benefits of PT, OT, SLP, RT etc:
    As a practicing PT I saw alot of the benefits of rehab...but I never realized how much I didn't know! If I am working the ER, and a patient comes in with the complaint of back pain, it opens up a brand new differential, FAR more comprehensive than just musculoskeletal alone! You wouldn't believe the patients that come in with what they consider musculoskeletal complaints and what the true etiology of the pathology is!!!

    I had a patient come in with back pain in the ER once. Why? well she fell. But why did she fall? This is where medicine comes into play. After looking at her labs it was noticed she had the syncopal episode secondary to an early hyponatremia...this same hyponatremia eventually caused her death by initiation of respiratory arrest and cerebral edema!
    Coming from both fields I see how I once was..."oh those doctors don't know anything about musculoskeletal complaints!" But, if I would have let that same ego guide me in many ER cases, I would have missed HUGE pathologies that presented as minor musculoskeletal complaints (ie cholecystitis presenting as scapular pain, acute MI presenting as shoulder or jaw pain, prostatitis presenting as lower abdominal pain, DVT's presenting as calf strain etc etc).
    So what is the role of PT and OT? To treat the functional complaints of patients under the medical supervision of a physician and to offer suggestions for rehab assistive devices that enable pt's to attain functional independence. I am a true believer in rehab medicine, but I also believe in the strict following of guidlines by allied health professionals and their limitations.
    e
     
  8. DrCookie

    DrCookie Junior Member

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    Dec 29, 2000
    NY
    Hello... ewagner I think that i might be a bit out of my league on this one, but I do respect your experience and what you have to say... These posts are a little impersonal so unless I make myself clear, you cant go on much else! I am most interested in knowing if I am okay sticking to my guns, remaining a PT major and applying to medical school instead of the more orthodox science major, bio or chem (i know that there are plenty of nonscience majors as well, but i digress)

    I agree that PT has its own narrow scope of expertise as it pertains to the musculoskeletal world, but I enjoy it, learning and problem solving. I dont know my likes or dislikes... Im barely a twenty something with ambition and a pure thirst for knowledge. As a little background, I pursued dance for 12 years and performed in a lot of regional and semiprofessional theater. Im in PT school on a fluke. Pure chance. But I gambled and, in my opinion, won out because I have found something that I love. Learning, about the human body, what goes wrong, and how to treat it.

    Thats a disappointment that medical students arent exposed to a kinesiology course. I know their scope of knowledge encompasses way more than a measley PT but still i find it so helpful to have a solid grasp on my anatomy and kinesiology.

    Whats your take on the dozen plus states where PTs are autonomous?

    I appreciate yours and anyone's insight!!

     
  9. ewagner

    ewagner Senior Member 10+ Year Member

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    Nov 22, 1998
    I am sorry if I am monopolizing the conversation, college football isn't on!
    I think PT is a great profession, and I think you will do wonderfully in it because you have desire. My best friends are still practicing therapists!
    Regarding "direct access" laws, well, they really don't mean alot. The original intent (some 10+ years ago) was to be able to directly compete with chiropractors and at the same time save time by allowing pt's to get renewals on their rehab prescriptions without returning to the DR. and missing therapy.
    Since then, managed care has moved in, and any law allowing direct access has been neutered because insurance companies won't reimburse without physician evaluation. It is a good thing. And that is what keeps PT so in tuned with physicians and medicine. We communicate with each other! Unlike chiropractors who are in their own little chiropractic universe.

    Good luck and if you have anymore questions email me at [email protected]
    Yep, it is too bad we don't have kinesiology...but where in the world would we fit it!?
    Continue on your present course, but if you intend to pursue medicine, make sure you take biochemistry if you haven't already.
    ethan

    [This message has been edited by ewagner (edited 12-31-2000).]
     
  10. DrCookie

    DrCookie Junior Member

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    Dec 29, 2000
    NY
    I appreciate your insight ewagner... It means a lot to me... I think my biggest impetus is that I want to cointinue my learning. Now I know that people say a year in a clinic will teach you a lot more than a year in a classroom... FUrthermore I think Im capable of whatever I dream and that I can accomplish what I set my mind on... I love medicine and dont just want to help people. That I do want to do but I think the human body is such an awesome creation (why I think it was god and not a pure accident but thats another forum!!) which is so intricate and fascinating. I love PT and would think lack of communication with a physician would be detrimental... although I think there is way too much red tape (I live in NY which is one of the toughest states to be in practicewise.)

    Well I will email you soon... thanks for your input.. Happy New Year

     
  11. dcdo

    dcdo Senior Member 10+ Year Member

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    Jan 26, 1999
    Howdy,

    I think being a PT is a great foray into medicine, especially if you are planning on going into primary care. A fairly high % of patients visit their primary caregiver with NMS complaints. You can be in the position to help your patient much more than the average doctor. I have had many doctors tell me "If you can do the musculoskeletal thing too you will never be short of patients."

    I can't think of a better combination(even better than a DCDO).

    Good luck.
     
  12. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    6,222
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    Nov 21, 1998
    Over the rainbow
    I think that PT is a great preparation for any kind of medical education (MD or DO). Interestingly, DOs compete exceptionally well for top physiatry programs in nation. I'm doing rehab this month at Baylor and have been impressed with the degree to which OMT and manual medicine is embraced in the rehab setting. Several chief residents in rehab programs across the nation (including Baylor) are DO's. If you seek a career in rehab medicine as a physician, you'll do very well as a DO.

    All manual medicine suffers from a serious lack of evidence-based research (I'm acutely aware of this being both a 4th-year DO/MPH student and predoctoral research fellow in OMM). However, I'm not so pessimistic as Ewanger is about the whole situation. Afterall, DO's are comprehensively trained physicians who are also trained in manual medicine. While I've seen excellent clinical results from manual medicine performed by allied health providers (PTs OTs and DCs), I've also seen serious MEDICAL problems missed by manual practitioners who lack a medical education. The DDx for for musculoskeletal complaints is quite long and many serious medical problems can masquerade as "simple" musculoskeleteal problems. These observations have lead me to believe that all manual medicine should be performed by physicians (MD or DO) or performed by others (DC, PT, OT) under direct medical supervision.

    It is also true that in the osteopathic sphere, manaul medicine is approached less as science and more as art and is taught as such. There are multiple explanations for this, but suffice it to say that most are in agreement that the way manual medicine is taught today must be reformed.

    In terms osteopathic-specific research, the profession is turning the corner by belatedly (though better late than never) orchestrating large, scale, clincal trials in OMT. There's the MOOSE study (Maine Osteopathic Outcomes Study and Evaluation) underway in Maine and in conjunction with Dartmouth University, there's the evolving national center for osteopathic research, as well as NIH sponsored research with DO and PT primary investigators.

    I would like to see more DO's with a PT background get involved in OMM/OMT research. PT is an excellent field and PTs can bring much to osteopathic research. You will be welcomed...

    ------------------
    David Russo, MS3
    UNTHSC/TCOM
    StudentDoctor.Net Forum Moderator
     
  13. ewagner

    ewagner Senior Member 10+ Year Member

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    Nov 22, 1998
    I agree with you DRUSSO...I think that anyone that performs manipulation should perform such with a physician prescription only. And yes, I think that goes for DC's as well.
     

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