Hi,
I'd like to see if this thread can be rekindled a bit...
Wondering from those of you that posted in '07, what you have found out regarding NMM/OMT residencies and doctors.
1. how are the programs that are out there, are there truly some that are better than others in terms of the skills obtained? or does it depend on what your looking for (e.g. location, research experience, teaching experience).
2. any new info regarding the "scope of practice" question? For example if a NMM were to have a practice, thus seeing all ages, and gets a kid with some SD, but they also happen to have a URI, if need be can antibiotics be prescribed? or another example, seeing a patient with chronic LBP can you give pain meds? Geez with all the specialties out there it would look like any "primary care" doc (which I think NMM falls into, according to the board) could get sued for prescribing anything.
thanks a bunch for all your input.
1) It widely varies, as it does with any specialty. I have heard generally good things about Ettlinger's program in NY, KCOM, and MSU. Ultimately I'm afraid you will have to do your own research.
2) Scope of practice is always what you make of it in your training. Your competence determines both your comfort and your risk of litigation. Very few rural docs who do ER are ER board certified- and some are GP's. Having a full medical license and competence is more than enough to work in most rural ERs, regardless of residency. Make sure you are up on your ATLS, ACLS, PALS, and neonatal resuscitation if you go that route.
Personally I don't do much ER anymore, but when I did i found it the OMM diagnostic skill set is incredibly useful for the patients that most ER docs complain about- those in chronic pain or with vague/weird complaints. They are very easy to work up if you know your biomechanics well- usually there is a clear and obvious answer in the biomechanics and then you're done and they are out of your ER- end of story. Also it was very helpful for the chest pain workups- 90% of chest pain in the ER is non-cardiac, and to be able to give a patient a clear answer and send these patients home in no pain every time is priceless (musculoskeletal causes comprise about 40-50%, and another 30% is GI- and a good osteopathic exam can tell you which it is).
I have some time every day blocked for walk ins and urgent care stuff. I choose not to do primary care because I get bored with it. I'm in the business of getting patients better and solving problems- seeing patients back day in and day out for the same issues and doing med refills isn't my thing and isn't a good use of the skills I've worked hard to develop.
I do routine workups for cases that would normally fall under rheumatology, neurology, orthopedics, PM&R and sometimes GI or pulmonology. Some of these patients have been kicked around a lot and docs haven't been able to give them an answer because they did not test the right things. Having good hands and a broad knowledge base (as successful OMM demands) affords you more tools to narrow down your differential diagnosis. Once I have an answer- if I can cure them with OMM I do, if I cannot (autoimmune disease, cancers, occult fracture requiring , pancreatitis, etc.)- I will give them back to their PCP or a specialist for chronic management.
Basically- if you want to be a PCP I'd recommend you do the relevant residency (FM, Peds, IM, OB) and then do a +1 omm, or FP/OMM. That will school you up on the guidelines and nuances of chronic med management- of which there are many.
if you love OMM and want to teach or just master the art of musculoskeletal medicine as a specialist- the strait OMM residency may be a good choice. The closest specialty in scope of practice is PMR.
OMM- you work on all sorts of patients in training but can specialize later if you want to. The goal is comprehensive workup with detailed problem solving and fast cures. You can have hospital privileges and work on ICU patients trying to get off the vent or you can work on newborn babies with messed up heads or poor feeding. If you do it right you have immediate gratification (baby's head looks normal within minutes, or they are able to feed normally within minutes of you working on them). Generally poor evidence base for much of what you do, and poor understanding by the rest of the physician community. It is a vary rare talent and is in HUGE demand nationally (they want noninvasive and cost effective alternatives to the mainstream approach, but they want it administered by a physician that knows what they are doing). You can literally go into any city in the country and have a flourishing practice very quickly. You tend to work solo or in small groups.
PMR- your training is on a variety of patients, but you tend to specialize and work on only one type of patient. Problem solving is somewhat limited to a narrow scope, and the guidelines tell you what to do for treatment. Progress is often very slow, but monitored closely. You tend to work in teams for managing patients. Most physicians understand quickly what you are and what you do, and there is a fairly healthy respect for the specialty. Patient demand for your work is good, but your services are probably more needed in certain areas of the country. Tend to have organized didactic learning and good evidence based medicine and research worked into their training. Good opportunity to go on to other fellowships if you want to do pain, spine or sports med. OMM is a powerful adjunct to help your patients in this specialty, but do not expect anyone to help you improve your skills and dont expect big improvements in your spinal cord injury and stroke patients.
Some OMM docs go on to do other fellowships as well- I've heard of omm specialists doing pain fellowships and sports med. Spine might be possible too. You would have to be a strong candidate and it would still be a somewhat uphill battle (you'd have to prove your competence, and some might require extra training before the fellowship), but still very doable.
