"The D.O.", the AOA, and What They Don't Get.

[homeboy]

I debated long and hard whether to submit this to The D.O., and in the end I probably should have, but realizing the futility in arguing with old-timers that don't plan on changing any time soon, it's not worth the risk and is not going to accomplish anything.
---------------------------------------------------------------------

As a third year student in an osteopathic medical institution, my meager experience offers little in terms of qualification when speaking on matters of professional direction, educational standards, or the practice of medicine. However, being I am a constituent of a group that frequents the topic of editorials in this publication—ie. the future of this profession—my opinion warrants at least recognition.

Of the plethora of articles that lament the current state of osteopathic medical education, Morton Morris, DO, in his October 2006 article A.T. Still revisited, did an extraordinary job of highlighting what the current leadership of our profession feels problematic. Mainly, that osteopathic schools have been turning out essentially allopathic physicians with an enhanced knowledge of the musculoskeletal system and manual medicine. But with all the respect that is due to Dr. Morris, I disagree that there is anything other than the natural course of modern medicine to blame, or that implementing a more pervasive teaching of OPP in didactic and clinical education will alleviate this situation.

An important factor of this situation that is rarely discussed is the role of pre-med education and the perception of this profession from a collegiate standpoint. Since the inception of osteopathic medicine, our educational process has evolved in every aspect, from topics covered in didactic years to length of training to licensing exams. Pre-med students do not see this timeline; they only see the end result as advised by every pre-med program across the country, which is that the DO degree—for the most part—offers everything the MD degree offers in terms of career potential. On a whole, pre med students (excluding those that apply to off-shore schools) fall into one of three categories: 1.) those that apply strictly allopathic,
2.) those that apply both allopathic and osteopathic, and
3.) those that apply strictly osteopathic.

Such an obvious statement should not be dismissed without reflecting on the proportion of osteopathic students that fell into category #2 when applying, or in other words, those students that were willing to go either route to enter the medical profession. My point is that the osteopathic profession is merely a passenger in the progression of modern healthcare, and being such, is subject to the needs and changes of modern healthcare. The idealistic notion that “going DO” will make you a better physician is antiquated, and if anything, the only true difference lies in the fact that DO students on average care more about being good physicians than any stigmas (real or imagined) associated with the osteopathic profession, as evident by their mere acceptance of the osteopathic route. This says nothing of osteopathic education, but speaks volumes of the types of people that apply osteopathic.

If one presents the core osteopathic principles (as outlined by Dr. Morris) to a 21-year old college student who has taken several years of modern chemistry, biology, and physics, there is nothing revolutionary about the notion that “the body has an inherent ability to heal itself.” I am quite baffled as to how our educators are supposed to adopt recommendations to better incorporate osteopathic principles into classroom and clinical education when those principles are already such a basic component to understanding modern anatomy, physiology, pharmacology, etc... Adopting superficial policies, such as requiring osteopathic students to identify themselves as “OMS” rather than “MS,” does nothing to solve the core of the problem, but merely serves as a desperate attempt to remedy the oft-quoted “osteopathic identity” problem.

I am in no way attempting to be blasphemous or disrespectful, but to suggest that the initials behind our name define our quality of patient care not only discounts personal skills and attributes, but suggests that words speak louder than actions.

---

Members don't see this ad.

 

[Dr JPH]

homeboy

Since your inception here at SDN we have disagreed on nearly every point from OMM to the color of the sky, albeit we have tried (at least lately) to remain cordial.

Despite our "you say its black because I said its white" history, I must admit that what you wrote above is excellent.

You hit on a few points that are in the minds of 90% of osteopathic medical students and did so professionally and eloquently.

I wouldnt hesitate to send that in to The DO with perhaps a bit of editing...not to alter content or tone, but to produce something that is more likely to get published.

Well done.

 

[Shinken]

The idealistic notion that “going DO” will make you a better physician is antiquated...

Actually, that's the whole point the AOA have tried to make. That being a DO will make you a better physician by virtue of knowing OMT as an adjunct to conventional allopathic-style therapies, but most DO grads don't use OMT and therefore don't distinguish themselves from a regular allo doc. Whether that's true or not is not the point. The point is that's what the AOA believes, and that's what the AOA will try to force people to accept.

The fact that most students don't agree with that stance, or the fact that most practicing DOs don't use OMT is irrelevant to the AOA.

I hate to use the religion analogy, but I can't think of anything better. Just because 99.9% of catholics have premarital sex doesn't mean that the Pope and the Vatican are going to say "well, everyone does it so let's stop saying it's a sin." Won't happen.

Similarly, it's the AOA's "dogma" that DOs are somehow better than MDs, and all the people that disagree won't change their views. Someday, perhaps when all the old-timers are replaced by people that have experienced medicine without the bad blood that allos and osteos share that might change. But until that happens the AOA will be the AOA.

 

[Dr JPH]

Actually, that's the whole point the AOA have tried to make. That being a DO will make you a better physician by virtue of knowing OMT as an adjunct to conventional allopathic-style therapies, but most DO grads don't use OMT and therefore don't distinguish themselves from a regular allo doc. Whether that's true or not is not the point.

I seem to think that the entire point.

JMHO

 

[It'sElectric]

homeboy

Since your inception here at SDN we have disagreed on nearly every point from OMM to the color of the sky, albeit we have tried (at least lately) to remain cordial.

Despite our "you say its black because I said its white" history, I must admit that what you wrote above is excellent.

You hit on a few points that are in the minds of 90% of osteopathic medical students and did so professionally and eloquently.

I wouldnt hesitate to send that in to The DO with perhaps a bit of editing...not to alter content or tone, but to produce something that is more likely to get published.

Well done.

Cosign. I attempt to allude to these ideas, but homebody does it quite eloquently.

 

[hyperbaric]

Well said, homeboy. Send it in.

 

[It'sElectric]

Well said, homeboy. Send it in.

I have an even better idea than simply just sending it in. Why don't we refine it (JP and homebody, possibly?), make it the best damn "letter to the editor" ever, and then most importantly get as many DO students to sign it as possible. Wouldn't there be a way to start a very small website where you can electronically sign the "petition"?? A few thousand signatures backing up said letter would, I assume, be something new. Or am I way out in left field here and grasping at straws?

 

[jrf331]

I have an even better idea than simply just sending it in. Why don't we refine it (JP and homebody, possibly?), make it the best damn "letter to the editor" ever, and then most importantly get as many DO students to sign it as possible. Wouldn't there be a way to start a very small website where you can electronically sign the "petition"?? A few thousand signatures backing up said letter would, I assume, be something new. Or am I way out in left field here and grasping at straws?

Homeboy, I have always found your editorials well written and worth publishing. This one is no exception.

 

[Red Beard]

...but most DO grads don't use OMT and therefore don't distinguish themselves from a regular allo doc.

Just a small comment here:

I've heard this statement quite a bit, and generally accepted it as true. However, I recently attended a talk in which the speaker pointed out that the statistics that are often used to back up this statement were derived from medicare billing data. In other words, the data only indicates that the majority of osteopathic physicians aren't billing for OMT. This is not the same as saying they do not use the techniques or fundamental knowledge frequently in their practice.

 

[Kuba]

Just a small comment here:

I've heard this statement quite a bit, and generally accepted it as true. However, I recently attended a talk in which the speaker pointed out that the statistics that are often used to back up this statement were derived from medicare billing data. In other words, the data only indicates that the majority of osteopathic physicians aren't billing for OMT. This is not the same as saying they do not use the techniques or fundamental knowledge frequently in their practice.

one of the osteopathic physicans I talked to said that he doesn't bill specifically for OMM if insurance won't cover, but rather for a higher level visit? I don't even know what that means yet, but you guys might.

 

[VALSALVA]

Send that biatch in homeboy...aside from a little polishing, it's great!!

 

[FutureNavyDOc]

I have an even better idea than simply just sending it in. Why don't we refine it (JP and homebody, possibly?), make it the best damn "letter to the editor" ever, and then most importantly get as many DO students to sign it as possible. Wouldn't there be a way to start a very small website where you can electronically sign the "petition"?? A few thousand signatures backing up said letter would, I assume, be something new. Or am I way out in left field here and grasping at straws?

I'd definitely sign my name to it, as I feel many others would as well. I'd have to think that if even 1% of all DO students signed such a letter, they would have little option but to publish it!

Well put homeboy!

Just a small comment here:

I've heard this statement quite a bit, and generally accepted it as true. However, I recently attended a talk in which the speaker pointed out that the statistics that are often used to back up this statement were derived from medicare billing data. In other words, the data only indicates that the majority of osteopathic physicians aren't billing for OMT. This is not the same as saying they do not use the techniques or fundamental knowledge frequently in their practice.

That's like claiming that just because most DO physicians don't bill for suturing despite actually doing it.
Seems like a pretty weak stretch if you ask me. Besides, how many physicians intentionally sell themselves short for the services provided?

 

[Shinken]

Just a small comment here:

I've heard this statement quite a bit, and generally accepted it as true. However, I recently attended a talk in which the speaker pointed out that the statistics that are often used to back up this statement were derived from medicare billing data. In other words, the data only indicates that the majority of osteopathic physicians aren't billing for OMT. This is not the same as saying they do not use the techniques or fundamental knowledge frequently in their practice.

True. I've seen quite a few DOs that perform OMT because they can, but don't bother billing it. However, some JAOA surveys find that many DOs don't perform it frequently.

 

[Red Beard]

That's like claiming that just because most DO physicians don't bill for suturing despite actually doing it.
Seems like a pretty weak stretch if you ask me. Besides, how many physicians intentionally sell themselves short for the services provided?

My understanding is that many DOs don't wish to take the time (or don't know how) to to code correctly for the additional OMM reimbursement to a normal office visit--especially if its something they do only occasionally. If you use OMT during a regular office visit a couple times a week, say, thats not going to net you more than an extra $100/month or so, probably less than that...it might seem "not worth it" for some docs to bill for that kind of occasional use.

I'm not trying to refute the claim that a lot of DOs don't use OMM, I am only pointing out a caveat. We can't know for sure how many DOs use OMM occasionally based on a study of reimbursement.

In my mind, the statement "DOs practice no differently than MDs, so we should merge the professions" is based on an assumption that hasn't really been proven--its just conjecture from a bunch of us who aren't even in the field yet.

As a side note, why don't we ever hear practicing DOs talk about converting degrees? Perhaps they have some information garnered from their experience that we haven't seen.

 

[FutureNavyDOc]

My understanding is that many DOs don't wish to take the time (or don't know how) to to code correctly for the additional OMM reimbursement to a normal office visit--especially if its something they do only occasionally. If you use OMT during a regular office visit a couple times a week, say, thats not going to net you more than an extra $100/month or so, probably less than that...it might seem "not worth it" for some docs to bill for that kind of occasional use.

I'm not trying to refute the claim that a lot of DOs don't use OMM, I am only pointing out a caveat. We can't know for sure how many DOs use OMM occasionally based on a study of reimbursement.

In my mind, the statement "DOs practice no differently than MDs, so we should merge the professions" is based on an assumption that hasn't really been proven--its just conjecture from a bunch of us who aren't even in the field yet.

As a side note, why don't we ever hear practicing DOs talk about converting degrees? Perhaps they have some information garnered from their experience that we haven't seen.

Or perhaps they know that it's a worthless attempt since they have the same abilities as MD's and have an advantage we don't: they don't have to deal with the AOA's bullcrap, which is why I believe the claim that more DO's are in the AMA than the AOA.

 

[homeboy]

My understanding is that many DOs don't wish to take the time (or don't know how) to to code correctly for the additional OMM reimbursement to a normal office visit--especially if its something they do only occasionally. If you use OMT during a regular office visit a couple times a week, say, thats not going to net you more than an extra $100/month or so, probably less than that...it might seem "not worth it" for some docs to bill for that kind of occasional use.

I'm not trying to refute the claim that a lot of DOs don't use OMM, I am only pointing out a caveat. We can't know for sure how many DOs use OMM occasionally based on a study of reimbursement.

In my mind, the statement "DOs practice no differently than MDs, so we should merge the professions" is based on an assumption that hasn't really been proven--its just conjecture from a bunch of us who aren't even in the field yet.

As a side note, why don't we ever hear practicing DOs talk about converting degrees? Perhaps they have some information garnered from their experience that we haven't seen.

1. The AOA would vehemently disagree with statements like Shinkin's suggestion that "...DO grads don't use OMT and therefore don't distinguish themselves from a regular allo doc." According to AOA leadership, osteopathic medicine is not defined by OMT--it is a merely another "tool" in our osteopathic arsenal. Of course, most people think along the lines of Shinkin, but the AOA is precluded from having this stance by the mere fact that MDs can take CME classes for OMT and can subsequently bill for it with the EXACT same billing codes that DOs use.

2. As far as merging the professions...the only reason they're separate is because of a.) money , b.) power, and c.) red tape--NOT because there are differences sufficient to have 2 separate professions. And I guarantee you that if AT Still were around today versus 100 yrs ago, he'd have a hell of a time creating the osteopathic profession in 21st century medicine.

3. we don't hear practicing DOs complain because the only ones that care are the ones that toe the line. the ones that think along the lines of many of the students on this forum simply turn their backs, go AMA, and practice medicine.

 

[homeboy]

The fact that most students don't agree with that stance, or the fact that most practicing DOs don't use OMT is irrelevant to the AOA.

It seems vitally wrong that the governing body of the osteopathic profession--which is in existence to serve and protect the interests of its constituents, which includes practicing DOs AND students--would blatently ignore everyone.

The AOA serves its members, not itself.

 

[czanetti]

I am merely a student that will be entering medical school at TCOM this coming summer but I do have a few things to say. I am very interested in this topic and intrigued to see what effects the new paradigm of osteopathic doctors will have in the near future. I would like to know before I even start school what steps I can take to learn more about this topic, and how I may become more actively involved. Thanks

 

[Shinken]

The AOA serves its members, not itself.

Ideally, that is true. But unfortunately, in reality the AOA serves its members as long as its core principles aren't compromised.

It's similar to the way many organizations operate, if you think about it. After all, if the core principles change according to the whim of the majority of the members, then the organization will be pretty worthless (and its purpose would change constantly). The way the organization would deal with those people is by removing (or ignoring) the members that threaten the organization's values.

 

[Dr JPH]

I dont want to get too far into this because people have blasted me in the past for being "money hungry" when I talk about billing for OMT and making money while treating with OMT. (Funny that these are the same people who covet high end specialties).

Anyway, OMT pays very well.

1. Insurance does cover it
2. You can not only bill for a higher level visit but there are codes to specifically bill for OMT based on # of areas treated
3. There is a large number of docs who bill cash for OMT services (going rate is about 75% of what a chiropractor in the same area charges)

So OMT can net you more than $100/month as someone above said. It can net you $100 per DAY or more if it is billed correctly.

BUT, in order to do that you need to:
- Be good at it...patients wont pay for and wont return if you hurt them or dont help them
- Be efficient. You only lose money if it takes a 15 minute visit and turns it into a 50 minute visit
- Know how to bill for it. We teach it here at PCOM to an extent but you need to see how its done in a real life practice.

Any way you break it down becoming a physician is a CAREER choice. There is no ethical qualms about billing for OMT unless you dont believe it to be an efficacious treatment modality...and thats your own personal opinion.

There is research to back it up.
There are clinical trials to back it up.
There are patients to back it up.

And yes, it is covered by most major insurance plans as well as covered by Medicare.

I have quote the financial numbers somewhere else (all while taking heat from future Dermatologists and Radiologists saying that I am "money hungry") ...anyway, a family doc who uses OMT only a few times/day on only a few patients/day can make upwards of $40,000 more per year than their partner who doesnt do OMT.

Again...not feasible if you arent good at it or cant keep it under a few minutes.

So OMT can pay the mortgage while your other medical practice can cover everything else.

Thats all I have to say about that.

I need to get back to stacking my gold coins now.

Bah humbug.

 

[Jamers]

Ideally, that is true. But unfortunately, in reality the AOA serves its members as long as its core principles aren't compromised.

It's similar to the way many organizations operate, if you think about it. After all, if the core principles change according to the whim of the majority of the members, then the organization will be pretty worthless (and its purpose would change constantly). The way the organization would deal with those people is by removing (or ignoring) the members that threaten the organization's values.

You also must know that core values need to EVOLVE to fit in with the changing world. Core values are all fine and good, but if they fail to make progress anymore then they themselves must evolve. No corporation existing now is the exact same corporation it was 50 years ago. And, you know what, that same corporation will be different 50 years into the future.

 

[Dr JPH]

I am merely a student that will be entering medical school at TCOM this coming summer but I do have a few things to say. I am very interested in this topic and intrigued to see what effects the new paradigm of osteopathic doctors will have in the near future. I would like to know before I even start school what steps I can take to learn more about this topic, and how I may become more actively involved. Thanks

Attending conventions. Getting involved in SOMA and similar organizations on campus.

 

[Red Beard]

It seems vitally wrong that the governing body of the osteopathic profession--which is in existence to serve and protect the interests of its constituents, which includes practicing DOs AND students--would blatently ignore everyone.

The AOA serves its members, not itself.

Good point, and all the more reason to submit that article!

 

[homeboy]

I dont want to get too far into this because people have blasted me in the past for being "money hungry" when I talk about billing for OMT and making money while treating with OMT. (Funny that these are the same people who covet high end specialties).

Anyway, OMT pays very well.

1. Insurance does cover it
2. You can not only bill for a higher level visit but there are codes to specifically bill for OMT based on # of areas treated
3. There is a large number of docs who bill cash for OMT services (going rate is about 75% of what a chiropractor in the same area charges)

So OMT can net you more than $100/month as someone above said. It can net you $100 per DAY or more if it is billed correctly.

BUT, in order to do that you need to:
- Be good at it...patients wont pay for and wont return if you hurt them or dont help them
- Be efficient. You only lose money if it takes a 15 minute visit and turns it into a 50 minute visit
- Know how to bill for it. We teach it here at PCOM to an extent but you need to see how its done in a real life practice.

Any way you break it down becoming a physician is a CAREER choice. There is no ethical qualms about billing for OMT unless you dont believe it to be an efficacious treatment modality...and thats your own personal opinion.

There is research to back it up.
There are clinical trials to back it up.
There are patients to back it up.

And yes, it is covered by most major insurance plans as well as covered by Medicare.

I have quote the financial numbers somewhere else (all while taking heat from future Dermatologists and Radiologists saying that I am "money hungry") ...anyway, a family doc who uses OMT only a few times/day on only a few patients/day can make upwards of $40,000 more per year than their partner who doesnt do OMT.

Again...not feasible if you arent good at it or cant keep it under a few minutes.

So OMT can pay the mortgage while your other medical practice can cover everything else.

Thats all I have to say about that.

I need to get back to stacking my gold coins now.

Bah humbug.

I'd rather not rehash all this OMT / billing stuff, but I will comment on a related subject matter, which is the propensity of Dr's to bill for so called "procedures" as a means to generate higher income.

Don't get me wrong: I'm as capitalistic as the next guy, but the rise of specialties like derm, GI and the like, have been proportionate to the rise of procedural billing. Not that doing these procedures is wrong, but because certain specialties have annexed certain procedures, the cost of things as simple as freezing off a solar keratosis by a dermatologist has skyrocketed.

This isn't entirely medicine's fault, and the insurance industry can shoulder most of the blame, but just because someone can perform a "procedure" and bill for a "procedure" doesn't mean it is right.

Example: a relative of mine recently discovered she had toe nail fungus. She went to a podiatrist, who proceeded to do a KOH prep (fine and dandy) and a "biopsy"...because a "biopsy" is billed as a "procedure." Bam: $515.
This is just one example, but is extremely common, and goes back to the whole OMT thing: just because you can, should you? And just because you're billing the insurance company vs the patient directly, does that make it better?

Yes, medicine is a business, and I wouldn't be in it if we worked for peanuts, but don't get caught up in money and forgetful of the important things in life.

 

[CatsandCradles]

I am in no way attempting to be blasphemous or disrespectful, but to suggest that the initials behind our name define our quality of patient care not only discounts personal skills and attributes, but suggests that words speak louder than actions.

What? You dare question the AOA?

Heretic! Heretic!

Stone Him! Stone the heretic!


Seriously though, the AOA is like a semi-religious body. The AOA president visited our school with the vice president and the VP opened his talk with a long prayer. And one of the editors of the JAOA quoted the Bible "Works Without Faith is Nothing" when he tried to refute a criticisms made Norman Glevitz PhD. Don't get me wrong, I am a very religious person myself, but I was suprised by AOA.

So please be careful Homeboy, they might have an inquisition come to your school or something. I say wait until you have graduated - otherwise who knows what they might do to you?

 

[Red Beard]

I'd rather not rehash all this OMT / billing stuff, but I will comment on a related subject matter, which is the propensity of Dr's to bill for so called "procedures" as a means to generate higher income.

Don't get me wrong: I'm as capitalistic as the next guy, but the rise of specialties like derm, GI and the like, have been proportionate to the rise of procedural billing. Not that doing these procedures is wrong, but because certain specialties have annexed certain procedures, the cost of things as simple as freezing off a solar keratosis by a dermatologist has skyrocketed.

This isn't entirely medicine's fault, and the insurance industry can shoulder most of the blame, but just because someone can perform a "procedure" and bill for a "procedure" doesn't mean it is right.

Example: a relative of mine recently discovered she had toe nail fungus. She went to a podiatrist, who proceeded to do a KOH prep (fine and dandy) and a "biopsy"...because a "biopsy" is billed as a "procedure." Bam: $515.
This is just one example, but is extremely common, and goes back to the whole OMT thing: just because you can, should you? And just because you're billing the insurance company vs the patient directly, does that make it better?

Yes, medicine is a business, and I wouldn't be in it if we worked for peanuts, but don't get caught up in money and forgetful of the important things in life.

$515 for a "biopsy" on a nail fungus...wow!

I'm going to biopsy everything that walks through the door! j/k

 

[Dr JPH]

This is just one example, but is extremely common, and goes back to the whole OMT thing: just because you can, should you? And just because you're billing the insurance company vs the patient directly, does that make it better?

Yes, medicine is a business, and I wouldn't be in it if we worked for peanuts, but don't get caught up in money and forgetful of the important things in life.

I agree completely.

I can take any person off the street and find SOMETHING to HVLA.

You hear it pop, you can get paid for it.

Is that ethical? Not at all.

Patient comes in for bloodwork or for a DM med refill, they dont need OMT.

But what are your big visits?

- MSK pain
- URI
- HA/migraines

These patients CAN benefit from OMT.

So just because you can, should you? Not at all.

I wouldnt do an EKG and bill for it for someone who came to my office with knee pain and I wouldnt perform OMT and bill for it for someone who came in with a stomach virus.

If the visit does not call for OMT then its unethical to try and find a reason to do it.

Again, this goes back to the people who are more experienced with OMT. You can indeed learn techniques for a variety of complaints so your arent limtied to treating just your LBP patients.

But homeboy, I do agree with you. Luckily I dont know any DOs who do OMT on everyone just for the sake of getting paid. The notable exception being people who do ONLY OMT and thats the reason for the patients visit.

 

[CatsandCradles]

Example: a relative of mine recently discovered she had toe nail fungus. She went to a podiatrist, who proceeded to do a KOH prep (fine and dandy) and a "biopsy"...because a "biopsy" is billed as a "procedure." Bam: $515.
This is just one example, but is extremely common, and goes back to the whole OMT thing: just because you can, should you? And just because you're billing the insurance company vs the patient directly, does that make it better?
Yes, medicine is a business, and I wouldn't be in it if we worked for peanuts, but don't get caught up in money and forgetful of the important things in life.

Wow. One expensive biopsy.

 

[homeboy]

$515 for a "biopsy" on a nail fungus...wow!

I'm going to biopsy everything that walks through the door! j/k

well, the bx itself was only $250 or so, but with the KOH prep and the office visit, the total bill as $515.


JP: I agree.

 

[FutureNavyDOc]

What? You dare question the AOA?

Heretic! Heretic!

Stone Him! Stone the heretic!


Seriously though, the AOA is like a semi-religious body. The AOA president visited our school with the vice president and the VP opened his talk with a long prayer. And one of the editors of the JAOA quoted the Bible "Works Without Faith is Nothing" when he tried to refute a criticisms made Norman Glevitz PhD. Don't get me wrong, I am a very religious person myself, but I was suprised by AOA.

So please be careful Homeboy, they might have an inquisition come to your school or something. I say wait until you have graduated - otherwise who knows what they might do to you?

You mean semi-religious-like cult?

There are tons of similarities I have noticed over the past 3 years, I wish I had time right now to post more, but here are a few:
1. Initiation ceremonies
2. Homage paid to a dead semi-diety
3. Those who do not believe are shunned as ignorants and not allowed to drink the magic Kool-aid.
4. Many people who disagree are afraid to disagree aloud for fear of being thrown/run out.

 

[Dr JPH]

You mean semi-religious-like cult?

There are tons of similarities I have noticed over the past 3 years, I wish I had time right now to post more, but here are a few:
1. Initiation ceremonies
2. Homage paid to a dead semi-diety
3. Those who do not believe are shunned as ignorants and not allowed to drink the magic Kool-aid.
4. Many people who disagree are afraid to disagree aloud for fear of being thrown/run out.

You have yet to offer anything insightful to this debate in the 8 months you have been here. Now I know why I am starting to conciously avoid topics where you run your mouth. I'm tired of hearing your "I did it because of geography" comments and your absolute useless contributions to discussions. There are a few people on here that I often downright disagree with but I think you are one of a very few, quite posibly the only one, who regardless of what other people state refuse to take time to respect anothers opinion. Not a matter of agreement or disagreement but the plain and simple ability to read what another person has written and aknowledge the fact that they have a different opinion and its just as valid as yours.

Thats all I have about that right now. You can continue with your ridiculous babble now.

 

[julia645]

homeboy,

I also encourage you to seriously reconsider sending this in to the DO magazine. I think it’s fair to say that the AOA leadership is out of touch with the opinions and values of students. Like most organizations, the leadership of the AOA is a self-selected, atypical group that does not reflect the characteristics or opinions of the majority of the members they supposedly represent. True, you letter probably won’t do anything to change AOA policy right away, but you have to make yourself heard to at least sow the seeds of change in the minds of other students and DO’s.

Your letter also prompted me to go back and re-read Dr. Morris’ original article. While I applaud him for arguing that osteopathic medicine is more than just OMT, I find his proposed definition of osteopathic medicine lacking. He dances around the issue, talking about how it’s hard to define, yada yada, and then lists these 4 principles:

1) The human being is a dynamic unit of function.
2) The body possesses self-regulatory mechanisms, with inherent self-healing properties.
3) Structure and function are interrelated at all levels.
4) Rational therapy is then based upon this understanding of body unity, self-regulatory mechanisms and the interrelatedness of structure and function.

Now, there is nothing wrong with those principles. I think they are good principles. But they are principles of good MEDICINE. I doubt that an allopathically trained physician would disagree with any of those principles. I don’t understand why AOA leaders think that osteopathic medicine has a monopoly on the principle of “treat the patient, not the symptoms”. That’s what good DOCTORS do, regardless of where they went to school. Excluding people from teaching at osteopathic schools solely because they were allopathically trained (which is what Dr. Morris proposes) and therefore couldn’t possibly comprehend or teach the above “osteopathic principles” is ridiculous, IMO.

 

[Shinken]

You also must know that core values need to EVOLVE to fit in with the changing world. Core values are all fine and good, but if they fail to make progress anymore then they themselves must evolve. No corporation existing now is the exact same corporation it was 50 years ago. And, you know what, that same corporation will be different 50 years into the future.

I agree. However, the AOA is not an organization that will allow their core principles to evolve because that would be tantamount to extinction. If the AOA agrees that DO=MD, then what's the reason for the AOA's existence? (or osteopathic medicine's existence?).

As Dr. Gevitz so eloquently stated, the battle for equality has long been won, now it's a battle for distinctiveness. Right now the only thing that makes the DO route different than the MD route is the internship requirement and OMT (and of course, COMLEX). The AOA will hold on to those for dear life.

Personally, I have no problem with two coexisting degrees that are the same. I believe that if the AOA accepted that DO=MD and removed non-proven OMT techniques from the curriculum and the COMLEX, DOs would still exist. The AMA has long abandoned its quest to destroy osteopathic medicine, and patients don't care about the initials as long as the doctor is good.

 

[drusso]

This article by Felix Roger covers many of these points and also outlines how to "re-interpret" fundamental osteopathic ideas for "modern medicine."

http://www.jaoa.org/cgi/content/full/105/5/255?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=rogers%2C+felix&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

 

[homeboy]

This article by Felix Roger covers many of these points and also outlines how to "re-interpret" fundamental osteopathic ideas for "modern medicine."

http://www.jaoa.org/cgi/content/full/105/5/255?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=rogers%2C+felix&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

That's fine and dandy, but I've yet to see how this "fundamental reorientation" (as described by the author) is going to transpire.

More importantly, if the majority of the profession could care less about this "fundamental reorientation," it will be no different than any other AOA mandate that falls on deaf ears.

The AOA has no crippling power of practicing DOs, only medical education...I'm not sure how "reorienting" the profession to ca. 1890s "fundamentals" is going to be a boon.

I’m sorry—I don’t mean to sound negative all the time, but I’m just sick of hearing the same crap. This “identity” issue isn’t new…it’s been around for YEARS, and we’ve yet to see any change in the right direction.

Bottom line: nothing’s going to change until all the old timers, to be blunt, pass on, and some new blood (with motivation to change things) gets in.

 

[FutureNavyDOc]

I dont want to get too far into this because people have blasted me in the past for being "money hungry" when I talk about billing for OMT and making money while treating with OMT. (Funny that these are the same people who covet high end specialties).

Anyway, OMT pays very well.

1. Insurance does cover it
2. You can not only bill for a higher level visit but there are codes to specifically bill for OMT based on # of areas treated
3. There is a large number of docs who bill cash for OMT services (going rate is about 75% of what a chiropractor in the same area charges)

Is taking a Wal-mart choose us because we're cheaper type approach really the best way of going about this?

If we really think our manipulation skills are equal to those of chiro's, why not charge the same amount?



On a side note, I learned about a new profession yesterday, "Chiropractic Radiologists."

Has anyone else ever heard of these?

The reason I learned about this is that a patient at the clinic where I'm rotating came in panicked because he had gone to a chiropractor, the chiropractor took x-rays and said the patient had a AAA. The chiropractor then sent the X-ray to a "Chiropractic Radiologist" who agreed with the diagnosis and said the patient should go see a physician immediately.

On physical exam, there were no signs of a AAA on physical exam and the patient didn't appear to have one on our CXR. By this point, the poor guy's BP had climbed to 200/110 and his pulse was 105, so we sent him to the hospital for a CT, which showed there was not even mild dilation of any portion of the aorta.

Does anyone know anything about what training a "chiropractic radiologist" has?





JP,
I love you too.

 

[Shinken]

All these discussions about the AOA and DOs are fun and all but in the end, when you graduate from your GME program and begin practicing medicine, does it really matter what the AOA thinks as far as OMM, osteopathic vs allopathic, etc.? Probably not.

 

[drusso]

That's fine and dandy, but I've yet to see how this "fundamental reorientation" (as described by the author) is going to transpire.

More importantly, if the majority of the profession could care less about this "fundamental reorientation," it will be no different than any other AOA mandate that falls on deaf ears.

The AOA has no crippling power of practicing DOs, only medical education...I'm not sure how "reorienting" the profession to ca. 1890s "fundamentals" is going to be a boon.

I’m sorry—I don’t mean to sound negative all the time, but I’m just sick of hearing the same crap. This “identity” issue isn’t new…it’s been around for YEARS, and we’ve yet to see any change in the right direction.

Bottom line: nothing’s going to change until all the old timers, to be blunt, pass on, and some new blood (with motivation to change things) gets in.

All old-timers begin as young-timers. Nothing is going to change until people with fresh ideas and progressive points of view invest their personal time and energy into changing things. There is no magic. Social movements evolve over time and are shaped by stakeholders who have interest and "skin in the game."

There are plenty of venues within the osteopathic profession with reform-minded agendas. Engage them. The specialty colleges, student groups, and state societies are good places to start. The "old-timers" didn't win their fights (federal accreditation standards, indepedent licensure, military parity, etc) without taking a few kicks to the nuts from people inside and outside the profession. Are you willing to take a few kicks to the nuts to get your point across?

If you want cranial off the boards, better GME programs, etc start with battles you can actually win. Start locally. Start small. Angry letters and petitions are fun but they don't really *CHANGE* anything. Before you can change something you need to understand how it works. Once you understand the *PROCESS* then you can begin to manipulate the outcomes.

You have a life's work ahead of you.

 

[Shinken]

Once you understand the *PROCESS* then you can begin to manipulate the outcomes.

Ha! Ha! Nice pun...

 

[homeboy]

All old-timers begin as young-timers. Nothing is going to change until people with fresh ideas and progressive points of view invest their personal time and energy into changing things. There is no magic. Social movements evolve over time and are shaped by stakeholders who have interest and "skin in the game."

There are plenty of venues within the osteopathic profession with reform-minded agendas. Engage them. The specialty colleges, student groups, and state societies are good places to start. The "old-timers" didn't win their fights (federal accreditation standards, indepedent licensure, military parity, etc) without taking a few kicks to the nuts from people inside and outside the profession. Are you willing to take a few kicks to the nuts to get your point across?

If you want cranial off the boards, better GME programs, etc start with battles you can actually win. Start locally. Start small. Angry letters and petitions are fun but they don't really *CHANGE* anything. Before you can change something you need to understand how it works. Once you understand the *PROCESS* then you can begin to manipulate the outcomes.

You have a life's work ahead of you.

Thanks for the ‘advice,’ but you speak as if you could care less, and say it from a condescending vantage point at that. I'm fully aware of the amount of work it takes to change things, and I'm not expecting anything other than being ignored (which is why I didn't submit the article)…after all, I’m just a student, what do I know. (As someone mentioned earlier, the last time the entire student body petitioned the AOA to change something...the match process...they were shut down "for their own good." Father knows best.)

So what's the point?

At least talking back and forth on here opens people up to new ways of thinking of issues they may have previously ignored; it allows instant feedback on how to formulate your argument; it allows you to see how opponents of your view are going to react so you can better articulate your argument next time.

If there’s no point in posting on threads like these, there’s no point in wasting any literary effort on any cause bigger than one’s self.

 

[homeboy]

Thanks for the ‘advice,’ but you speak as if you could care less, and say it from a condescending vantage point at that. I'm fully aware of the amount of work it takes to change things, and I'm not expecting anything other than being ignored (which is why I didn't submit the article)…after all, I’m just a student, what do I know. (As someone mentioned earlier, the last time the entire student body petitioned the AOA to change something...the match process...they were shut down "for their own good." Father knows best.)

So what's the point?

At least talking back and forth on here opens people up to new ways of thinking of issues they may have previously ignored; it allows instant feedback on how to formulate your argument; it allows you to see how opponents of your view are going to react so you can better articulate your argument next time.

If there’s no point in posting on threads like these, there’s no point in wasting any literary effort on any cause bigger than one’s self.

sorry, that was kind of a harsh reply. i understand what you're saying drusso.

 

[drusso]

You don't have to apologize; I'm a "moderator" and I try to "moderate" these threads from time to time. I've been watching this conversation unfold for over 10 years!

But I think that you're still missing my point. The osteopathic profession is a "big tent." You've got a lot different points of view (and a lot of mouths to feed---don't forget there are many people who depend on the osteopathic profession directly or indirectly for their livelihood).

At the same time, you probably don't realize that there are influential people out there (committee members, delegates to the AOA House of Delegates, academics, and other assorted "big wigs") who agree with your point of view. The trick is finding them, connecting them, building the momentum, and getting things to the Tipping Point. Once it tips, no one could ever imagine it "not happening."

A lot of people post here to vent about "the big, bad AOA" or the "big, bad whatever." The reality is that these groups are just made up of people thinking that they're doing "the right thing."

Having said that, I will say that after spending a lot of time in allopathic environments interacting with and teaching MD students and residents, they don't complain about this stuff. I rarely hear MD students vent about "the big bad ACGME" or the "big bad LCME." I know most of them don't agree with all of these organization's policies ("brainwashing disguised as professionalism" or "ivory tower idealism") but they don't have the same degree of disdain that so many DO students express toward their organizations. Maybe it's easier to be apathetic or anonymous when you're in the majority group.

Returning to your OP: I think the real question you ask is, "Why, given all the resources available to various COM's, is the 'packaging' of osteopathic ideas so poor?" If your undergraduate college can make you a fan of their athletic teams in less than four years, why can't a DO school make you a 'fan' of the osteopathic approach to patient care in the same amount of time?

I think that the answer comes down to applicant selection---the three groups you mentioned. Medical school admission is a high stakes endeavor. Pre-meds are smart and there exists ample resources out there to "game the system." I know many, many, many MD students who got accepted to their state's primary-care medical school with no real intention of ever doing primary care. That's the way the game is played.

Similarly, most people willing to put out an ounce of effort can shadow a D.O., get a letter of rec, and tweak up their AMCAS essay for AACOMAS. That's fine. We've all been there.

But, osteopathic admission committees could probably get a little more sophisticated about who they select. There is a sub-set of students, I think that we all know them, who really struggle to adapt to their circumstances. They may excel academically, but they dislike primary care, they dislike OMM, they dislike the whole osteopathic professional culture, etc. Is it any wonder that they disengage? Duh...they never engaged in the first place!

 

[Dr JPH]

But, osteopathic admission committees could probably get a little more sophisticated about who they select. There is a sub-set of students, I think that we all know them, who really struggle to adapt to their circumstances. They may excel academically, but they dislike primary care, they dislike OMM, they dislike the whole osteopathic professional culture, etc. Is it any wonder that they disengage? Duh...they never engaged in the first place!

I agree completely.

Its always humorous when talking with adcoms about an applicant and someone (ususally a DO) brings up "well, they really didnt have any idea what osteopathic medicine is...they brushed off the question."

Non-DO interviewer: "But look at their MCAT and GPA."

DO: "I realize they are strong academically, but when I specifically asked them why they applied to an osteopathic school they had no sense of what I was talking about or what osteopathy IS. They just looked at me like I have two heads."

Non-DO interviewer: "But...did look at their MCAT and GPA?"

 

[Old_Mil]

Nice job with the letter homeboy, I'd sign my name to it. However I think we're missing the big picture here, and that is that the AOA doesn't really care what it is that those who disagree with its dogma think. In fact, I think that if a whole lot of us signed on to the letter, that would make it less likely to get published.

If one letter arrives from one individual, the powers that be can spin it as the musings of a "wannabe MD". If a letter arrives that's signed by hundreds of student DOs, that's when it becomes a problem for the leadership.

 

[Kuba]

I agree completely.

Its always humorous when talking with adcoms about an applicant and someone (ususally a DO) brings up "well, they really didnt have any idea what osteopathic medicine is...they brushed off the question."

Non-DO interviewer: "But look at their MCAT and GPA."

DO: "I realize they are strong academically, but when I specifically asked them why they applied to an osteopathic school they had no sense of what I was talking about or what osteopathy IS. They just looked at me like I have two heads."

Non-DO interviewer: "But...did look at their MCAT and GPA?"

It's a two-sided sword, tho, isn't it? The school has to keep up a competitive application process in order to keep a certain reputation. Regardless whether it is good or bad, MCAT and GPA are the easiest factors to acknowledge when consider the competitiveness of a program. The trick should be to open the eyes to even more competitive applicants way before they start applying. How do you get 25% of the applicants (Mcat = or >30) to consider the osteopathic principles? Maybe engaging them through high school and college summer programs, etc. Steller applicants with no interest in osteopathy and really bad applicants dying to do NMM residencies are both going to be bad for the school and the profession.

 

[Dr JPH]

The school has to keep up a competitive application process in order to keep a certain reputation.

Your reputation is worsened quicker when you have 260 students who could care less about OMT and spend their time trying to destroy it on SDN.

I would take a lower academic student who really gave a damn about what they were learning than the 35 MCATer who could get into an allopathic school.

I dont know what sort of reputation taking students with higher MCATs and GPAs is trying to maintain. Who are we trying to impress with our freshman classes? Are we trying to look over at Jefferson or Hopkins and say "See, we have smart people too?"

No.

Your reputation is built on the quality of doctors you produce, not on the numbers they generate.

Overall I think you get a better doctor when they are engaged, active and interested in what they are learning as opposed to bitter and condescending.

You hear the way some of these DO students talk about their professors and classmates, especially the pro-DO & pro-OMT people...you think THEY are going to carry themselves professionally and be a good representation of the school. They dont even have enough class to be respectful. Disagreeing or questioning is one thing, but outright disrespect and ridicule is another.

Would you want someone judging YOUR school based on them? I wouldnt.

Ive worked with these types of people on rotations and they are usually pretty useless. Doesnt have so much to do with OMT or osteopathy, but it has a lot to do with being grateful for the opportunity you were given in becoming a physician and having respect for your teachers.

 

[homeboy]

JP and drusso,
I understand what you guys are saying, and it makes sense in terms of the whole application process.

My contention is this: how does an interviewer (per JPs example) try to truly understand an applicant's dedication to the osteopathic profession when--other than OMT--pre med students aren't going to see any genuine difference in DO medicine during their shadowing?

I mean, how do applicants truly experience osteopathic medicine from a pre-med standpoint, other than personal opinions a DO may tell them?

Personally, I'd take an applicant that had a burning desire to learn applied A&P over an applicant that for whatever reason thinks DO school is going to make him a better physician, they like "holistic medicine," etc...

 

[Kuba]

Your reputation is worsened quicker when you have 260 students who could care less about OMT and spend their time trying to destroy it on SDN.

I would take a lower academic student who really gave a damn about what they were learning than the 35 MCATer who could get into an allopathic school.

I dont know what sort of reputation taking students with higher MCATs and GPAs is trying to maintain. Who are we trying to impress with our freshman classes? Are we trying to look over at Jefferson or Hopkins and say "See, we have smart people too?"

No.

Your reputation is built on the quality of doctors you produce, not on the numbers they generate.

Overall I think you get a better doctor when they are engaged, active and interested in what they are learning as opposed to bitter and condescending.

You hear the way some of these DO students talk about their professors and classmates, especially the pro-DO & pro-OMT people...you think THEY are going to carry themselves professionally and be a good representation of the school. They dont even have enough class to be respectful. Disagreeing or questioning is one thing, but outright disrespect and ridicule is another.

Would you want someone judging YOUR school based on them? I wouldnt.

Ive worked with these types of people on rotations and they are usually pretty useless. Doesnt have so much to do with OMT or osteopathy, but it has a lot to do with being grateful for the opportunity you were given in becoming a physician and having respect for your teachers.

I totally agree that I wouldn't want mine schools to be judged based on high-stat students who don't want to learn osteopathic principles. But some sort of balance between the two must exist.

 

[It'sElectric]

It's a two-sided sword, tho, isn't it? The school has to keep up a competitive application process in order to keep a certain reputation. Regardless whether it is good or bad, MCAT and GPA are the easiest factors to acknowledge when consider the competitiveness of a program. The trick should be to open the eyes to even more competitive applicants way before they start applying. How do you get 25% of the applicants (Mcat = or >30) to consider the osteopathic principles? Maybe engaging them through high school and college summer programs, etc. Steller applicants with no interest in osteopathy and really bad applicants dying to do NMM residencies are both going to be bad for the school and the profession.

Plus, won't MCAT scores and GPAs naturally increase (as they have) simply as a result of more and more applications coming in. Getting into medical school is more competitive than its ever been, and it's my guess that it will continue this way at least for awhile (I can't predict the future economy and when the ceiling will finally hit). Thus, I think DO schools statistics are continuing to climb not simply because they're looking more for a "high MCAT, high GPA" student. Rather, I think it's just a natural progression of applicants. If 4000 people apply to your school, you have to narrow the search quickly. You can't interview every single person to determine just how genuine they are in regards to osteopathic medicine. Thus, GPAs and MCATs will inevitably become a larger factor.

 

[FutureNavyDOc]

Plus, won't MCAT scores and GPAs naturally increase (as they have) simply as a result of more and more applications coming in. Getting into medical school is more competitive than its ever been, and it's my guess that it will continue this way at least for awhile (I can't predict the future economy and when the ceiling will finally hit). Thus, I think DO schools statistics are continuing to climb not simply because they're looking more for a "high MCAT, high GPA" student. Rather, I think it's just a natural progression of applicants. If 4000 people apply to your school, you have to narrow the search quickly. You can't interview every single person to determine just how genuine they are in regards to osteopathic medicine. Thus, GPAs and MCATs will inevitably become a larger factor.

Your logic would work perfectly were it not for the new DO schools opening on a yearly basis forcing the admissions committees to accept students they maybe wouldn't have a few years back due to needing to fill the seats.

Does anyone honestly think any DO school is going to allow vacant seats in their class when there are applicants willing to come drop in their $30,000 a year + the money the government pays the school for each student?