The real future of Osteopathy

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It seems as if OMM is on its way out, with fewer and fewer DOs using it after completing med school. In addition, more and more DOs are opting for allopathic residencies, even in primary care.

Given this, it seems only a matter of time before DOs and MDs truly are exactly the same, as many people on these forums routinely profess.

My question is, what will happen to the dual-degree system when it is finally realized by the public and legislators that we are all in the same family? Will the DO degree fall by the wayside? Will osteopathic schools need to gain allopathic accreditation or face closure? Will DOs lose their licensure, or will they become MDs ala the California Merger?

Any thoughts, guesses, speculation?

 

[(nicedream)]

It seems as if OMM is on its way out, with fewer and fewer DOs using it after completing med school. In addition, more and more DOs are opting for allopathic residencies, even in primary care.

Given this, it seems only a matter of time before DOs and MDs truly are exactly the same, as many people on these forums routinely profess.

My question is, what will happen to the dual-degree system when it is finally realized by the public and legislators that we are all in the same family? Will the DO degree fall by the wayside? Will osteopathic schools need to gain allopathic accreditation or face closure? Will DOs lose their licensure, or will they become MDs ala the California Merger?

Any thoughts, guesses, speculation?

My guess is that despite the accurate representation you give the situation, the fields will continue to be maintained as separate because the AOA wants them to and because osteopathic graduates rely on the osteopathic GME for spots (there aren't enough ACGME spots for every US allopathic grad, osteopathic grad, and FMG - especially in the specialties).

 

[spyyder]

The reason OMM is going out is because it mostly is useless. Look at the people applying to ostepathic schools. They convince themselves they belieive in the "holistic" approach, but when they actually get a job and start earning money, they realize what fools they have been. Ostepathy should have never become its own field, it should have been made into a type or residency or fellowship. Why wasn't it? Because no one in there right mind would apply to it. DO schools are no different from the carribean, its another way to become a doctor. Anyone who thinks otherwise, is delusional and should see and a psychiatrist (lets see omm treat that). I have NOTHING AGAINST OSTEPATHIC DOCTORS. My problems is when these physican try to convince people that they "treat the whole person" and suggest OMM is useful in mainstream medicine. I have shadowed many ostepathic physicians, and one important and immutable fact is clear: they don't give a crap about ostepathy and it principles. I definetly see a day when law makers force ostopathy to be merged into mainstream medicine, and we will be better for it. Insurance companies already realize this as most DO NOT REIMBURSE OMM PROCEDURES, as they feel it is you job to do them. I appologize for offending those of you who are hardcore ostepaths, but it is definetly time for a reality check.

 

[WestcoastMedicine]

I am only a first year medical student and have little experience in the medical field outside of EMS. I will agree that many Osteopathic Physcian's don't use OMM in their practice. Being an osteopathic physician is not all about using OMM, I don't want to pursue an OMM residency, but I do feel there is a use for. Many people really don't have an understanding of Osteopathy, but I feel that it will help me immensely with diagnosis. I have friends in allopathic schools, and it seems that at my school we are forced to learn anatomy much more in depth. We also have to learn anatomical landmarks that many allopathic physicians may not be pushed to learn. As a result, I feel from my experience shadowing and in class that many DOs seem to be able to diagnose patients using less "technology". I think in the US we have been spoiled with tons of MRI, and CT Scan machines and from friends who have done residencies abroad(in industrialized Europe), that outside of the US you really have to be a better doctore with diagnosing, because you don't have these amenities.

To get back to the topic of DOs not using osteopathic treatment, a reason I feel many don't use is due to time constraints. I'm sure many docs would be glad to do some treatment as an additional modality on top of their standard therapy w/o reimbursement if they didn't have time constraints. Since most of you are probably at MD schools and may not be aware of it, there are OMM residencies. Additionally, there have been several new Osteopathic Schools opening and my OMM professors tell me that in the past 10 years they have been lecturing at more and more allopathic schools for diagnosis and during musculoskeletal lectures. I am off couse biased, but I see a need for Osteopathy to continue and spread further. It seems like everyone discredits OMM due to reimbursement issues, some docs have a true desire to help patients and that dispite not being paid for it, if they have a few extra minutes to help the patients, they may not care if they are reimbursed for the OMM.

I do agree that one day it would be ideal if both branches of medicine were integrated. It is my feeling that most Dos feel this way, but hope that some of our methods would be kept. I am by no means an advocate that OMM should be used across the board and is the end all solution, but there are some techniques that take a little amount of time and if you experienced the techniques yourself, there would be no question in your mind that it is beneficial. Again, I think if I never use OMM outside of my family of the nurses begging for treatments when its slow, I think the HUGE emphasis of anatomy that we get pounded into our heads over and over again can in no way hurt me as a physician and may give me an advantage in some cases.

 

[Shodddy18]

The reason OMM is going out is because it mostly is useless. Look at the people applying to ostepathic schools. They convince themselves they belieive in the "holistic" approach, but when they actually get a job and start earning money, they realize what fools they have been. Ostepathy should have never become its own field, it should have been made into a type or residency or fellowship. Why wasn't it? Because no one in there right mind would apply to it. DO schools are no different from the carribean, its another way to become a doctor. Anyone who thinks otherwise, is delusional and should see and a psychiatrist (lets see omm treat that). I have NOTHING AGAINST OSTEPATHIC DOCTORS. My problems is when these physican try to convince people that they "treat the whole person" and suggest OMM is useful in mainstream medicine. I have shadowed many ostepathic physicians, and one important and immutable fact is clear: they don't give a crap about ostepathy and it principles. I definetly see a day when law makers force ostopathy to be merged into mainstream medicine, and we will be better for it. Insurance companies already realize this as most DO NOT REIMBURSE OMM PROCEDURES, as they feel it is you job to do them. I appologize for offending those of you who are hardcore ostepaths, but it is definetly time for a reality check.

My friend, what you don’t know could fill up more space than all of the forums on this site. The only part of your rant that I'm going to bother responding to is your attack on OMM. My problem is people like you that have never studied OMM and shrug it off as quackery. You get your ideas from other idiots even less knowledgeable than yourself and then try to speak intelligently about something that is way over your head. I’m not going to sit here and try to convince you that every OMT technique is 100% efficacious because it is not; but neither is any other medical therapy. Osteopaths don’t believe that OMT is a complete alternative to other forms of western medicine… but where do you get off saying that it is completely useless? You know nothing about it! How do I know this you are asking yourself… Well, because if you knew anything about it you would know how full of crap you really are and would not want to open your mouth because you would realize how ignorant it makes you sound. 👎


And where exactly do you get the idea that the vast majority of Osteopaths don’t use OMT. All of the FP DOs that I know use it routinely. Many of the osteopathic specialists I know also use it. And if they don’t what is the big deal? What physicians do you know that routinely use everything that they learned in Med school?

And where did you get the idea that "Most" insurance companies do not pay for OMT? All of the DOs I know routinely get paid for their OMT services in addition to their FP services. Many insurance companies don’t like to pay for routine preventative screenings like colonoscopies or mammograms until many years after many patients are at high risk. Does this mean to you that these procedures should not be performed?

 

[Docgeorge]

Give the OP a break...due to increasing numbers of Osteopathic Students and US Allopathic Students he's going to have a rough time matching a residency.

Good luck buddy! 🙂 \ 🙄

 

[Sirius Black]

OMM is not the only thing that separates an osteopathic education from an allopathic one. As a 1st year medical student at an osteopathic medical school, I have already learned numerous soft tissue techniques to enhance lymphatic flow and relax the fascia of various muscles. The stuff works - besides the patient feedback, you can actually feel the improvement in the muscle tension. We develop skills in using our hands for sensing slight palpations and variations in temperature. There is a lot of emphasis placed on the musculoskeletal system, and allopathic institutions are gradually following suit. Regardless of whether or not osteopathic graduates are using OMM, I believe that most of them will walk into their residincies with a slightly different perspective and "bag of tricks" than an allopathic student.

As for "treating the whole patient", I agree that it's just a silly catchphrase. None of the professors at my school actually use that line when advocating osteopathy.

 

[raptor5]

Give the OP a break.

But don't go saying Insurance Compaines don't reimburse for OMM unless you know the facts.

Many of the things we learn in OMM are also used by physical therapists. I guess we should send them packing too.

 

[(nicedream)]

And where exactly do you get the idea that the vast majority of Osteopaths don’t use OMT. All of the FP DOs that I know use it routinely. Many of the osteopathic specialists I know also use it. And if they don’t what is the big deal? What physicians do you know that routinely use everything that they learned in Med school?

There have been a couple studies that show around 5% of practicing DOs routinely use OMM.

 

[Tallulah]

The reason OMM is going out is because it mostly is useless. Look at the people applying to ostepathic schools. They convince themselves they belieive in the "holistic" approach, but when they actually get a job and start earning money, they realize what fools they have been. Ostepathy should have never become its own field, it should have been made into a type or residency or fellowship. Why wasn't it? Because no one in there right mind would apply to it. DO schools are no different from the carribean, its another way to become a doctor. Anyone who thinks otherwise, is delusional and should see and a psychiatrist (lets see omm treat that). I have NOTHING AGAINST OSTEPATHIC DOCTORS. My problems is when these physican try to convince people that they "treat the whole person" and suggest OMM is useful in mainstream medicine. I have shadowed many ostepathic physicians, and one important and immutable fact is clear: they don't give a crap about ostepathy and it principles. I definetly see a day when law makers force ostopathy to be merged into mainstream medicine, and we will be better for it. Insurance companies already realize this as most DO NOT REIMBURSE OMM PROCEDURES, as they feel it is you job to do them. I appologize for offending those of you who are hardcore ostepaths, but it is definetly time for a reality check.

While it is true that there are a lot of DOs who do not use OMM, it is absolute BS to call it useless. I think the problem is some of the people going to DO, not the profession. Have you ever talked to patients who have been treated by a DO who DOES use OMM?? Their responses are ASTOUNDING! I have not met anyone yet who has had OMT used on them and hasn't loved it.
And isn't OMM on the rise? Doesn't Harvard offer courses for MDs who want to learn it?

 

[JakeHarley]

This is an interesting topic to me, I don't think the OP is slamming anyone.

I have been wondering some of the same things. There are now post-graduate programs out there for MDs to learn OMM (can't locate the info at the moment, but its out there.) If MDs can learn to use the few effective OMM techniques, then how will the AOA continue to consider osteopathy to be a distinct profession in the future? If there are is no longer an obvious distinction between the two (and I DON'T by into the purported philosophical differences), then doesn't it stand to reason that down the road we will face a consolidation of some sort?

Is it possible that DOs could lose their practice rights, or suffer a demotion in their licensure, in the next 50 years? Probably not, but what do you guys think about it?

 

[Shodddy18]

There have been a couple studies that show around 5% of practicing DOs routinely use OMM.

Send a link.

 

[Dr Alo]

My friend, what you don’t know could fill up more space than all of the forums on this site. The only part of your rant that I'm going to bother responding to is your attack on OMM. My problem is people like you that have never studied OMM and shrug it off as quackery. You get your ideas from other idiots even less knowledgeable than yourself and then try to speak intelligently about something that is way over your head. I’m not going to sit here and try to convince you that every OMT technique is 100% efficacious because it is not; but neither is any other medical therapy. Osteopaths don’t believe that OMT is a complete alternative to other forms of western medicine… but where do you get off saying that it is completely useless? You know nothing about it! How do I know this you are asking yourself… Well, because if you knew anything about it you would know how full of crap you really are and would not want to open your mouth because you would realize how ignorant it makes you sound. 👎


And where exactly do you get the idea that the vast majority of Osteopaths don’t use OMT. All of the FP DOs that I know use it routinely. Many of the osteopathic specialists I know also use it. And if they don’t what is the big deal? What physicians do you know that routinely use everything that they learned in Med school?

And where did you get the idea that "Most" insurance companies do not pay for OMT? All of the DOs I know routinely get paid for their OMT services in addition to their FP services. Many insurance companies don’t like to pay for routine preventative screenings like colonoscopies or mammograms until many years after many patients are at high risk. Does this mean to you that these procedures should not be performed?

You are right on the money. Unfortunately, it seems like he is new to this and just wants to rant and rave about OMM, without really trying it out or knowing very much about it.

And you are right about reimburstment, even medicare reimburses for OMT, and every technique counts as in in-office procedure, so you get paid pretty good.

 

[raptor5]

DO does not equal OMM. I can teach my wife OMM, but that doesn't mean anything unless you can integrate the priciple of osteopathy into a differential diagnosis that would seem ludicrous to most MDs. Osteopathy is about understanding just b/c you have a belly ache doesn't mean the source is your belly (sorry for the layspeak). Chest pain may not be gerd or an MI but really a muscle spasm causing a facilitated segment leading to referred pain in your chest and arm. Most students, myself included, enter DO school with no clue what osteopathy is about. As times goes on they learn but don't care or do not feel confident in their skills to apply it. Some may shun OMM b/c their peers during clinical rotations and residency don't have a clue what they are talking about. I don't know if any of these topics are taught in MD schools but they do become evident when one enters fields such as neurology, PM&R, Pain Management, or sports medicine.

 

[Gibby Haynes]

Give the OP a break. Is he not allowed to think for himself and question the dogma of osteopathy?? Or will the gods of osteopathic medicine strike him down for falling out of line b/c he is not a yes man? I think he brings up some valid points and thought provoking questions. Should we burn him at the stake just for using his own mind?

 

[drusso]

Are any of you informing your discussions above with information from the osteopathic medicine journal club articles?

Osteopathic Medicine Journal Club

 

[Taus]

holy **** drusso...I can't believe that I've never looked at the forum....I've hit the motherload of research...

 

[JakeHarley]

DO does not equal OMM. I can teach my wife OMM, but that doesn't mean anything unless you can integrate the priciple of osteopathy into a differential diagnosis that would seem ludicrous to most MDs. Osteopathy is about understanding just b/c you have a belly ache doesn't mean the source is your belly (sorry for the layspeak). Chest pain may not be gerd or an MI but really a muscle spasm causing a facilitated segment leading to referred pain in your chest and arm. Most students, myself included, enter DO school with no clue what osteopathy is about. As times goes on they learn but don't care or do not feel confident in their skills to apply it. Some may shun OMM b/c their peers during clinical rotations and residency don't have a clue what they are talking about. I don't know if any of these topics are taught in MD schools but they do become evident when one enters fields such as neurology, PM&R, Pain Management, or sports medicine.

I find this post to be pretty informative. Don't feel a need to reply if you don't want to, but I am curious:

Are you confident in the skills you've learned, and will you apply them regardless of those you work with in the future? Also, can you elaborate a little more on why an osteopathic differential diagnosis would seem 'ludicrous' to most MDs? Do you mean to say that the Osteopathic aproach would consider a number of additional causes to explain a particular symptom or set of symptoms?

Thanks!

 

[fuegorama]

Are any of you informing your discussions above with information from the osteopathic medicine journal club articles?

Osteopathic Medicine Journal Club

Not for this thread, but I have been using the shoosh out of it on my clerkships. Thank you for the effort.

When threads like this get me surly over my degree I frequently turn to your Journal Club project to get me over the hump. Real articles in real journals, Spine, Arch PM&R, JAMA. you have provided a great resource.Thanks again.

Now nicedream, shoddy et al. start using this great corner of SDN.

 

[electra]

I think that several posters have alluded to this....but osteopathic training is just not the same as allopathic training. I can do an allo residency but I will still always be an osteopathic physician. I can usually pick an osteopathic physician out of a group as well. We train in the same areas, but we don't train the same.

I don't even have to do OMM to be different, although I do. I actually have done more OMM this month in the ED than anywhere else. I have found it extremely effective for acute problems, also migraines, specific pain.

I respect the right of any osteopathic physician to use OMM or not (might not agree necessarily, but that's another story.) Keep in mind for all you students out there - until you have seen a PROFESSIONAL (I mean someone boarded in NMM/OMM) use OMM, you haven't seen anything. I did a month with a doctor who inproved a patient's PFTs more than 20% over baseline using OMM. That is just one example. There is a lot that OMM is good for. You cannot say that it is crap, because you will see it work.

Osteopathic education will go on because people will continue to seek out DOs and students and residents will continue to train in osteopathic programs. One of my goals for residency is to get an OMM/NMM training at Spaulding.

 

[fuegorama]

Do you mean to say that the Osteopathic aproach would consider a number of additional causes to explain a particular symptom or set of symptoms?

I'll attempt to field this.
Yes.

I'm not sure where you are in your training, but as a MSIII with a few years of nursing and EMS behind me, I have always been amazed at the rule out mentality of our diagnostic medical model. All Western medicine, including osteopathy, adheres to the most deadly---most likely rule of differential dx. As an EM wannabe, I embrace this model as the one that will hopefully allow me to catch the possible killers, and treat those common c/o that can't be taken care of by the unavailable PCP.

The problem with "ruling-out" is that it blinds us to what could probably be ruled-in.
Example: CP R/O MI is an admitting dx. Everybody that interacts with this chart knows we're looking for an MI. A normal EKG, CXR, pain relieved following ASA/NTG/MSO4 etc., flat enzymes times x hours and a negative mibi/clean cath most of the time will clear us of a "miss". We've dodged an MI dx. but what brought this person into hospital?

A good doc can see the same data and then take a look again to find the source of pain. As osteopaths we are taught to 'look for the health', well that's great, but the pt. isn't paying to be told "you have great skin and pink cheeks".
If that good doc happens to be a DO she might palpate the thoracic vertebrae looking for hypertonic musculature for a somatic-somatic or viscerosomatic response. (look it up-it's a good neuro review even if you don't buy). She might appreciate a geographic distribution that indicates this is a GI issue or pulmonary problem that simply wasn't illuminated by a medicare diagnostic code.

She might find that the parascapular musculature "felt funny" which led to the accurate dx. of myosititis ossificans with suprascapular nerve involvement (confirmed later by MRI). DOs seeing this would at least have it in their background to consider that C5/6 provide a portion of the cardiac plexus. bing!
(BTW this was a pretty cool case snagged by an NMM attending on a patient that was on our service a couple of weeks ago...unfortunately it was post clean cath)

My point is that DOs don't necessarily have more on their differential. We do have a few more tools to elicit a broader list.
Of course, I would never d/c a person with a good CP story without the EKGCXRENZYMEASABBLOCKER knee jerk, but I will have a few more items in mind when I do examine this pt.

Hope this goes somewhere toward answering your question.

 

[macman]

I think that several posters have alluded to this....but osteopathic training is just not the same as allopathic training. I can do an allo residency but I will still always be an osteopathic physician. I can usually pick an osteopathic physician out of a group as well. We train in the same areas, but we don't train the same.

I don't even have to do OMM to be different, although I do. I actually have done more OMM this month in the ED than anywhere else. I have found it extremely effective for acute problems, also migraines, specific pain.

I respect the right of any osteopathic physician to use OMM or not (might not agree necessarily, but that's another story.) Keep in mind for all you students out there - until you have seen a PROFESSIONAL (I mean someone boarded in NMM/OMM) use OMM, you haven't seen anything. I did a month with a doctor who inproved a patient's PFTs more than 20% over baseline using OMM. That is just one example. There is a lot that OMM is good for. You cannot say that it is crap, because you will see it work.

Osteopathic education will go on because people will continue to seek out DOs and students and residents will continue to train in osteopathic programs. One of my goals for residency is to get an OMM/NMM training at Spaulding.

Great post Electra.

The below is for the OP and OMM slammer:

OMM is not magic or quakery. It is anatomy and physiology, plain and simple. Just as we listen to the lungs, or get a x-ray to make clinical decisions, why not be skilled with our hands to determine disease in the musculoskeletal system. It's very simple. Just admitted a guy in the ED who the allopath ED doc decided to admit because the chest pain did not go away with GI cocktail, or nitro. EKG/CXR unrevealing. no cardiac hx. c/o L sided CP with radiation to upper chest. I see him, get a little extra hx. the guy was working on his car the day before, doing heavy lifting. Chest pain most at rib 4, check motion. Rib 4 w. inspir somatic dysfunction, tx/ w/ ME. Pain gone immediately after being there for 12 hours without relief. MD co-intern and resident are impressed and fully understand what I'm doing when I show them the problem, let them palpate for themselves, and explain how and why the treatment works via the anatomy. Now they want to learn OMM.

Stick that in your pipe and smoke it...for the guy who thinks OMM is useless, I think wasting thousands of dollars to admit someone because you do not have a full understanding of the human body is 'useless'.

 

[Taus]

awesome posts....

 

[dcratamt]

Great post Electra.

The below is for the OP and OMM slammer:

OMM is not magic or quakery. It is anatomy and physiology, plain and simple. Just as we listen to the lungs, or get a x-ray to make clinical decisions, why not be skilled with our hands to determine disease in the musculoskeletal system. It's very simple. Just admitted a guy in the ED who the allopath ED doc decided to admit because the chest pain did not go away with GI cocktail, or nitro. EKG/CXR unrevealing. no cardiac hx. c/o L sided CP with radiation to upper chest. I see him, get a little extra hx. the guy was working on his car the day before, doing heavy lifting. Chest pain most at rib 4, check motion. Rib 4 w. inspir somatic dysfunction, tx/ w/ ME. Pain gone immediately after being there for 12 hours without relief. MD co-intern and resident are impressed and fully understand what I'm doing when I show them the problem, let them palpate for themselves, and explain how and why the treatment works via the anatomy. Now they want to learn OMM.

Stick that in your pipe and smoke it...for the guy who thinks OMM is useless, I think wasting thousands of dollars to admit someone because you do not have a full understanding of the human body is 'useless'.

There is some hope for the profession. I am interested in which school do you attend? And how did you keep up your skills?

 

[spyyder]

Great post Electra.

The below is for the OP and OMM slammer:

OMM is not magic or quakery. It is anatomy and physiology, plain and simple. Just as we listen to the lungs, or get a x-ray to make clinical decisions, why not be skilled with our hands to determine disease in the musculoskeletal system. It's very simple. Just admitted a guy in the ED who the allopath ED doc decided to admit because the chest pain did not go away with GI cocktail, or nitro. EKG/CXR unrevealing. no cardiac hx. c/o L sided CP with radiation to upper chest. I see him, get a little extra hx. the guy was working on his car the day before, doing heavy lifting. Chest pain most at rib 4, check motion. Rib 4 w. inspir somatic dysfunction, tx/ w/ ME. Pain gone immediately after being there for 12 hours without relief. MD co-intern and resident are impressed and fully understand what I'm doing when I show them the problem, let them palpate for themselves, and explain how and why the treatment works via the anatomy. Now they want to learn OMM.

Stick that in your pipe and smoke it...for the guy who thinks OMM is useless, I think wasting thousands of dollars to admit someone because you do not have a full understanding of the human body is 'useless'.

Who are you trying to convince?

 

[Taus]

Spyder: You said in your post that OMM was useless in mainstream medicine and people responded with very well thought out, intelligent responses about examples of it being practical and helpful. I don't see the discrepancy here about who they were trying to convince...

Either way, take from these posts what you want...

 

[Megalofyia]

holy **** drusso...I can't believe that I've never looked at the forum....I've hit the motherload of research...

The osteopathic journal club section was so increadibly useful to me when I wanted to talk about OMM last year since I am sorely lacking in DO shadowing experience. It is an excellent area that goes unnoticed too often.

 

[doc_gnosis]

OMM has a use in physical medicine complaints. Manipulative procedures are great for palliative and some corrective care in PM&R modalities. I think however there needs to be a great deal more research in DDx of these complaints. And there are some quackery ghosts still present, like cranial osteopathy, I think could be done away with.

 

[jhug]

i think the best part of spyyder's post is his signature...he's going to Ross!!! before you knock the carribean...take one long look at why you are going there...is it worth it?

bottom line: AOA is allowing malignant growth of DO schools all the while they are grossly ignoring the need for post-graduate educational opportunities...this is forcing us to be more and more dependent on the ACGME for finishing the education of future DO's...no residency=no doctor...
eventually (heaven forbid) the ACGME is going to say enough is enough and require that the AOA leadership stop acting like the bunch of fools that they are and either join resources or get DO grads out of their programs...
Now we all have to ask ourselves...when it comes down to a) being faithful to those wonderful men who can't see past the one year they are "elected" (even though there is no election process, thus preserving the stagnant state of affairs) or b) having a job after 4 years of medical school...what will you do???

 

[(nicedream)]

Send a link.

Johnson SM et al. Variables influencing the use of osteopathic manipulative treatment in family practice. Journal of the American Osteopathic Association 97:80-87, 1997.

"Only 6% of the respondents treated more than 50% of their patients with OMT, and nearly one third used OMT on less than 5% of their patients."

 

[Shodddy18]

Johnson SM et al. Variables influencing the use of osteopathic manipulative treatment in family practice. Journal of the American Osteopathic Association 97:80-87, 1997.

"Only 6% of the respondents treated more than 50% of their patients with OMT, and nearly one third used OMT on less than 5% of their patients."

Ok, so lets examine that and explore what it means.

What medical therapies are used on all or most of any doctors patients? Granted I'm only a second year but I can not think of any off hand. The truth is that docs will only use a therapy if it is indicated. In your earlier post you stated that less than 5% of docs even use OMM at all. This article states that over 2/3 of DOs use OMM on a fairly regular basis. 2/3 is roughly 67%. 67% is a much higher number than the 5% you stated earlier. And that 1/3 that uses it on less than 5%... It is less than 5%... not 0%

So lets say that the average FP doc sees 4 patients an hour, for an 8 hour day. That is 32 patients a day. In reality it is often more than this. But that means that 67% of FP DOs use OMT on between 2 and 16 patients per day.

So to me this says that the MAJORITY of DOs do use OMT. I will agree with you that OMT may be underutilized, but it is not lost.

 

[fuegorama]

Who are you trying to convince?

No attempt at convincing.
As a profession and a forum we are open about the political issues affecting our training. This opens us to some criticism, but it also facilitates useful discussion among members of the minority physician group.

We have tried to educate someone who has a yawning gap in their knowledge base. As an aspiring physician it is probably a good idea for you to know who the players are. While your original post was an attack on our chosen degree, we have elected to give you the benefit of some teaching.

It would behoove you to remember that you are the new kid. On this site alone, there are several moderators/posters who are emerging leaders in their respective fields. These folks are senior residents, attendings and members of residency boards. They just happen to double as DOs in their spare time. 🙂

I sincerely hope you get what you want/need out of your education at Ross. Feel free to PM me with any questions you might have about the DO degree or school. Good luck.

 

[JakeHarley]

...this is forcing us to be more and more dependent on the ACGME for finishing the education of future DO's...no residency=no doctor...
eventually (heaven forbid) the ACGME is going to say enough is enough

Do you (or any of you) think that in the next 5-10 years we will see changes in the residency match situation? Will ACGME residencies begin to refuse DO graduates on a large scale?

It seems possible that this chain of events could occur:

1) ACGME residencies slowly become closed to DOs, or all at once DOs are suddenly not allowed to enter the allopathic match;

2) The AOA scrambles to create residencies for DO graduates, and these residencies end up sub-par relative to established AOA and ACGME residencies;

3) Do graduates are forced to train in these programs, since there aren't any alternatives;

4) A DO specialist can't get a job anywhere, because everyone knows the AOA training spots suck.


Disclaimer: I only want to bring up the discussion, I am not trying to make any statements for or against osteopathic training 😀

 

[misparas]

The reason OMM is going out is because it mostly is useless. Look at the people applying to ostepathic schools. They convince themselves they belieive in the "holistic" approach, but when they actually get a job and start earning money, they realize what fools they have been. Ostepathy should have never become its own field, it should have been made into a type or residency or fellowship. Why wasn't it? Because no one in there right mind would apply to it. DO schools are no different from the carribean, its another way to become a doctor. Anyone who thinks otherwise, is delusional and should see and a psychiatrist (lets see omm treat that). I have NOTHING AGAINST OSTEPATHIC DOCTORS. My problems is when these physican try to convince people that they "treat the whole person" and suggest OMM is useful in mainstream medicine. I have shadowed many ostepathic physicians, and one important and immutable fact is clear: they don't give a crap about ostepathy and it principles. I definetly see a day when law makers force ostopathy to be merged into mainstream medicine, and we will be better for it. Insurance companies already realize this as most DO NOT REIMBURSE OMM PROCEDURES, as they feel it is you job to do them. I appologize for offending those of you who are hardcore ostepaths, but it is definetly time for a reality check.

Is this a new sentiment? Didn't you apply to D.O. schools last year? That is a very strong opinion for someone who wanted to become a D.O. Why the change of heart?

 

[fuegorama]

Do you (or any of you) think that in the next 5-10 years we will see changes in the residency match situation? Will ACGME residencies begin to refuse DO graduates on a large scale?

It seems possible that this chain of events could occur:

1) ACGME residencies slowly become closed to DOs, or all at once DOs are suddenly not allowed to enter the allopathic match;

2) The AOA scrambles to create residencies for DO graduates, and these residencies end up sub-par relative to established AOA and ACGME residencies;

3) Do graduates are forced to train in these programs, since there aren't any alternatives;

4) A DO specialist can't get a job anywhere, because everyone knows the AOA training spots suck.


Disclaimer: I only want to bring up the discussion, I am not trying to make any statements for or against osteopathic training 😀

I see where you're coming from and it does sound dramatic, scary and remotely plausible. Kind of like 'The day After Tomorrow', possible, but extremely unlikely.

A huge chunk of the picture has been neglected during this discussion. The ACGME NEEDS those spots filled. Under recent medicare (the funder of residency spots) rules, slots that go unfilled for x number of years go away. They simply disappear. Despite the alarmist timbre in some voices, 2005 was the very first year that there were more applicants than there were positions in the ACGME match (Iserson).
So yeah, now there are more applicants. But who are these folks. A growing number of these people are IMG/TWAs. Many of them are fantastic clinicians with a breadth of experience that makes them very desirable to residencies. some of them are from Lord Sinhs' School of Bones and Beeping Things.
PDs know who is who.
They also recognize that osteo schools put out a pretty good product. So good in fact that in a minority of instances we are preferred over US MD grads and in a majority of programs over IMGs.
Is there loyalty first to the kidz coming out of LCME schools? I would hope so. That said, I will be hanging with my MD colleagues on the interview trail.

 

[(nicedream)]

Ok, so lets examine that and explore what it means.

What medical therapies are used on all or most of any doctors patients? Granted I'm only a second year but I can not think of any off hand. The truth is that docs will only use a therapy if it is indicated. In your earlier post you stated that less than 5% of docs even use OMM at all. This article states that over 2/3 of DOs use OMM on a fairly regular basis. 2/3 is roughly 67%. 67% is a much higher number than the 5% you stated earlier. And that 1/3 that uses it on less than 5%... It is less than 5%... not 0%

So lets say that the average FP doc sees 4 patients an hour, for an 8 hour day. That is 32 patients a day. In reality it is often more than this. But that means that 67% of FP DOs use OMT on between 2 and 16 patients per day.

So to me this says that the MAJORITY of DOs do use OMT. I will agree with you that OMT may be underutilized, but it is not lost.

First of all, I never said that "less than 5% of docs even use OMM at all." I said "There have been a couple studies that show around 5% of practicing DOs routinely use OMM." ROUTINELY. Also, where does the article state that "over 2/3 of DOs use OMM on a fairly regular basis"? I didn't see that.

On a personal note, the only DOs I've ever seen use OMM (this is in FL, not PA/MI/OK) are the ones teaching OMM class.

 

[little_late_MD]

Many of them are fantastic clinicians with a breadth of experience that makes them very desirable to residencies. some of them are from Lord Sinhs' School of Bones and Beeping Things.

But they teach you how to treat the "whole" patient there.

 

[JakeHarley]

Lord Sinhs' School of Bones and Beeping Things.
PDs know who is who.

I just about spit coffee on my monitor here at work when I read that

Seriously though, thanks for your thoughts. And thanks to raptor5 who wrote me a great PM about some of this stuff.

 

[drtongue_danger]

The reason OMM is going out is because it mostly is useless. Look at the people applying to ostepathic schools. They convince themselves they belieive in the "holistic" approach, but when they actually get a job and start earning money, they realize what fools they have been. Ostepathy should have never become its own field, it should have been made into a type or residency or fellowship. Why wasn't it? Because no one in there right mind would apply to it. DO schools are no different from the carribean, its another way to become a doctor. Anyone who thinks otherwise, is delusional and should see and a psychiatrist (lets see omm treat that). I have NOTHING AGAINST OSTEPATHIC DOCTORS. My problems is when these physican try to convince people that they "treat the whole person" and suggest OMM is useful in mainstream medicine. I have shadowed many ostepathic physicians, and one important and immutable fact is clear: they don't give a crap about ostepathy and it principles. I definetly see a day when law makers force ostopathy to be merged into mainstream medicine, and we will be better for it. Insurance companies already realize this as most DO NOT REIMBURSE OMM PROCEDURES, as they feel it is you job to do them. I appologize for offending those of you who are hardcore ostepaths, but it is definetly time for a reality check.

where do you go to school again?
Ross? so how large is your class? (in 250+ range right)
My DO class is 101,
what is the drop out rate for school?
Ross and other carribean schools are nothing like DO schools, you can't even get the same loans!
good luck to you matching taking into account that carribean schools have to wait untill after MD and DO.
just because your mad that you didn't get into a U.S. MD school does not mean you can put down other to make yourself feel good

 

[Shodddy18]

First of all, I never said that "less than 5% of docs even use OMM at all." I said "There have been a couple studies that show around 5% of practicing DOs routinely use OMM." ROUTINELY. Also, where does the article state that "over 2/3 of DOs use OMM on a fairly regular basis"? I didn't see that.

On a personal note, the only DOs I've ever seen use OMM (this is in FL, not PA/MI/OK) are the ones teaching OMM class.

Read between the lines man... interpret it. If it says that 1/3 of DO's use OMT with less than 5% of patients, that means that the remaining 2/3 use it more than 5% of the time. Even if the 2/3 used it on only 5% of patients that would still average out to a few patients per day... I would consider this routine. In reality I expect that this 2/3 utilizes OMT somewhere around 30% of the time.

I’m sorry that you have not seen an DOs using OMT, but if this is the case I have a hard time believing that you are looking hard.

 

[Nate]

I interpret it as 2/3 of DOs don't use OMM at all while 1/3 only uses it 5% of the time. I know in NJ there are only 3 DOs who are board certified in OMM. I think OMM has its uses and I am somewhere in between calling it useless and calling it a cure-all. I don't understand how anyone can think in either of those extremes.
However, I think the additional training in OMM is very valuable, even though sometimes I curse it out because I have so little time, because it really does give us knowledge of body mechanics and relationships between the systems in the body (visceral-somatic). It also gets us used to using our hands on other people for diagnosis and it definitely gives us a tool for healing in ADDITION to medicine and surgery if we feel confident to use it.
I don't see Osteopathic Medicine as "going away" but rather it is growing really fast. The physicians and surgeons I shadow have more patients than they know what to do with who are so very happy to be seeing a DO most of the time and our OMM professor is scheduled months ahead of time because he is one of the three who practice OMM alone. Patients want it because it has its uses. Even knowing that I personally will probably not use OMM in practice I am proud to be a DO and feel that my education is equal in quality to ANY MD School and that I also have had unique experiences and training that set me apart. Having said that, I need to go back to what all first year medical students have to do MD or DO, read more biochemistry. Good luck to all.

 

[Shodddy18]

I interpret it as 2/3 of DOs don't use OMM at all while 1/3 only uses it 5% of the time. I know in NJ there are only 3 DOs who are board certified in OMM. I think OMM has its uses and I am somewhere in between calling it useless and calling it a cure-all. I don't understand how anyone can think in either of those extremes.
However, I think the additional training in OMM is very valuable, even though sometimes I curse it out because I have so little time, because it really does give us knowledge of body mechanics and relationships between the systems in the body (visceral-somatic). It also gets us used to using our hands on other people for diagnosis and it definitely gives us a tool for healing in ADDITION to medicine and surgery if we feel confident to use it.
I don't see Osteopathic Medicine as "going away" but rather it is growing really fast. The physicians and surgeons I shadow have more patients than they know what to do with who are so very happy to be seeing a DO most of the time and our OMM professor is scheduled months ahead of time because he is one of the three who practice OMM alone. Patients want it because it has its uses. Even knowing that I personally will probably not use OMM in practice I am proud to be a DO and feel that my education is equal in quality to ANY MD School and that I also have had unique experiences and training that set me apart. Having said that, I need to go back to what all first year medical students have to do MD or DO, read more biochemistry. Good luck to all.

The article says that 6% use OMT more than 50% of the time, and that 1/3 use OMT less than 5% of the time. The rest are somewhere in between. If what you suggest were the case the article would have said that 2/3 never use it, and 1/3 use it less than 30% of the time. Since the less than 5% category goes from 0-5%, they would have included it there had that been the case.

 

[Nate]

I see, well from my personal observations I feel that statistic is high albeit I am very confined and just a newbie. I have also heard that "most DOs do NOT use OMM" many times. The DOs that I have shadowed say that there is just not enough time for OMM. I still feel learning OMM in med school is worthwhile for the reasons that I stated and that it has its uses and I also feel that its influence on my education helps set it apart from other schools whether I use it or not.

 

[jonb12997]

I see, well from my personal observations I feel that statistic is high albeit I am very confined and just a newbie. I have also heard that "most DOs do NOT use OMM" many times. The DOs that I have shadowed say that there is just not enough time for OMM. I still feel learning OMM in med school is worthwhile for the reasons that I stated and that it has its uses and I also feel that its influence on my education helps set it apart from other schools whether I use it or not.

plus it makes for good foreplay with your significant other!! haha... :-D

 

[Nate]

plus it makes for good foreplay with your significant other!! haha... :-D

I'll drink to that.

 

[drusso]

Do you (or any of you) think that in the next 5-10 years we will see changes in the residency match situation? Will ACGME residencies begin to refuse DO graduates on a large scale?

It seems possible that this chain of events could occur:

1) ACGME residencies slowly become closed to DOs, or all at once DOs are suddenly not allowed to enter the allopathic match;

2) The AOA scrambles to create residencies for DO graduates, and these residencies end up sub-par relative to established AOA and ACGME residencies;

3) Do graduates are forced to train in these programs, since there aren't any alternatives;

4) A DO specialist can't get a job anywhere, because everyone knows the AOA training spots suck.


Disclaimer: I only want to bring up the discussion, I am not trying to make any statements for or against osteopathic training 😀

I've been trying to stay above the fray, but this discussion is getting a little silly. ACGME residencies won't close to DO's now or anytime in the future. There would be huge anti-trust law suit issues. The DO's of 1950-60's fought the hard political battles that helped pave the way for today's DO's to apply and potentially match into any specialty they choose. Born of neccessity, DO's created and maintained their own hospitals and post-graduate residency training programs. These programs, along side their ACGME-accredited counter-parts, are legitimate pathways for DO physicians to become board-certified in a given specialty. Again, the AOA, the specialty colleges, and earlier DO pioneers fought the hard political battles that helped policy-makers and payors see that these programs are bona-fide residency training programs. This is good.

There are problems with the current situation in osteopathic graduate medical education, but these problems are not insurmountable. They do require conscientious attention. One positive trend is the ever increasing collaboration between ACGME and AOA-accredited programs. BTW, you have to remember that DO's are *RECRUITED* into ACGME programs! It's not like DO's go begging. These programs recognize that DO graduates are well-prepared, knowledgable, hard-working physicians and are generally very welcoming to us. Within the primary care arena, ACGME training programs gobble up DO's just about every chance they get.

Due to the vagaries of the medicare reimbursement system for resident education, many OPTI's are retooling and redistributing their slots to offer more specialty and sub-specialty training opportunities for DO's. I think that this is good. DO specialists are needed in order to 1) teach DO medical students and generalists; 2) sustain the osteopathic profession as a full-service enterprise and not a "feeder route" to MD programs.

Almost 10 years ago I applied and was accepted to osteopathic schools. I had some of the same concerns and worries as do many people posting here. Was I as good as my MD colleagues? Would I be able to get into the residency of my choice? Will patients accept my authority as a physician? Will I be able to find a good job or join a lucrative practice. I remember meeting and speaking to recent DO grads at that time. They said something that has turned out to be true: "Things get better in this profession all the time."

10 years hence (about the time many of you will be coming out residency) these issues will seem trivial. Opportunities will abound. Concentrate on your own personal and professional development as a physician. Study and work hard. Keep abreast of changes in the field and advances in osteopathic research. Be confident and humble when dealing with patients and colleagues and the rest will fall into place.

 

[JakeHarley]

I've been trying to stay above the fray etc. etc. etc.

Well, thank you for entering the fray...input and insight from those who have been through the gauntlet is exactly what we need. Your comments are very helpful to prospective DO students as well as to mis-informed MD students and graduates.

Passing along reliable information is always a good thing in my book.

Again, thanks! 👍

 

[Portier]

US NEWS


Just an FYI: In the US News and World Report ranking, many Osteopathic Schools show up, and Ross don't.

Surprised? 😱

Not me.

P.S.
I do actually look like cooter.

 

[allendo]

US NEWS


Just an FYI: In the US News and World Report ranking, many Osteopathic Schools show up, and Ross don't.

Surprised? 😱

Not me.

P.S.
I do actually look like cooter.

Actually, if you look in the mag there is a article with the rankings speaking highly of Osteopaths and their training. It also has a quote from the pre-med advisor at Tufts Univ speaking about how Osteopath is a good option and how he encourages students to apply to both MD and DO

 

[JakeHarley]

US NEWS


Just an FYI: In the US News and World Report ranking, many Osteopathic Schools show up, and Ross don't.

Surprised? 😱

Not me.

P.S.
I do actually look like cooter.

To be fair, the report only ranks U.S. schools...that doesn't say anything about the relative quality of medical education at Carribean schools.