by Tayson DeLengocky, DO

The landscape of healthcare delivery has changed so drastically over the past three decades with the proliferation of allied health professions, increased in medical specialization, managed health care, and technology advancement.

The direct doctor-patient relations have been relegated to the relations between healthcare providers and patients, in which doctors are only participants among other healthcare givers. A healthcare consumer, patient, can be easily further confused when visiting medical offices or hospitals as there is no dress code, i.e., any employee can wear any scrubs or white coats. Moreover, allied health professions have upgraded their degrees to doctorate levels such as Doctor of Pharmacy, Doctor of Physical Therapy, Doctor of Audiology, and Doctor of Nursing Practice, which can further confuse patients from distinguishing these doctors with their physicians, whom they normally used to know as doctors. M.D.s, doctors of medicine, are widely-known as physicians.

Have you ever heard of D.O.s, doctor of osteopathic medicine, as your physicians?

How to become a practicing physician in the US?

There are two types of complete physicians, M.D.s and D.O.s, who are fully-licensed to prescribe medication and practice in all specialties of medicine and surgery. In 2008, there were about 780,000 practicing physicians in the United States, of which 68% were graduates from a US M.D. school, 25% were graduates from a foreign medical school, and 7% were graduates from a D.O. school. All these graduates must pass the medical licensing board examinations and complete internships and residencies before being licensed to practice medicine.

What is osteopathic medicine?

D.O.s are fully licensed physicians and are recognized as equals to M.D.s at every level of government in all 50 states. There are more similarities than differences between M.D.s and D.O.s. The medical education and training of D.O.s follow the exact rigorous curriculum of M.D.s training. The main difference lies in the osteopathic philosophy of the preventive and holistic approach of these tenets:

• The body is a unit, and the person represents a combination of body, mind and spirit.
• The body is capable of self-regulation, self-healing and health maintenance.
• Structure and function are reciprocally interrelated.
• Rational treatment is based on understanding the body unity, self-regulation and the interrelationship of structure and function.

With the concept that diseases of internal organs can manifest externally as referred pain to different musculoskeletal regions and vice versa,  D.O.s are trained at least 200 hours extra in osteopathic manual medicine (OMM), a hands-on technique for diagnosis and treatment. OMM incorporates aspects of traditional manual therapy, soft-tissue massage therapy, and other body-based modalities to relieve pain from strained muscles, tendons, and joints and improve motion and function of blood circulation, lymphatic and respiratory systems.  Another important educational difference in the D.O. schools is the emphasis placed on primary care specialties such as internal medicine, family medicine, pediatrics, and obstetrics/gynecology during the clinical years. Therefore, approximately 60% D.O.s practice in the primary care specialties in contrast with 35% of M.D.s. Furthermore, osteopathic schools focus on providing care to rural and urban underserved areas by recruiting students from these areas, promoting rural medicine, and even establishing new schools in the underserved areas. While D.O.s constitute 7 percent of all U.S. physicians, they are responsible for 16 percent of patient visits in communities with populations of fewer than 2,500.

Recently, the Annals of Internal Medicine released a new national study that ranks medical schools based on their contributions to meeting the nation’s health care needs, “social mission” scale, based on an analysis of graduates who practice primary care, work in medically underserved communities or are themselves minorities. The discussion section of the study praises osteopathic medical schools’ achievements in their “social mission.” Six osteopathic schools ranked in the top 50 overall. In contrast, some prestigious institutions such as Columbia, Johns Hopkins, Northwestern, Duke, University of Pennsylvania and Stanford all ranked in the bottom twenty.

Relevance of osteopathic medicine

First, there has been a growing public interest in complementary and alternative medicine (CAM) recent years. According to data reported in 2007 by the National Institutes of Health’s National Center for Complementary and Alternative Medicine, 38% of adults and 12% of children in the United States used some form of CAM that year. According to the National Center for Statistics’ 2007, Americans spent $33.9 billion out-of-pocket on CAM, of which $11.9 billion were spent on an estimated 354.2 million visits to CAM practitioners.

Most allopathic medical schools have responded to this public interest by offering some elective instructions in CAM. Even a tentative proposal of core competencies in integrative medicine in undergraduate medical curriculum in allopathic schools was advanced in hope of instilling graduating physicians with the values, knowledge, attitudes and skills to improve the physician-patient communication.

D.O.s are better positioned to respond to this public interest thanks to its long tradition of a holistic and preventive philosophy to patient care.

Second, musculoskeletal conditions and injuries are among the most common reasons for visits to physicians in the United States. They accounted for more than 131 million patient visits in 1995 and cost $215 billion annually. According to the National Center for Health Statistics in 2003 and 2004, 21% of individuals aged 18 to 44, 59% of those aged 45 to 54 years, and 98% of those aged 55 to 64 years reported limitation of activity due to musculoskeletal conditions. According to a 1999 survey of the Steering Committee on Collaboration among Physician Providers Involved in Musculoskeletal Care, the percentages M.D.s who felt adequately prepared to physically assess problems of low back pain and foot pain were, respectively, 31% and 10%. By contrast, the percentages of D.O.s who felt adequately prepared to assess low back pain and hand problems were, respectively, 84% and 41%. Thus, osteopathic training appears to be at the forefront of addressing major healthcare issues and fulfilling public demands for patient-focused care.

A similar study (in 2005-06) among Harvard Medical School students found that musculoskeletal education was important (rated a 3.8 on a 5-point scale, with 1 meaning “no importance” and 5 meaning “critical importance”). At the same time, though, the students rated the amount of time spent on musculoskeletal education as poor (rated 2.1 on a 5-point scale, with 1 meaning “inadequate” and 5 meaning “excellent.”). On an exam of cognitive mastery of musculoskeletal medicine, fourth-year medical students had a passing rate of only 26%; the pass rate for third-year students (7%) was even worse.  According to the study’s authors, “[R]ecent studies suggest that the discrepancy between the magnitude of musculoskeletal problems and physician competency in musculoskeletal medicine likely stems from educational deficiencies at the medical school level.” Osteopathic medical educational programs are addressing this every day.

Growth of osteopathic medicine: An answer to physician shortage

Osteopathic medicine has enjoyed the exponential growth over the past three decades while M.D. schools decided to remain stagnant. In 1980, there were 17,620 practicing D.O.s and 1,059 D.O. graduates. In 2010, there are 63,000 practicing D.O.s and 3,845 D.O. graduates. The number of colleges of osteopathic medicine has increased from 15 to 26 colleges and 5 branch campuses. At least three schools and two branch campuses are being planned. Marian University in Indianapolis, IN, Campbell University at Buies Creek, NC, and Southeast Alabama Medical Center in Dothan are applying for accreditation. Interestingly, because of the continuous growth, one in five medical students in the United States is currently enrolled in an osteopathic medical school. 32% of the D.O. student body is made up by minority groups. By 2020, there will be 100,000 D.O.s practicing in the U.S., more than 6,000 D.O.s will graduate yearly, and one in four medical students will be D.O. students.

The looming forecast of physician shortage in 2030 estimated to be from 160-250,000 physicians as the population will grow to 350 million, the number of people over 65 will double, a third of current physician work force will retire, and the new healthcare law providing more coverage to 32 million persons. In 2006, Association of American Medical Colleges called for increased of 30% M.D. student enrollment by 2020, i.e., additional 5,000 students. Despite this expansion, shortage of physicians can not be prevented. The continuous growth of osteopathic medicine will somewhat alleviate the future physician shortage, and its unique blending characteristic of holistic and conventional medicine makes it a special and leading force responding to the healthcare needs of the nation.

Tayson DeLengocky is a vitreo-retinal surgeon who blogs at Eye Dr DeLengocky.

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