The best-kept secret and fastest-growing medical profession…
The landscape of healthcare delivery has changed drastically over the past three decades, with the proliferation of allied health professions, increases in medical specialization, managed healthcare and technology advancement. Direct doctor-patient relations have been relegated to the relations between healthcare providers and patients, in which doctors are mere participants among other healthcare givers. Moreover, allied health professions have upgraded their degrees to doctorate levels—Doctor of Pharmacy, Doctor of Physical Therapy, Doctor of Audiology or Doctor of Nursing Practice—which can further confuse patients. MDs, or doctors of medicine, are widely known as physicians, but have you ever heard of DOs, doctors of osteopathic medicine?
There are two types of complete physicians—MDs and DOs—that 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 percent were graduates of MD schools in the U.S., 25 percent were graduates of foreign medical schools, and seven percent were graduates of DO schools. All must pass licensing board examinations and complete internships and residencies before being licensed to practice medicine.
What is Osteopathic Medicine?
DOs are fully licensed physicians and recognized as equals to MDs at every level of government in all 50 states. There are more similarities than differences between the two. The medical education and training of DOs follow the same rigorous curriculum of MD 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, DOs are trained at least 200 additional hours 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 the motion and function of blood circulation and the lymphatic and respiratory systems.
Another important difference in the DO schools is the emphasis placed on primary care specialties such as internal medicine, family medicine, pediatrics and obstetrics/gynecology. Therefore, approximately 60 percent of DOs practice in the primary care specialties, in contrast with 35 percent of MDs. 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 these underserved areas. While DOs constitute just seven percent of all U.S. physicians, they are responsible for 16 percent of patient visits in communities with populations of fewer than 2,500.
The Annals of Internal Medicine recently released a national study that ranks medical schools on their contributions to meeting the nation’s healthcare needs, “social mission” scale, and an analysis of graduates who practice primary care, work in medically underserved communities or are themselves minorities. The discussion section of the study praises the achievements of osteopathic medical schools in their social mission. Six osteopathic schools ranked among the top 50 overall, while prestigious institutions like Columbia, Johns Hopkins, Northwestern, Duke and Stanford ranked in the bottom 20.
The Chicago College of Osteopathic Medicine (CCOM), one of the oldest osteopathic schools in the nation, ranked 88th in “social mission.” CCOM graduates approximately 165 DOs per year and plans to increase this number to 200. Fifty-four percent of 2010 graduates were matched to primary care specialties. There are about 2,635 practicing DOs out of 32,000 physicians in Illinois.
Relevance of Osteopathic Medicine
There has been a growing public interest in complementary and alternative medicine (CAM) in recent years. According to data reported in 2007 by the National Center for Complementary and Alternative Medicine, 38 percent of adults and 12 percent of children in the U.S. used some form of CAM that year. The National Center for Statistics states that Americans spent $33.9 billion out of pocket on CAM in 2007, including $11.9 billion on an estimated 354 million visits to CAM practitioners.
Many allopathic medical schools have responded by offering elective instructions in CAM. Even a tentative proposal of core competencies in integrative medicine in the undergraduate curriculum in allopathic schools was advanced in hopes of instilling graduating physicians with the values, knowledge, attitudes and skills to improve physician-patient communications. DOs are better positioned to respond to this public interest, thanks to the long tradition of a holistic and preventive philosophy to patient care.
Musculoskeletal conditions and injuries are among the most common reasons for physician visits in the U.S. According to the National Center for Health Statistics, in 2003 and 2004, 21 percent of individuals aged 18 to 44, 59 percent of those between 45 and 54, and 98 percent of those aged 55 to 64 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 of MDs who felt adequately prepared to assess the problems of lower back pain and foot pain were 31 percent and 10 percent, respectively. By contrast, the percentages of DOs who felt adequately prepared to assess these issues were 84 and 41 percent, respectively. Osteopathic training appears to be at the forefront of addressing major healthcare issues and fulfilling public demands for patient-focused care.
Answering the Physician Shortage
Osteopathic medicine has enjoyed exponential growth over the past three decades. In 1980, there were 17,620 practicing DOs and 1,059 DO graduates. In 2010, there are 63,000 practicing DOs and 3,845 DO graduates. The number of colleges of osteopathic medicine has increased from 15 to 26 colleges and five branch campuses, at least three schools and two branch campuses are being planned, and three additional colleges are applying for accreditation. Interestingly, with this continued growth, one in five medical students in the U.S. is currently enrolled in an osteopathic medical school. By 2020, there will be 100,000 DOs practicing in the U.S., more than 6,000 DOs will graduate yearly, and one in four medical students will be DO students.
The looming forecast of physician shortages is estimated to be between 160,000 and 250,000 by 2030, as the U.S. population grows to 350 million, the number of people over the age of 65 doubles, one third of the current physician workforce retires, and the new healthcare law provides more coverage to 32 million persons. In 2006, the Association of American Medical Colleges called for a 30-percent increase of MD student enrollment by 2020—an additional 5,000 students. Even with this expansion, a shortage of physicians cannot be prevented. The continuous growth of osteopathic medicine will somewhat alleviate this issue, and its unique blending of holistic and conventional medicine makes it a leading force in responding to the healthcare needs of the nation. iBi
Tayson DeLengocky, DO, is an osteopathic physician at Bond Eye Associates, specializing in vitreo-retina surgery and neuro-ophthalmology.