The D.O. will see you now

By Tanya Albert Henry

While doctors of allopathic medicine (M.D.’s) still account for the vast majority of practicing physicians in Georgia and the rest of the nation, 2019 marked the highest number of doctors of osteopathic medicine (D.O.’s) ever – with more than 120,000 in the U.S., according to the American Osteopathic Association (AOA). AOA reports that nearly 7,000 new physicians graduated from osteopathic medical schools last year. And today, one of every four medical students attend a college of osteopathic medicine. Overall, the profession has grown by more than 60 percent in the past decade – a nearly 300 percent increase over the past 30 years per AOA’s ‘2019 Osteopathic Medical Profession Report.’ Georgia now boasts two osteopathic medical schools, the newest campus opening in South Georgia last fall. There were nearly 1,700 practicing D.O.’s in Georgia in 2019 – up from about 1,600 in 2018 – representing 1.6 percent of the state’s practicing physicians, keeping in mind that there were less than 1,000 D.O.’s in Georgia in 2006. So, what is the driving force behind this increase and what makes D.O.’s unique? In part, there are simply more osteopathic schools of medicine in the U.S. Georgia’s new campus was one of three that opened last year, with others opening in Tennessee and Florida. There are now 38 osteopathic schools that offer instruction at 59 locations, a 150 percent-plus increase from the 23 colleges and branch campuses in 2005. But that growth would not be possible without demand. In addition to a shortage of physicians, many believe that there has also been a change in mindset in what some patients expect from their physician. They want physicians who will spend more time listening, focusing on wellness, and “treating the whole person” – which are the cornerstones of osteopathic philosophy and training. 8 MAG Journal “Today’s patients are more informed as a practical matter, and many are looking for specific qualities in a physician,” says H. William Craver III, D.O., a general surgeon who became the dean of the Philadelphia College of Osteopathic Medicine (PCOM) South Georgia in Moultrie after serving in that role at the PCOM Georgia campus in Suwanee since 2010. “We want every osteopathic medical student to graduate with an understanding of how to treat the patient as a whole and focus on wellness.”

The D.O. philosophy

Andrew Taylor Still, M.D., D.O., designed the osteopathic medicine model in Kirksville, Missouri in the 1870s and 1880s. He then opened the first school of osteopathy in 1892 to “promote the body’s innate ability to heal itself,” a philosophy that continues to be instilled in today’s D.O. students. Osteopathic medicine, which is known for producing a lot of primary care physicians, emphasizes the need for physicians to create partnerships with their patients to assess how one’s lifestyle and community affect their health. D.O.’s help patients manage acute and chronic illnesses, while preventing disease and promoting wellness. A D.O. is educated and trained to view their patients’ body parts and functions as interconnected, with one part impacting the others. For example, Dr. Craver says that if a patient comes in with knee pain, a D.O. is trained to check their ligaments and cartilage, but they are also trained to look at the bigger picture. He explains that, “Sometimes there may be knee pain that is coming from a problem with the hip or the ankle, or it could be a problem with your back that is changing your gait, and perhaps that is causing the pain to show up in your knee.” Dr. Craver says it comes down to making sure that the physician is coming back and evaluating the whole person and then asking what they as a physician can do to help the

patient, noting that, “It may be that there is some action that we should be taking, in addition to what would be considered the standard practice of care.”

How is osteopathic training unique?

D.O.’s are synonymous with osteopathic manipulative medicine (OMM). Osteopathic students complete four years of academic study and learn the same core subjects as their allopathic counterparts. But they spend an extra 200 hours or so training above and beyond those topics to learn about OMM. This hands-on diagnosis and treatment technique involves manipulating the musculoskeletal system. It can help alleviate pain, restore motion, support the body’s natural functions, and influence the body’s structure to help it function more efficiently. There are about 15 major types of osteopathic manipulative treatment and more than 1,000 individual techniques. According to the American Association of Colleges of Osteopathic Medicine (AACOM), the “therapeutic application of manual pressure or force” can… • Treat common ailments such as headaches, arthritis, stress injuries, sports injuries, and pain in areas such as the lower back, neck, shoulders, and knees • Provide a non-invasive and medication-free treatment option • Be performed in many different health care settings • Enhance a physician’s overall diagnostic skills • Be administered safely in combination with other medical treatments to improve outcomes One of the key concepts that osteopathic medical students learn is that structure influences function. If a patient is experiencing a problem in one part of the body’s structure, function in that area and potentially other areas of the body may also be impacted. If someone has a heart attack, M.D.’s and D.O.’s are going to follow the same standard of care throughout the treatment, explains Savannah emergency physician John Sy, D.O., the former chair of the MAG Foundation’s Georgia Physicians Leadership Academy Steering Committee and an associate professor at the Mercer University School of Medicine. D.O.’s are fully licensed physicians who use the latest technology, surgical procedures, and prescription drugs. But if a patient comes in with pain, aches or musculoskeletal complaints, osteopathic manipulation provides an additional tool for D.O.’s to use to treat that patient. “If a patient has chronic back pain, I can refer them to a physical therapist or specialist and/or I can prescribe the appropriate medication,” Dr. Sy says. “But I also try to alleviate their pain with osteopathic manipulation. I might not be able to eliminate the patient’s pain altogether, but this approach can reduce the amount of medication that I am prescribing – which is a big win.”

A focus on primary care

D.O.’s can be licensed to practice the full scope of medicine in all 50 states. After graduating from an osteopathic medical school, D.O.’s, like M.D.’s, who plan to go into practice must

John Sy, D.O.

H. William Craver III, D.O.

complete an Accreditation Council for Graduate Medical Education residency program (and some complete fellowship training), which prepares them to become board certified. You will find D.O.’s in the military and specialties ranging from surgery to aerospace medicine, but most end up in primary care. According to AOA’s ‘2019 Osteopathic Medical Profession Report,’ nearly 57 percent of the nation’s D.O.’s go into primary care, including about 34 percent in family medicine, 18 percent in internal medicine, and seven percent in pediatrics. That is by design, says AACOM, as the mission of most osteopathic medical schools is to produce primary care physicians. At PCOM and other colleges of osteopathic medicine, there is an emphasis on preventive medicine and holistic patient care during the medical school years. Of course, every D.O. does not end up in primary care (e.g., Dr. Sy). Nearly 44 percent go into another specialty. According to AOA’s ‘2019 Osteopathic Medical Profession Report,’ some of the common D.O. specialties include…

Emergency medicine (9.7 percent)

Anesthesiology (4.2 percent)

OB-GYN (4.1 percent)

General surgery (3.6 percent)

Psychiatry (3.4 percent)

First-year PCOM South Georgia medical students learn to identify cardiac sounds in the school’s Simulation Center.

Dr. Craver is among those who went into one of those “other” specialties, and he values the osteopathic education he received – and has frequently drawn on the lessons he learned during his training – during his career as a surgeon. “I believe that my background as a D.O. has enabled me to make better diagnosis,” he explains. “I have been trained to listen to the patient and look at them in the context of a whole patient rather than focus on one specific organ or complaint.”

Focus on underserved areas

As the nation faces a physician shortage, osteopathic medical schools also have a special focus on caring for patients who live in underserved areas. Over the past three years, more than a third of osteopathic medical school graduates indicated that they planned to practice in a rural or underserved area, according to a survey that was conducted by AACOM. Georgia’s first osteopathic school, PCOM Georgia in Suwanee, opened about 30 miles north of Atlanta in 2005. Meanwhile, the goal of PCOM’s new campus in Moultrie – which is between Albany and Valdosta – is to become a “regional health professions education center in the medically underserved area of the state.” PCOM South Georgia welcomed its inaugural class of 59 doctor of osteopathic medicine students in August of last year. While studies show that physicians often end up practicing close to where they complete their residencies, Dr. Craver believes that by opening a campus in South Georgia, PCOM will highlight the need and value for having physicians in underserved areas – with the hope that many will ultimately settle in these areas. “We believe that this approach will help these students understand and appreciate the great potential and emotional rewards of serving in an underserved community and showing them that they really can make a difference,” says Dr. Craver, who served as the only surgeon in a rural county for a period of time. “By opening a campus in an underserved part of the state, we have created the opportunity for students to go out and spend time with physicians and gain that experience.” He is convinced that, “The students that we are attracting at PCOM are looking for an education that is going to allow them to have a significant impact on underserved communities in the primary care setting.” And Dr. Craver notes that, “It seems like PCOM appeals to individuals who want to give back and serve the community and make a difference. By choosing to open a school in an underserved area, we are creating those pathways and opportunities.”

Gaining popularity

For years, osteopathic schools were more common in the Midwest and Northeast. The small numbers of osteopathic physicians often left patients, and even some M.D.’s, in states “I believe that my background as a D.O. has enabled me to make better diagnosis,” [Dr. Craver] explains. “I have been trained to listen to the patient and look at them in the context of a whole patient rather than focus on one specific organ or complaint.”

 like Georgia confused about the differences between an M.D. and a D.O. “I can’t tell you how many times in my career, both with training residents and working on a national and local level, that I heard comments like ‘I had no idea your students were so knowledgeable and well-versed’,” Dr. Craver says. “I think it’s human nature to question what we don’t understand.” But Dr. Craver believes that attitudes are changing as the numbers of osteopathic medical physicians increase and people become more familiar with the D.O. skill set and philosophy. “At the end of the day,” he believes, “it really comes down to personal preference – as there are far more similarities than differences between M.D.’s and D.O.’s.” Over the years, Dr. Sy has had countless conversations with his M.D. colleagues, and people in general, to clear up misconceptions about his training in holistic medicine. “When I ask them to define holistic medicine, most can’t,” he says. “I explain that it’s treating the whole body. I ask my fellow physicians, ‘When someone comes in with a cellulitis of their leg and their other organs display signs in other organs, are you only treating the leg?’ They say, ‘No. We treat all the organs because it’s multiorgan sepsis.’ And I say, ‘Well, yes.’ The point is that we all treat patients holistically on some level.” Dr. Sy adds that, “In the years since I graduated from medical school, there has been a greater awareness among patients…a lot of them want to try something other than just hearing let’s throw some drugs at it.” And he concludes that, “Once patients experience the benefits of osteopathic manipulation, it’s an approach many of them will embrace for the rest of their lives. And since many physicians have less time to spend with their patients given the practical realities of today’s health care system, a lot of patients welcome and enjoy the osteopathic manipulation process and holistic approach and getting a chance to spend 45 minutes to an hour with their physician.” Of MAG’s 8,400 members, about 400 are D.O.’s. Go to www. pcom.edu/campuses/georgia-campus for additional inform on PCOM Georgia.