Doctor of Osteopathy

[toddjh]

I just got a letter from my insurance company saying my old primary care physician has left and they've assigned me a new one. I did a little research and found that he's a Doctor of Osteopathy (DO) and not an MD.

I've found some conflicting information on the web about what exactly that means. Some make it sound like it's pretty much identical to an MD with some extra stuff about "total patient wellness" thrown in, while others actually use the word "quack."

Is this something I should be concerned about? Even if the rest is the same as an MD, the "total patient wellness" thing doesn't sound too encouraging to me. I can change my PCP, but it's a pain in the ass and I want to know if it's worth giving this a chance.

[Freethinker]

An osteopath is basically a chiropractor with real medical training. Go to Merck's website at http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommon zSzdorlandszSzdorlandzSzdmd_o_08zPzhtm
and read their definition. They use words like "total body wellness" and "the body can make its own remedies against disease and other toxic conditions when it is in normal structural relationship"

[fls]

I just got a letter from my insurance company saying my old primary care physician has left and they've assigned me a new one. I did a little research and found that he's a Doctor of Osteopathy (DO) and not an MD.

Is this something I should be concerned about? Even if the rest is the same as an MD, the "total patient wellness" thing doesn't sound too encouraging to me. I can change my PCP, but it's a pain in the ass and I want to know if it's worth giving this a chance.

I don't have any experience practising with a DO (I've mostly practised in Canada), but there were several in my Internal Medicine residency. I will admit that I quizzed the first one I met mercilessly about what a DO was. <g> It sounded pretty much like med school with a bit more emphasis on the musculo-skeletal system. The training meets the requirements for them to practise as a physician. And my residency was at one of the top programs in the US, so they must be at least somewhat competitive with MD's.

ETA: I understand that this may be different in countries other than the US.

Linda

[Dogdoctor]

My impression is that DOs are similar to MDs only the have some unscientific training in addition. They used to be like chiropractors but it seems like they wanted to be different so they downplayed to manipulation and upscaled the science. A graduated DO can do a normal medical residency just like a graduated MD does or they can do osteopathic residencies. So my guess is if you choose a DO who did a regular residency they will be similar to a MD.

[Katana]

I don't have any experience practising with a DO (I've mostly practised in Canada), but there were several in my Internal Medicine residency. I will admit that I quizzed the first one I met mercilessly about what a DO was. <g> It sounded pretty much like med school with a bit more emphasis on the musculo-skeletal system. The training meets the requirements for them to practise as a physician. And my residency was at one of the top programs in the US, so they must be at least somewhat competitive with MD's.

ETA: I understand that this may be different in countries other than the US.

Linda

My impression is that DOs are similar to MDs only the have some unscientific training in addition. They used to be like chiropractors but it seems like they wanted to be different so they downplayed to manipulation and upscaled the science. A graduated DO can do a normal medical residency just like a graduated MD does or they can do osteopathic residencies. So my guess is if you choose a DO who did a regular residency they will be similar to a MD.

Both of you are largely correct. I have friends who are DOs and work with a number who are, and they are very well-trained. They will say that the manipulation and other "non-traditional" education was not an emphasis. They are all in very good residencies and are considered excellent residents in them. So their post med-school training will be the same as any MD's from the same residencies. I will add that I had a PCP who was a DO a few years back (I don't now because I moved), and he was wonderful.

So there is my admittedly biased opinion.

Having said that not all DOs are good but then neither are all MDs. Consider waiting until you meet the doc before forming an opinion.

[toddjh]

Okay, I'll give it a shot. My concerns weren't so much that they don't know their stuff as that they may have a different approach than the type of doctor I'm usually most comfortable with.

Another friend of mine had a DO as her primary and she says he was a good doc, so I'll try to keep an open mind.

[KillerBob]

My impression is that DOs are similar to MDs only the have some unscientific training in addition. They used to be like chiropractors but it seems like they wanted to be different so they downplayed to manipulation and upscaled the science. A graduated DO can do a normal medical residency just like a graduated MD does or they can do osteopathic residencies. So my guess is if you choose a DO who did a regular residency they will be similar to a MD.


Pretty much. I use a DO who's probably the best physician I've ever had as far as getting things right the first time. I come from a medical background myself (respiratory therapist), so I have a pretty good idea of when I'm getting straight medical answers.

In fact, for a while, my wife and I were doing side by side comparisons between my DO and her MD. We'd both come down with something and see who got better first. Every time, my DO would hit on the right diagnosis with the first try, give me the proper treatment, and I'd be well in no time. My wife, on the other hand, would usually have to go back several times before her doctor would make it around to the same plan of care I had received.

That's all obviously anecdotal and I don't mean for it to be a general comparison of MD's and DO's, but it was enough to get my wife to switch to my doctor and our kids now see him too.

However, before I went to see him the first time I had made sure that he did his residency in a facility that graduated MD's, just because I was hesitant about seeing a DO myself.

[joobz]

Yeah, They got to do their boards and residency just like a MD, so I wouldn't worry about training.

From what I understand
DOs were initially MD like training who thought that Muscle skeletal issues would play a roll in non-physical effects beyond pain(e.g., changes in blood supply, pinching nerves resulting in wierdness..). Since this initial belief and since DOs are rooted in science, a lot of these claims have been dismissed. They still use joint manipulation for issues that it is used and they focus on physical therapy as a tool for rehabilitation. And since they had this initial whole body approach, they tended to also focus on better Doctor-patient interaction.

During this same time, allipathic schools have incorporated (I'm guessing independantly) physical therapy and focused more on bed side manners. So, the differences aren't so major. And now that alliphathic MDs are moving toward a preventative maintaince type approach, I don't think differences are that big at all.

[Horrible speculation=on]
The only guess I'd have (and this may offend some DOs) is that since DOs classically didn't have the respect of MDs, they had fewer people applying to their programs. As such, DOs may have lower requirments into their programs, meaning this students didn't test as well as their MD counterparts. But since they passed thier boards, this shouldn't matter.
[/Horrible speculation]

[Blue Wode]

The training meets the requirements for them to practise as a physician. And my residency was at one of the top programs in the US, so they must be at least somewhat competitive with MD's.

ETA: I understand that this may be different in countries other than the US.



It's certainly different in the UK. Osteopaths here receive a training that is more on a par with that of chiropractors.

[Upchurch]

It's certainly different in the UK. Osteopaths here receive a training that is more on a par with that of chiropractors.
Of course, both are very powerful figures on the Scrabble board.





apologies to Eddie Izzard

[joobz]

It's certainly different in the UK. Osteopaths here receive a training that is more on a par with that of chiropractors.
Does that mean UK recognizes homeopathic Drs. as more reputible than DOs?

[Sagger]

I believe what it means is that Osteopaths are only going to be on par with MDs in the USA. In the UK they may be more like traditional Osteopaths. Osteopathy was started around the same time as chiropractic in the late 19th century. Chiropractic was discovered by DD Palmer. DD Palmer spoke about getting many of his ideas from a seance with the spirit world. He also was influenced by AT Stills, the founder of Osteopathy. The philosophical roots of both religions were quite similar. AT Stills believed that the key to restoring health was through the circulatory system. By contrast, DD Palmer chose to make the metaphysical focus of his religion the nervous system. In the USA osteopathy eventually made the right decision and aligned itself with medicine. However chiropractic is a profession that to a significant extent actively chooses to continue to live in the dark ages with the help of it's occult philosophy.

[quixotecoyote]

I went to school at Truman State University in Kirksville, MO which is also home to one of the more prominent Osteopathic colleges in the US. From everything I picked up being around that, it's just a slightly differently focused MD. The quackery seems to have been weeded out over the years.

[Loss Leader]

DOs and MDs must take and pass all the same core courses, sit for all the same licensing tests and do all the same internships and sub-internships. They are treated identically by the law. DOs can and do practice in all fields of medicine including pediatric neurosurgery and any other really hard specialty you can think up.

DOs and MDs actually co-evolved. Real formal medical training is only a little over a hundred years old. Before that the majority of doctors just apprenticed with older doctors without ever going to school. The only supposed difference is one of philosophy - DOs being stereotypically more concerned with the "whole" patient. For that reason DOs are more likely to choose to be primary care doctors. Even so, whatever philosophy med school imparts, one's residency imparts another one and MDs and DOs generally emerge from their residencies with the philosophy of their specialty.

By the way, what's the difference between a surgeon and God?

God knows he's not a surgeon.

[The Atheist]

My doctor is a registered medical doctor who then completed osteopathy training and uses it when necessary. He is an excellent doctor and general practitioner who has looked after my family for about five years when we changed doctors after the previous one turned out to be useless.

The current doctor has been great, diagnosing all sorts of weird and wonderful kids' troubles and I only had cause to need osteopathy when I had a case of whiplash. I was getting such awful dizzy spells that I had to be driven to the surgery. He had me lay down on my stomach and gave my back a huge shove - fixed! I would have nominated him for a million bucks immediately, such was the miracle cure.

Obviously, the key is, as everyone has stated, find a good doctor and if he's an osteopath as well, even better. I can't see the problem with it, although the lesser training in UK would make me a little sceptical of their prowess.

[Blue Wode]

Does that mean UK recognizes homeopathic Drs. as more reputible than DOs?
Homeopaths and osteopaths in the UK are not normally recognised as “Drs”.

With regard to who is the more reputable, the osteopaths win since there is a little bit of evidence for some of their treatment approaches.

With regard to primary care, osteopaths here may consider themselves to be primary care providers, but their training is still very much inferior to that of MDs.

More on osteopathic training in the UK here:
http://www.osteopathy.org.uk/careers/Osteopathy_as_a_career_-_watermark.pdf

And this is the website of the UK osteopathic regulatory body, the General Osteopathic Council:
http://www.osteopathy.org.uk/

In a nutshell, osteopaths in the UK are similar to chiropractors but they don’t carry as much pseudoscientific baggage.

[asthmatic camel]

Hmm. source (http://www.quackwatch.org/04ConsumerEducation/QA/osteo.html)


A former osteopathic medical school faculty member wrote:
I spent 12 years teaching basic sciences and 7 years as an associate dean at the an osteopathic medical school. However, since the school's faculty came from institutions throughout the United States, I doubt that what I observed differed much from the situation at other osteopathic schools.
Students carried a heavy curriculum in osteopathic manipulative therapy (OMT), beginning in their freshman year. The department of manipulative medicine was completely segregated from the other departments, both in principles and in practice. The osteopathic faculty members in the standard medical departments neither practiced nor taught OMT. Nor did the OMT faculty practice or teach the standard forms of medicine. It was as if OMT was a freestanding form of health care -- one that, unlike other departments, was not necessarily bound by scientific foundations. Being a basic science researcher, I have made attempts to set up an animal model to objectively test the claim that certain harmful forms of sympathetic nerve traffic could be altered by spinal OMT. However, I never received any support from the osteopathic faculty in seeing such a study completed. The general attitude of the osteopathic manipulation physicians was, "since we already know it works, why should we bother with proving it."
Cranial therapy was a large component of the manipulative medicine department, both for patient care as well as for teaching the medical students. Interestingly, while the other faculty accepted most forms of OMT even though they did not use them, they did not endorse the use of cranial therapy. Indeed, I heard many criticisms of the practice by the non-OMT faculty. Their objections were the same as mentioned on Quackwatch -- that the cranial bones fuse early in infancy, after which no motion of these bones takes place. As you indicate, the alleged sensing of such motion forms the heart of cranial therapy.
I have never heard any attempt by an OMT practitioner to offer a tenable defense to such criticism. To me it almost seemed as if the OMT practitioner felt that the practice could not be defended with ordinary logic since its basis lay somewhere in the metaphysical and that only their gifted hands were able to "sense" the cranial motion.
But the seemingly metaphysical did not stop with the practice of cranial therapy. I know of one case in which a student with an undiagnosed illness consulted one of her OMT mentors who concluded that she had "a "hole in [her] aura."
David E. Jones, Ph.D.

[toddjh]

Irony of ironies: I just got another letter from my insurance company telling me that the DO they just assigned me is no longer available, and setting me up with yet another primary -- an MD who went to Johns Hopkins.

We'll see how long this one lasts. :rolleyes:

[nimzov]

Irony of ironies: I just got another letter from my insurance company telling me that the DO they just assigned me is no longer available, and setting me up with yet another primary -- an MD who went to Johns Hopkins.

We'll see how long this one lasts. :rolleyes:
Excuse my ignorance but why can't you choose your doctor ?

nimzo

[toddjh]

It's an HMO type plan. I can choose my doctor, but only from an approved list. What happened here is that my old doctor (who was great) left the system, so they automatically assigned me a new one just to make sure I wasn't without a doctor. I'm sure it was just bad luck that the new one they assigned me also happened to leave just a couple weeks later.

I can switch to a different doctor on the list at any time, but there's paperwork involved so it's a chore.

[grunion]

Good luck with that, I have also had a series of mishaps with doctors departing from or being dropped by my insurance plan.

Regarding DOs, I was recently a patient in the Cardiac Intensive Care unit of the local University hospital for a few days and was attended by a DO among a number of MDs. I found her to be at least on par with the other doctors in her ability to answer medical questions about my condition and superior in bedside manner and communication skills, but that could be just a single personality issue. I did ask her quite a bit about the history and practice of osteopathy and though she admitted that the specialty seemed to attract some practicioners who were a bit "fringe" in their notions, in all the training was identical to that of MDs with a bit more focus on the musculo-skeletal structure and the interconnectedness of the body's systems - no notion of "chi" but essentially one of the whole body being a system with subsystems rather than discrete organs and functions. I was satisfied that she was basing her decisions and advice, at all times, on sound science.

I subsequently saw a local DO in a private practice and was very dissatisfied with her manner and professionalism. Didn't stay with her long enough to be able to judge her science.

So in all I think the individual doctor's personality and approach is nearly as important as his or her training. I would suggest you keep switching until you find a doctor that you can trust.

[yersinia29]

DOs and MDs must take and pass all the same core courses, sit for all the same licensing tests and do all the same internships and sub-internships. They are treated identically by the law. DOs can and do practice in all fields of medicine including pediatric neurosurgery and any other really hard specialty you can think up.


Thats not entirely accurate. USMLE is the MD licensing exam, COMLEX is for DOs, although DOs can choose to take the USMLE if they wish.

MD licensing and DO licensing is entirely separate. Each state has their own licensing board.

DOs can practice in all fields. However, its somewhat rare to find a DO in a super subspecialty such as peds neurosurgery. In fact, I doubt there's a single peds neurosurgery DO fellowship in the entire country, so if a DO wanted to do that, they would have to match into an ACGME (MD) fellowship.

DOs are much more likley to do primary care. The vast majority of DO residencies are primary care residencies. They dont offer nearly as many kinds of residencies or fellowships. For example there are only 10 DO neurosurg residencies in the entire country, compared with over 80 for MD.

[elaine]

I just got a letter from my insurance company saying my old primary care physician has left and they've assigned me a new one. I did a little research and found that he's a Doctor of Osteopathy (DO) and not an MD.

I've found some conflicting information on the web about what exactly that means. Some make it sound like it's pretty much identical to an MD with some extra stuff about "total patient wellness" thrown in, while others actually use the word "quack."

Is this something I should be concerned about? Even if the rest is the same as an MD, the "total patient wellness" thing doesn't sound too encouraging to me. I can change my PCP, but it's a pain in the ass and I want to know if it's worth giving this a chance.


Give the Doc the benefit of the doubt and have a consultation to find out what your doc is about. My Doc is a DO, and he has no patience for non-science crap. I haven't seen anything wooish in his practice at all. At least with me. Just no-nonsense stuff.

[Mouthfire]

Thats not entirely accurate. USMLE is the MD licensing exam, COMLEX is for DOs, although DOs can choose to take the USMLE if they wish.

MD licensing and DO licensing is entirely separate. Each state has their own licensing board.

DOs can practice in all fields. However, its somewhat rare to find a DO in a super subspecialty such as peds neurosurgery. In fact, I doubt there's a single peds neurosurgery DO fellowship in the entire country, so if a DO wanted to do that, they would have to match into an ACGME (MD) fellowship.

DOs are much more likley to do primary care. The vast majority of DO residencies are primary care residencies. They dont offer nearly as many kinds of residencies or fellowships. For example there are only 10 DO neurosurg residencies in the entire country, compared with over 80 for MD.


I personally know a DO pediatric neurosurgeon. I also know a DO pediatric endocrinologist. Both are top-notch physicians.

[Dr. Imago]

There needs to be more access for highly qualified graduates to get into U.S. medical schools that grant the "Doctor of Medicine" (MD) degree in the U.S. Because there are more qualified applicants than there are spots, those who do not gain acceptance are forced to choose alternative pathways to becoming a physician. Many of these college graduates choose to go to Osteopathic physician school, others go abroad to study in Europe, Australia, or the Caribbean.

I have worked with all of these kinds. Most (not all) osteopathic graduates in the U.S. ended-up in osteopathy programs because of the above reason. It is medical school, just like MD-granting programs, and in the end graduates can continue to train and practice medicine side-by-side with MD graduates. There are roughly 22,000 residency spots each year, and only about 16,500 U.S. MD graduates. So, it doesn't take a lot of imagination to figure out who are filling these left-over spots.

What most people don't realize is that the practice of medicine is a highly individualized pursuit. Some physicians are more savvy, better read, more motivated and energetic, better able to use their formal training to deliver effective care, (etc.) than others. DO graduates, remember, are individuals who have completed their formal medical training and have passed the licensure exams are completely on-par with their "allopathic" colleague graduates.

My experience is that, on-average, the DO graduates I've worked with in my residency program (anesthesia) are every bit as competent and qualified as the MD graduates. There is no difference in our anesthesia training. There is no use of Osteopathic Manipulative Medicine in our program, and likewise no emphasis on this treatment paradigm.

Those DO graduates who have been accepted into our program are bright, motivated, and equally capable in understanding and using the science that drives our field. They have been trained, for all intents and purposes, in the exact same disciplines as I have.

So, to answer the bigger question, there are woo DO's out there just as their are woo MD's out there. It is not something inherent to the training or the degree. They are not "inferior" doctors, at least in the U.S. And, they are not people you should be cautious in seeking a health opinion from, provided that they have completed an accredited residency and have received a license to practice medicine, in good standing, in the state in which they are working.

As for the reasons why this pathway exists - and has grown immensely over the past ten years - well... those are mostly political and beyond the scope of discussion in this thread... unless you want to "go there". ;)

-Dr. Imago