We learned last week that Idaho could get its first medical school two years from now. But the announcement that it would be a school of osteopathic medicine left a lot of people wondering just what that is. Everybody knows what an M.D. is. But you may not know that an M.D. has a degree in allopathic medicine. Someone with a degree in osteopathic medicine is a D.O.
Don’t feel bad if you don’t know much about osteopathic medicine, because Dr. Diane McConnehey D.O. had never heard of it until she was about to graduate pre-med at UC Irvine. She'd just had her first child and needed a family doctor. The nurses at the hospital raved about one in town, so McConnehey and her husband made an appointment.
“And when we pulled up to the office I see her name and it says, Cynthia Hill D.O. Osteopathic Medicine. And so my husband and I kind of scratched our heads and said ‘we don’t need a chiropractor, we don’t need a bone doctor.’ But since we were in the parking lot I thought ‘I can’t cancel the appointment so I guess we’ll just go in.’ So I went in and met this physician and she told us that she was board certified in family practice and explained what she does.”
Over the next few months as they brought their baby in for checkups and shots this doctor convinced them to look at osteopathic medical schools. Fast forward more than 20 years and today McConnehey and her husband are D.O.s and family physicians in Boise.
For McConnehey, the appeal of osteopathic medicine is the philosophy behind it.
D.O.s look at medicine a little differently than M.D.s. According to the American Osteopathic Association,
“[D.O.s] believe there’s more to good health than the absence of pain or disease. As guardians of wellness, D.O.s focus on prevention by gaining a deeper understanding of your lifestyle and environment, rather than just treating your symptoms. Listening to you and partnering in your care are at the heart of our holistic, empathic approach to medicine. We are trained to promote the body’s natural tendency toward health and self-healing. We practice according to the latest science and use the latest technology. But we also consider options to complement pharmaceuticals and surgery.” – doctorsthatdo.org
Though D.O.s can go into any of the specialties that M.D.s can, it’s often claimed that this holistic, empathetic approach makes D.O.s uniquely qualified for general medicine or family practice.
M.D.s in recent years, especially those in family medicine, have also begun to espouse this “whole patient” philosophy, causing some people to wonder if the distinction between the two branches is relevant.
A Big Difference
At med school D.O.s learn a practice called Osteopathic Manipulative Treatment, or OMT. The American Osteopathic Association describes it this way:
“D.O.s use their hands to diagnose illness and injury and encourage your body’s natural tendency toward self-healing. As part of their education, D.O.s receive special training in the musculoskeletal system, your body’s interconnected system of nerves, muscles and bones. Using OMT, your D.O. can effectively treat your muscles and joints to relieve pain, promote healing and increase overall mobility.” - doctorsthatdo.org
Some critics describe OMT as quackery and pseudoscience. For example, noted biomedical blogger Steven Salzberg writing in Forbes says,
“Osteopathic medicine started out as little more than pseudoscience, based on the mistaken idea that manipulations of the skeleton and muscles – massage, basically – would cure disease. It was invented by Andrew Still in 1874, who made this and many other claims, none of them supported by science . . . Thus was born osteopathic manipulative therapy (OMT), a practice that has virtually no scientific basis and that is similar in many ways to chiropractic. Unfortunately, claims that OMT works are everywhere on the Internet…On the other hand, some D.O.s do not practice OMT, although they receive OMT training in osteopathic colleges.” - Steven Salzberg
What scientific support there is for OMT is mostly around treating things like back pain. That’s convincing enough that some M.D.s learn OMT principles in residency to supplement muscle and joint treatment. But other claims have less evidence. The American Osteopathic Association says while it is usually used to treat muscle pain,
“. . . it can also help provide relief for patients with asthma, sinus disorders, carpal tunnel syndrome and migraines. In many cases, OMT can be used to complement, or even replace, drugs or surgery.” –doctorsthatdo.org
Some D.O.s claim OMT can help with Parkinson’s and other diseases. Diane McConnehey says she does very little OMT in her practice but she has seen it do great things for people with joint and muscle injuries. She says there is a big push in the osteopathic community to do more research on what OMT can and cannot do.
“. . . doing placebo controlled double-blind studies and really doing science that can be repeated and verified,” McConnehey says. “In the past people have just not taken the time to do all of that. Because, I think for the most part they were busy treating patients. And when you get patient feedback and somebody says, ‘you know what, I feel better’… you get used to doing that. And yes it would be nice to have the science and to have the studies.”
Are D.O.s as good as M.D.s?
They can be. But they might start at a disadvantage. Jessica Freedman M.D. who studies medical school admissions wrote about osteopathic medical school for U.S. News and World Report:
“Do students apply to osteopathic medical school primarily because it is easier to get accepted?” Freedman writes. “For many applicants, the answer to this question is yes, but getting accepted to an osteopathic school still isn’t easy. You still need to do very well in medical school prerequisites and on the MCAT and must pursue meaningful extracurricular activities. And the competition for admission is intense. [In 2013,] nearly 16,500 applicants vied for 5,600 first year spots. But overall, students accepted to osteopathic medical schools have lower average MCAT scores and GPAs than their allopathic counterparts.”
And then training at osteopathic schools is not as high quality as training at allopathic schools, according to Dr. Ted Epperly, head of the Family Medicine Residency of Idaho. He says D.O.s usually come to him less prepared than M.D.s. But Epperly says residency is more important than med school in making a good doctor.
“I’ve been a family physician educator for 35 years,” Epperly says. “And I’ve trained a lot of M.D. graduates and osteopathic or D.O. graduates. At the end of their residency I would tell you categorically there is no difference in their abilities and skills. They are both absolutely ready for practice and safe for the public.”
Correction: In an on-air story announcing the Burrell Group's plans to create an osteopathic school in Meridian, we reported that once fully trained, doctors of osteopathy don't do everything that doctors of medicine do. That is not correct. Osteopathic doctors are widely viewed as having skill sets on-par with doctors trained at traditional medical schools. In another version of that story, we reported that osteopathic schools are less rigorous than traditional medical schools. Reporting that idea as fact was an error. Some who work in medicine do hold that opinion, but it’s a highly subjective point, and one the osteopathic community vehemently argues against. It should have been presented in our story as an opinion and attributed to a doctor we spoke with during the reporting process. We apologize for the error.
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