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June 2012
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Number of osteopathic doctors surging

BY LAUREL BLACKlblack@paducahsun.com

Even as news outlets and physicians' organizations warn of a looming doctor shortage, a sometimes overlooked medical degree is seeing a boom in enrollment.

The American Association of Medical Colleges, or AAMC, predicts that a growing, aging population, health insurance expansion and a freeze on Medicare funding for residency training positions will lead to a physician shortage of more than 90,000 by 2020. The shortage is expected to hit rural areas especially hard and will be most severe in the area of primary care.

Enter osteopathic medicine, a field of study that emphasizes primary care and aims to place physicians in under-served regions. Although it emerged in the late 1800s, interest in the field has surged recent decades.

"There are a lot of osteopathic schools. It's definitely a growing field," said Dr. Griffin Bicking, a vascular surgeon who practices at Baptist Health Paducah. He attended the Philadelphia College of Osteopathic Medicine and went on to complete his residency there.

The number of graduates in osteopathic medicine increased by more than 250 percent between 1980 and 2005, according to a study by the AAMC. In 1980, there were 14 schools and fewer than 5,000 students in America; there are now 30 schools with more than 30,000 students. It's estimated that today nearly 30 percent of all medical school graduates are doctors of osteopathy.

Local D.O.s say there's something about the decades-old field that appeals to today's culture.

"Everybody's trying to be healthy on a daily basis - disease prevention is huge nowadays - and that's a big part of (osteopathic medicine's) philosophy," Bicking said. "We're trained to look at the whole person, from the first day of medical school."

Osteopathic schools take a more holistic approach to preventing and treating illness than their conventional counterparts, emphasizing hands-on diagnostic techniques such as palpation or percussion. The schools also tend to accept more nontraditional students, taking into account life circumstances during the admissions process. There are campuses in locations such as Harlem, New York and Pikeville, Kentucky - not the standard places for medical schools, but areas that are in need of doctors.

Like Bicking, Dr. Bradley Albertson, an internist and pediatrician at Mercy Primary Care in Benton, said the field's philosophy is part of what drew him toward osteopathic medical school. "Curriculum-wise, it's pretty much the same," Albertson said of osteopathic medicine, which also requires four years of training followed by an internship and a residency. "The differences are more political and social."

After medical school, Albertson opted for a non-osteopathic residency because it allowed him to study both internal and pediatric medicine. And when it came to receiving his board certification, Albertson said he took the conventional M.D. route. He believed it would add legitimacy to his practice.

A fading stigma

"Ten or 15 years ago, there still were some physicians and some institutions that frowned on osteopathy. They viewed it as an inferior being, kind of like how chiropractic (medicine) was looked down on in the past," Albertson said.

The most notable way a D.O.'s training differs from that of an M.D. is a required 300 to 500 hours of training in osteopathic manipulative treatment. Known as OMT, it involves the movement of patient's bones and muscles to treat illness and injury - and has been derided by some doctors and laypeople as a pseudoscience.

Neither Albertson nor Bicking use OMT, and that's not uncommon for D.O.s, according to an article published in Academic Medicine, the journal of the AAMC. The study found that more than 50 percent of osteopathic physicians used OMT on less than five percent of their patients.

Osteopathic medicine is sometimes seen as academically inferior to its conventional counterpart. The schools are somewhat easier to get into: last year, students entering osteopathic schools scored an average of 27 on the MCAT, while their allopathic counterparts boasted a 31. Incoming M.D. students have a median GPA of 3.6, while D.O. students lag slightly with a 3.5, according to the American Association of Osteopathic Medicine.

But, Albertson points out, "time in the field is really what hones your skills."

As people become more aware of osteopathic medicine, the stigma is fading, local D.O.s say.

And the differences between the two branches of medicine are shrinking. As much as osteopathic schools try to push primary care, the fact remains that a D.O. can go into any field an M.D. can - and it usually pays more to specialize.

Albertson is skeptical that osteopathic schools can fill the predicted patient-physician gap. He said medicine will have to look to a variety of solutions, such as allowing nurse practitioners broader privileges, to keep pace with patient growth.

"I think as long as somebody meets the standards of quality, that's great," he said. "I think those would be the potential fillers in that gap. The issue that it really comes down to, unfortunately, is the dollar."

Contact Laurel Black, a Paducah Sun staff writer, at 270-575-8641, or follow @LaurelFBlack on Twitter.

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