During his “60 Minutes” commentary on April 25, Andy Rooney bemoaned the overspecialization of physicians. Without acknowledging osteopathic physicians, he declared, “We need more medical schools that graduate doctors who specialize in everything and nothing—the whole body, not just one part.”
More vexing, a front-page article on the surge in U.S. medical schools in The New York Times in February failed to recognize the fastest growing element of medical education—osteopathic medical colleges. And in April, an article on the shortage of primary care physicians in The Wall Street Journal neglected to mention the osteopathic medical profession’s focus on family medicine.
Although both the AOA and the American Association of Colleges of Osteopathic Medicine (AACOM) report better press recognition of osteopathic medicine than in the past, oversights and slights persist, compelling the AOA and other osteopathic medical organizations to be vigilant and quick with letters of rebuttal to editors.
“Andy Rooney was describing what osteopathic physicians already do,” notes Pierre Bellicini, the director of communications and marketing for the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pa. After viewing Rooney’s “What Happened to Family Doctors?” segment, Bellicini helped rally colleagues in the osteopathic medical profession to use Rooney’s remarks as a springboard for educating CBS and other media outlets about the DO difference and the profession’s traditional focus on primary care.
Part of the problem, according to Bellicini, is that layoffs at major newspapers have turned the remaining reporters into jacks-of-all-trades, making it less likely that a reporter covering health care will be aware of osteopathic medicine. In addition, many newspapers, magazines and broadcast news entities have style policies dictating that the generic Dr. title be used for all physicians, without noting their particular degrees. Such policies reinforce the misconception that the MD degree is the only one synonymous with physician.
But the osteopathic medical profession faces even higher hurdles, Bellicini notes. Despite the rapid growth in osteopathic medical schools, MDs still outnumber DOs 10-to-1. And osteopathic physicians are divided over whether to align themselves with or distinguish themselves from allopathic physicians.
The AOA’s 2006-07 president, the late John A. Strosnider, DO, understood this divide. In conceiving the AOA’s Greatness Fund, he envisioned that a significant share of it would be used for a national television advertising campaign, which would allow the AOA to trumpet a specific message about osteopathic medicine to a vast audience. But the recession, which prompted the AOA to suspend fund-raising temporarily, squelched this dream for the time being. Although the Greatness Fund has been reinstated and a Greatness Campaign task force last December recommended budgeting for a pilot ad program in one state, “there is no funding for any advertising initiatives at present,” says Karyn Szurgot, the AOA’s director of communications.
However, Kelli M. Ward, DO, MPH, a family physician from Lake Havasu City, Ariz., contends that advertising should be a funding priority for the AOA. “If the profession is ever going to do national TV advertising, now is the time because of the prominence of primary care in health care reform,” says Dr. Ward, the president of the Arizona Osteopathic Medical Association. She notes that nurse practitioners and physician assistants have done a better job than DOs in promoting themselves as the answer to the physician shortage.
Physicians in general tend to be uncomfortable promoting themselves, observes Ned Rosch, JD, the executive director of the Northwest Osteopathic Medical Foundation (NWOMF), agreeing that some nonphysician clinician groups have been much more aggressive in their marketing initiatives. “Why do people think of chiropractors first rather than DOs when they have backaches?” he asks.
Virginia M. Johnson, DO, is convinced that her profession’s internal identity struggles paralyze promotional initiatives. “Fundamentally, if we don’t get our own house clean—if our graduates don’t care about the heritage of our profession—how can we raise public awareness of osteopathic medicine?” asks Dr. Johnson, who practices neuromusculoskeletal and osteopathic manipulative medicine in Santa Monica, Calif.
“For years the profession has been trying to establish itself as different or distinctive,” says Al Turner, DO, an OMM specialist in Portland, Ore. “In reality, many osteopathic physicians are no different in thought or practice than our allopathic colleagues.”
Dennis J. Dowling, DO, who specializes in OMM in Syosset, N.Y., points out that many of his referred patients don’t even realize when their primary care physicians are DOs. “One key way to promote the profession is for DOs to talk about osteopathic principles with their patients—the importance of looking at the whole person, the interrelationship of structure and function, the body’s inherent healing properties,” says Dr. Dowling, a former president of the American Academy of Osteopathy and a member of the editorial advisory board of JAOA—The Journal of the American Osteopathic Association.
To educate new patients about the profession, Dr. Turner gives them the AOA’s “What Is a DO?” and “Osteopathic Medicine” brochures as a starting point for deeper discussions on how OMM can contribute to health.
A medical director for Arizona’s North Country HealthCare, Dr. Ward prints a custom version of the “What Is a DO?” brochure for patients. With a computer in each examining room at her clinic, Dr. Ward developed a screen saver that reinforces the profession’s identity with the phrase “Treating people, not just symptoms.” As a result, her patients see this catchphrase again and again.
Dr. Turner stresses the importance of DOs using their full name followed by DO on their signs, lab coats, name badges, business cards and Web sites. “A lot of osteopathic physicians try to hide their identity behind the Dr. title,” he says.
Besides using DO after their names, osteopathic physicians should use the term osteopathic physician instead of osteopath in accordance with AOA policy, Szurgot notes. “Often I hear DOs and osteopathic medical students using outdated terminology,” she says. “Using proper terminology when referring to the profession will go a long way in dispelling stereotypes.”
The AOA also supports the use of osteopathic medicine over osteopathy, with five AOA bureaus and committees recommending that AOA policy be modified to reflect this preference, already adhered to in the AOA’s brand and publication style guidelines.
Not every DO agrees with the AOA, however. The Cranial Academy, for example, debated changing its terminology but decided to keep its traditional descriptor osteopathy in the cranial field. The term osteopathy, as established by Andrew Taylor Still, MD, DO, reflects a philosophy and scientific approach that are distinct from conventional medicine’s, emphasizes Melvin Friedman, DO, The Cranial Academy’s president. “We take great pride in being osteopaths as opposed to being just physicians,” he says.
Words to actions
Strengthening professional identity goes beyond terminology and explanations to patients, however, says Dr. Dowling. He would like to see more primary care DOs perform at least basic OMT techniques for uncomplicated conditions. Doing so would improve patient health and satisfaction while spurring positive word-of-mouth publicity for the profession, he says.
“As DOs, we have to ‘try harder’ like Avis,” observes Robert S. Gotlin, DO, the director of orthopedic and sports rehabilitation at Beth Israel Medical Center in New York City. “We have to earn respect, not demand it, by being educated, being diligent, being proud and producing results. Unfortunately, DO residents and fellows often demonstrate insecurity about their distinctiveness and a lack of confidence in their OMT skills. As a profession, we need to turn this around.”
Dr. Turner attributes this insecurity to osteopathic medical trainees not having enough opportunities to perform OMT during their third- and fourth-year rotations and their residencies. Addressing the root of this problem is essential to advancing the profession, he maintains. For his part, Dr. Turner has two or three students at a time from around the country serving rotations in his three-DO practice. He also reaches out to DOs who are serving allopathic residencies in the Portland area, giving these residents the chance to hone their OMT skills in his practice.
Mentoring future generations of osteopathic physicians is critical to promoting the profession, notes Dr. Ward, whose mother, husband and sister-in-law are DOs. Striving to be a role model to students who rotate in her community health center, Dr. Ward has them stay at her house as guests during their rotations. “My husband and I immerse the students in the life of a DO,” she says. “We take them with us wherever we go, so they see how we interact with others in the community.”
The New York Times article on the emergence of new medical schools dismissed osteopathic medical education with one remark: “His premed adviser told him that with his 3.3 grade-point average, he should apply only to osteopathic schools.”
To counteract such misconceptions, staff members from the AOA Department of Communications have visited undergraduate college campuses to speak about DOs and osteopathic medicine.
Because they tend to be biased toward MDs, premed advisers are a major target of AACOM’s and osteopathic medical schools’ promotional initiatives. AACOM exhibits at the annual meeting of the National Association of Advisors for the Health Professions, and LECOM and other osteopathic medical colleges advertise in the association’s quarterly journal. Also recognizing the influence of premed advisers, the NWOMF invites them to its annual Confluence of Northwest States, which addresses issues facing osteopathic medicine in the Pacific Northwest.
But it is particularly important for premed advisers to meet practicing DOs, Dr. Turner says. “Osteopathic physicians in college towns need to contact premed advisers because they usually don’t know anything about us or they have misconceptions,” he explains.
Recruiting the right students into osteopathic medicine—those who truly want to become DOs—is integral to promoting the profession, Dr. Turner says. To that end, he gives an hour-long presentation on osteopathic medicine during the “Introduction to Health Careers” workshop at Portland State University. He also talks about the osteopathic medical profession to gifted high school students who take part in a program based at Oregon Health and Science University in Portland.
Similarly, for the past 10 years, Portland family physician John T. Pham, DO, has led monthly meetings for premed students that address the rewards and challenges of being a physician, as well as osteopathic philosophy and OMT. Twenty to 30 undergraduate college students from Oregon and Washington attend the two-hour evening meetings, which take place at the Portland office of the Osteopathic Physicians and Surgeons of Oregon.
The AOA’s 2007 Mentor of the Year, Dr. Pham encourages premed students who have attended at least three monthly meetings to shadow him in his practice and, depending on their interest and ability, take blood pressure readings and even help take patient histories. “How are you going to promote the profession if you don’t let kids shadow you?” he asks.
Dr. Pham will write letters of recommendation to osteopathic medical colleges only for students who have impressed him with their commitment to osteopathic medicine.
The premed and high school programs do more than recruit future DOs, Drs. Turner and Pham say, noting that even those students who choose not to attend osteopathic medical school are more aware of the profession and may speak well of it.
To promote the profession to the public, the AOA undertakes a variety of initiatives, including National Osteopathic Medicine (NOM) Week, during which the AOA organizes and encourages other organizations to sponsor attention-grabbing activities, such as fun runs and health fairs. During this year’s NOM Week, which began on April 18, AOA staff handed out 600 bottles of AOA-branded hand sanitizer on Michigan Avenue in downtown Chicago. And the AOA brought several DOs and osteopathic medical students to an elementary school in Warrenville, Ill., for a “mini med school” that taught children about medicine and good health habits.
The AOA’s Osteopathic Public Awareness Network (known as OPAN), available to AOA members on Osteopathic.org, provides resources that can be used to set up similar mini med schools and other events and promote them to the media.
According to LECOM’s Bellicini, the AOA has been especially successful at alerting the media to DOs who are expert sources on particular health topics—through news releases, phone calls to media outlets, Twitter updates and advisories on the AOA’s Media Center. For example, in conjunction with National Inhalants and Poisons Awareness Week in March, the AOA arranged for Baltimore family physician Jennifer N. Caudle, DO, to take part in a press conference on inhalant abuse at the National Press Club in Washington, D.C. She has been quoted by several major media outlets on “huffing” addiction, including FoxNews.com and CNN.com. The AOA’s Media Center maintains an updated list of osteopathic physicians cited in the media and links to the news items.
“When promoting yourself as an expert source to the media, you need to be prepared and available on a moment’s notice because of reporters’ deadlines,” Dr. Caudle says. To work around style policies that disallow the display of DO, osteopathic physicians can mention their medical credentials as they are being interviewed, she advises. For example, DOs can precede statements with “As an osteopathic physician, I understand that.”
Besides joining the AOA’s database of expert sources, DOs can write health-related articles for local newspapers to boost their own and the profession’s visibility, recommends Dr. Caudle, who interned at a local television station when she was an osteopathic medical student. She also suggests that osteopathic physicians consider getting involved in organizations such as the National Association of Medical Communicators.
Also on the AOA’s list of expert sources, Chicago general internist Laura M. Rosch, DO, promotes osteopathic principles and practice whenever she is interviewed by reporters about fitness, healthful diets and other aspects of preventive medicine. A part-time aerobics instructor, she makes a point of sharing with her classes osteopathic medicine’s emphasis on wellness and belief in the body’s inherent ability to heal itself.
“A.T. Still understood that structure and function are linked. I want to use his philosophy to empower people to take care of themselves,” says Dr. Rosch, whom the AOA has filmed for YouTube videos on working out at the office and parenting during the recession.
Being able to produce videos at a reasonable cost and share them online has enhanced the power of nonprofits to communicate with the public, observes Ned Rosch. The Northwest Osteopathic Medical Foundation has been promoting the profession and raising money for its scholarship fund with a polished seven-minute video depicting two DOs performing OMT, explaining OPP and talking to patients.
The AOA, AACOM and a number of other organizations in the profession have Facebook pages to keep “friends” updated on activities and issues. “The osteopathic medical profession is only beginning to tap the power of social media in getting out the message of osteopathic medicine,” notes Wendy Fernando, AACOM’s vice president for communications and marketing.
The AOA has already had success in using social media to increase awareness of the profession, Szurgot points out. The AOA’s Facebook page has more than 4,700 followers, many of whom post comments, she says. In February, for example, a link to a letter published in Chicago magazine by AOA President-elect Karen J. Nichols, DO, drew eight posted comments on the Facebook page.
The Internet has also changed the profession’s advertising practices. To build public awareness in the communities in which it has campuses, LECOM buys TV advertising in Erie, Pittsburgh and Sarasota, Fla. But in the past couple of months, the college also began advertising on Google, with its ad appearing on specific keyword searches related to medical education and osteopathic medicine.
Besides harnessing new media for promotional initiatives, the osteopathic medical profession needs to seize on current trends in health care favorable to osteopathic medicine, Fernando maintains. “With health care reform having passed, we have a particular opportunity,” she says. “I have heard over and over that health care reform is designed to produce physicians who provide patient-centered, community-focused care and can work as part of a team. This is what osteopathic physicians are already doing. This has always been the educational model of osteopathic medicine. As a profession, we need to work in concert to tell this story.”