How to specialize in osteopathic manipulative medicine
Trained originally as a family physician, residency director David C. Mason, DO (left), feels strongly that all primary care physicians and many other specialists should use OMT. (Photo courtesy of Dr. Mason)
Any licensed osteopathic physician can focus his or her practice on osteopathic manipulative medicine. No residency or board certification is required. Indeed, notes Michael A. Seffinger, DO, the immediate past president of the American Academy of Osteopathy (AAO), some DOs straight out of osteopathic rotating internships have set up cash-only OMM specialty practices in wealthy communities and reportedly make $500,000 or more a year working three days a week.
But, generally, those who specialize in OMM have additional credentials and are not in it mainly for the money, which tends to be in the mid-range for medical specialties—more than primary care but less than surgical specialties, says Lisa A. DeStefano, DO, who chairs the OMM department at the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing.
Many OMM specialists feel they have a calling. They devote themselves to learning as much as they can about osteopathic principles and practice over the course of their professional lives to improve the health of their patients, and they seek to share their knowledge with others to raise the quality of health care on a broader scale. Some of these DOs also perform or promote OMM research to advance the profession and enhance patient outcomes.
More than a decade ago, DOs who had five years of practice experience and 500 hours of continuing medical education in OMM could become AOA board certified in the specialty by taking examinations. “Our specialty was the last in the profession to have such a practice track,” points out Dr. Seffinger, who was certified in OMM in this manner. Today, only those who serve a residency in neuromusculoskeletal medicine (NMM) and OMM are eligible for board certification in NMM/OMM.
Such board certification is a prerequisite for chairing an OMM department at an osteopathic medical school or directing a residency program in the specialty, but it does not increase the amount or likelihood of reimbursement for osteopathic manipulative treatment, says Melicien A. Tettambel, DO, who chairs the American Osteopathic Board of Neuromusculoskeletal Medicine, the AOA certifying board overseen by the AAO.
DOs who desire to deepen their knowledge of NMM and OMM to better care for patients and who aspire to OMM-related leadership positions in academia, hospital settings and organized osteopathic medicine should consider an NMM/OMM residency, recommends Dr. Tettambel, who chairs the OPP department at the Pacific Northwest University of Health Sciences, College of Osteopathic Medicine in Yakima, Wash. Osteopathic physicians who simply want to hone their OMT skills or learn new techniques can do so by attending CME workshops and practicing on their peers and later their patients, she says.
In fact, the neuromusculoskeletal designation stems from the need to distinguish the residencies and board certification from skill in OMT, Dr. Tettambel says. Expected to become experts in neuromusculoskeletal function, NMM/OMM residents serve rotations in neurology, orthopedics, rheumatology, pain management, physical medicine and rehabilitation, and other specialties. Although the emphases of each program differ, all residents receive inpatient and outpatient clinical training and have teaching and research obligations.
Four pathways to certification
Becoming board certified in NMM/OMM requires completing one of four residency tracks:
- A two-year program in NMM/OMM following a traditional osteopathic internship.
- A one-year program in NMM/OMM following an AOA-approved residency in another specialty, known as a “Plus One.”
- An integrated three-year program in family medicine and NMM/OMM.
- An integrated three-year program in internal medicine and NMM/OMM.
Those selecting an integrated residency generally plan to become primary care physicians who emphasize but don’t limit themselves to OMM. Those pursuing a two-year NMM/OMM residency right after their internship typically specialize in OMM. Those completing a Plus One residency often do so later in their career and sometimes drop their original specialty in favor of OMM, says Dr. Tettambel, an AOA board-certified obstetrician and gynecologist who for much of her career integrated OMM into her other specialty but currently focuses on OMM.
“Residency-trained specialists in NMM/OMM have the skills and confidence to handle a huge range of conditions afflicting patients of all ages.”
After completing their residencies, DOs need to pass an oral, a written and a practical examination to become certified in NMM/OMM.
DOs who are certified in NMM/OMM, whatever the route, should not be confused with DOs who are AOA board certified solely by the American Osteopathic Board of Family Physicians in family medicine and OMT. Dr. Tettambel notes that while the AAO would like to see osteopathic physicians in all specialties perform or at least appreciate the value of OMT, NMM/OMM-trained DOs have deeper knowledge of musculoskeletal medicine, more experience applying OMM to a broad range of patients, and more OMM teaching and research experience.
“We are seeing a renaissance of people—patients and MDs especially—who seek DOs who do OMT,” Dr. Tettambel notes. “Yet only a small proportion of DO graduates do manipulation. And those who devote their lives to OMM and are board certified in NMM/OMM tend to be looked down on by our profession’s other specialties.”
With certain exceptions, NMM/OMM residencies often do not fill. Rather than being funded by the federal Centers for Medicare and Medicaid Services, NMM/OMM residencies for the most part are funded by hospitals or osteopathic medical colleges. Some of the programs struggle to maintain their funding amid declining interest among DO graduates and competition from specialty training programs that generate more revenue for hospitals.
Such concerns notwithstanding, osteopathic physicians who train in NMM/OMM point to fulfilling, lucrative careers with plenty of opportunities. More important, patients benefit from the additional knowledge and skills their DOs gleaned during residency.
“Residency-trained specialists in NMM/OMM have the skills and confidence to handle a huge range of conditions afflicting patients of all ages,” notes Dr. Seffinger, who chairs the NMM/OMM Department at the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif. “They are able to make a living by about four months after residency via word-of-mouth recommendations from satisfied patients.”