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The DO | Patient Care | Art of Healing

How to specialize in osteopathic manipulative medicine

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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.”
Dr. Seffinger

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.”

9 Responses

  1. Sarah Nasir on July 6, 2012, 11:15 p.m.

    Thank you for writing an article like this. It is a question in the back of my mind as I am trying to figure out which direction to go & also how to sustain myself with infusing as much OMT as possible. And articles like this are quite helpful.

  2. David Teitelbaum, D.O. on July 7, 2012, 4:58 p.m.

    I have been in specialty OMM practice for 27 years, and still love each day. What a joy to be able to help my patients feel better and become more functional by using natural methods! I added prolotherapy after 7 years in practice, and then acupuncture. Both are great compliments to OMM. Also, it is a great life style. I work 4 nine hour days a week, (stopping only briefly for lunch). I do accept Medicare, which pays well for OMM in Texas, but it is only 20% of the practice. All else is cash. This provides a very good income for my family, (3 sons and my beautiful wife of 31 years). I could not reccomend it more highly, but only if you have a passion for it: there is no faking a good OMM treatment- the patients know immediately.

  3. Roselia Conrad, DO on July 8, 2012, 5:11 a.m.

    I became BC in NMM/OMM through the practice tract, 6 years ago. It was a cruel and unfair path for this osteopathic physician expecting to succeed without adequate preparation, even after 500 hrs of CME in OMM. You have to know what is expected before right decisions can be made to fulfill requirements. This article is the first to clearly delineate the expectations for my specialty. I am devoted to spending the rest of my life learning to deepen my knowledge about osteopathic principles and practices; however, retaining BC in NMM/OMM requires more than that. As Dr. Tettambel has stated, it requires a deeper knowledge of neurology, orthopedics, rheumatology, pain managment, physical medicine and rehab, and yes, radiology, and other specialities as well. Let’s hope our professional organizaion, the AAO, provides us with enough of those topics which will insure success when recertification comes up; and to insure a realistic, fair path in achieving the goal of “expert” status in neuromuscular function within our specialty, along with our fellow colleagues who have completed a residency in NMM/OMM.

  4. Theodore Jordan, DO NMM on July 9, 2012, 8:27 a.m.

    The AOA needs to look closely at the general financial viability of an OMM specialty practice. From my limited experience, OMM specialists either:
    -Take cash only, and charge high fees for service
    -Are employed full, or part time through a teaching institution
    -Or they sell product (e.g. supplements) or other services (e.g. prolotherapy) for additional income.

    I would argue that the model where the OMM specialist is in private practice, performs only OMM and accepts insurance, Medicaid and Medicare, is not financially viable solely by itself. If my premise is true, then the osteopathic profession should reconsider the goals and curricula of the OMM/NMM residencies.

  5. Jonathan Bruner, D.O. on July 13, 2012, 7:40 a.m.

    Articles like this one are step in the right direction for the NMM/OMM profession. I am the program director for the Michigan State University NMM/OMM 2-year program. All of our graduates have gone on to lucrative careers in private practice (almost all insurance based) and academia. We work hard to provide advanced education in NMM and OMM, so our residents are able to be extremely effective practitioners. There is a desperate need for more NMM/OMM physicians and many available positions. I encourage anyone that is interested to contact a program and/or speak with NMM/OMM residents to find out what they are actually all about and be weary of people that try to steer you away from any field.

  6. Jonathan Bruner, D.O. on July 13, 2012, 7:41 a.m.

    You can click on my name to lead you to our websites if you would like any more information on our program.

  7. Harriet H. Shaw, D.O. on July 13, 2012, 1:12 p.m.

    This is a very informative article that answers many questions that portential NMM/OMM residents have.
    As a program director of a Plus One NMM/OMM program, I get numerous requests from osteopathic college seeking NMM/OMM graduates for their OMM faculty. The demand is much greater than the supply of residents finishing NMM/OMM programs.
    Especially the new osteopathic colleges may want to consider incentive funding of residents in these programs to improve faculty recrutment.

  8. David Ciaccia on July 14, 2012, 12:39 p.m.

    Thanks for all the inputs so far, much encouraged this time of year as 4th years (including myself) are looking at specializing in NMM/OMM. Especially those that represented the residency programs. Love to hear from the other 4 about their unique qualities since descriptive information on these programs are not the most widely available.

  9. Residency: Prepare Early on Feb. 14, 2013, 11:54 a.m.

    […] Surgery Anesthesiology Physical Medicine and Rehabilitation (PM&R) Pediatrics Osteopathic Manipulative Medicine (OMM) Dermatology Emergency Medicine Obstetrics-Gynecology (Ob-gyn) Internal Medicine […]

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