Single GME spotlight

‘Maintaining the integrity of osteopathic medicine in the modern era’

Kelly Raj, DO, of the Cleveland Clinic, explains how osteopathic recognition encourages DO and MD residents to embrace the osteopathic philosophy.

Over the past decade, Kelly Raj, DO, has witnessed a shift in the care provided to patients through the family medicine residency program at Fairview Hospital-Cleveland Clinic in Cleveland, Ohio.

Since the 40-year-old program became dually accredited by the AOA and ACGME in 2008, the program’s incorporation of osteopathic training has resulted in an emphasis on whole-person care and osteopathic manipulative treatment (OMT). It’s a change that has benefited patients, says Dr. Raj, the program’s osteopathic medicine director.

“We have patients who strictly come into our clinic for osteopathic manipulative treatment now,” Dr. Raj says. “That wasn’t happening when I trained in this program a decade ago.”

Preparing for the transition to a single graduate medical accreditation system, the program applied for and received osteopathic recognition from the ACGME last year. “We felt strongly about applying for osteopathic recognition because we wanted to maintain our osteopathic identity,” Dr. Raj says.

Providing unified care

Maintaining an emphasis on osteopathic training has played a big role in unifying the program’s DO and MD residents, according to Dr. Raj.

Cory Fisher, DO (left), the associate director of osteopathic curriculum for Fairview Hospital-Cleveland Clinic's family medicine residency program, instructs faculty members during a faculty development session. (Photo provided by Kelly Raj, DO)

Since the program became dually accredited, all of its MD residents have participated in the additional osteopathic training that DO residents receive, and osteopathic recognition underscores the importance of each resident—DO or MD—understanding the osteopathic philosophy.

By receiving osteopathic training, every MD resident who’s come through the program has learned valuable takeaways about the osteopathic approach to family medicine and the benefits of OMT, Dr. Raj says.

This helps to spread the reach of osteopathic medicine, she adds. With a greater awareness of how OMT works, MD residents are more likely to recommend it to patients.

“Our allopathic residents become more motivated to seek out OMT in their outpatient clinics,” she says. “And they often include OMT as an option in their treatment plans.”

How recognition benefits DOs

Having osteopathic recognition, and emphasizing osteopathic training, also benefits DO residents, Dr. Raj notes.

“DOs are trained that the body is a unit, with the capability to heal itself,” she says. “That notion can get lost in modern medicine. Sometimes, physicians are just writing prescriptions, and patients are even coming in expecting a prescription.”

By committing to osteopathic training and osteopathic recognition, residency programs are helping maintain the osteopathic philosophy students are taught in osteopathic medical school, according to Dr. Raj. “They’re helping maintain the integrity of osteopathic medicine in the modern era,” she says.

Dr. Raj encourages other programs to apply for osteopathic recognition, noting that many osteopathic residency programs are probably already fulfilling many of the requirements for recognition.

At any point in the application cycle, programs are also encouraged to use the AOA’s application assistance program, a free service providing access to advice from AOA staff experts and consultants who are familiar with single GME transition processes.

    12 comments

    1. Kudos to Drs. Raj, Snyder and the entire faculty at Fairview. Their DO and MD residents are engaged and energetic. Their positive and supportive approach is preparing our next generation of family docs to lead our profession. A great place to train and work. Keep it up!

    2. How is an MD resident who completes a training program that carries osteopathic recognition to be addressed? “MD-DO?”
      What added benefit does this offer our DO residents who train(ed) in a program that was previously only AOA certified? Given that programs already had in place an osteopathic training curriculum.
      I see osteopathic recognition as merely a “bone” thrown to the osteopathic training programs that have essentially been told that what you were doing before was “not good enough” to be considered equal with ACGME standards. Please note that every turn, whenever there was a conflict in training standards that the ACGME standard won out.
      WE ARE LOOSING OUR IDENTITY AND “OSTEOPATHIC RECOGNITION” IS NOT THE WAY TO SOLVE IT.

    3. Losing the “osteopathic identity” is a must in this day and age. It is holding our fellow DOs back from advancing our careers and our marketability. Merging with the ACGME and identifying with MDs is the best thing we can do to further advance our antiquated “osteopathic identity”

    4. You, Michael, obviously, are not a student of history. I recommend to you the book “The DO’s: Osteopathic Medicine in America” by Norman Gevitz.

    5. We need to shift from “osteopathic medicine” to just medicine. The word Ostepathic means nothing and only serves to delegitimize our training.

    6. If osteopathic “means nothing”, then I might as well tear up my degree and quit practicing along with the thousands of other proud, practicing DO’s who CHOSE to become a DO.
      You, cynic1 are a disgrace to our profession.

    7. You, Doug, are taking advantage of people with osteopathic examination and treatment. I utilize evidence based medicine in my practice. I will not use OMT (nor bill my patients for it) until there is any evidence for its benefit/effectiveness. Evidence which has yet to be proven in over 100years…. There should be no ‘osteopathic medicine.’ There should only be medicine.

      1. I’ve done plenty, Doug. There has yet to be a high-powered convincing prospective study on anything proving the value or effectiveness of OMT. An n=10 study published in the Osteopathic journal does nothing

    8. I support the concept of osteopathic recognition, however, in its current form it provides no level of benefit to the resident. There is no additional certification for the additional training tied to the additional expense and requirements. I am proud to be a DO and proud of osteopathy, but osteopathic recognition in its current form is toothless and wanting for revision.

    9. Bickering does nothing to solve these arguments. The osteopathic profession has given me a wonderful opportunity to practice cardiovascular medicine and I am not afraid to touch people physically to augment my diagnosis and treatment plan. To argue that ‘osteopathic medicine’ means nothing is degrading to all of us DO’s and to the person whose own insecurity allows him/her to think this way. Medicine is a huge responsibility and a privilege granted by God and our osteopathic training institutions. I did my internship and residency in osteopathic programs then went to Cleveland Clinic and UPMC for additional training. I am grateful and proud to represent my profession and unless you are insecure about your own knowledge, you should also be thankful and proud of this opportunity. James AM Smith DO Wichita, KS

    10. I think Michael and Cynic do a pretty apt job at characterizing the mindset of the new generation of DO’s.

      The AOA/COCA may find this a bitter pill to swallow, but it’s the reality.

      The percentage of DO’s actually using OMM is quite small, which is not so say it doesn’t have a roll in treating some MSK conditions. The problem that the current generation has, and especially the ones that beat the evidence-based drum, are with the dubious aspects such as cranial and chapman’s points.

      These should be done away with, and focus put into more substantiated practices.

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