Osteopathic manipulative treatment is one of the main factors that distinguishes osteopathic physicians from their allopathic counterparts.
However, I’ve noticed that fewer DOs these days are incorporating OMT into their practice of medicine, and fewer attending physicians, who are tasked with training the next generation of DOs, are teaching manipulation. Why is this?
Some of the reasons may be the myths surrounding OMT. To summarize the more common ones:
- OMT is too hard, takes too long to master.
- OMT takes too long to perform during an office visit.
- OMT does not work or is potentially dangerous.
- It does not pay to do OMT.
- If it works, why aren’t all DOs doing it?
Please allow me to dispute each myth.
1. OMT takes too long to master.
Osteopathic medical students spend the first two years of their education learning palpation and the skills to practice OMT. Part of their frustration with OMT may be that the nomenclature used to describe lesions is often complicated and nonstandardized among the medical schools.
If osteopathic medical schools could simplify the terminology, spend more time teaching how osteopathic manipulation works and hire preceptors who are passionate about OMT, students could be more enthused about OMT. In one month, my medical students learn to be very comfortable using OMT because I use efficient nomenclature and techniques.
2. OMT takes too long to perform in a practice setting.
Using palpatory skills alone, a practitioner can easily identify the vertebrae that are out of place. Diagnosis and treatment can take less than 10 minutes with efficient HVLA (High-Velocity Low-Amplitude), FPR (Facilitated Positional Release), Still and muscle energy techniques. As one’s skill level increases, it can take even less time.
3. OMT does not work.
Many students are understandably frustrated when they have difficulty manipulating their classmates. It takes persistence, patience and good instruction to “lock out” lesions and to correctly apply gentle forces.
Taking a few moments to explain the techniques and its benefits can put the patient at ease, which makes for a much easier and safer manipulation.
In my own practice, it is common to see several “miracles” a day, where patients have been going to specialists for years without any answers to why they are hurting. Often after one OMT treatment they are pain free. When done properly, OMT can help many patients and give you an amazing reputation.
4. It does not pay to do OMT.
With proper documentation, you can be well paid for doing OMT. This documentation takes no more time than documenting for a regular visit.
For billing, you need to submit a proper E/M code with a modifier 25 for the OMT. You get paid for both. Many of the problems that we see in a primary care setting have to do with back pain, and using our training to diagnose and fix these problems can be invaluable to a practice’s success.
5. Why aren’t all DOs using OMT in their practices?
OMT is mostly used in primary care practices and specialties such as emergency medicine, physical medicine and rehabilitation, and neuromusculoskeletal medicine. Of course, some specialties and subspecialties have less use for it.
Part of the reason fewer medical students see OMT in practice may be because fewer primary care physicians are comfortable performing OMT. This can be fixed by offering more seminars taught by physicians who are skilled at using OMT in their practices.
It would be a tragedy if OMT, which can dramatically increase the well-being of our patients, falls by the wayside. We have this amazing diagnostic/treatment modality that is part of our “DNA,” and more of us should be using it.