Opinion

It’s time to rethink what it means to be a DO

The two pathways to AOA board certification will accommodate the realities of modern osteopathic medicine by more accurately validating how physicians practice.

Editor’s note: This is an opinion piece; the views expressed are the author’s own and do not necessarily represent the views of The DO or the AOA.

The future of our profession lies in our ability to come together with a unified voice. We must also recognize that the practice of osteopathic medicine, and the training of osteopathic physicians, has evolved significantly since A.T. Still, MD, DO, created osteopathy.

The AOA recognized this when its Board of Trustees announced that the AOA will start providing two pathways for board certification. DOs will be able to choose to become board certified:

  • 1. In the osteopathic practice of their specialty, or:
  • 2. In their specialty only by taking an initial certification exam without osteopathic content.

A different generation

We are a different generation of DOs. The vast majority of graduating DOs entered osteopathic medical school far more interested in earning the “Dr.” in front of their name than the “DO” after it, and almost 75% of applicants to DO schools even applied to MD schools the same year or the year before.

Following graduation from DO school, the majority of DOs enter residencies without osteopathic recognition, obtain board certification through ABMS rather than the AOA, and rarely (if ever) use osteopathic manipulative treatment in their daily practice of medicine.

Seger S. Morris, DO, MBA

This isn’t to say we aren’t a different breed of physicians than our allopathic colleagues. We still pride ourselves on less objective measurements of “The DO Difference” like empathy, bedside manner, communication skills and our holistic approach to healing the patient.

However, we no longer have a patent on this approach to patient care. MD schools and ACGME standards are now emphasizing these characteristics more. While some may choose to further validate these skills—along with OMT—by choosing board certification in the osteopathic practice of their specialty, this “DO Difference” is instilled in us mostly as we earn our Doctor of Osteopathic Medicine degree. Once a DO, always a DO.

I am a third-generation DO from a family with more than 15 osteopathic physicians. I completed an AOA residency and am board certified by the American Osteopathic Board of Internal Medicine. I seek OMT above all else as treatment for my personal chronic musculoskeletal conditions.

The realities of modern osteopathic medicine

I’m proud to adhere to osteopathic principles and practice (OPP) as a physician, but I do not use OMT in my daily practice as a hospitalist. It simply was not emphasized in my training program. I consider myself to be an “osteopathic physician who is board certified in internal medicine” as opposed to a “physician board certified in osteopathic internal medicine.” Osteopathic medicine is integral to how I practice, but I don’t feel the need to validate that beyond my DO degree. On the other hand, those who wish to do so will have the option to take an exam that’s even stronger than ever before.

Simply put, the two pathways for AOA board certification will accommodate the realities of modern osteopathic medicine by more accurately validating how physicians practice.

Additionally, these two pathways will allow the AOA to further advance its mission and vision by offering board certification services to physicians who don’t hold the DO degree. MDs across the country are engaged with osteopathic medicine in clinical practice and in training. Those enrolled in ACGME training programs with osteopathic recognition deserve the opportunity to validate their learned skills in OPP and OMT, and the AOA is right to open osteopathic board certification to these individuals.

Providing a pathway to specialty certification that does not validate osteopathic knowledge or skills also provides physicians, both DO and MD, who are seeking a more focused specialty certification (either by choice or by virtue of their training) with a nationally recognized alternative to ABMS. This is a tremendous opportunity for the AOA to expose an entirely new demographic to the culture, philosophy and practice of osteopathic medicine.

Join me in this exciting time of change by supporting the two pathways for AOA board certification with a unified voice.

Related reading:

AOA board certification will soon include two pathways

16 comments

  1. Bravo. Now modify the degree in some way so that patients don’t look up “osteopathy” and get “bone disease”. Maybe: M/DO.

    1. I suggested the “MDO” degree change back in the ‘70s, and was labeled a “black sheep of the family”. It reflects modern DOs. Perhaps those of us who agree, could use “MDOBS”. The “BS” is for black sheep”

  2. 2 comments, one administrative, one practical (as in “practice.”)

    1. “MD” is a generic term; literally translated, it is “Doctor of Medicine.” “MDA” and “MDO” (MD-A/MD-O?) would be more correct, designating one trained in allopathic philosophy, the other in osteopathic philosophy.

    2. It is the osteopathic philosophy that distinguishes us; the use of manipulation is logical but derivative. When we reverse this, we confuse others into thinking we’re chiropractors. Eventually we will confuse even ourselves.

  3. Historical Perspective:

    The time to “rethink” what it means to be a D.O. was around 2009 when the core competencies were being seriously examined.

    D.O.’s had the opportunity then to define themselves without defining themselves in the shadow of the M.D. degree. The A.O.A. leadership made the choice not to do so.

    The conscious decision to let some other entity define the profession was unwise. None-the-less it was the A.O.A.’s decision. The merger was in the workings and the rest shall we say is now history.

  4. The second option is a bit confusing to me. Will the AOA speciality boards accept the ABIM specialty boards for those DO’s who received training in allopathic programs?

  5. There is no excuse for any DO, no matter what specialty, for not using OMT on every patient. I did not use OMT for the first 10 years I was in practice, certified in Family Medicine. When I became proficient at Strain-Counterstrain (S-CS), it changed everything. The incredible value it affords in making a diagnosis as well as performing a safe and incredibly effective treatment, should make S-CS an indispensable part of every DO’s practice. I advise every DO to become proficient at S-CS. I asked Dr. Lawrence Jones how best to learn his technique (after he removed my chronic torticollis in 90 seconds) and he told me “practice, practice and practice”. I listened to him and it changed my Family Practice practice and my life. No other OMT modality is easier and more effective than S-CS.

    1. No excuse for not using OMT, no matter the specialty? I’m just a diagnostic radiologist. Please help me understand.

      1. Kenneth, you could consider Pamela Lee Wilson, DO.
        She’s the diagnostic radiologist who presented her research at this years AAO Convocation on the respiratory motion of the thoracic and abdominal organs and implications for osteopathic treatment. It was amazing and the profession could really benefit from more diagnostic radiologists like her.
        Not only is she advancing the research base for OMT with her expertise in diagnostic radiology, she has her own OMM practice too.
        It has always been my personal opinion that osteopathic radiologists and surgeons would make the absolute best practitioners of OMM because of their vast, deep working knowledge of anatomy.
        If you are interested Kenneth, you have the makings of a physician who could really help the profession and patients with your training. No specialty should discount OMT.
        In addition to Dr. Wilson in radiology, there is also Dr. Hujiz, Psychiatrist in Colorado Springs who incorporates OMM in his practice and has spoke nationally.

  6. Ahh OMT, the reason I chose osteopathic Medicine, so this is where we are at now….
    Years of uninterested DOs filling the growing osteopathic schools. Those students who that are receptive getting lost in rotations, or getting in to residency where the skills are shelved.
    DOs now make up one quarter of the US medical students. Sadly, there is just a fraction that care about OMT, and of those just a fraction that will use it in their practices.
    Decades of this trend and we find ourselves now proposing cutting OMT out of osteopathic boards and changing the requirement at osteopathic schools that the chair of the OMM department no longer needs board certification in NMM/OMM.
    Those students who will have no interest in OMT now have a valid reason not to engage in mastering these skills, and those who are interested will possibly be taught by a faculty chaired by a physician who may not have a complete skill set.
    Students will not see the value in OMT if their education itself is not valuable. Physicians will not see the value in OMT if their own AOA discounts it as an adjunct.
    For those who don’t take the OMT portion of their boards, they should not have the privilege to use it. MDs interested should be trained and allowed to sit for a OMT portion of their boards.
    Physicians who want to use OMT and bill would need proof of training. Perhaps then you would see a growing appreciation for the value of this unique and distinct aspect of our profession among all physicians

  7. Please clarify.

    For those of us currently board certified in FM/OMT who are up for RECERTIFICATION in 2019-2020, how does this effect us? Are we able to choose option 2 or must continue w/ the OMT pathway?

  8. So far not mentioned here:

    I believe the decline in emphasis on OMT has a direct relation to the current healthcare environment, i.e. pressure to see more patients with less time. Why use your hands when the urge is there to just medicate in a fraction of the time? As a pulmonologist I more so like using ENT and visceral techniques, but it’s hard when the waiting room is packed and/or the hospital census surges…

  9. This is disheartening to say the least. Rather than improving the osteopathic experience and fostering the usage of OMT by practicing physicians, let’s remove it fully. Many of our incoming students have no idea what OMT is , let alone how they will implement OMT into a specialty that they have not chosen? While you say they also interview at allopathic schools and they are more interested in the DR than the DO, most have little to no idea what the DO actually stands for. Sure, you can Google it but we all know the dangers of misinformation that happen with that. We should be doing a better job as a profession of advertising and raising awareness of what we do. We should be encouraging practicing osteopaths to use, refine and refresh their OMT skills so that they can better teach the next generation. Instead, we are allowing the “new generation” to opt out of one of our defining talents. Not because of any rational reason that is given, simply because they don’t want to learn it. We don’t apply that to any other medical skill. You don’t want to learn how to do a PAP because you want to do Ortho? OK! No PAPs for you on your OB/GYN rotation. You are going to be a radiologist? Great! Don’t worry about learning how to do a physical exam in med school or read an EKG since you won’t do it it practice! This is what you propose for OMT. How un-holistic.

  10. Dr. Morris, you state “osteopathic medicine is integral to how I practice”. Can you say more about that? How do you feel that is true for you in your practice?
    I disagree that “The DO Difference” is (or has ever been) about empathy, bedside manner, communication skills or “our holistic approach to healing the patient”. DOs do not have, nor have we ever had, a monopoly on any of those things. “The DO Difference”, in my opinion, is that we are taught to touch our patients, to understand how the musculoskeletal system influences every other body system, and to change the condition of the patient by treating their physiology, structure, and function. We are taught to help return the body to homeostasis. I think DOs who bother to use their hands-on skills offer a world of wonders to their patients, and that’s the real DO difference.

  11. I disagree with your comments Dr. Morris. I have been teaching medical students and residents for quite a number of years (DO AND MD). DOs learn differently from the very beginning. Our COMs integrate holistic components of care from the very beginning and it shows. Their history and exam skills are more polished earlier in training. They are more comfortable touching patients when examining or treating because of our their interactions in OMT lab. While there may be a number of students not interested in providing OMT in the current COM population – to say our degree name should change devalues the overall philosophy taught. I use OMT daily. I am not sure what I would do for a number of patient conditions without these skills. Pills are not the solution for a good deal of patients and they certainly do not achieve a cure quicker in many. I am a D.O. and I would have it no other way!

  12. Wow! If it is true that our students are more interested in being known as “Dr.” instead of being known as a D.O., then I am filled with sadness.

    Furthermore, if we think M.D. graduates are going to take D.O. boards we are flirting with delusional thinking.

    It’s good to be old!

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