Leadership

The state of DO-MD relations: This emergency medicine physician has a unique take

Marilyn Heine, MD, is married to Arlin Silberman, DO, and has spent her medical career collaborating with the osteopathic profession.

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Although members of the media have recently suggested that there’s a pervasive sense of competition between MDs and DOs, Marilyn Heine, MD, says that hasn’t been her experience.

“I see solidarity among MDs and DOs,” says Dr. Heine, a clinical assistant professor of medicine at Drexel University College of Medicine. “This has been the case since my medical school days, when osteopathic and allopathic medical students were in the same lecture halls and labs. As a resident, fellow, and now as an attending, I have witnessed and enjoyed great cooperation and collegial relationships between MD and DO physicians.”

Dr. Heine is married to Arlin Silberman, DO, a clinical associate professor of psychiatry at the Philadelphia College of Osteopathic Medicine. In this edited Q&A, she discusses DO-MD relations, how she has advocated for the osteopathic profession, and her perspective on the single GME accreditation system.

How did you get into medicine? When you chose a specialty, what drew you to emergency medicine?

Growing up, I was inspired by the stories of individuals who helped others who are less fortunate – leaders at the local, national, and international levels – and family members in their daily activities. My viola teacher encouraged me to consider becoming a music therapist. My mother, a phenomenal educator, suggested that I consider becoming a physician. Two of my uncles were physicians, and they were known for compassionate care in their communities.

My route to emergency medicine was via hematology oncology. During medical school, I worked with remarkable oncologists in New Jersey and at the National Cancer Institute whose approach exemplified person-centered care. My postgraduate training was in internal medicine, hematology and oncology. After two years of every other night and weekend on call, I met my husband, who advised that I consider a practice change for more flexible hours and more opportunity to provide patients with immediate benefit.

Regional emergency departments were recruiting internal medicine trained physicians to join them. I made the transition to emergency medicine with excellent support from my colleagues and additional training. Ever since then, I have worked clinically in both emergency medicine and hematology oncology.

All along, I maintained my appointment as Clinical Assistant Professor of Medicine at Drexel University College of Medicine, and for many years I was also on the faculty of the Philadelphia College of Osteopathic Medicine. I am honored to serve as faculty on hematology oncology emergencies and advocate for the profession with the American College of Emergency Physicians and via other conferences. Throughout my training and career, I have had wonderful mentors, including colleagues who are MDs and DOs. 

You’re an MD. Your husband is a DO. How did you meet?

Mutual friends introduced us. At the time that we first met, he was an attending physician in addiction psychiatry and I was a fellow.  

Many issues important to physicians aren’t specific to osteopathic or allopathic physicians. What are some of these issues that unite MDs and DOs?

MDs and DOs face myriad issues where we advocate collaboratively. Here are a few examples: physician practice challenges such as prior authorization and Medicare physician payment, scope of practice, public health, the COVID-19 pandemic, graduate medical education, and physician wellness.

As President of the Pennsylvania Medical Society (PAMED), I embraced opportunities to work with MD and DO members and in concert with the Pennsylvania Osteopathic Medical Association. As Chair of the State Board of Medicine, I valued our relationship with the State Board of Osteopathic Medicine. And, as Chair of a Congressional Physicians Advisory Board, I include MD and DO physicians.

Once, when my husband was attending an AOA conference, the AOA hosted a Town Hall meeting with a Congressional leader. Since I am passionate about advocacy for physicians and patients, I enthusiastically attended, promoted legislation to ensure a key protection for patients who seek emergency care, and learned that legislators are not always aware of the importance of specifying that benefits should apply to both MD and DO physicians.

My heightened awareness helped years later when a bill was moving through our state legislature with a provision that would have helped only allopathic physicians; I secured an amendment so that osteopathic physicians would also benefit.

What kind of impact is the single GME accreditation system having on the relationship between DOs and MDs?

The increased opportunities to work together in graduate medical education programs enhances the camaraderie, communication, and mutual understanding between DOs and MDs.

You and your husband are members of multiple associations in organized medicine. Why is it important for you to volunteer?

My husband was instrumental to the development and success of the American Osteopathic Academy of Addiction Medicine (AOAAM). A former President and long-time Secretary Treasurer of the AOAAM, he is committed to ensuring an effective voice for osteopathic physicians interested in addiction medicine. 

I have been honored to hold prominent positions in county, state, and national medical associations, including President of PAMED and Chair of the AMA Council on Legislation. It is imperative for physicians to advocate for patients not only at the bedside but also with our legislators who impact our practice of medicine and within our organizations.

What’s your next challenge?

As my service on the AMA Council on Legislation concludes in June of 2022, I have been nominated for a seat on the AMA Board of Trustees.

Related reading:

Future osteopathic physicians embrace growing lifestyle medicine field

An MD student reflects on learning osteopathic manipulative medicine from a DO

One comment

  1. Patrice

    As an MD, PhD in France, I had been working as a clinician in internal medicine and researcher at INSERM for 15 years when I started to learn osteopathic medicine. After 3 years of training, I ended practicing osteopathic manipulations (mostly based on techniques from A.T. Still, founder of osteopathic medicine in Chicago) 3 half-days a week. Then I moved to the US, 25 years ago and worked only in biotech. But I have been rowing for many years and I now have bilateral carpal tunnel, TOS and C1-C2 symptoms, and I have not been able so far to find a DO who could really adjust my neck. It seems that in the US, DOs are too scary to do real manipulations as it was performed by Still in the old days.

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