The current state of the osteopathic profession: An in-depth discussion with two veteran DOs, continued

Last month, Brian Loveless, DO, sat down with two physician leaders, Richard Thacker, DO, and Sarah Wolff, DO, to discuss the present and future of osteopathic medicine. This column is a continuation of their conversation. For the first half of this discussion, please read the previous column. The second half of the interview follows:

What would be a best-case and worst-case scenario for the osteopathic profession in the next ten to 15 years?

Dr. Thacker: Sometimes the worst-case and the best-case are tied very closely together; that’s the unprecedented growth in our profession. I’m for growth, but it’s got to be managed. I attended the fifteenth school chartered in 1979, and it was years before another DO school was established. After that, they really started to pick up. Through the years, there were concerns that the number of GME positions did not align with the number of graduating students, and I don’t think that’s necessarily the case anymore.

What is the problem? Is it the access to preceptors and clerkships, particularly in pediatrics and training with osteopathic-minded physicians who are going to demonstrate and continue to utilize the skills and philosophy that they were taught in school? Even with all of this growth, the students are going to be residents and subsequent physicians. You’ve got to have a willingness to give back and to continue to pay it forward. That means we’re standing on the shoulders of others, but are we letting other people stand on our shoulders and, if so, how are we supporting them?

I’m now in education after a very successful practice. I wasn’t burned out. I wasn’t necessarily done with my practice, but I had an osteopathic school spring up in my backyard and I wanted to be part of it. I jumped on board, and the one thing that I love doing is helping to train students. One of the things I tell them is, “When you’re ready, I want you to train some medical students too.”

Maybe some people will say that when we developed Osteopathic Recognition as part of the single accreditation system, we lost a little bit of our edge and ability to innovate. Osteopathic Recognition is the goal, but less than 20% of the programs are on board. The risk is that as we grow and expand, we could lose some of our distinctiveness. If you want to get even more granular on a national and state-by-state level, where is the membership in our osteopathic organizations and associations? Where are our state medical boards? Are they mixed boards or are they unique and separate?

My state of Florida has a distinct osteopathic board of medicine. That’s great, but every once in a while, that rears its ugly head on the legislative floor. Why do we have two boards? Why do we have different board certifications? It’s going to get harder to defend some of our positions if we don’t maintain our distinctiveness and get back to innovating. We don’t own primary care, but we have staked a lot on that over the years and it has served us well. I think the osteopathic profession does primary care better than anyone. We don’t want to get too far from that.

Dr. Wolff: I can piggyback. I feel pretty similar about a lot of things. I think the opportunity threat is that hard science can be memorized. You can give someone a book, and if they study it long enough, they should be able to memorize it, especially with the smart students that we admit. But what we can’t do is just have them read and learn the art of medicine. If we’re not spending time teaching and cultivating the art of medicine in teaching programs, be that with schools or residencies, then that’s where we’re losing.

Because all of the other stuff has opportunities, with educational growth to be given in 15 different formats, and eventually education could in 20 years look completely different than it does now. It could be that all you have to do is prove that you’ve read these books or watched this many videos and take a test at the end of it and therefore you are educated. What we really need to focus on are the elements that require the finesse of a position to understand and teach and give back.

I worry that with the growth of schools, if we don’t spend time teaching real skills, we are no different 20 years down the road than anyone else. I need to be the best physician I can be for my patients. They deserve that. And that can’t be achieved through memorization of a book: it is all of those pieces that take the right kind of teacher to teach.

I think it’s an opportunity to change the way we’re thinking because level one is now a pass/fail system. This benchmark that we’ve arbitrarily leaned on for years just changed. What we care about now is the clinical aspect. It’s how you relate to patients. It’s how you can synthesize material. It’s how you understand that a patient doesn’t present as the bullet-pointed textbook case you studied. If we realize that the important part was always what we learned in those second two years, in the unique way that we approach patients and the art of medicine, then we’ve got it. I think the next five to 10 years will provide a benchmark to see if we can get there.

Dr. Thacker: One of the first things that I’m asked about medical school is, what’s the difference between MDs and DOs? Well, I like to think that it starts with the students that are selected. I still want to believe that although it has kind of changed a little bit, the first week on campus generally involves our hands on theirs; we’re all utilizing our hands and touching people. I truly believe in the DO touch, even from the moment I come into the exam room and shake someone’s hand; I believe that that’s the first aspect of building trust.

Dr. Wolff: In some ways, it’s paradoxical: the rest of the world looks at DEI for students in education. The students want education the way that they want it. They’re going to tell you how they think it’s best, and it’s the same way that their friend who goes to another school is being taught. One of the opportunities that we have is to really say, “No, we’re branding this school. This is what we do. We want you to come here. We think it’s great. We think you’re going to be a great physician because of these specific skills we teach you.”

Any closing thoughts?

Dr. Wolff: I think we all know that COVID was a blessing and a curse. Mostly the curse, but the blessing of it is that we had to rethink things that we did just because we did them that way for so long. Education is a real prime example of this. We always taught in the same way, then someone would break the mold a little bit, but not much. Now we have the ability and the need to redesign and reassess the system. The same idea applies to medicine.

I think we need to continue to assess our institutions and practices to ensure they make sense in this newer world, because we should feel a sense of belonging to our organization. I think that in our associations, be it small state, specialty, large state, affiliate, etc., we really need to stop and think about how we’re doing things and why we’re doing things, and if it makes sense for the future.

The profession and who it is today is certainly not who it’s going to be tomorrow, and we can’t really rely on who it was in the past. We need to keep all of that memory with us because history will repeat itself. We need to continually reassess how to make sure that we engage and keep our family together.

Dr. Thacker: I love the concept of the House of Medicine and all of the folks that participate in it, and we’ve carved out our rightful place there. There’s a lot of folks that want to live in this house, and we can cohabitate together, but if we’re not utilizing the whole house, someone else will take up space in every room in the house, from the attic to the basement.

Osteopathic physicians have earned their rightful place in the House of Medicine. I want to see us continue to do that. If we vacate a certain area, such as primary care, or lessen ourselves in some way, then somebody else will fill that void and take up that space. I truly believe that we need to self-regulate, and if we don’t, someone else will regulate us.

Every osteopathic physician and resident and student should get involved in advocacy, public policy and education. We all need to be part of training the next generation. If you can’t give your time and energy and expertise, then give your treasure to contribute to political action, and at the very least join your medical associations.

I’m on the AOA Board of Trustees. If you don’t believe that the AOA is representing you and you’re not getting value for your money, then help me and others figure out how to deliver more value. Join your state and local osteopathic associations, because we still, even in this day and age, have distinctively unique issues that only other DOs can help us navigate.

I’m obviously a big proponent of staying involved and I think the average physician, DO or MD, could do a lot more for the House of Medicine.

Dr. Wolff: I agree. I don’t think it’s a one-size-fits-all. For some, it may be as simple as money and for others, it may be time and still for others it’s legislative or research. I think you should find whatever it is that fills that bucket in your heart, but still contributes to the betterment of patient care and medicine and the profession.

Following this path has led me to life-long relationships with like-minded people I would never have met otherwise. I have friends across the country now just because I decided to jump in and participate in things that I already wanted to do. There’s someone across the country that understands me better than my next-door neighbor does because we fight the same issues in different locations. Pick something that you’re passionate about and give to the profession in that way.

Related reading:

Thoughts on defending the osteopathic medical profession

Brand identity: Highlighting the osteopathic physician’s distinctiveness