All about NMM/OMM

What I wish other doctors knew about NMM/OMM

I’m here to tell you why there is a specialty for something we all learn in medical school and when to refer patients to NMM/OMM specialists.

Brian Loveless, DO

Brian Loveless, DO, is the chief medical officer of WesternU Health.

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There is quite a lot of confusion around the specialty of Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine (NMM/OMM). As faculty at an osteopathic medical school in the department of NMM/OMM, one of the questions I get often from our medical students is how to pursue NMM/OMM as a specialty. In a similar vein, many of my colleagues are confused as to why there is a specialty in something we all learn in school, or when to refer patients to NMM specialists as opposed to when to do the treatment themselves. I’m hoping to clear up some of that confusion.

The evolution of the specialty

The specialty of NMM/OMM is young by medical standards. In the 1960s a certification in OMM called the Special Proficiency in OMM (CSPOMM) was established. In 1999, the certification was retitled to Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine. It was administered by the American Osteopathic Board of Neuromusculoskeletal Medicine (AOBNMM). To become certified in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine, physicians must pass a written, oral, and practical exam. To maintain certification in NMM/OMM, physicians must participate in Osteopathic Continuous Certification.

Prior to the transition to the single graduate medical education accreditation system, there were multiple pathways for DOs to enter AOA-accredited residency programs in NMM/OMM. DOs could enter a two-year NMM/OMM residency after completion of an internship, enter a one-year NMM “Plus One” after the completion of residency, or complete a four-year integrated residency in family medicine/NMM or internal medicine/NMM.

As part of the transition to a single GME accreditation system,  the Accreditation Council for Graduate Medical Education (ACGME) recognized osteopathic neuromusculoskeletal medicine (ONMM) as a specialty and began accrediting ONMM programs. Now, DOs, MDs and international medical graduates can complete ACGME-accredited residency programs in ONMM. Under the ACGME requirements, residents can enter a three-year ONMM residency, a two-year ONMM residency after completion of a PGY1 year, or a one-year ONMM residency after completion of an ACGME-accredited residency program.

During ONMM residency, the focus is on not only developing improved hands-on skills in diagnosis and treatment on a variety of patients in a variety of settings, but also on a deeper exploration of osteopathic principles, including scholarly activity.

Many NMM/OMM physicians engage in research, and certification in NMM/OMM is considered a prerequisite for most academic positions. There is also a particular focus on inpatient and post-surgical treatment, as well as exposure to special populations such as obstetrics and pediatrics. Thus NMM/OMM specialists are engaged in a broad range of practice locations. Many hospitals offer inpatient NMM/OMM services.

Referring patients

When should you refer a patient to an NMM/OMM specialist? Of course, all osteopathic physicians are competent at graduation to perform osteopathic manipulative treatment (OMT), but not all use OMT in their practices. If you are not comfortable performing OMT or don’t feel that you have the time to do it, finding an NMM/OMM specialist in your area will be helpful for your patients who need OMT. You can also refer to an NMM/OMM specialist your complex patients who haven’t been responding to the OMT that is already being provided by their primary doctor. Patients who need osteopathic cranial manipulative medicine (OCMM) or other approaches which are beyond the scope of the average osteopathic physician are perfect referrals.

If your hospital has an OMT service, don’t think it is just for musculoskeletal complaints. OMT is indicated for many systemic complaints, such as pneumonia, post-op ileus or acute post-op pain. But thinking more broadly, if your patient would benefit from autonomic balance, fluid (lymphatic) movement or improved breathing, then we can help. And I’m sure most of your patients in the hospital can benefit from that type of treatment.

Learning more and refining skills

Finally, we are always ready and willing to teach! If you want to improve your skills, to figure out how to efficiently and effectively treat your patients in the inpatient or outpatient setting or are looking for the latest research documenting the effectiveness of OMT, don’t hesitate to ask. We would rather have more osteopathic physicians doing a little bit of OMT on everyone who needs it because patients currently will sometimes wait weeks to see an NMM/OMM specialist for a simple treatment.

Related reading:

What I wish other doctors knew about PM&R

Internal medicine: What other docs should know

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12 comments

  1. Rajiv Yadava

    After being in practice for 30 years I think OMM should being part of a 3 year FM residency which incorporate functional medicine. That is probably not going to happen anytime soon.
    But boy…what an experience base that would be to start practice.

    Reply

    2. Susan Cislo, DO

      ::waves hi.
      Seriously, our kind are out there but you have to look. You can call the DO’s in the directories around you and ask what they do to treat asthma, irritable bowel, preterm labor or any other of the visceral issues you are concerned with. Basically, the way we practice, if it requires a blood or nerve supply to be healthy, we can treat it. You should not have to do that kind of calling around, but it is no different from me having to call cardiologists in my area to find out what they do to adjust screening and treatment in hypermobile or autoimmune patients. Both have recognized increased cardiac risk, yet most cardiologists give me a deer-in-the-headlights stare when the subject comes up. This kind of cluelessness is endemic in modern medicine, and is a consequence of teaching and treating via algorithms, worrying more about the performance metrics of test questions rather than teaching thought process and integration of information. But that is what we have. So call and build your referral network, and good luck.

      Reply

    4. Stephen Cavanaugh

      I usually go to osteopathic cranial academy website and do a zip code search. There are areas of the country where there aren’t members, but many areas have one.

      Reply

  6. hasan c

    couple of things
    1) honestly im not sure if MDs or non-DOs should be doing OMT, but at least they will be trained and familiar with it. but to be board certified in it? it should be DOs

    2) functional medicine is dicey. at best every DO should be boarded in Lifestyle Medicine for sure. but functional medicine is something that many clinicians (many of which are not MDs/DOs) are not practicing evidence based treatments. some functional medicine clinicians are totally amazing but some are practicing things that have not be rigorously studied or practiced.

    Reply

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