November 25, 2020, 8:51 am Shyam Odeti, M.D., M.S. -- “Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.”
– Martin Luther King Jr.
More than 150 years after the philosophy of osteopathic medicine was developed, ignorance should not be an excuse for the trauma inflicted on the roughly 150,000 osteopathic physicians and trainees in the workforce by those who do not understand its extensive contributions to the health of Americans or the value it brings to health care.
I have heard from my D.O. colleagues and students who expressed their dismay in recent months regarding uninformed, derogatory statements related to osteopathic medicine in advertising, the press and social media. Although I offered support to my colleagues on a personal level, I was left wondering who will push back on these assaults, which are not only an affront to D.O.s but to the entire physician community and the patients who trust their physicians – regardless of the abbreviation behind those doctors’ names.
There is no data to support the idea that osteopathic training is inferior to allopathic training, and a well-trained, licensed physician – D.O. or M.D. – should never have to justify their training or degree’s credibility. As an M.D. colleague, teacher, friend and family doc, I strongly suggest that it is our responsibility to stand together when our profession is dragged by pundits and pitchmen. Given a chance to inform the uninformed on this issue, here are some pertinent facts we can share.
Osteopathic medicine was founded by Dr. Andrew Taylor Still in 1874, and he subsequently opened the first school of osteopathic medicine in Kirksville, Mo., in 1892. The salient philosophy of osteopathic medicine is a holistic approach to patient care; all body systems are interrelated and dependent on one another for good health. Osteopathic medicine also pioneered the concept of wellness and recognized the importance of treating illness within the context of the whole body.
There are more than 121,000 osteopathic physicians in the United States. They now account for 11% of all practicing physicians in the country (and the percentage is even higher in family medicine), and their numbers are rising dramatically. In the 2020 National Resident Matching Program Main Residency Match, 32% of students who matched to family medicine residencies were D.O.s. Even though there are far fewer osteopathic medical schools than allopathic medical schools in the United States, all together osteopathic schools graduate almost as many students into family medicine as the allopathic schools (1,557 U.S. M.D. students compared to 1,399 D.O. students in the 2020 Match).
Requirements to get into osteopathic and allopathic schools are identical, and their outcomes are similar. From 2018 to 2020, the average MCAT scores for allopathic medical school applicants was 506.1, compared to 503.8 for osteopathic applicants.
Training for both degrees includes four years of schooling with 12 to 24 months of pre-clinical coursework followed by clinical experiences. Osteopathic students also are required to complete additional, hands-on diagnosis and management training for osteopathic manipulative medicine.
Due to vast similarities in osteopathic and allopathic schools’ curriculum and education, osteopathic schools have many allopathic physicians as clinical faculty in addition to D.O.s, and the opposite is true for allopathic schools and osteopathic faculty. This applies to residency training as well; more often than not, both M.D. and D.O. physicians train all residents.
The first combined M.D.-D.O. NRMP match (with the Accreditation Council for Graduate Medical Education as a single accreditation body) in 2020 yielded a 90.7 % PGY1 match rate for osteopathic students, similar to the 93.7% rate of allopathic students. After further addition of military match (4.1%), the Supplemental Offer and Acceptance Program (3.8%) and other programs (0.6%), a total of 6,815 osteopathic graduates (99.3%) were accepted to GME programs and started their residency this year.
Osteopathic physicians are fully licensed physicians who can practice any specialty, prescribe medications, perform surgeries and practice in all 50 states and more than 65 countries. Though osteopathic physicians’ contributions are present in all medical fields, their contribution to primary and preventive care is unparalleled. Fifty-seven percent of osteopathic physicians practice primary care (including 31.4% in family medicine), and 20% serve in underserved areas.
Osteopathic physicians are an essential part of the solution to the anticipated primary care physician shortage of 52,000 by 2025. There has been a rapid increase in the number of D.O. physicians, 63% in the past decade, and they are relatively young. In 2019, 66% of practicing D.O.s were under age 45. With their propensity for rural and primary care practice, D.O.s present a potential long-term solution to improving access to rural health care.
I have been fortunate to work with several D.O.s., including my supervising physicians and mentors during my training and colleagues in my practice. As an educator, I have worked in various capacities with osteopathic students and residents in multiple settings. Having also worked with allopathic students and residents, I have not seen any difference in requirements during medicine rotation. Expectations from teaching faculty and expectations from trainees were the same from both allopathic and osteopathic schools.
As a physician leader at Ballad Health, which serves a rural Appalachian population in east Tennessee and southwest Virginia, I have worked with several osteopathic physicians and help recruit osteopathic family medicine physicians, including graduates from our in-house residency program. Our team has become stronger with the addition of each osteopathic physician. Our patients and community are healthier because of them, and medical education is more prosperous with them.
The AAFP proudly represents more than 14,500 active osteopathic physicians and residents. Academy CEO and EVP Shawn Martin strongly condemned disturbing comments made regarding osteopathic medicine last month. It is essential that M.D.s and D.O.s also stand against these types of ignorant assaults. We must make sure each one of us creates awareness that D.O.s and M.D.s are two sides of same coin, equally competent, qualified and prepared to fight for each other and our patients during this pandemic and beyond.
Shyam Odeti M.D., M.S., is a hospitalist in Johnson City, Tenn.