Part of cure for doctor shortage: Osteopaths

Hands-on approach differs from traditional medicine

Date: Friday, March 23, 2012, 3:00am PDT

A different breed of doctor is resurging in California.

A growing number of medical students are studying osteopathic medicine, which focuses on the body as a whole rather than a collection of parts.

Osteopaths are called “doctor” — like their conventional or allopathic peers — but a “D.O.” follows their names instead of “M.D.”

The branch of medicine has been around for more than a century, but confusion lingers about who these doctors are, what their training is and what they do.

“People have no idea what I am,” said Dr. Robert Duncan, an osteopath who works in the emergency room at Mercy San Juan Medical center in Carmichael.  "They see 'D.O.' and think dentist or eye doctor.  I do a lot of explaining to patients."

Acceptance is growing, however, and the presence of osteopaths is becoming indispensable as concerns mount about a growing shortage of primary-care providers.

California is at the lower end of the comfort range for primary care physicians, and the distribution is poor, according to a study by the California Health Care Foundation.

The state has 63 primary-care doctors per 100,000 residents; the acceptable range set by the Council on Graduate Medical Education is 60 to 80 per 100,000 residents.  The potential coverage of more than 4 million more residents under federal health care reform will put further strain on the system.

"The osteopathic schools in California have made a tremendous contribution to the number of trained primary-care physicians in the state," said John Troidl, manager of California Health Workforce Alliance, a partnership of schools, health care employers, government agencies and other established to built the workforce in the state.  "Not only are they training primary-care physicians, but they are - as a group - more inclined to settle in underserved areas."

Nationwide, one in five first-year medical students is studying osteopathic medicine.

Board dissolved - and resurrected

It's been a rough road to acceptance in California.

Andrew Taylor Still opened the first osteopathic medical school in the nation in 1892 in Kirksville, Mo., because he thought traditional medicine was killing patients.  Believing that the body has an inherent ability to heal itself, he shifted focus from treatment of symptoms to treatment of the root causes of disease.

Osteopathic medicine also uses touch to diagnose and hands-on manipulation to correct them.

The approach gained support.  In 1922, California voters passed a measure that created an osteopathic medical board to regulate the industry.  By 1960, there were more than 2,600 osteopaths in the state, 59 osteopathic hospitals and a college.

In 1962, voters - prompted by political intrigue, peer pressure and mergers between M.D.s and D.O.s - approved a measure to consolidate oversight under the Medical Board of California, which regulates M.D.s.  Osteopaths were given the option of paying $65 to get an M.D. degree.  many did.  About one in five balked and left the state or stopped practicing.

All the osteopathic hospitals closed.  the college - now University of California Irvine School of Medicine - became an allopathic medical school.

Legal action ensued and, in 1974, the California Supreme Court said it was unconstitutional to discriminate against D.O.s.  The court ordered the Osteopathic Medical Board to resume oversight, but D.O.s who had converted to M.D.s had to stay that way.

There's been a resurgence since then.

There were 3,298 osteopaths licensed by the Osteopathic Medical Board of California in 2001.  Now there are 6,368.

"Within the past 10 years, we have just about doubled the total number of licensees," board spokeswoman Angie Burton said.

Osteopathic doctors appear to have earned widespread acceptance too.

"We at the medical society and the California Medical Association see D.O.s and M.D.s as the same,"  said Aileen Wetzel, executive director of the Sacramento Sierra Valley Medical Society.  "They are licensed by a different board, but in all other way, shape, and form, they are considered physicians."

Numbers remain small by comparison, however.  There are 289 D.O.s in the four-county Sacramento area; there are 6,186 M.D.s.

The five local health systems combined have 169 D.O.s in their medical groups, 4.3 percent of their total local physician work force of 3,896.  Some hold leadership positions.

"I train family medicine physicians, and about 10 percent of our residents every year are osteopathic medical school grads," said Dr. Marion Leff, director of the Sutter Family Medicine Residency Program.

"We look at them as equally competitive."

Computer Neck

University of California Davis graduate Katrina Belova Chapman picked Touro University in Mare Island for medical school because she thinks medicine is about the whole body.  She will graduate from Touro in June.

"When i walk into a room, I see a human, not a disease," Chapman said.

There are two osteopathic medical schools in California; the other one is in Pomona.  Touro expects to expand to meet the growing need for doctors when health reform gets in full swing, provost Marilyn Hopkins said.

Osteopaths go through at least four years of college, four years of medical school and three year residencies like their allopathic counterparts.  They have extra training on muscle and skeletal function and manipulation.  Like M.D.s, the may go on for extra training in a specialty.

Unlike the chiropractors they are commonly compared to, osteopaths generally don't advocate ongoing, regular manipulation.  Instead they teach skills to help patients move and feel better.

"No one leaves my office without a prescription for exercise," said Dr. Sanjeev Batra, a Sacramento osteopath.

Listening is key and education is crucial, so these doctors generally take more time with patients than their allopathic counterparts.

Some M.D.s see 30 or 40 patients a day.  "You just can't take care of patients in 5 to 10 minutes unless it's a snotty nose," said Dr. Lance Holtry, an osteopath who works at the Marshall Center for Primary Care.  "I really enjoy the interaction I have with people.  They are intimate details of their lives, and I feel honored at being able to help them."

Take a patient who comes in with a vague abdominal complaint, for example.  "As you question further, psychological issues come up," said Dr. Scarlett Lu, an independent physician who works in south Sacramento.  "We talk about the foods they eat and their lifestyle.  People are resistant to the fact that the choices they make and what they put into their bodies make a difference."

Neck pain?  Does the patient sit at a computer eight to 10 hours a day?  "You're developing computer neck," Dr. Gregory Spears, a family-practice physician who works for Mercy Medical Group in Folsom, tells patients.

This perspective plays well with Folsom resident Bob Chase, 65.  A patient of Spears, Chase has been to other osteopaths and prefers the approach.  "They seem a bit more holistic than others and make great family docs,"  Chase said.  Spears "takes time to listen to me and hear my story.  He picked up something in a physical last year that could have caused major problems"

Not all osteopaths are primary care doctors, though.

Dr. Nicklesh Thakur is a neurologist who specializes in movement disorders and deep brain stimulation at Sutter Medical Center Sacramento.  As an undergraduate student in Arizona, Thakur was interested in sports medicine until he watched an osteopath doing manipulative techniques - and admired his knowledge of the spine and body.  He went to an osteopathic college, got further training in movement disorders like Parkinson's Disease, and went for one-year fellowship in deep-brain stimulation.

"I still use osteopathic treatment on a daily basis in my clinic," he said.


Kathy Robertson covers health care, labor/workplace issues, law immigration, medical technology and biotechnology., 916-558-7869