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Letters to the Editor  |   June 2006
Future of Osteopathic Medicine Depends on Investing in Graduate Medical Education
Author Affiliations
  • MARK TOSCA, DO
    Mountain Park Health Center Tempe, Ariz
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   June 2006
Future of Osteopathic Medicine Depends on Investing in Graduate Medical Education
The Journal of the American Osteopathic Association, June 2006, Vol. 106, 319. doi:10.7556/jaoa.2006.106.6.319
The Journal of the American Osteopathic Association, June 2006, Vol. 106, 319. doi:10.7556/jaoa.2006.106.6.319
To the Editor: I thoroughly enjoyed the frank discussion by Norman Gevitz, PhD, on the future of the osteopathic medical profession in the March 2006 issue of JAOA—The Journal of the American Osteopathic Association (“Center or periphery? The future of osteopathic principles and practices.” 2006;106:121–129). However, as an osteopathic family physician recently out of residency, I believe that the profession's future might be framed in a more useful manner than by asking, as Dr Gevitz does, whether osteopathic principles and practice (OPP) will be at the “center or periphery” of the profession. 
Given the healthcare environment that the majority of osteopathic physicians inevitably encounter today, the more important question is whether osteopathic medicine, in relation to allopathic medicine, will be an adjunctive form of medicine or basically another form of allopathic medicine. The answer to this question depends on how important graduate medical education is to the profession. 
I agree with Dr Gevitz's suggestion that osteopathic physicians need to create an evidence-based centrality within osteopathic medicine's unique approach to patient care. However, it is imprudent for Dr Gevitz to suggest that this idea should include assessing applicants' palpatory skills as part of the evaluation of prospective osteopathic medical students. 
The type of centrality that Dr Gevitz suggests the osteopathic medical profession strive for exists today only in academic departments of OPP and among those osteopathic physicians who treat patients solely with osteopathic manipulative medicine (OMM). 
When considered in the context of “center or periphery,” most osteopathic physicians practice OMM in a peripheral sense and, in fact, are even struggling to keep this aspect of their practices alive. In other words, osteopathic physicians live in an allopathic world—from our methods of diagnosis to our treatment modalities. The International Classification of Diseases, Ninth Revision, Clinical Modification1 includes codes for osteopathic diagnoses of somatic dysfunction, but how often does the average osteopathic physician use these codes, compared with the codes for allopathic diagnoses (eg, essential hypertension, gastroesophageal reflux disease, glaucoma)? 
Although osteopathic physicians live in an allopathic world, most remain proud of their uniqueness as osteopathic physicians, including their superior knowledge of the musculoskeletal system. Musculoskeletal problems are among the most common complaints of patients. Through their training in OMM, osteopathic physicians have the ability to offer patients noninvasive approaches to these problems. Allopathic physicians do not have this ability. That fact alone makes us unique. 
Thus, framing the future of osteopathic medicine in terms of an adjunctive form of medicine versus an allopathic form of medicine is an important, acute issue for our profession—especially when we are at risk of becoming indistinguishable from allopathic physicians and when increasing numbers of graduates of colleges of osteopathic medicine (COMs) are choosing residencies accredited by the Accreditation Council for Graduate Medical Education.2 The number of COMs and class sizes in COMs continue to increase, and many osteopathic medical students are paying more than $30,000 per year for tuition.3 Yet, there is little investment in quality osteopathic graduate medical education. 
I hope that Dr Gevitz's editorial will help to ensure that the OPP faculties at COMs are given the priority and resources they need. However, the more acute problem confronting the profession is how to improve and stimulate greater investment in osteopathic graduate medical education. 
American Medical Association. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Chicago, Ill: American Medical Association;2005 .
Obradovic JL, Beaudry SW, Winslow-Falbo P. Osteopathic graduate medical education. J Am Osteopath Assoc. 2006;106:59–68. Available at: http://www.jaoa.org/cgi/content/full/106/2/59. Accessed May 15, 2006.
Griffin AV, Sweet S. Undergraduate osteopathic medical education: addressing the impact of college growth on the applicant pool and student enrollment. J Am Osteopath Assoc. 2006;106:51–57. Available at: http://www.jaoa.org/cgi/content/full/106/2/51. Accessed May 15, 2006.