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Letters to the Editor  |   August 2008
Increase Efforts to Promote Primary Care
Author Affiliations
  • Richard W. Rapp, II, OMS
    Des Moines (Iowa) University—College of Osteopathic Medicine
Article Information
Medical Education / Practice Management / Graduate Medical Education
Letters to the Editor   |   August 2008
Increase Efforts to Promote Primary Care
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 464-465. doi:10.7556/jaoa.2008.108.8.464
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 464-465. doi:10.7556/jaoa.2008.108.8.464
To the Editor:  
In regard to the letter by Taras Lisowsky, DO,1 titled “Pushing bodies through COMs,” and the response by Diane N. Burkhart, PhD,2 in the March issue of JAOA—The Journal of the American Osteopathic Association, I would like to share my experiences and thoughts as a first-year osteopathic medical student at Des Moines (Iowa) University—College of Osteopathic Medicine (DMU-COM). I am inclined to agree with Dr Lisowsky's intended point that osteopathic medical students are not being encouraged to pursue careers in primary care. In fact, my experience thus far has been more in the realm of, “You can do anything as a DO now. All specialties are open to you.” 
Of course, all specialties are open to DOs now, and this has happened as a result of the outstanding work and effort of so many osteopathic physicians during the past century. In addition, recent efforts of the osteopathic medical profession to focus on physician availability in underserved areas are to be commended. For example, last August, DMU (including DMU-COM) and the University of Iowa in Iowa City announced the formation of several health education centers in our state.3 These centers will serve as a network to recruit and retain healthcare professionals, including osteopathic physicians, in rural Iowa. My school also has loan repayment options available for students who decide to practice in state after residency training.4,5 
However, these efforts are indirect and somewhat ineffective. In the communications I have received as a student member of the American Osteopathic Association (AOA), American College of Osteopathic Family Physicians, and the Student Osteopathic Medical Association, it seems that the impetus behind any promotion of primary care is related to concurrent political efforts to improve Medicare reimbursements and student loan re pay ment programs for DOs. Although such political endeavors are necessary, they, again, fail to recruit students to primary care practice. 
I do not doubt that the AOA and the COMs have considered how best to promote the fact that DOs can pursue any medical specialty while also promoting primary care as a noble, relevant, and economically feasible career choice. I'm sure that balancing these two objectives is a difficult task. After all, our profession does need to address the problem of rising student loan debt coinciding with stagnant primary care physician income, especially in light of declining Medicare and Medicaid reimbursements. 
More importantly, however, we need primary care DOs promoting their chosen career path one-on-one with students in the COMs—asking students to shadow them and discussing economics, lifestyle, and other aspects of primary care with them. 
We also need directors of osteopathic primary care residency programs to promote their programs in the COMs. In addition, we need more of these residency programs in locations where students actually want to live during training. 
For example, my home state of Colorado, considered to be a desirable location by many students, currently has no osteopathic medical residency programs in any specialty.6 I have already looked at which specialties have allopathic medical residency programs in Colorado, and I know from conversations with other students that residency location often plays a role in specialty selection.7 
Combined, the actions taken to address these issues could turn the page and get more DOs into primary care. 
Lisowsky T. Pushing bodies through COMs [letter]. J Am Osteopath Assoc. 2008;108:105. Available at: http://www.jaoa.org/cgi/content/full/108/3/105. Accessed July 31, 2008.
Burkhart DN. Response [letter]. J Am Osteopath Assoc. 2008;108:105-106. Available at: http://www.jaoa.org/cgi/content/full/108/3/105-a. Accessed July 31, 2008.
DMU, U of I receive millions to improve Iowans' health care access, awareness [press release]. Des Moines, Iowa: Des Moines University; August 28, 2007. Available at: http://www.dmu.edu/communications/index.cfm?NewsID=184. Accessed July 31, 2008.
Osteopathic forgivable loan program; January 2007. Iowa General Assembly Web site. Available at: http://www.legis.state.ia.us/lsadocs/SC_MaterialsDist/2007/SDMAS007.PDF. Accessed July 31, 2008.
DO scholarship information: loan repayment programs. Des Moines University Web site. Available at: http://www.dmu.edu/fa/scholarship_info/do/. Accessed July 31, 2008.
Opportunities: osteopathic medical internships and residencies. American Osteopathic Association Web site. Available at: http://opportunities.osteopathic.org/index.htm. Accessed July 31, 2008.
Schierhorn C. Slumping OGME piques educators at Summit. The DO. February 2008:22-28. Available at: https://www.do-online.org/pdf/pub_do0208training.pdf. Accessed July 31, 2008.