Kaiser Health News (KHN) ran an article titled, As Fewer MDs Practice Rural Primary Care, a Different Type of Doctor Helps Take Up the Slack. It’s about osteopaths working in rural America. I know several Doctors of Osteopathy (DOs). I also know quite a few Doctors of Medicine (MDs). In fact, I have relatives who are both MDs and DOs. I call this old news because the divisions between the two similar, but slightly different medical societies were patched long ago. Indeed, KHN says as much:
Leaders from both sides of the profession say tension between DOs and MDs has eased. In the past, many osteopathic physicians felt their MD counterparts looked down on them. They were denied privileges in some hospitals, so they often founded their own facilities. But their training is now widely considered comparable, and students from both kinds of medical schools compete for slots in the same residency training programs.
If you are unfamiliar with the topic a good place to start is The Social Transformation of American Medicine, an award-winning book by Paul Starr. Starr is a professor of sociology and public affairs at Princeton University. His book explains how physicians became the most prestigious professional occupation in America.
Medicine only emerged from being about equally likely to help you as harm you 200 years ago. The germ theory of disease came about gradually, 140 to 170 years ago. As recently as the turn of the 20th Century, practitioners of the healing arts varied in skill, training, education and belief system. The American Medical Association (AMA) was the medical society with arguably the strongest basis in scientific methods at the time. Over time it gained control over state medical boards, state licensure and the legal authority to regulate the practice of medicine. It was instrumental in stamping out competitors and closing rival medical schools training competing physicians it considered substandard. This battle continues to this day. The AMA strongly opposes expanding scope of practice for nurse practitioners (NPs), physician assistants (PAs) and physical therapists (PTs).
The AMA managed to largely extinguish complementary & alternative medicine practitioners in the first two decades of the 20th Century. The Flexner Report of 1910 was instrumental in closing about half of all medical schools in the United States and Canada. Flexner was not a physician, but he shared similar beliefs and goals as the AMA. Two medical professions that struggled to survive (just barely) were osteopathic medical schools and schools that conferred Doctor of Chiropractic degrees.
DOs are lesser-known physicians but with almost identical training to MDs. The residency requirements are the same. There are about eight times the number of MDs as DOs. Currently there are about 938,000 MDs in the US compared to 117,000 DOs. The letters MD has entered the popular culture nomenclature. Remember the television shows such as Doogie Howser, M.D. and Marcus Welby M.D. I don’t know if I’ve ever watched a television show or movie depicting a DO.
Although the two medical societies were bitter rivals for many years, they now stand united against encroachment by other practitioners of the medicine. This AMA press release basically says DOs are doctors too.
The Kaiser Health News article explained that many DOs practice primary care in rural areas, saying:
For 35 years, this town’s residents have brought all manner of illnesses, aches, and worries to Kevin de Regnier’s storefront clinic on the courthouse square — and he loves them for it.
De Regnier is an osteopathic physician who chose to run a family practice in a small community. Many of his patients have been with him for years. Many have chronic health problems, such as diabetes, high blood pressure, or mental health struggles, which he helps manage before they become critical.
The article went on to explain:
Broad swaths of rural America don’t have enough primary care physicians, partly because many medical doctors prefer to work in highly paid specialty positions in cities. In many small towns, osteopathic doctors like de Regnier are helping fill the gap.
Osteopathic physicians, commonly known as DOs, go to separate medical schools from medical doctors, known as MDs. Their courses include lessons on how to physically manipulate the body to ease discomfort. But their training is otherwise comparable, leaders in both wings of the profession say.
Both types of doctors are licensed to practice the full range of medicine, and many patients would find little difference between them aside from the initials listed after their names.
The article claimed a larger proportion of DOs go into primary care than MDs (50% vs. 40%). DOs are slightly more likely to work in rural areas than MDs. That is great if you’re in a rural area lucky enough to have an MD or DO willing to work there. I grew up in a rural area far from civilization. Unfortunately, most MDs, DOs, nurse practitioners, physician assistants and assistant/associate physicians prefer to work in more densely populated areas with cultural amenities and a higher concentration of private health insurance.
I’ve had doctors who were MDs and doctors who were DOs. I can’t say I noticed a difference in their practice. I’ve always had good luck with my physicians. Yet, I don’t think most DOs want to be relegated to rural areas any more than MDs do. Rural medicine is a problem without an easy fix.