Osteopathic physicians in integrated networks help fill primary care void

Wellness, prevention orientation make good fit with managed care

The increased popularity of the primary care physician is a well-documented phenomenon in today’s managed care environment. If your hospital is looking for ways to expand your community-based primary care physician network, you may want to think outside the box and consider an alternative to the traditional internal medicine or family medicine doctor — doctors of osteopathic medicine (DOs).

And just as managed care has become more popular, so have these doctors of osteopathic medicine, says David Rearick, DO, MBA, the network medical director for Aetna U.S. Healthcare in Alpharetta, GA.

"There is no question that managed care has increased the demand for primary care physicians, and this in itself has created a surge in the demand for DOs," Rearick says.

What also makes doctors of osteopathy fit so well with managed care is the emphasis each places on preventive care. Both have the credo that if you can keep the patient healthy, that is good for both the patient and the health system. This is especially true in this age of capitation, Rearick adds. "Managed care means providing the right amount of health care in the right location, distributed correctly, and for the right price," he explains. "The osteopathic medical association has always put an emphasis on those things, and the physician who can do that is the ideal physician."

Others agree with Rearick’s assessment. "The demand for primary care physicians is definitely increasing, and the structure to meet that demand is already built into American medicine," says E. Kenneth Freiberg, DO, director of osteopathic medical education, Wyckoff Heights Medical Center in Brooklyn, NY. "We need not look past our noses. Osteopathic medicine is poised to fill a significant portion of the primary care needs in this country."

"Whether health care managers want to recognize it or not, health care in this country has come full swing behind the osteopathic medical community," says Roger Bonds, president of the Atlanta-based National Institute of Physician Recruitment and Retention. "They are totally wellness oriented, and that fits perfectly into managed care."

Rearick says, in the past, some communities were less eager than others to hire doctors of osteopathy, but that has changed. "It really isn’t even an issue anymore," he adds. "I think today, in almost all communities, you’ll see osteopaths and allopaths (MDs) sitting on the same boards and practicing in the same offices."

That is the case at Aetna U.S. Healthcare, which makes ample use of DOs in its primary care networks, Rearick adds. In fact, one of the organization’s top executives, Jay Rosan, corporate medical director and a founder of U.S. Healthcare, is a DO. "Aetna U.S. Healthcare has always looked favorably on the osteopathic community. DOs represent an integral part of our primary care network."

One problem that health systems and group practices face when looking for DOs is that there really aren’t that many around, at least compared to MDs. Statistics show that there are only about 40,000 doctors of osteopathy nationwide, according to the American Osteopathic Association in Chicago. In the MD community, there are about 700,000 physicians nationwide.

Each year, the 19 osteopathic medical schools across the country graduate more than 2,000

doctors — only a fraction of the MD world. But the doctors graduating from these osteopathic schools are much more likely to practice primary care, a long-standing tradition of the osteopath profession. Each graduating class sends about 60% to 70% of its physicians into primary care. The MD world is just the opposite, traditionally with 60% to 70% of each graduating class going into specialty practice, Freiberg says.

Doctors of osteopathic medicine also have a tendency to set up practice in rural and underserved areas, Freiberg adds.

Osteopath training parallels MDs’

Doctors of osteopathic medicine go through much of the same training as their allopathic counterparts. Admission to osteopathic medical schools is just as rigorous, Freiberg adds. The curriculum is identical, except for the additional training osteopath students get on the muscular and skeletal systems. And all 50 states give DOs full practice rights and privileges.

"If anything, we’ve been indicted on occasion if not for overachieving then for making sure that our students have been tested to the nth degree," says Freiberg, also a fellow with the Osteopathic Heath Care Policy Fellowship, a leadership group studying health care reform.

Because osteopathic medicine takes a holistic approach, some people get hung up on that word "holist" and relate practitioners to herbalists, naturalists, and the like, although this isn’t necessarily true.

Doctors of osteopathic medicine also have other treatment methods in their arsenal that MDs tend to ignore, says Rearick. One of the biggest difference between the two medical disciplines is that osteopathic doctors incorporate the use of "hands-on" therapy through manipulations, usually of the spine, Rearick adds.

"Any way you look at it, we are, and have been for a while, one of the fastest growing health care professions," Rearick says.