‘An exciting time for osteopathic medicine’ — growth in numbers, influence, financial effect

Colleges of osteopathic medicine (COMs) train budding physicians while providing a $6 billion investment in communities they call home.

The American Association of Colleges of Osteopathic Medicine (AACOM) commissioned a study of direct and economic effects of COMs, and the numbers, in finances and in personnel, are adding up as osteopathic medicine becomes a larger part of the U.S. health care system.

It’s encouraging, not least because osteopathic physicians have a large presence in primary care. It’s challenging because the United States does not support primary care at the level it should. Robert A. Cain, DO, FACOI, FAODME, the president and CEO of AACOM, spoke with Medical Economics about the report, the state of osteopathic medicine, and what the future might look like.

This transcript has been edited for length and clarity.

Medical Economics: How would you describe the current state of osteopathic medical education in the United States?

Robert A. Cain, DO, FACOI, FAODME: To take a big question and make it actually very simple, we're growing. When we look at our visibility, we look at the numbers, influence, reputation, all of those things are growing. This is an exciting time for osteopathic medicine. Some of us feel like we are really at a tipping point as we think about what our contribution to the U.S. health care system can be. And because of that visibility, interest is growing, and applications have been high for students who would like to become osteopathic physicians.

Medical Economics: In your own career, can you talk about some of the factors that really attracted you or influenced your decision to pursue osteopathic medicine?

Robert A. Cain, DO, FACOI, FAODME: For me, it was actually a very personal experience. I was working as an EMT part time in western Pennsylvania when I was going to college, and the community I was in actually had two hospitals at the time. There was a general hospital, an osteopathic hospital, because there was still some segregation of the two degrees at that particular point in time. I had gone to college fully intending to become a physician. Really didn't know a lot about osteopathic medicine, but my experience as an EMT going into each of those hospitals, I was intrigued by the osteopathic physicians, and what I enjoyed was their interest to pull me to the side, talk to me not just about medicine, but about osteopathic medicine, and that it was medicine based upon a philosophy, a way of thinking about how patients should be treated, how care should be delivered, as well as the use of manipulation, learning to use my hands, not just to diagnose, but also treat. And because of personal interests, the philosophical piece was very attractive. The manual medicine piece was very attractive. The fact that I could learn to do any form of medicine and surgery, and ultimately chose to go that direction. But we were a much smaller profession at the time, and as I said, still a segregated profession to some degree.

Medical Economics: Regarding the workforce and economic impact report, what are some findings from that report that you would like to highlight?

Robert A. Cain, DO, FACOI, FAODME: You know, we are particularly happy with the results on primary care. We've talked for a long time about the positioning of osteopathic medicine around primary care, the role it can play. When you look at our principles, one of which is this focus on body, mind and spirit, as well as the others, it's not a surprise that whether you enter primary care or that you would take that into primary care. It aligns very well to what happens in primary care. But it's also very aligned to some of the high-need specialties as well. So one of the findings of the report that's exciting is that roughly 50% of our graduates, if you look at all the colleges of osteopathic medicine, are going into primary care. Every single one of our colleges exceeded 45% of their graduates doing so. That's more than twice that of our colleagues. Very needed in today's health care system. But we also were able to show that about 25% of our graduates are going into high-need specialties, areas like general surgery, obstetrics, psychiatry, things that are also important to maintaining that general health. We're very pleased with the fact that our colleges are placed, over half of them are placed in medically underserved areas. That's going to be important to trying to change health care delivery in those, especially if we talk about graduates ultimately staying and practicing in the areas where they've trained.

Medical Economics: How would you describe the economic effect that the colleges of osteopathic medicine have on their communities?

Robert A. Cain, DO, FACOI, FAODME: Now maybe I'll make just some broad comments first to answer that question and actually tell a very specific story. It was exciting to see some of the numbers that the number of jobs that are generated when you open a new college of osteopathic medicine, and recognizing that some of those jobs are new educators you may be bringing into the area, people who are going to teach might be PhD, EDD, DO, MD, who are going to become part of that school. But it's also all of the other people that are necessary to make that institution work. And so the school itself creates jobs, and then in the community, there tend to be new jobs that are created as well. I already mentioned to you that over half of our schools are medically underserved areas, and a fair number are touching on rural adjacent communities. All communities need jobs, but what better place to create jobs than some of those? And we could go through the names of where are schools located in smaller rural communities that hopefully we've actually been able to make a difference.

But there's one example I always use, because it was, for me a very personal opportunity, Pikeville, Kentucky, in rural eastern Kentucky, in coal country. And many, many years ago, I was invited there to potentially join the initial staff as they were opening this medical school in the mountains, as they called it. And there were people who thought, how can you open a medical school here? And what is it going to do? And I remember visiting Pikeville for the first time, as it truly was a rural community with a small college. I didn't take the job. But over the years, as I would go back and I would visit, I was watching this transformation in that town, as that initial college of osteopathic medicine brought not only those new people to that school, but it caused them to have a resurgence. You go down to Pikeville now, and it's a vibrant city with a vibrant hospital that wasn't there in 1997 and the only thing that changed was putting a college of osteopathic medicine in that particular space. So the good thing about this report is, we see that repeated in other places. Bring a college of osteopathic medicine to a particular community, you can expect to see new jobs and changes in the economics of that community.

Medical Economics: What are some policy changes, either at the state or federal level, that you would like to see that could really help osteopathic medical education?

Robert A. Cain, DO, FACOI, FAODME: Community-based education is challenging to operate, and when we look at so many of the institutions where our students train, their margins are small. Sometimes there's no margin at all, and we're asking them, on top of worrying about taking care of their community, to also train medical students and to enter into the education space. And sadly, when we look at decisions that are often made when those challenges begin, the first thing that goes is education. And so we do have one program we're currently working on called the Community TEAMS Act, which is trying to direct more funding into some of these smaller communities where we're training our students so that you can actually support the preceptors, the physicians who are doing the teaching. And that's important, because they're busy trying to take care of patients and teaching the sense, the sense is that they're giving something up. But for a long time that was always done for free. But as health care has changed, it becomes hard to be a teacher and a practitioner. So finding ways to better support those communities from a funding standpoint, into the teaching institutions, helping to make those local hospitals into teaching institutions for the type of model we use can be incredibly important, and so we do have a lot of advocacy work that is addressing that particular issue.

Medical Economics: What are some ways you anticipate that osteopathic medical colleges will integrate, and maybe already are integrating, artificial intelligence (AI) programs into their instruction?

Robert A. Cain, DO, FACOI, FAODME: At the national level, in the association, we're actually trying to wrestle with that question. We've actually brought on special advisers to help us with that question, as we try to work in partnership with our colleges to figure out exactly how do you integrate this, and the key here is to not be too slow and not be too early, right? To learn what we need to learn, so that whatever we integrate and we do well. The interesting thing for us has been a conversation about, can AI be used to help us get back to the things we think are most important? And throughout this interview, I've been talking about the importance of putting the patient at the center of the experience. But if we think about experiences in the past two decades with the rise of technology, all too often, the physician’s looking this way, and the patient's back here, and the conversation isn’t eye-to-eye, face-to-face in the way it should be. As DOs, it's about, as I mentioned, where do our hands, in terms of the use of manual medicine, fit into this care that can't be done with a computer? And as we think about things like ambient scribing that can potentially listen to what's happening in the room, let me, as a physician, be able to pay attention to you and give you the time that you actually deserve. What we're hoping is to, in our classrooms and in our experiences, integrate AI and other technologies in a way that allow us to maintain the high-touch history, the high-healing-touch history that we've had with the high tech that I think is available to us, to offer a form of precision care to you that ultimately, down the road, done right, improves the relationship with the patient and allows us to have less waste in the experience, in the system, in terms of testing and unnecessary diagnoses that aren't really going to help to make you better and realize your health potential.