Osteopathic medical education: Primary care for body, mind and spirit

Osteopathic medicine’s historic emphasis on treating patients as a combination of body, mind, and spirit, and training students with a generalist mindset, has naturally led many graduates into primary care. Sustaining this role in the future will depend on continued advocacy for better reimbursement, working conditions, and respect for primary care physicians so students remain willing to pursue primary care careers. Robert A. Cain, DO, FACOI, FAODM, president of the American Association of Colleges of Osteopathic Medicine, explains more.

Medical Economics: Doctors of osteopathic medicine do play a huge role in primary care in the United States. Can you elaborate about how that happened historically, and do you anticipate that will continue in the future?

Robert A. Cain, DO, FACOI, FAODME: If you go back to the origins of osteopathic medicine, and I've referred to these tenets or principles, as I said, one of the first tenets is the the idea that the individual in front of you, the person that you're going to take care of, is a combination of body, mind and spirit. So from the very beginning of medical school, we try to embed that into the training and into the mindset of the students. We expose them throughout medical school, both in the first two years, where they're predominantly in the classroom, and then in the third and fourth years as well, to primary care physicians and to settings that promote primary care. Now that's not because we expect everybody to become a primary care physician. But what we think, and certainly data help to support this, is that if you train someone with a generalist mindset, they actually perform better even as specialists later on. It gives them a real appreciation of what that entire system needs to be. Sometimes I refer to that as a complexivist mindset, right? Rather than breaking things down into their smaller parts, we want to think about how they actually go together. So I don't think it's a surprise that at the end of medical school that impacts students going into primary care. But the fact that our schools emphasize the importance of primary care throughout the four years of the experience, so that we're sort of trying to nudge students in that direction. We also try to select them so that we think the raw materials are there for people who may be willing to enter primary care. And I think the data, as we just talked about, show that we've done a pretty good job.

The question is, what's going to hold true for the future? And I think the challenge is, we're swimming upstream in this space. The forces around us in the system have, until recently, not really supported primary care and work to push people away from that particular space. So we continue to advocate for better reimbursement for primary care physicians, for better working conditions for primary care physicians, for better respect for primary care physicians. And if we can elevate those things, and we continue to do the things I talked about, hopefully we can keep our numbers high as we go forward.