Toward Osteopathic Psychiatry

I was surprised to find that my commentary was referrenced as introduction of a psychiatry article, recently published in the Journal of American Osteopathic Association. Dr. Niall McLaren, a psychiatrist practicing in Australia, embraces the holistic approach of osteopathic medicine. Holistic approach to mental disorders or diseases should be emphasized instead of the reductionist approach which places priority of bio-chemical imbalances. This article is scholarly and an eye-opening. It is also interesting that an Australian medical doctor appreciates  the philosophy of osteopathic medicine.

• "In a thoughtful commentary, Delengocky1  offered three reasons why osteopathic medicine should remain parallel to but distinct from allopathic medicine. First, there is the widespread and growing interest in complementary and alternative medicine (CAM) in the United States. For a number of reasons, osteopathic medicine is an alternative to the reductionist biological tradition of allopathic medicine. Osteopathic medicine places great emphasis on the fact that the body is a self-regulating unit in which structure and function are reciprocally interrelated, providing a basis for a rational, holistic therapy.
• Second, he argued that because of the prevalence, the morbidity, and the huge cost of musculoskeletal disorders, there is a place for a form of medicine that sees a need to manage these debilitating conditions as more than “simply pains.”
• Third, he saw a political advantage in medicine having two “separate but equal” traditions to counter the aggressive push by nonmedical professions for equal rights (eg, laboratory investigation, prescribing, procedures) with physicians within their narrowly defined areas. Medicine must see the patient as a whole, must advance by rational scientific research and must be distinct from the paramedical professions, which seek to advance themselves by legislative advantage. Medicine is strengthened, not weakened, by having the two traditions of allopathic reductionist biology and osteopathic holism."

You can read the entire article at http://www.jaoa.org/cgi/reprint/110/12/725 or in the publication page above.

Physician Surplus or Shortage? How reliable are the studies of projected need of physicians? How reliable are the studies of projected costs?

Studies can never provide an accurate assessment of future physician demand.  Some studies, in fact, have missed the boat completely.  Edward J. Miller, Ph.D., a Political Science professor at University of Wisconsin-Stevens Point, outlined a number of such studies in his paper, “The Physician Workforce Shortage and the Implications for Expanded Medical Coverage.”[1] Among Miller’s findings:

• “The Council on Graduate Medical Education (COGME) in 1991 predicted a surplus of 80,000 physicians by 2000 and recommended limiting the number of residencies to 10% above the number of U.S. medical graduates.”
• “To reduce the number of physicians trained, the federal government included in the Balanced Budget Act of 1997 an incentive for hospitals to reduce the number of residency slots available.”

Some researchers disagreed that a physician surplus in the making.  In fact, they argued the opposite.    

• “Richard Cooper and colleagues challenged the potential glut conclusion, arguing that the U.S. will experience a shortage of around 200,000 physicians between 2020 and 2025 (Cooper, et al., 2002).”

§         “The COGME projects a shortfall, but about 85,000 nationally, less than half of what Cooper forecasted (Wilson, 2005, pp. 469-470; Association of American Medical Colleges, 2006a).”

A Physician Workforce Shortage Loomed Even Before the Passage of Health Care Reform.

• “An analysis of the projected supply and demand for physicians, conducted by the Health Resources and Services Administration in 2008, foretells of a total shortage across the entire workforce. Particularly evident is the deficit projected in non-primary care subspecialties, with a shortage of 35,000 surgeons and 27,000 medical specialists by 2020.”[2]
• “Even five years from now – in 2015 – there will be a deficit of 62,900 physicians. Looking out further – to 15 years from now, in 2025 – that shortage is likely to have doubled, with a projected deficit of more than 130,000 physicians across all specialties.”[3]

The Congressional Budget Office’s estimates regarding specific legislative proposals have sometimes been too low (like Medicare, and the recent health care law):

• “In 1965, the
  House Ways
  and Means Committee estimated that the hospital insurance program of Medicare - the federal health care program for the elderly and disabled - would cost $9 billion by 1990. The actual cost that year was $67 billion.”[4]

§         “In 1987, Congress projected that Medicaid - the joint federal-state health care program for the poor - would make special relief payments to hospitals of less than $1 billion in 1992. Actual cost: $17 billion.”[5]

In conclusion, studies are important to provide guidance in setting up public policies; but the projected needs or costs are usually wrong. For instance, Texas’ budget shortfall was estimated to be $11 billion in early 2010 and was recently forecast to be as high as $25 billion. The actual amount is $27 billion, just released yesterday by the Texas Comptroller.

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[1] Miller, Edward J.  “The Physician Workforce Shortage and the Implications for Expanded Medical Coverage.”  Accessed December 26, 2010.  URL: http://www.uwsp.edu/business/cwerb/SR%20PDFs/The%20Physician%20Workforce%20Shortage%20and%20The%20Implications%20for%20Expanded%20Medical%20Coverage.pdf.

[2] American Association of Medical Colleges (AAMC).  “Physician Shortages to Worsen Without Increases in Residency Training.”  Accessed December 26, 2010.  URL: https://www.aamc.org/download/150584/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf.

[3] Ibid.

[4] “U.S. health plans have history of cost overruns.”  The Washington Times, November 28, 2009.  Accessed December 28, 2010.  URL: http://www.washingtontimes.com/news/2009/nov/18/health-programs-have-history-of-cost-overruns.

[5] Ibid.

Osteopathic Oath

Only 50% of US medical dotors take Hippocratic Oath upon their graduation from medical schools, all doctors of osteopathic medicine take Osteopathic Oath. Even though the oath does not carry any legal obligations, it inculcates the common ethical, professional, and moral values that physicians should have.

The need for a modern version of the Hippocratic Oath specifically designed for  the DO graduates was first suggested by Frank E. MacCracken, D.O., of California to his state society. Within a year, the suggestion was transmitted from the state to the national association, and a committee was formed under the Associated Colleges of Osteopathy to prepare the text. Members of that committee included Dr. MacCracken as chairman and Drs. R.C. McCaughan, Walter V. Goodfellow and Edward T. Abbott. The first version of the Osteopathic Oath was used from 1938 until 1954, at which time minor amendments were proposed by the AOA Bureau of Professional Education and adopted by the AOA House of Delegates. (see JAOA 54:77, Sep 54.) This version has been in use since 1954. (From the American Osteopathic Association's website)

I do hereby affirm my loyalty to the profession I am about to enter.

I will be mindful always of my great responsibility to preserve the health and the life of my patients, to retain their confidence and respect both as a physician and a friend who will guard their secrets with scrupulous honor and fidelity, to perform faithfully my professional duties, to employ only those recognized methods of treatment consistent with good judgment and with my skill and ability, keeping in mind always nature's laws and the body's inherent capacity for recovery.

I will be ever vigilant in aiding in the general welfare of the community, sustaining its laws and institutions, not engaging in those practices which will in any way bring
shame or discredit upon myself or my profession.

I will give no deadly drugs to any, though it may be asked of me.

I will endeavor to work in accord with my colleagues in a spirit of progressive cooperation and never by word or by act cast imputations upon them or their rightful practices.

I will look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for its best interests and for the interests of the students who will come after me.

I will ever be alert to adhere to and develop the principles of osteopathy which were first
enunciated by Andrew Taylor Still.