Join Now | What is a D.O.? | Upcoming Events
Article from Wisconsin Public Radio.
WINTERSET, Iowa — 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.
"I just decided I'd rather prevent fires than put them out," he said between appointments on a recent afternoon.
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.
DOs are still a minority among U.S. physicians, but their ranks are surging. From 1990 to 2022, their numbers more than quadrupled, from fewer than 25,000 to over 110,000, according to the Federation of State Medical Boards. In that same period, the number of MDs rose 91%, from about 490,000 to 934,000.
Over half of DOs work in primary care, which includes family medicine, internal medicine, and pediatrics. By contrast, more than two-thirds of MDs work in other medical specialties.
The number of osteopathic medical schools in the U.S. has more than doubled since 2000, to 40, and many of the new ones are in relatively rural states, including Idaho, Oklahoma, and Arkansas. School leaders say their locations and teaching methods help explain why many graduates wind up filling primary care jobs in smaller towns.
De Regnier noted that many MD schools are housed in large universities and connected to academic medical centers. Their students often are taught by highly specialized physicians, he said. Students at osteopathic schools tend to do their initial training at community hospitals, where they often shadow general practice doctors.
U.S. News & World Report ranks medical schools based on the percentage of graduates working in rural areas. Osteopathic schools hold three of the top four spots on the 2023 edition of that list.
William Carey University's osteopathic school, in Hattiesburg, Mississippi, is No. 1 in that ranking. The program, which began in 2010, was intentionally sited in a region that needed more medical professionals, said Dean Italo Subbarao.
After finishing classwork, most William Carey medical students train in hospitals in Mississippi or Louisiana, Subbarao said. "Students become part of the fabric of that community," he said. "They see the power and the value of a what a primary care doc in a smaller setting can have."
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.
Michael Dill, director of workforce studies at the Association of American Medical Colleges, said it makes sense that osteopathic school graduates are more likely to go into family practice, internal medicine, or pediatrics. "The very nature of osteopathic training emphasizes primary care. That's kind of their thing," said Dill, whose group represents MD medical schools.
Dill said he would be confident in the care provided by both types of doctors. "I would be equally willing to see either as my own primary care physician," he said.
Data from the University of Iowa shows osteopathic physicians have been filling rural roles previously filled by medical doctors. The university's Office of Statewide Clinical Education Programs tracks the state's health care workforce, and its staff analyzed the data for KFF Health News.
The analysis found that, from 2008 to 2022, the number of Iowa MDs based outside the state's 11 most urban counties dropped more than 19%. Over the same period, the number of DOs based outside those urban areas increased by 29%. Because of the shift, DOs now make up more than a third of rural Iowa physicians, and that proportion is expected to grow.
In Madison County, the picturesque rural area where de Regnier practices, the University of Iowa database lists seven physicians practicing family medicine or pediatrics. All are DOs.
De Regnier, 65, speculated that the local dominance of the osteopathic profession is partly due to the proximity of his alma mater, Des Moines University, which runs an osteopathic training center 35 miles northeast of Winterset.
Des Moines University has one of the country's oldest osteopathic medical schools. It graduates about 210 DO students a year, compared with about 150 MD students who graduate annually from the University of Iowa, home to the state's only other medical school.
Many patients probably pay no attention to whether a physician is an MD or a DO, but some seek the osteopathic type, said de Regnier, who is a past president of the American College of Osteopathic Family Physicians. Patients might like the physical manipulation DOs can use to ease aches in their limbs or back. And they might sense the profession's focus on patients' overall health, he said.
On a recent afternoon, de Regnier worked his way through a slate of patients, most of whom had seen him before.
One of them was Ben Turner, a 76-year-old pastor from the nearby town of Lorimor. Turner had come in for a check of his diabetes. He sat on the exam table with his shoes off and his eyes closed.
De Regnier took out a flexible plastic probe and instructed Turner to say when he felt it touch his feet. Then the doctor began to gently place the probe on the patient's skin.
"Yup," Turner said as the probe glanced against each toe. "Yup," he said as de Regnier brushed the probe against his soles and moved to the other foot. "Yeah. Yeah. Yup. Yeah."
The doctor offered good news: Turner had no signs of nerve damage in his feet, which is a common complication of diabetes. A blood sample showed he had a good A1C level, a measure of the disease. He had no heaviness in his chest, shortness of breath, or wheezing. Medication appeared to be staving off problems.
Chris Bourne, 55, of Winterset, stopped in to consult de Regnier about his mental health. Bourne has been seeing de Regnier for about five years.
Bourne takes pills for anxiety. With input from the doctor, he had reduced the dose. The anxious feelings crept back in, and he had trouble sleeping, he told de Regnier, sounding disappointed.
De Regnier noted the dose he prescribed to Bourne is relatively low, but he had approved of the attempt to reduce it. "I'm glad you tried," he said. "Don't beat yourself up."
In an interview later, Bourne said that until he moved to Winterset five years ago, he'd never gone to an osteopathic physician — and didn't know what one was. He's come to appreciate the patience de Regnier shows in determining what might be causing a patient's problem.
"When he sits down on that stool, he's yours," Bourne said.
Another patient that day was Lloyd Proctor Jr., 54, who was suffering from previously undiagnosed diabetes. His legs were swollen, and he felt run-down. Tests showed his blood sugar was more than four times the normal level.
"The pancreas isn't happy right now, because it's working too hard trying to take care of that blood sugar," the doctor told him.
De Regnier diagnosed him with diabetes and prescribed medication and insulin, saying he would adjust the order if necessary to minimize Proctor's costs after insurance. He brought out a syringe and showed Proctor how to give himself insulin injections. Proctor listened to advice on how to measure blood sugar.
"And maybe I should quit grabbing Mountain Dew every time I'm thirsty," the patient said, ruefully.
De Regnier smiled. "I was just getting to that," he said.
The appointment was one of the doctor's longest of the day. At the end, he reassured Proctor that they could get his diabetes under control together.
"I know that's a lot of info. If you get home and think, 'What'd he say?' — don't hesitate to pick up the phone and give me a call," de Regnier said. "I'm happy to visit anytime."
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Copyright 2023 KFF Health News. To see more, visit KFF Health News.
Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.
Without a doubt, parenting is a full-time job. Being a medical resident in training is also a full-time job. What does that mean for a parent who is working an average of 80 hours per week as a medical resident? A double full-time job? A quadruple full-time job?!
Some residents are fortunate to live near family and friends who can assist with childcare, but others explore different avenues, including daycare centers, nannies, au pairs or babysitters.
We spoke with one mother who would prefer to remain anonymous, so we’ll refer her using her initials, “ACF.” A DO emergency medicine resident and mother of a two-year-old daughter, ACF says that juggling the demands of residency with motherhood has been a roller coaster. While she completes her training, ACF’s daughter is at daycare or with an au pair, which is a helper who assists with childcare and household duties. Although expensive, ACF considers this a sacrifice worth making.
Let’s talk parental guilt. Undoubtedly, guilt is something many working parents struggle with every day.
Coping with parental guilt is something that ACF is still trying to manage, but she has found a few ways to ease the remorse. Finding a free 10-minute window to FaceTime her daughter helps keep her connected and brightens her day. Additionally, ACF says, “It always helps to find ways to talk about your kid at work. Show people pictures and talk to co-residents who also have kids about how they’re coping with things.”
Another resident we’ll refer to as “MM” is a mother of six who is working to balance her residency training and family. Working a schedule of 12 days on and two days off, MM says she has had to cash in retirement funds to help pay for childcare. Due to the fact that some schools have kept pandemic adaptations in place, MM’s children often have “virtual days” where they learn at home rather than going to school. This has led to increased childcare expenses, and with the current economic state of inflation, MM has found it hard to stay afloat.
There is no denying that childcare is expensive and it can be difficult to manage the physical, financial and emotional demands of balancing residency and parenthood. Regardless of your situation, it’s important to remember that residency is a temporary phase of your life and the sacrifices you make now will ultimately make you a stronger physician and parent in the future.
*Initials have replaced names for privacy.
WAOPS signed on with 31 other osteopathic associations in support of the Strengthening Medicare for Patients and Providers Act. The letter was sent out from the American Osteopathic Association to Representatives Ruiz, Bucshon, Bera and Miller-Meeks and reminded them that the legislation would apply a permanent inflation-based adjustment to the Medicare Physician Fee Schedule (MPFS) which would provide stability to providers delivering essential care to Medicare beneficiaries and help ensure that patients have access to timely and high-quality care.
The letter went into further detail regarding what this would continue to mean for providers and patients, and emphasized that the Strengthening Medicare for Patients and Providers Act would provide transformative stability to the Medicare payment system. The message concluded with thanking the representatives for their leadership on this essential issue.
Click here to read the letter in its entirety.
WAOPS sent a letter to the Wisconsin legislature members regarding their support for the All Copays Count Legislation.
Read the full letter here.
WAOPS signed on to a letter to Senator Baldwin regarding PBMs:
Dear Senator Baldwin,
We are aware that the Senate HELP Committee will be considering legislation to regulate pharmacy benefit managers on April 19, and we are writing to share what we would like to see from this hearing.
As you no doubt know, pharmacy benefit managers (PBMS) are prescription drug middlemen owned by insurance companies that leverage their place in the drug supply chain to reap huge profits for themselves while leaving patients with few options at the pharmacy counter. While better regulations targeting the frankly monopolistic practices of PBMs has been considered in the past, we would like to encourage you and your colleagues to move forward with bold and impactful new policies that will make a real difference for patients across the country.
Due to the fact that just three PBMs, OptumRx, CVS Caremark, and ExpressScripts, control 80 percent of the drug marketplace they have been able to engage in practices that don’t just cost money, but actively hurt patient access to medicines. Since PBMs manage drug formularies for insurance plans they are able to decide which drugs will be covered, and frequently they have given preference to higher cost medications because they can make more money off them than lower priced alternatives. PBMs are too often leaving low-priced generics and biosimilars off formularies entirely, which in turn drives up prescription drug costs and puts many drugs out of reach of the average patient. Additionally, PBMs are the vertically integrated through the ownership or management of many specialty and retail pharmacies. This integration allows PBMs to steer patients toward their own pharmacies in order to increase their own profits, even if their pharmacies are not convenient or preferred by the patient.
Action at the federal level must be taken to regulate PBMs and ensure they are working for patients not their own bottom lines. Strong transparency requirements should be implemented to PBM contracting practices so they can be monitored to ensure they are operating in the best interest of patients and not their own profits.
In Wisconsin, we have passed legislation requiring PBMs in the state to disclose what they pay for drugs and whether the savings on those drugs have been passed on to patients. This type of transparent accountability is critical to ensuring a more equitable drug supply chain. We cannot continue to allow PBMs to reap unprecedented profits thanks to a lack of transparency and accountability.
Recent litigation by several Attorneys General have found that hundreds of millions of dollars in government funding has been lost to PBMs thanks to their purposefully opaque business practices. The link between the price of a medicine and PBMs profits must be broken.
We hope you will remember our concerns during the upcoming HELP Committee and will support significant new regulations to ensure patients are being treated fairly and can more easily access the medications they need.
The AOA is circulating a sign-on letter in response to the Federal Trade Commission’s proposed rule banning the use of non-compete clauses in employment contracts and WAOPS has signed on in support.
The rule would designate the use of such clauses as an unfair method of competition under the FTC Act. The AOA is circulating this sign-on to express the osteopathic physician community's support for this effort. Overall, the letter:
View the letter here.
WAOPS submitted a proclamation to Wisconsin Governor Evers office for National Osteopathic Medicine Week, and received an official proclamation!
Happy National Osteopathic Medicine week to all DOs!
WAOPS was glad to sign onto a group health letter to the Environmental Protection Agency (EPA) urging them to finalize stronger annual and 24-hour standards for the National Ambient Air Quality Standards (NAAQS) for fine particulate matter pollution (PM2.5).
The letter read as follows:
"Particle pollution poses a dangerous threat to human health. According to the American Lung Association’s 2022 “State of the Air” report, Wisconsin is home to 75,199 children and 467,737 adults with asthma, 244,094 people with COPD, and 321,019 with cardiovascular disease, all of whom could be at greater risk of health harm from particulate matter. The current limits on both short-term spikes and annual levels of particle pollution are currently too weak to protect the health of people in Wisconsin.
The revision of the NAAQS for particulate matter pollution represents an important step toward healthier air. To ensure that the standards are aligned with the current science, the undersigned organizations support a final standard of 8 micrograms per cubic meter (μg/m3) for annual PM2.5 and 25 μg/m3 for 24-hour PM2.5.
The Clean Air Act requires that the NAAQS be set based solely on what the best available science says is necessary to protect public health with an adequate margin of safety. EPA was correct in reconsidering the PM2.5 standards following the 2020 review. Overwhelming scientific evidence shows that the current standards are inadequate, putting vulnerable populations at risk and further entrenching environmental injustices in exposure.
PM2.5 can increase the risk of heart disease, lung cancer and asthma attacks and can interfere with lung development. Overwhelming evidence shows that both acute and chronic PM2.5 exposures are deadly. For example, a 2016 study of individuals 65 and older in New England found that the risk for premature death occurred even in areas that meet the current level.1 A more health protective standard is needed, especially for individuals most at-risk, including pregnant people, infants, children, seniors, people living with lung and heart conditions, lower-income communities, and communities of color.
As health organizations committed to improving public health and advocating on behalf of the patients and communities we serve, we urge you to follow the science by proposing and finalizing standards of 8 μg/m3 for annual PM2.5 and 25 μg/m3 for 24-hour PM2.5 to ensure healthier air for all."
WAOPS was among other Wisconsin health organizations that signed on to support; American Lung Association in Wisconsin, Wisconsin Allergy Society, Wisconsin Asthma Coalition, Wisconsin Medical Society, Wisconsin Primary Health Care Association.
From the American Osteopathic Association.
CHICAGO—March 17, 2023—Breaking records from all previous matches, the 2023 National Resident Matching Program (NRMP) matched 7,132 osteopathic medical students and past DO graduates into postgraduate year 1 (PGY1) residency positions. Reaching another all-time high, 91.6% of the 7,436 participating DO students matched into residency programs in 37 specialties.
Overall, the number of osteopathic fourth-year students who matched into PGY1 positions increased by 0.3% from last year. Final placement numbers will be available in May and are expected to exceed the 99% rate reported in prior years.
“We are thrilled to see continued growth in the number of osteopathic medical students and graduates who successfully place into residency positions through the NRMP Match each year,” said AOA President Ernest R. Gelb, DO. “The percentage of matches for our residency candidates continues to keep pace with the growth of our profession, demonstrating that residency programs and patients are actively seeking the distinctive approach DOs provide across the full spectrum of medicine.”
Era of growth
Top specialties
A total of 3,902 (57%) matching DO students landed positions in primary care programs, with the remaining 2,910 (43%) matching into secured non-primary care placements across a wide range of specialties. This year’s Match resulted in increased placements for DO residents in family medicine, internal medicine, and pediatrics. The number of DO placements in specialty training programs increased for general surgery, neurology, psychiatry, pathology, orthopedic surgery, child neurology, obstetrics and gynecology, physical medicine and rehabilitation, vascular surgery and otolaryngology.
Additionally, a record number of 320 graduating osteopathic fourth-year students and 68 graduates secured residency positions via the military match, which places applicants into programs run or sponsored by the military.
“It’s exciting to witness the continued growth and expansion of osteopathic medicine across the full House of Medicine, and this year’s high match rate speaks to the exceptional quality of our DO residency candidates and the pivotal role they will play in the future of health care,” said AOA Interim CEO Kathleen S. Creason, MBA. “I am inspired by the dedication and tenacity of these future residents and can’t wait to see how they will influence the landscape of medicine for years to come.”
For graduating fourth-year osteopathic medical students, the top 15 specialties by number of PGY1 matches are:
The American Osteopathic Association (AOA) represents more than 178,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. To learn more about DOs and the osteopathic philosophy of medicine, visit www.osteopathic.org.
From Wisconsin Health News
Insurers and pharmacy benefit managers would have to count copayment assistance from drug companies toward patients’ annual deductibles and maximum out-of-pocket costs under a bill introduced by a bipartisan group of lawmakers Tuesday.
In response, associations representing insurers and pharmacy benefit managers raised concerns about drug coupons, warning they increase overall drug costs.
Sen. Andrè Jacque, R-De Pere, said the “critical legislation” is about medication adherence and better health outcomes. He said that it can be “devastating” for patients to learn that they haven’t met their out-of-pocket commitments.
“This is about making sure people can afford their medications and not have to choose between groceries and gas and being able to progress and deal with a chronic condition,” Jacque said at a press conference.
A memo for the bill circulated to gain support for the plan from lawmakers noted that the legislation applies to prescriptions if there's not a "medically appropriate generic equivalent available," which the bill's sponsors argued removes concerns that the financial assistance would drive patients to higher-cost drugs.
Rob Gundermann, CEO of the Coalition of Wisconsin Aging and Health Groups, which is leading a group of around 40 patient and provider groups in support of the bill, said copay assistance programs were created by manufacturers to respond to efforts by health plans to shift the cost burden of prescriptions onto patients.
“Copay assistance is a critical lifeline for patients across our state,” he said.
Similar legislation introduced last session didn’t make it into law. It faced criticism from insurers and the Pharmaceutical Care Management Association.
“Drug companies offer coupons to insured patients, regardless of their incomes, to induce patients to take a more expensive brand drug instead of an equally effective, less expensive, alternative with lower cost sharing,” Sean Stephenson, director of state affairs for the association, which represents pharmacy benefit managers, said in a Tuesday statement. “Numerous analyses show an increase in the use of copay coupons correlates to a total increase in prescription drug spending.”
Wisconsin Association of Health Plans Executive Director John Nygren said some aspects of the proposal have changed since last session.
"Our fundamental concern remains the same: Copay coupons are marketing tools used by pharmaceutical companies to encourage use of their drug over alternative therapeutic options," Nygren said in a statement.
The Alliance of Health Insurers said in a statement that the legislation “would do nothing to control the soaring prices of prescription drugs.”
“Perversely, this legislation would reward drugmakers for steering patients towards and keeping them on expensive brand-name drugs, costing all of us more money,” they said in a statement. “The federal government considers copay coupons an illegal kickback if used by an enrollee in Medicare or Medicaid because they induce a patient to use a specific drug. Copay coupons should be banned."
Wisconsin Association of Osteopathic Physicians and Surgeons563 Carter Court, Suite B | Kimberly, Wi 54136© Copyright 2022. All rights reserved.Privacy Policy
.png){kind=spacer}