How will becoming a Family Practice DO change my practice?
Now that most people know I will be embarking on the journey of medical school to become a Family Practice Doctor of Osteopathic Medicine (FP-DO), conversations have shifted from congratulatory celebration towards inquiries on what exactly being a FP-DO means and the most important question on the minds of folks: will I still be attending births/practicing midwifery?
So, let us begin with discussing exactly what Osteopathic Medicine is. Wikipedia states:
In the 21st century, the training of osteopathic physicians in the United States is equivalent to the training of Doctors of Medicine (MDs). Osteopathic physicians attend four years of medical school followed by an internship and a minimum two years of residency. They use all conventional methods of diagnosis and treatment. Though still trained in Osteopathic Manipulation Treatment, the modern derivative of [Andrew Taylor] Still's techniques, they work in all specialties of medicine.
Osteopathic principles Osteopathic medical students take the Osteopathic Oath, similar to the Hippocratic oath, to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:
1) The body is a unit; a person is a unit of body, mind, and spirit. 2) The body is capable of self-regulation, self-healing, and health maintenance. 3) Structure and function are reciprocally interrelated. 4) Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
Contemporary osteopathic physicians practice evidence-based medicine, indistinguishable from their MD colleagues.
Some people like to say that DOs are the "crunchy" physicians, who are (w)holistic, patient-centered, and focus more heavily on mind-body wellness and prevention. And while this is true for many DOs, the reality is that most practice almost indistinguishably from MDs. The main difference in education is the learning of modern Osteopathic Manipulation Treatment, which includes palpation and manipulation of bones, muscles, joints, and fasciae -- similar treatments are employed by physical therapists and chiropractors. Despite learning OMT, only about 5-10% of DOs regularly utilise OMT with their Primary Care Patients.
Why have I chosen the DO route to becoming a Primary Care Provider?
1) I am a hands-on and holistic care provider already. After 21 years of birthwork and midwifery, clinical and community herbalism, reflexology and therapeutic touch, somatic and spiritual counseling, and despite even heavy scepticism, a tango with homeopathy, Osteopathic Medicine seemed like a natural fit.
2) It was the more economical choice regarding money and time. If accepted to the accelerated program of my choosing, I will eliminate a year of "classroom" time and two years of residency. This program exists in an effort to help mitigate the lack of PCPs, especially those in Family Practice. As such, the program is tuition-free for those graduates who commit to working as PCPs in Family Practice for a minimum of five years post graduation. I get to save time and money to provide a greater level of care for my clients.
Speaking of care, what exactly is a Family Practice Physician?
Succinctly, they are physicians who take care of people "cradle to grave", through all of life's transitions, and typically see entire families in their practices. Wikipedia says:
Family practice is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body; family physicians are often primary care physicians. It is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The issues of values underlying this practice are usually known as primary care ethics.
Providing this kind of care is nothing more than a broadening of scope and skill, a continuation of the care I have provided members of my community with already in some way or another for two decades.
What kind of care do I intend to focus on and provide for my community?
- well care/regular check-ups for all ages and stages of life
- family planning, all types of birth control, and pregnancy termination*
- fertility awareness, cycle tracking, & preconception care
- perinatal care for expectant parents & gestational carriers
- newborn health screenings, infant/child well checks, & sick visits
- hormone treatment & replacement therapy for all genders
- neurodiversity and mental health
- addiction and recovery
- queer and transgender inclusive & competent care for all ages
- body positivity/Health at Every Size
- care for all family types (single parents, co-parenting, polyamory, multigenerational, etc.)
- providing evidence-informed care while respecting client choice and cultural & indigenous practices
- accessible & affordable care for marginalised communities (primarily Q/T/GNC & IBPOC)
*Opportunity for getting trained in providing surgical abortion in med school is severely lacking and unfortunately not a requirement. I will train locally with a physician after graduation. It is likely that I will be providing surgical abortions at an established local clinic and not at my office.
But what about homebirth!?
This seems to be one of most pressing questions for so many. The short answer is a resounding yes! The longer answer is that I am not entirely sure how that will look since I will be acting as a PCP as well as taking on-call birth clients. I know that it will require me to hire a Physician's Assistant or Nurse Practitioner or partner up with another Family Medicine or Ob/Gyn Physician to cover my appointments while I am away at a birth. In addition to homebirths, which will still remain my priority, my office will have a birth suite, and I will accept a limited number of planned hospital births. I will also be working with my associate homebirth midwives offering co-care for their clients and continuity of care should they need an office birth or to transfer to the hospital.
One of my main goals and reasons for traveling this path is so that I can offer the greatest continuity of care for those who choose to have me as part of their birth team. Having the same provider who can offer seamless care for someone annually, perinatally, for their newborn, their older or future child(ren), and any partner(s) is just the dreamiest arrangement I can imagine. Minimising the need to juggle separate doctors for everyone in the family should reduce some stress and anxiety around seeing the doctor, allow for more holistic and contextual care within the family unit, and provide greater opportunity for community building and strengthening families.
I have a million more thoughts and ideas, but I will save the rest for another day.
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