Osteopathic Physicians Take Up Slack in Rural Primary Care Situations

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.

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.

The number of practicing physicians per person in the United States is lower than in just about any other developed country. Yet from 1980 to the early 2000s, the prevailing wisdom was that the number of physicians within the United States ought to be reduced . During this period, a series of ill-judged reports by the federal government warned of an impending physician surplus.

Well they got that one wrong!

It’s difficult to overstate the influence of the GMENAC report in cementing the narrative of physician surplus during the 1980s and 90s. The report is pervasively referenced in medical and policy journals during this period. In subsequent years, the “surplus” narrative would be routinely endorsed by governmental bodies.

In years following the GMENAC report, the surplus narrative would motivate efforts by both governmental and associational actors to restrict the U.S. physician supply. Just a few of the various actions taken included:

** Scaling back federal support for medical school scholarships through the National Health Service Corps;*
** Raising the stringency of residency training requirements with the intent of decreasing the financial attractiveness to hospitals of operating residency programs;*
** Gradually withdrawing federal support for residencies, culminating in the freeze on direct funding for residency training implemented in 1997.*

But perhaps the most long-lasting and damaging impact of the surplus narrative was the medical school moratorium from 1980 to 2005.

One side effect of the medical school moratorium was the mainstreaming of D.O.-granting osteopathic medical schools, which opted not to participate in the moratorium.

One impact of the medical school moratorium was an increasing U.S. reliance on physicians educated abroad.

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.