A Day in the Life of an Academic NMM/OMM Specialist

Session 155

The field of Osteopathic Medicine is still relatively new in the country both from a knowledge standpoint and an awareness standpoint. Dr. Kara Mintier talks about her journey into Osteopathic Medicine including her specialty of Academic Neuromusculoskeletal and Osteopathic Manipulative Medicine.

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:50] Interest in Osteopathic Manipulative Medicine (OMM)

Kara ended up getting a bad concussion when she was 12. Then she started seeing a specialist for her headaches and post concussion problems until she was 12. Through high school, Kara was a big athlete. She played three sports year-round for all four years, and she ended up with a lot of sports injuries.

Her senior project was specifically on osteopathic medicine. They told them to pick something they were passionate about, shadow somebody, and write a project on it. Specifically, she was working on the difference between osteopathic physicians and allopathic physicians.

Kara feels blessed to have seen it from a patient perspective and from the doctor’s standpoint, having been able to shadow and witness a DO perform an OMM.

Kara initially felt like her premed advisors were telling her what she wanted to do and she got scoffed at. They found her MCAT to be an issue and told her she can’t be an allopathic physician. But it was okay because Kara really wanted to be a DO in the first place.

“With all the hands-on, the actual osteopathic curriculum is maybe a little bit harder for some people.”Click To Tweet

[08:08] What is Neuromusculoskeletal Medicine?

Neuromusculoskeletal Medicine is actually its own specialty that you need to go to. You can be a pediatrician or a family practice doctor and you integrate OMM into your practice. However, people don’t know that there’s this whole specialty out there for them.

Kara found out about the specialty from her physician mentor who went from family practice and did manipulation, to a full manipulation practice.

So she saw from her what a full manipulation practice looks like. She has also seen what the path looks like since they’ve created specific residencies that weren’t even around when she was a student. So an OMM residency is definitely newer.

Before that point, you did just your regular specialty and you just do manipulation as part of that practice. And you choose whether to do more or less of it. And then you just became a specialist because that’s what you did all the time.

Then they started to create a board. Currently, there are three different paths to become an OMM specialist. Once you finish that residency, you can do a plus one fellowship year.

Kara thought about doing family medicine and then the plus one fellowship year. But by the start of her third year, she did three months of Family Medicine back to back. And by the end of three months, she thought she couldn’t do three years of this.

The chronicity of the diseases and the routine seemed like the same thing over and over again, with just a different patient. So this didn’t entice her and it didn’t spark her interest.

You can manipulate a lot of things. There’s probably a study out there suggesting that manipulation could affect blood sugar levels temporarily. But it’s not standard of care.

And being a student, Kara knew she wanted to do mostly a full manipulation practice. So it was more about either taking more treatment aspects or spending more time doing the manipulation. Kara could have gone either way.

Then there’s also a few programs out there that are integrated. That doesn’t mean you do all family practice and then you do a one year of manipulation. But you do four years, and you’re doing both simultaneously. You’re alternating months and you’re seeing both family practice patients and manipulation patients. Currently, there are only two or three of those programs in the country.

[13:26] Biggest Myths or Misconceptions Around Neuromusculoskeletal Medicine or OMM

A lot of people think that chiropractic medicine and OMM are the same thing. Basically, this depends on which type of chiropractor you’re talking about. Because she knows of some chiropractors that are very good.

But one of the main differences is that chiropractors only work on more articular problems. And as a DO, they can manipulate anything from head to toe.

“Chiropractors only work on more articular problems. DOs can manipulate anything from head to toe.”Click To Tweet

DOs do the cracking or popping that chiropractors do. But it’s only one of the 10 or 12 different types of techniques that DOs do. She can work on the muscle layer, the fascia layer, the periosteal layer. She can do visceral techniques, on cranial dura and all those attachments and the nervous system and vasculature. A lot comes down to what you’re interested in and what you want to explore and do eventually.

[16:53] Good Traits that Lead to Being a Good Neuromusculoskeletal Physician

Besides the anatomy and physiology puzzles, you have to be okay with knowing that there’s no one correct step of what to do next. So each time you see a patient, you have to start through the same process even when you see the same patient.

You have to take into account what you’ve done before. But then start that process over again. And each time, it’s a puzzle.

Sometimes, you have to figure out what is the key thing that’s going on that’s causing everything and it is a massive puzzle of working through the anatomy, physiology, and history. Then you have to add on the palpation component that you don’t know until you actually feel what the tissues are doing.

“Every patient is different.”Click To Tweet

[19:51] Types of Patients and Typical Day

A lot of times, Kara doesn’t require referrals. She has treated everybody, from her youngest patient being hours old to patients in their 90s. Kara has handled patients that have had difficult births and babies are now having colic and the parents are not sleeping.

She helps patients with chronic ear infections or speech problems or developmental delays due to these restrictions. It just gives them that jump in life and makes everything just if you can get it early. It makes the biggest difference with them and then also their parents too.

As for her typical day, Kara usually has meetings on Monday. She has one day of clinic seeing patients. Then she rotates as an attending at the local hospital for their Plus One Program where she works with residents.

“There is a big role for inpatient medicine.”Click To Tweet

A lot of times, insurance companies and administration do not understand the impact of inpatient medicine. There’s been multiple studies to show how beneficial OMT is in decreasing antibiotic use of patients who get out a day or two earlier than patients that did not have OMT. There is also a decrease in post-surgical complications.

There are specific techniques they do on surgery patients after they get out of surgery to help them so that they don’t get pneumonia as well as the post op alias and the swelling on that.

So they’d get to see some post surgeries patients and some new babies born. Occasionally, they’d see the mothers helping them induce labor and post labor. They also see psych patients that were in the locked ward, usually for weeks or months. They help with chronic pain issues that may be leading to more difficulty with their mental health.

[24:42] Taking Calls

Kara does not take calls. It is mostly like an eight-to-five job, Monday through Friday. If it’s urgent enough to call in the middle of night, the answer is they go to the ER. Because if it’s something that bad, then the likelihood is that they shouldn’t be manipulating it. You need actual medical care that they’re not providing.

Sometimes, when you do manipulation treatments, you can have problems post-treatment, depending on what you’re doing. She has had patients with problems like vertigo or seizures. And the treatment is supposed to help those conditions, but occasionally, you can actually make them worse temporarily. So Kara usually gets calls the next day after treatment.

[26:41] The Training Path

As she mentioned before, three three pathways to OMM training: integrated, full residency, and plus one program. This depends on the hospital or school the program is associated with.

“If the residency is associated with a medical school, the resident has to give lectures and lab on top of their normal residency duties on a regular basis.”Click To Tweet

There are programs that are purely more clinic-based and then there are other programs that are more hospital-based.

So if this specialty is something you’re interested in, look at the programs individually and see what they’re offering.

Look at how much hospital experience they’re offering. Kara recommends finding a place that is offering in-hospital experience. Because in the hospital OMT, how you treat an acutely ill patient is significantly different from the 30 to 45 minutes you spend with a clinic patient. But if you never want to work in the hospital and want to do more teaching, look at a program more associated with a school that gives you that ability.

To be a competitive applicant to match, Kara says that you should have the passion for it. You should understand whether it’s something you should be manipulating. Is this something more problematic and worth referring to?

There’s this stigma sometimes that if people do manipulation, you don’t do any of that doctor stuff. But they do that too.

Moreover, the sense of palpation takes a while to develop. A lot of students get frustrated because they come through and they feel things but they miss it. And there are times when you can’t necessarily address the thing that patients come in to see you for.

[34:16] Message to Future Primary Care Physicians

Kara wants primary care physicians to understand that they do more than manipulate patients with injury and pain. There’s a variety of conditions that can be treated with manipulation. So find your local people scattered around the area. And figure out who they’re accepting and what they specialize in..

There are some OMM specialists that just do pediatric patients, other ones that specialize in traumatic brain injury, and then other ones like herself.

“Don't be afraid to refer to an OMM specialist.”Click To Tweet

There’s still a big difference in the level of knowledge for somebody that does it just occasionally versus somebody that does it on a regular basis. So there are still 50% or probably better patients that just need a little bit of OMT. Family practice and internal medicine physicians can also learn those minor techniques to have big benefits in their patients.

[36:39] What Kara Would Tell Her Early Self

If there’s something Kara could tell her younger self that would be to understand the business of medicine better. For the procedure, what does it look like to do private practice? A lot of people don’t do private practice due to the stress and all the other logistics involved.

Kara did private practice for a little bit and being young and dumb, she made some business mistakes that cost her financially. That being said, it didn’t change her passion for treating patients.

“What drives some people away from the specialty is currently the amount of insurance not giving payments.”Click To Tweet

[37:55] The Most and Least Liked Things

Kara is grateful seeing the way that it changes her patients’ life. The amount that her physician, and now mentor, worked with her to help her gain her quality of life back is the type of physician she wants to be.

She doesn’t want to be the one that gives her patient a pain pill and tells them to try to live with it. Because she was a patient on the other end of that. One of her goals was to change somebody’s life for the better like it did her.

On the flip side, what she likes the least are people who don’t bathe before they come in. Kara has allergies to different types of smoke so she has to tell patients not to smoke cigarettes or marijuana right before the visit.

That being said, Kara is able to make good connections with her patients, and sometimes act as a counselor as they’re working through all the issues.

[43:07] Final Words of Wisdom

If she had to do it all over again, Kara would still have chosen the same specialty. OMM makes Kara feel relaxed and happy. There are days where they are physically and mentally exhausted after seeing patients, but it’s not out of frustration.

Finally, her advice to premeds and medical students out there is to be willing to try and see. There is no correct answer to a lot of what you do. But be willing to try. Trying builds up your skill to be able to actually have the benefit you want to give to your patients.

“Don't be afraid to put your hands on somebody because trying to make a little change is better than not trying at all.”Click To Tweet