On Monday, 162 first-year medical students filed into the University of the Incarnate Word School of Osteopathic Medicine with hopes of being part of its first graduating class. They received their white coats Sunday in a traditional rite-of-passage ceremony welcoming them into the medical profession that takes a holistic approach, helping people gain a deeper understanding of how lifestyle and environment impact health, rather than just treating symptoms.
“It is vitally important that you become active in our vibrant society so that you will be able to chart the course of healthcare in your future,” said Dr. Adam Ratner, vice president of the Bexar County Medical Society, welcoming new students to the “family of physicians” during the white coat ceremony Sunday. It’s up to you … [to] be ready to do whatever it takes to become the most caring, effective, and happy physicians that you can be.”
The osteopathic medical school is located in District 3 on San Antonio’s Southside, where the population has the highest risk for health complications.
Dr. Anil Mangla, director of public health and research at the new school, told the Rivard Report that the new school’s purpose is to make a difference in the community.
“Our first priority is public health, and we have clearly identified that [District 3] has a high amount of disparities,” Mangla said. “We plan to really try to make a significant difference in the disparity of health outcomes in South San Antonio.”
Student doctors will be set up with families in District 3 as part of the university’s “adopt-a-medical student” campaign, where physicians work with patients and families on an ongoing basis to address social, cultural, biological, and environmental factors that contribute to wellness.
Instead of treating a disease, osteopathic medicine aims to delve deeper, looking into family culture, background, living circumstances, and work to set the patient up for health through education and behavior change.
Many are drawn to the field for this more personal, hands-on approach and its emphasis on community medicine and preventive care. There are pragmatic reasons as well. Medical schools are failing to keep pace with the patient population, and competition for careers in medicine is growing. More students see osteopathy as a sensible alternative to conventional medical school, a way to get a medical education with MCAT scores that may not make the cut for traditional medical schools.
According to the American Association of Colleges of Osteopathic Medicine, students entering osteopathic schools in 2015 scored, on average, 27, compared to 31 for M.D. matriculants.
Many osteopathic schools have an added mission: to dispatch doctors to poorer neighborhoods and towns most in need of medical care.
Mangla said that a main educational focus for the school is on community, social, and health engagement. Through integrated curriculum, students will be assigned families and exposed to cases immediately. They will learn to evaluate what a disease is, but also how to address social determinants of health along with implementing biomedical science to improve patient outcomes – one of the cornerstones of osteopathic medicine.
Texas ranks 47th in the country when it comes to the number of physicians per population, and San Antonio is continuing to grow rapidly with no signs of slowing down. According to Mangla, “the number of graduates that are being produced by Texas medical schools is not effective for the [community] demand.”
There is a shortage of primary care physicians and family physicians in Texas, especially in South Texas. Primary care and family physicians often work long, grueling hours, compared to their counterparts who choose a more lucrative, and often less time-consuming, path toward a medical specialization.
“I think the greater community will be excited when they see what we are doing, and by the quality of the first 162 students we graduate. We’re already getting so many applications and we’re very enthused by that,” said Dr. Blandine Bustamante Helfrich, vice-chair of clinical and applied science education at the school. “[Family practice] is really where the need is in this country right now, and since that is our focus I think that will fuel growth for the future.”
Allison Ogle is part of the medical school’s inaugural class. She told the Rivard Report that even without a medical specialization, a doctor’s salary is still “more money than [she] has ever seen.
“I think being a physician is a very comfortable living no matter where you are,” Ogle said. “So I would rather be somewhere where there is need rather than being somewhere just to make money.”
The school received more than 3,000 applications and completed 700 interviews. Admission officials looked for candidates who were interested in community and population health with plans to go into family practice. Seventy-five percent of the current student population are Texas residents, which Mangla explained was because the school “want[s] people to graduate and stay here.”
Twenty-three percent of the students accepted were from Bexar County.
Ogle, who is from Boerne, said that her decision to pursue osteopathic medicine was because of its focus on the patient-doctor relationship, where much of the work involves longitudinal time spent with the patient, with an “emphasis on the relationship and treating people like they are human.
“Osteopathic medicine, for me, is looking at the person as a whole, not just prescribing medicine and getting people out of the office,” Ogle said.
It can be difficult for doctors who are in good health and financial standing to connect to and build empathy for the social determinants of health that may contribute to a patient’s chronic illness, Ogle said. “You look at a population like San Antonio and say – these people are plagued by diabetes – and the attitude here is toward [preventing] people from becoming victim to a disease.”
Ogle believes the holistic approach of osteopathic medicine “makes for more compassionate doctors.”
Mangla told the Rivard Report that in Texas, the rate of individuals diagnosed with diabetes per 100,000 is 23.4%. In Bexar County that number increases to 26.8%. In District 3, the number of individuals diagnosed with diabetes is a staggering 67.8%.
The same pattern continues when addressing diabetic amputations. In Texas, the rate is 30.8%. In Bexar County it is 42.3%. In District 3 the rate is 45%, which Mangla describes as a “significant difference.”
Lauren Hatherall, a student from San Antonio, told the Rivard Report that she was drawn to the university because of its mission to serve the community.
“[I am] here to serve the underprivileged, and that is a mindset that I share with my classmates,” Hatherall said.
As part of their orientation week, the student doctors visited Haven for Hope to complete service projects throughout the campus, which included folding and tagging clothes for sale, painting, and organizing games of bingo for the residents. Hatherall described the experience as both powerful and humbling, and something that got her “excited to serve these groups of people.”
At the end of the four-year medical program, graduates will receive a Doctor of Osteopathy (D.O.) degree, which differs from allopathic medicine (M.D.) due to a focus on holistic wellness, and the interrelationship of the various systems of the body to maintain health, and to prevent illness and disease.
Osteopathic physicians also receive additional training in the musculoskeletal system, the body’s interconnected system of nerves, muscles, and bones, and perform osteopathic manipulative treatment using their hands to treat muscles and joints to relieve pain, promote healing, and increase overall mobility.
Osteopathic skills were first introduced by a 19th-century frontier physician, Andrew Taylor Still, who opposed the overuse of arsenic, castor oil, opium and elixirs and believed that many diseases had roots in a distressed musculoskeletal system that could be treated hands on.
Some critics regard the techniques as pseudoscience, though the medical establishment has come to accept the approach. Osteopathic schools offer the same academic subjects as traditional medical schools and the same two years of clinical rotations.
In 1980, there were just 14 schools across the country and 4,940 students. There are now 33 accredited osteopathic medical schools offering education in 48 locations across the United States.
Today, osteopathic schools turn out about 22% of the nation’s medical school graduates.
The school of osteopathic medicine was one of two universities in Texas to receive a Hogg Foundation for Mental Health grant to develop a program that works to address social determinants of health. Mangla will be the principle investigator for the $407,000 award, and will work to train medical students and other helping professionals – such as counselors and teachers – who may refer families or individual patients to the school for services.
Another focus will be on reducing the stigma around mental health through appropriate education for both the medical professionals and the patients about the effects that poor mental health can have on physical well-being, Mangla said.
“This has been one of the best opportunities I’ve had,” Mangla said. “I have the ability to bring up this new generation of physicians who will think very different. We can’t teach an old dog new tricks, but we can teach these learners how to implement correct ways of practicing medicine.”
Tom Bugg contributed to this report.