Holistic approach to doctor shortage

As a Navajo Indian and physical therapist helping patients move normally again, Joe Rasor knew becoming an osteopathic physician was the right move for him.

He is learning the holistic medical approach of osteopaths, which is similar to American Indian thinking, as well as osteopathic techniques to manipulate parts of the body, which resemble physical therapy.

"It just kind of fit like a glove," he said.

Rasor, a Gilbert resident and third-year student at Midwestern University’s Arizona College of Osteopathic Medicine in Glendale, joins a rising number of osteopathic medical students expected in the Valley.

A.T. Still University is planning to open an osteopathic medical school in its existing facilities at Recker and Baseline roads, where about 100 students would begin in fall 2007, said Dr. Craig Phelps, provost of the Mesa campus. And Midwestern University plans to boost admissions to 250 students from about 150 during the next four years.

"We think we’ll have to ramp up the number of physicians to meet increasing demand," said Kathleen Goeppinger, president and chief executive of Midwestern University. "That will really make a huge impact in the Valley."

A recent physician work force study in Arizona found the ratio of doctors to patients was well below the national average: 208 doctors for every 100,000 people in Arizona compared with 283 doctors for every 100,000 nationwide.

As the state’s population continues to grow, the disparity in ratios may indicate that Arizona has a physician shortage that will likely get worse, said Dr. Michael Grossman, co-author of the study.

The entrance of a new osteopathic medical school, as well as the expansions of Midwestern University and the University of Arizona College of Medicine in Phoenix, will help fill the ranks of needed doctors, Grossman said. But many students will leave Arizona after medical school, choosing residencies out-ofstate, where they are more likely to set up practices.

"How many of them will remain in Arizona is unknown," he said.

Keeping newly trained doctors here to practice medicine is critical, health care authorities said. Legislation signed into law this year establishes a $1.5 million scholarship fund for tuition and living expenses for medical school students who agree to provide their services in Arizona for at least two years after graduation. And medical schools are exploring ways to expand residency training programs, which provide the personal and professional ties that often convince doctors to stay where they’ve trained.

Adding or expanding the hospital-based programs, however, is difficult and costly, Grossman said. There are regulatory hurdles for accreditation, caps on the number of residents a program can have and reimbursement from Medicare that usually does not cover a hospital’s costs to train residents, he said.

Nearly all of the osteopathic residency programs have closed in the state. Small programs at Mesa General and Tempe St. Luke’s, both owned by IASIS Healthcare, will shut down in the next three years for financial reasons, said Dr. Lori Kemper, assistant dean of graduate medical education at Midwestern University and a family practice doctor in Tempe.

Osteopathic residency programs continue to operate at John C. Lincoln Health Network in Phoenix and at a medical facility in Kingman, and Midwestern University is trying to open another program in Sierra Vista, she said.

Osteopathic doctors in training can complete residencies for medical doctors. But those programs typically don’t include osteopathic medicine’s holistic approach, which can involve manipulating parts of the body, Kemper said.

It would be ideal to have residencies accredited jointly by the organizations that oversee education for medical and osteopathic physicians, Kemper said. That way, both medical philosophies would be present during training.

While licensed medical doctors far exceed osteopaths in the state — about 2,000 osteopathic doctors compared with more than 17,000 medical doctors — health care authorities said the growth of osteopathic medical schools will boost the number of osteopath’s licensed to practice in Arizona.

Education standards and licensing requirements are the same for osteopathic and medical doctors. Osteopaths, however, receive extended instruction in physiology and anatomy, Kemper said.