What's in a name? For DOs, plenty

A new public awareness campaign aims to make osteopathic physicians as recognizable as MDs. Few think it will be easy.

By Wayne J. Guglielmo, Senior Editor

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Osteopathic FP Gail Dudley recalls the incident vividly. She was at a supermarket checkout counter in Melbourne, FL, and had just handed the young cashier a bank check. "That 'DO' after your name," the teenage girl asked curiously. "Does that stand for, like, 'district attorney'?"

"There was no way I could get through that conversation," Dudley says today. "I answered Yes, picked up my stuff, and left."

Even among the less spelling-impaired, DOs have had a hard go of it, despite an impressive swelling of their ranks in recent years. Indeed, according to a recent consumer survey conducted for the Chicago-based American Osteopathic Association, 89 percent of respondents couldn't accurately say what a DO is. A series of follow-up focus groups confirmed the confusion. Osteopathic medicine was frequently associated with treatments to cure back pain or the study of bones.

"Somehow, A.T. Still, the founder of osteopathic medicine, gave us the wrong name over 100 years ago," says FP Robert S. Maurer of Edison, NJ. "Since 'osteo' refers to bone, it confuses people."

To help clear up the confusion, the AOA last year kicked off a three-year public awareness campaign. The tag line: DOs: Physicians Treating People, Not Just Symptoms.

"We found the line resonates in a couple of areas," says internist Karen J. Nichols of Mesa, AZ, a member of the AOA committee spearheading the campaign. "For one thing, we're one of the only two professions in the US that can use the term 'physician'—allopathic doctors being the other, of course. Also, from Day One of our training, we're taught to find out as much as we can about a patient, rather than focusing simply on what's wrong." MDs can do the same thing, says Nichols, but it's second nature to DOs because of their training.

Maintaining the patient focus in the age of managed care

Like all slogans, of course, the AOA's raises at least as many questions as it answers. How, for instance, does the average DO practice according to the osteopathic credo in this era of managed care, without falling woefully behind?

Nichols admits it isn't easy, but she thinks it can be done—and profitably. "It's a false sense of economy to think you can do seven-minute visits all the time," she explains. "Spend more time up front really getting to know a patient, and it will pay off in the long run."

Thus far, the AOA campaign has employed some well-tested marketing tools to get across its message. Working with an outside firm, the AOA has:

• Created and distributed a pair of video news releases.
• Distributed its monthly Wellness Watch newsletter to 1,500 radio and print news outlets.
• Held "deskside briefings" with reporters and editors, from magazines such as Woman's Day, Mirabella, and Time, and with producers from CBS This Morning.
• Conducted training sessions for its Doctor Spokesperson Network.

Results have been encouraging, according to AOA spokeswoman Karyn Gianfrancesco. As of late September, 44 local TV stations had run segments on DOs. Newspapers, as well as local and national magazines, have also responded to the DO push. Fitness magazine (circulation 1.9 million) plans to run an interview with recently elected AOA President Eugene A. Oliveri. The campaign has also moved online with stories on various Web sites.

Internal splits make the PR task harder

It's a big country out there, of course, and it's going to take a lot more work before DOs become the household name they want to be.

The quirks of geography will certainly play a role. In certain parts of the nation, DOs need no introduction. "They love DOs here," says osteopathic FP Jeffry Hatcher, who practices in rural eastern Illinois. "In the '30s and '40s, there were several osteopathic physicians in this area, and then they passed away and nobody replaced them. When the folks around here found out a new DO was moving in, they were very excited. I came in thinking they wouldn't know what DOs are, and it turns out they really did."

In other parts of the country, however, DOs don't have that kind of legacy to build on. As a result, they're often called upon to debunk some longstanding myths. "Sometimes, I get comments like, 'Well, you're a DO and can't do surgery,' " says FP Audrey Jones, who practices in Alamo, TX, close to the Mexican border. "My answer is, 'Actually, I'm a family physician, and that's why I can't do surgery.' " Jones says there are probably fewer than 30 DOs within a 100-mile radius of her.

DOs face another, potentially knottier problem in getting their message out: a disagreement within the profession about what really distinguishes DOs from MDs. Marketing slogans aside, traditionalists argue that it's DOs' hands-on approach—known as osteopathic manipulative treatment, or OMT—that sets them apart. If that's so, DOs who don't incorporate OMT into their practice—and some studies indicate many do not—are left with a fuzzy identity.

"When I was in private practice, patients would sometimes schedule appointments with me rather than my MD colleagues so they could get OMT," says Jeffrey Kirchner, who now teaches in an allopathic family medicine residency program in Lancaster, PA. "The trouble is, I don't practice OMT. It was embarrassing to have to admit that when they came in."

Is Kirchner a "real" DO? Certainly, he's respectful of colleagues who've trained in OMT and practice it regularly. But for him "a doctor is a doctor is a doctor." He asks: "Is there a difference that extends beyond the degree? I don't know. It's a tough issue for the osteopathic profession."

Meanwhile, the AOA's campaign moves forward, focusing less on metaphysics than on public misperception. In the months ahead, according to AOA officials, the strategy will shift from a predominantly top-down campaign, with the AOA doing most of the heavy lifting, to a more grassroots-style campaign involving state associations around the country. The AOA offered attendees to its late October convention in San Francisco some lessons on how to talk nice to the media. It also provided special media training to physicians and others selected as "ambassadors"—in effect, liaisons between state associations and local media.

After three years, and perhaps sooner, the AOA's marketing people will go back and measure the impact of all this activity on public perception.

With luck, no one at that point will mistake a DO for a DA.

How much confusion can "DO" after your name cause?

Just ask osteopathic FP Steven Kamajian of Montrose, CA.

"A couple of years ago, California began switching Medicare patients to an all-HMO format," Kamajian says. "If patients didn't pick a primary care doctor, the state assigned one based on specialty, location, and ethnicity. When the program kicked in, I was amazed to find I'd ended up with 500 Chinese-speaking families. 'What's going on?' I asked the state office handling the enrollment. 'Aren't you Doctor Kamajian Do?' the person at the other end of the phone asked back."

Clearly, a mistake had been made, but the state had no system to notify patients of the error. Kamajian was forced to disenroll from the program for six months. As he says: "When I re-enrolled, I tried to make it clear that no one would name their kid 'Kamajian Do.' After all, how many Chinese Armenians are out there?"