Osteopathic college chief looks to the past and future to improve health care

For more than a century, the Philadelphia College of Osteopathic Medicine has been training health-care practitioners.

This month, the college formally installed its eighth president, Jay S. Feldstein, an alumnus of the college and a Philadelphia native. He has been in office for more than a year, during which he has developed a five-year strategic plan to help the college grow academically and physically.

More than 1,000 students are seeking a doctor of osteopathic medicine degree at the college, where tuition is $45,036 a year. The college also offers doctor of pharmacy and doctor of psychology degrees, plus graduate programs in mental health counseling, school psychology, physician assistant studies, forensic medicine, organizational development and leadership, and biomedical sciences.

Feldstein recently shared some of his thoughts about his vision for the school and how osteopathic physicians can help forge a better, more collaborative health-care system.

What is an osteopathic physician?

The osteopathic philosophy takes a patient-centered, holistic approach as opposed to the medicinal approach, which focuses on symptoms, treatments, and medications. You're really looking at the individual from all aspects of their care - their social environment, their economic environment, and their mental health. Today, a lot of medicine is trying to become more holistic and integrated. But it is not new for us. It is something that is core to our being.

It also involves manipulation. We teach musculoskeletal techniques that can improve overall patient care and wellness. For instance, if someone has low-back pain or neck pain, can that be treated with osteopathic manipulation? Nine times out of 10, yes.

Is this a golden moment for osteopathic physicians?

There's a projected shortage of 35,000 primary-care physicians in the nation. We think we're a great solution to that problem because we continue to turn out highly trained primary-care physicians.

About 20 percent of all graduating physicians are doctors of osteopathic medicine. When I graduated in 1981, there were six schools in the nation. Now, there are 31. The profession has grown to fill the niche of primary care.

We've always had a primary-care focus. Sixty percent of PCOM graduates go into primary care. And 60 percent stay in the state of Pennsylvania. Our definition of primary care is family practice, general internal medicine, pediatrics, obstetrics/gynecology, and general surgery.

What are some of the new things you're trying to do at PCOM?

For one, we're trying to teach more preventative medicine, in terms of exercise science and nutrition. We're trying to get physicians to teach patients to have healthy behaviors and to change their behaviors to prevent chronic disease.

We also need to get our students prepared to understand the business and insurance world that they're getting into. And we need to teach them to leverage and use technology. We have state-of-the-art simulation labs so they can practice operative techniques and resuscitation techniques on mannequins and in software programs.

Consider: The standard sign of a physician is a stethoscope. But what if your iPhone has an attachment and now can perform a bedside echocardiogram that, in essence, would replace the stethoscope? That's a possibility. That's what we're talking about when we say "being prepared for the future."

You've also referred to the terms "patient-centered medical home" and "team-based approach" as important elements of better patient care.

A patient-centered medical home is an accreditation term. It helps the patients within the system meet all their health-care needs in one place. It has various components - electronic records, social workers, psychologists. It also means you have a team take care of each patient. If you go somewhere that's not a patient-centered medical home, who's coordinating your follow-up care? Who's helping with any behavioral diagnoses you have? Here, you're handling that all in one visit, all under one roof.

In addition to a physician, there might be a physician's assistant, a psychologist, even a pharmacist - partly to cross-check and make sure there are no serious interactions with multiple drugs, but also to help patients with adherence. Did you get the prescription filled? Did you take it as directed? Or did you even take it at all? With a national adherence rate of only about 50 percent, there's a lot of room for improvement.

I understand you're also focusing more on old-fashioned house calls.

We formed a partnership with a California company called the Residentialist Group, which specializes in house calls. The idea is that this takes care of homebound patients. They generally have Medicare or Medicaid. They want to live in their house; they don't want to go to a facility. But it can be difficult to get to the doctor.

Home care will become a bigger and bigger part of the health-care system. A 20 to 30 percent increase is expected over the next 10 years. Baby boomers are not getting any younger, and more and more of us want to stay at home as long as we can.

This partnership will allow students to get experience taking care of patients in the home setting. Think of it: A medical student often does a rotation in the emergency room. Now, they would do a rotation on home visits.

This is just a further extension of our philosophy. It doesn't get more holistic than taking care of patients in their homes.

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