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A Quarter Century of Achievements |
In order to frame the successful achievements of the Osteopathic Institute of the South (OIS) over the last 25 years, we must return to the very beginning of the osteopathic profession itself. Just a mere 28 years prior to the formal establishment of the Georgia Osteopathic Medical Association in 1902, Dr. Andrew Taylor Still realized a reformation of medical thought and practice when he “flung to the breeze, the banner of osteopathy.” Against the tide of popular mediocrity and resistance to change, Dr. Still challenged the medical and scientific establishment of his day, holding fast to his convictions in the face of social pressures and intellectual ostracism. The discrepancy between the primitive state of medical knowledge and the hubris of the physicians of the day set the stage for the drama that unfolded as Dr. Still first formulated and then advanced his new model of medicine: osteopathy.
Osteopathy was, and continues to be, based upon a fundamental belief in the relationship between structure and function. Disease is, after all, the absence of health, so it was natural for Dr. Still to believe that it was the physician’s role to restore health by correcting structural anomalies so that the body would be allowed to heal itself.
Years ahead of the prevailing medical establishment, Dr. Still fought for recognition. News of the “great healer’s” abilities spread far and wide. Many rich and famous traveled great distances to Kirksville, Missouri to be treated. So busy was Dr. Still, he was often found treating patients on the train depot platform. As he was aging quickly, he felt the need to train others in his new philosophy of medicine so he established the American School of Osteopathy (ASO), the first school, in the primitive setting of a two-room, frame building on the outskirts of Kirksville in 1892. The furnishings of that first school were sparse, but even so the classes of students crowded the tiny building.
Although smaller in numbers when compared to its allopathic ancestor, osteopathic medicine’s influence spread like wildfire throughout the United States. In fact, by the time Abraham Flexner, the author of a famous report on the sorry condition of medical education around the country, had completed his writing, twenty separate colleges of osteopathic medicine were operating. As early as 1901, the American Osteopathic Association (AOA) was sufficiently organized, as was its partner organization, the Associated Colleges of Osteopathy to make visits on the condition of education of those that were members.
As Dr. Still’s fame spread, students from all over the country flocked to the school for training. One such student was Melvin Cox Hardin who eventually graduated from ASO on January 30, 1899. Shortly thereafter, Dr. Hardin moved to Atlanta to open his medical practice; the first DO to do so. About the same time, James E. Anderson, DO, a classmate of Dr. Hardin’s, established his practice in Augusta with Clyde Warren Mayhugh, DO who, upon his graduation from ASO in June of 1899, began his practice in Savannah. By 1901, the AOA Osteopathic Directory listed six osteopathic physicians in Georgia.
After years of tireless work, by 1909, Dr. Hardin had succeeded in lobbying the Georgia General Assembly to pass the “Osteopathic Practice Act” which outlined the rules governing the practice of osteopathic medicine. By that date the State of Georgia had issued 47 DO licenses of which 14 were women; located in cities all over the State. One thing could be said of this profession; from the beginning, women were welcome. In fact at ASO around the time of Dr. Hardin’s graduation there were enough women enrolled that they were able to form their own professional club. From such humble beginnings, grew a proud profession.
For the first 25 years of the practice of osteopathic medicine in Georgia, there was relative peace within the general practice of medicine; with allopathic and osteopathic relationships being cordial, friendly and accepting. By 1927, 120 licenses had been granted to practicing osteopathic physicians in Georgia, however, that year also brought an interruption in cordial relationships between DOs and MDs, which came in the form of the Medical Association of Georgia’s (MAG) sponsored “Basic Science Bill” which was introduced that year in the Georgia General Assembly. The Bill, which would have given MDs a monopoly in the field of medicine by eliminating the practice of osteopathic and chiropractic medicine, was defeated time and time again after it was reintroduced in 1929, 1939 and 1942. There is no question that MAG’s efforts clearly signaled the end of peaceful co-existence between the two professions.
Even though efforts to pass the “Basic Science Bill” were redoubled and more intense with each passing session of the General Assembly, they did not seriously affect or interfere with DO’s ability to practice and deliver health care to their patients. However, starting in 1938, organized medicine in the US and MAG, more specifically, mounted an all-out offensive against osteopathic medicine.
With intense efforts to extinguish its practice in Georgia over the next ten years, it is amazing that the profession survived and even grew. Indeed it did grow, in fact the number of DO’s increased as did acceptance by local, state and federal agencies; although that acceptance was tenuous. During World War I, DOs were commissioned as officers in the medical corps, however, because of the all-out attack against the profession during World War II, they were not recognized as physicians.
By the late 1940's, osteopathic specialists were having difficulty in receiving staff privileges at area hospitals. As such, a group of osteopathic physicians gathered together to develop a non-profit hospital in Atlanta; resulting in the charter of Georgia Osteopathic Hospital, Inc. (GOHI), on December 19, 1950. Hoyt Trimble, DO, surgeon, and Matt Henderson, DO, a proctologist, organized a Board of Trustees to establish the hospital, however the process was slowed because of a persistent lack of funds. Finally, on June 1, 1957, Ben Wright, DO, with the aid of his parents, opened a six-bed facility in Tucker, Georgia, known as Doctors Hospital. He influenced a few of his classmates from the Kansas City College of Osteopathic Medicine and Doctors Trimble and Henderson to join him. Shortly thereafter, the hospital was expanded to 16 beds. Now DO’s could treat their own patients in their own hospital with the help of their own fellow specialists. By 1972 growth of the hospital resulted in various expansions to 248 beds; with the number of physicians on staff increasing proportionately. Most of these new physicians were ‘home grown’ as the hospital had been approved for the education of DO interns. Once trained, many stayed to treat patients in the growing metro-Atlanta area.
As osteopathic medicine became accepted in most agencies of the State and Federal governments, some osteopathic physicians moved their practices into other local hospitals. This, in conjunction with the introduction of DRGs in the early 1980s, resulted in a declining hospital census, which eventually culminated in a search for a buyer of the Doctors Hospital operation.
The Board of Trustees of GOHI sold certain assets of Doctors Hospital to Hospital Corporation of American (HCA) in 1985, which operated out of the original Idlewood Road property until it had completed the construction of its replacement facility known as Northlake Regional Medical Center on Montreal Road in Tucker in March of 1989.
From the early 1970s through the hospital’s sale, it was difficult throughout the South to run into an osteopathic physician that had not been a recipient of the benefits of training, either from an undergraduate or a postgraduate perspective, in Doctors Hospital; being that its post-graduate training program was the only one existing in the Deep South at the time.
After the sale of Doctors Hospital, the Board of Trustees of GOHI decided that the focus of the “new” organization would be medical education. They took the proceeds of the sale and invested them so that earnings would be used to perform the activities of the organization; especially as it related to graduate medical education in the replacement hospital. With a 20-year agreement in hand, which assured HCA’s commitment to a continuation of the internship, Family Practice Residency and the Surgical Podiatric Residency programs in the new hospital, GOHI dedicated its funds to any shortfalls that might arise that would endanger program continuation. With so many newly-trained physicians, osteopathic medicine grew beyond the Tucker-area.
Satisfied with the gains that had been made, and seeking new directions for GOHI, the Board embarked on a search for an Executive Director who would monitor the Corporation’s assets and make recommendations for future organizational operations. In November, 1989, Barry A. Doublestein, DSL, was hired. Having spent the previous nine years in various positions at the Michigan State University College of Osteopathic Medicine and the Kirksville College of Osteopathic Medicine (KCOM), he was certainly quite aware of the state of osteopathic medical education and the climate in which the profession existed; especially as it did in the Deep South. Yet there were a few positive happenings that demonstrated that the tide of acceptance was beginning to turn. As early as 1991, Cathy Garris, Executive Director of the Georgia Osteopathic Medical Association (GOMA) and leaders from KCOM partnered to develop internship opportunities with the Medical College of Georgia (MCG) and Columbus Regional Medical Center in their existing family practice residency programs; which remain committed to the recruitment and training of excellent practicing osteopathic physicians. In compliance with AOA-accreditation standards, both institutions implemented parallel accreditation for their residency programs in the late 1990s.
At the same time that positive interest in osteopathic graduate medical education was growing in Columbus and Augusta, it was declining in Tucker. Although not clearly evident at first, HCA, and especially the hospital administrator at Northlake Regional Medical Center, began to demonstrate their contempt for osteopathic medical education. In a series of conversations with Mr. Frank Murphy, Dr. Doublestein realized that even though the sale of the hospital had taken place five years prior and GOHI had made several sizeable payments in support of both the osteopathic and the podiatric residency programs, there was an undercurrent of resentment that the hospital had the albatross of osteopathic medicine around its neck. Mr. Murphy made it clear that he believed the future success of his hospital was dependent upon getting rid of osteopathic GME.
Dr. Doublestein began to notice in various places around the State that osteopathic medicine was merely tolerated rather than seen as a full-blown partner. Since the Joint Board of Family Practice had been capitating state government payments in support of primary care residency training, most people accepted the inferior quality of the on-going training at Northlake; choosing instead to ignore rather than rock the boat and fear appearing that there was some bias against osteopathic medicine arising again in the State. Although the tide was turning toward acceptance of osteopathic medicine, the perceived lack of quality medical education was damaging the profession’s credibility.
After much negotiation and heartache, GOHI was able to wrest administrative responsibility for the osteopathic residency from Northlake fueled by simultaneous blows of probationary status from AOA oversight committees. Heroic efforts were made to make changes which, even for a short time, improved quality. GOHI hired Don May, PhD, an expert in adult education and curriculum development, to oversee the overhaul. He and Dr. Doublestein made two separate presentations to the Committee of Osteopathic Postdoctoral Training seeking relief from the impending loss of accreditation. Because of a good plan and Dr. Fred Tinning’s (President of KCOM and mentor of Dr. Doublestein) membership on the committee, his recommendation vouching for the reputations of Dr. Doublestein and Dr. May, brought short-term relief to both the residency and the internship programs.
The most significant change that was required as part of the accreditation overhaul was the development of an ambulatory clinic in which residents could be trained. GOHI realized that just farming out residents to work with various practicing family practitioners would not find acceptance by the accreditation committee, so without any financial support from Northlake, GOHI purchased an established clinical practice from a retiring physician in Decatur, Georgia. In addition, GOHI hired various training faculty to run the practice and train the residents.
Unfortunately, in a confluence of many differing circumstances, it was clear that osteopathic GME at Northlake was in the throws of death. Declining commitment from the hospital administration and local clinical faculty in concert with the known lack of quality of the program, led to the decision by the Board of GOHI to close the residency and internship programs.
Simultaneous with the commitment to improve the quality of the osteopathic family practice residency program, Dr. Doublestein and Dr. May had begun to develop a pipeline for prospective residency applicants by working with various volunteer faculties to train third- and fourth-year osteopathic medical students in the State. Unknown to everyone involved in GOHI at the time, was the silver lining found in the death of GME at Northlake and the development of the undergraduate clinical education network on a statewide basis; which eventually led to the creation of Georgia’s own osteopathic medical school.
So, at the March, 1993 meeting of the Board of Trustees of GOHI, in a painful moment for the profession, a motion was made, seconded and adopted that would begin the dismantlement of the family practice residency and internship programs at Northlake and the sale of the residency clinic. Immediately, thereafter, a motion was made, seconded and adopted which officially launched GOHI’s commitment to put its financial assets behind the development of a statewide undergraduate clinical education network for third- and fourth-year osteopathic medical students from schools around the country. Even though Dr. Doublestein was aware that the single most critical element in recruiting physicians was the establishment of GME programs, he knew that creating new GME programs would only come after there was a solid undergraduate clinical training network in place. His theory was that peer relationships, developed between clinical faculty and medical students would, in conjunction with the growing positive light in which the profession was being seen; result in greater numbers of physicians coming to Georgia and the Southeast.
Proof of the success of Dr. Doublestein’s theory was demonstrated in a study made of Georgia’s newly-licensed osteopathic physicians from 1995 through 2004 that 24 percent had received the benefits of training in GOHI’s clinical training network. As the number of students taking place in the network increased in the years since 2004, it is expected that the percentage of those receiving licenses because of their involvement in the network has increased as well. What is truly exciting about the network’s success is the number of practicing physicians who are now training students, who were themselves, beneficiaries of the network.
Although the clinical education network took time to develop, its influence moved rapidly out of the Tucker center. W. Alan Woolery, DO, PhD, saw the benefits that the network would bring to his hospital in Warner Robins, Houston Medical Center, so he, single-handedly, instituted the first hospital affiliation in the network. In the fourth year of operation, the network had grown to all areas of the State and proudly claimed over 200 volunteer clinical faculty. This movement out of the Tucker area necessitated a corporate name change to Georgia Osteopathic Institute; and within a few years to Osteopathic Institute of the South, because of its regional reputation.
The Institute realized that its success was dependent upon making students’ stay in Georgia as simple as possible; so it made a special effort in providing affordable short-term housing. In addition, Irene Hince, medical education coordinator, was hired to facilitate scheduling and paperwork requirements as efficiently as possible. Much of the success of the Institute’s network rests in the lap of Ms. Hince, who sacrificed much to assure quality experiences to participating students and faculty.
Dr. Doublestein continued to expand training opportunities by increasing the number of affiliated colleges. Early on in the network’s history, heavy recruitment found students from 13 of the 20 colleges doing part of their clinical training in Georgia. Eventually, however, the majority of students were from four colleges: Philadelphia College of Osteopathic Medicine (PCOM), Nova Southeastern University College of Osteopathic Medicine (NSUCOM), West Virginia School of Osteopathic Medicine (WVSOM), and Lake Erie College of Osteopathic Medicine (LECOM).
In early 2001, PCOM President, Matt Schure, PsyD, approached Dr. Doublestein about the possibility of working with them to create a branch osteopathic medical campus in Georgia. This effort was promoted after knowledge of the number of PCOM students taking part in the Institute’s network was realized. On an annual basis, PCOM students had reached almost 50 percent of the Institute’s capacity. After a series of informational meetings with Dr. Schure, PCOM Dean, Ken Veit, DO, and various OIS Board Members, the Institute made a commitment to assist PCOM with the development of the new campus in the Metro-Atlanta area.
About this time, major efforts were being undertaken through Georgia’s General Assembly to remove remaining biases against osteopathic and podiatric physicians in public hospitals. Senate Bill 138 was passed which simply stated that “if a hospital offers or provides a service which is within the scope of practice of a person licensed as a doctor of podiatric medicine, doctor of osteopathic medicine, or doctor of dentistry, that hospital may not deny to any such licensee staff privileges at such hospital based solely upon that person's license, board certification, or specialty membership in a professional association." This simple piece of legislation rooted out the final ‘official’ practices of discrimination found in some hospitals; especially, Georgia Baptist (now known as Atlanta Medical Center) and Gwinnett Medical Center. That legislation, in concert with GA-PCOM’s presence, made entry into new institutions much easier. Most hospital administrators and medical directors were unfamiliar with the osteopathic profession’s commitment to training in community health centers instead of huge training hospitals, thus having the solid reputation of PCOM, more and more hospitals, and training faculty were interested in assisting with the training of osteopathic medical students. Although the Institute had accomplished much over the years in development of the clinical education network, PCOM’s reputation, brought more stability and official standing to the network.
In 1999 with the approval of the AOA’s Osteopathic Postdoctoral Training Institution (OPTI) regulations, the Institute took steps to assure the continuance of osteopathic GME in Georgia. AOA rules stated that no GME programs could remain accredited unless they were members of an established OPTI. Since these new rules added a new level of bureaucracy to an all ready over-regulated industry, fears that programs would drop out of GME because of the extra costs were beginning to appear. The Institute’s Board offered to alleviate the financial burden by offering to pay OPTI fees for the existing AOA-accredited GME programs in the State. Eventually, in 2006, Floyd Medical Center’s Family Practice Residency Program became AOA-approved and joined the programs in Augusta and Columbus as OPTI partners with the Institute.
August 15, 2005 was the most important day in the history of osteopathic medicine in the State of Georgia to date, for it marked the opening of the State’s newest medical school; the Georgia Campus of the Philadelphia College of Osteopathic Medicine, located in Suwanee. That first class began with 86 students; 88 percent of whom came from Georgia or the Southeastern United States. In September of 2005, the Institute entered into a contract to provide administrative services for the Office of Undergraduate Clinical Education as it readied for clinical rotations to begin in June of 2007. Nothing short of a major effort, the Institute worked hand-in-hand with H. William Craver, DO, Director of Undergraduate Clinical Education and Paul Evans, DO, Vice Dean of the College to develop policies and procedures and continue the expansion of the network.
In 2000, the Institute’s Board saw the benefit of authorizing Dr. Doublestein to represent the Georgia Osteopathic Medical Association as a lobbyist to the Georgia General Assembly. Throughout the last eight years, he has seen a wholesale change in moving the profession from being seen as the ugly stepchild, to that of an equal heir. Probably the second most significant event for the profession in its history in Georgia occurred at GOMA’s Board meeting in June 2007 held in Hilton Head, when the Medical Association of Georgia’s President, William Clark, MD, “popped-in” just to mend fences with the profession. He spoke of bad blood between both professions and that he longed for a new day of mutual respect and comradery moving forward as partners.
It is amazing how we have all come full circle with institutions that, just 25 years ago were antagonistic to osteopathic medicine. Atlanta Medical Center and Gwinnett Medical Center are now major affiliated teaching hospitals for GA-PCOM students. Who would ever have imagined 25 years ago that MAG and the osteopathic profession would be equal partners in medicine in this State? This is nothing short of a miracle.
Some would argue that the huge investment of the Institute’s resources over the years has not yielded a significant return on its investment. On the contrary, the Institute's investment has yielded incredible results that are beyond codification or imagination. What organization, besides the Institute, could claim that it was intricately involved in remaking a profession that was seen in such a poor light, or that its meager investment portfolio was able to develop a state-of-the-art medical school? If all of the investment dollars of the Institute were to disappear today, what has been accomplished is beyond comparison and worth every penny of investment. It could be said that everyone else in Georgia changed their thinking about osteopathic medicine because the profession changed it's; choosing quality over tradition has brought greater days.
Has the Institute done everything there is to do to promote osteopathic medicine in Georgia and the Southeastern United States? Hardly. As we move into uncertain times with respect to the practice of medicine, the Institute will play a vital role in growing GME opportunities and even the practice of medicine. We have much more to accomplish; bring on the next 25 years.
Presented: March 24, 2008
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