145. Progress Note #16: Osteopathic (DO) vs. Allopathic (MD) Medicine & The Bias Against DOs

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Altamasharaja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in health care. Hey everyone, real quick, we are closer rolling out a newsletter containing high yield notes for our guests and tips and tricks from us. We want to put the health back in health care and want to help you do the same by giving you the necessary information to live your best lives and provide value to those around you. Just head to medicineredefined.com where you can input your email and stay up to date. All right, thanks. Time for the episode. All right. Welcome back, everyone. Progress note number 16 here, and this time we're going to stick to one theme. So Altamash, how are you doing, man? And if you want to start us off here, I'm doing awesome. Thank you. How are you? I'm doing well, man. Yes. So, I guess I am the senior osteopath here, and so today what we're talking about is osteopathic medicine versus alopathic medicine, and really all types of medicine. And so the age old debate, DOs versus MDs, I guess we've never really addressed this topic fully and directly, but we've had conversations with several providers, particularly Dr. Alex King about this. And the reason we're talking about this is because you shared a tweet with me and mentioned to you for whatever reason I haven't been connected with Twitter for the last month and a half. And I feel better. But you sent me a tweet about a 30 year medical student who reached out and she'll remain on name, but I'm sure everybody has seen it at this point. Reach out to a program. We don't know which program it is. And I think she's going into OBGYN for my understanding. Is that correct? I'm not sure actually. I didn't actually look and tell you. Yeah. So actually, I'll share this because I had mentioned this to one of the students that I work with. And he said he met her last week at AAP, which was in Orlando. So that's one of the PMR traditions. And the reason she was there is that's one of the hub sites. And so supposedly, this person actually goes to my school, and so that's kind of leave it there. But anyways, so apparently this person reached out to a program, expressed interest in their residency, and the program in writing, in writing, mind you, responded with that, hey, we're not considering DO candidates for next year, which is remarkable. And so it's been a huge buzz on Instagram, of course, in the DO community. People are kind of pushing AOA to pick this up and run with it, because it's a little per-bosterous in 2024 to be honest with you. I guess give much reasoning to it, but we don't have any more context than that. And so we thought that maybe this would be a good opportunity for us to address. Certainly more people are going to get wind of this. I can't imagine the AOA is not going to pick this up on one with this. It seems a bit of a violation, if you're asking me, it seems a bit actually an ACGME violation. Actually, yeah, that isn't ACGME violations now that I think about it. So I'm excited to see what's going to come of it. I'm also a little furious now that I'm in program leadership, and we considered candidates on both sides, right? And so that's what we're going to talk about, right? What's the difference? Why does it matter and what should people consider, and should people even care? Yeah, I like it. So like you said, I mean, AOA is definitely going to run away with this. They have time and time again. And to people to understand this biased against DOs, I mean, this has been almost like a yearly thing now for the past, you know, two, three, four years. And so we're going to talk about multiple examples. But like you mentioned, we really haven't addressed this through our podcast. And so, you know, people may see our titles, and people who are well attuned to medical training and things will understand, okay, DOs, osteopathic medicine, there's alopathic medicine, essentially the same thing. But I think we should really break it down into the nuances so that people can truly be well informed when they start talking to their colleagues, start talking to medical students. And, you know, we have a huge pre-med audience here. And as a pre-med mentor, I'm always getting asked, hey, should I apply DO? Should I apply MD? This is what I'm interested in, how should I look at this? I'm really interested in holistic medicine. And so I think we're going to give our honest thoughts here about everything. So I think the first thing we should do is really address what osteopathic medicine is, right? And how it kind of, not necessarily give a history lesson, but what makes a difference than alopathic medicine, right? And so essentially back in the 1800s, we had a different founder who believed in more of a quote-unquote holistic principle, where it was mind, body, and spirit. And this was essentially a different branch of medicine, right? I mean, people have to realize when we talk about education and institution across the world, there are different branches, right? It's like philosophy. There's not just one philosophy, there's different philosophy. There's stoicism, there's existentialism, essentially they all kind of come down to the same foundation at center point, they just have different branches. And that's exactly what osteopathic medicine is, is that we're not just looking at the patient at a diagnosis, but as a person, right? And that's the true underlying philosophy. Now, from the 1800s to now, when you have alopathic medicine being introduced, when you have different pharmaceutical companies and different industries, you tend to converge to a similar path in medicine, right? There tends to become more of an understanding as to what's more black and white. And so there has been a push in the past to make osteopathic medicine more like alopathic medicine, but a lot of the traditional old school founders, people in schools have always wanted to keep it separate because of that true philosophy of that holisticness, right? And so what the main difference between osteopathic medicine and alopathic, you know, osteopathic medicine and the DO, again, alopathic medicine, MD, is that we have an additional training in what we call osteopathic manipulative medicine. And so depending on your school, you're doing about 200 to 150 plus hours of additional training to everything else that you're learning just as much as an MD would in what we would call OMM, which is pretty much head to toe diagnosis of using our hands, doing different techniques to manipulate the body, different ways of releasing tension in the body, different ways, again, of diagnosing, from pediatrics all the way up to geriatrics. And so that's really the only difference, other than that, we're taking the same exam in a way, right? So there are two separate board exams, I'll say that DOs take something called complex, whereas MDs take the USMLE. Now as a DO, you can choose to opt in to take the MD exam as well. And so I did that, I took the step one, because again, as we'll talk about when it comes to residency, it can be important to do that nowadays. But I'll leave it at that, hopefully the audience didn't get confused at all if I missed anything, ultimately. Feel free to throw it in there. Now, I think you nailed it. I think it's worth emphasizing that osteopathic physicians are fully-fledged licensed physicians that can practice all forms of medicine in the United States. In fact, there's only two types, right? So there's osteopathic and alopathic physicians, and there are zero restrictions, zero differences between the two in terms of how they can practice medicine from a licensing perspective. So there's nothing available to you if you go to an alopath that isn't available with an osteopath and vice versa. In fact, right, as you mentioned, if that is an osteopath who does engage in the manual component of osteopathic medicine, you're going to be offered more. And that's not to say that an alopath cannot do manual type stuff, osteopathic treatments. In fact, there's lots of residencies that are alopathic accredited. My intern year, my transitional year, was alopathic ACG-emite accredited, and it was osteopathic recognized. What that means is we had a significant component of that hands-on stuff, the philosophy. So typically, I will, when I work with my trainees, medical students and residents and whoever I speak to, like the way that I'll break it down for them, it's kind of like I highlight, I said, hey, look, there's the manual piece of it, right? Which the hands-on head to toe thing that you talked about, and there's the philosophical piece of it. What drew me to osteopathic medicine, and I exclusively wanted to go to osteopathic medicine, was the philosophical piece of it. The manual piece of it was interesting. As you know, I had a coaching background, and so self-mife, or at least foam rolling that test up was big, firm believer on that, and I was like, oh, okay, so that's going to be easy for me to grasp, but the philosophical piece was the critical piece. And that's where I will use it day in and day out with every single patient. And I'm probably not the heaviest OMT, which is osteopathic medicine treatment. That's the hands-on piece that we talk about in our institution. You know, I do a lot of ultrasound-guided procedures, so that's my niche. But the philosophical piece applies every single thing. So I think I'll mention the four tenets of osteopathy that, and I'm quote, that AOA has these. So this is what every single person, and this is, I guess, AT still came up with this. For the record, you mentioned that guy, AT still was an alipad. This guy was an MD. He was like, hey, there's a better way to do it in 1812, maybe, if I remember that. 18 or 9 somewhere in there. But the bladder, the better was waving, something like that. Something like that. So number one, the body is a unit. The person is a unit of body, mind, and spirit. I think anybody who's been listening to this podcast, at least thus far, can agree with that. You don't have to be an osteopath. The body is capable of self-regulation, self-healing, and health maintenance. Again, another concept that over the last five years, particularly post-COVID, people have become very appreciative of it. Structure and function are reciprocally interrelated. Oh my god, talk about biomechanics and physiology. I mean, how much have we talked about that, right? Particularly PM&R. And this is one of the reasons why physiatrist or DOs make really good physiatrist. And the last but at least, putting it all together, it's a rational treatment is based upon understanding of the basic principles of body unity, self-regulation, interrelationship of structure and function. Basically, the last one is saying, hey, the first three need to be looked at together. So even like, you know, even within this holistic concept, the one two three, the fourth one is like, you got to, you know, got to integrate all of them. And so that really spoke to me, right? I remember speaking about this on my interviews is, you know, when I'm learning for people like Martin Rooney, Eric Cressy, all these individuals who are having these conversations about, hey, people are having shoulder pain, these high level athletes. And when somebody's coming down, you know, down the mound, just saw a high level pitch or yesterday, and they're pitching with 9,500 miles an hour, and they're having shoulder pain. But everything seems okay. MRIs are perfect. There's no structural damage. Like, what is going on? You take a, you zoom out and you watch them pitch. And it only hurts when they throw 9,500 miles an hour. And you see that maybe as they land with their front foot, if it's a right-handed picture, you look at that right, excuse me, left leg. And maybe it's too internally rotated. Maybe it's too externally rotated. And then you have this, you know, the cross-myo-facial slings that, since then, this component of slings has developed over the last five years. But these, these individuals, these coaches, these are strength coaches talking about how, hey, the left hip and the right shoulder are connected, and I was like, holy moly, right? And so that's why this spoke to me. Now, mind you, I've worked in my training with lots of MDs who think like this, who have the osteopathic philosophy. So when people say, oh, osteopaths are better, like, you know, again, this is our bias, right? So like, again, you know, and so I'll say, hold on a minute. Like, you know, like everybody, you just have to find the right individual, because by the same token, you and I, we both know majority, if not like a lot, of DOs, who only go into it for whatever reason, because that's the school they got into, and we can talk about that as well, with the RC quality thing later, but they don't really care for the philosophy. They just want the degree, and they just want to practice medicine, and they just want to get to the next step. So I'll leave it that. Yeah, for sure. So I think it's a good segue too, I just wanted to mention. So, you know, we talked about the medical school, we talked about the board exams. And this was literally during my time, where we had a single match system. So before, there could be something called a double match, where, like you said, there are osteopathic residencies. And that was a separate match before what we would call now the single match. During my time, 2020, when I matched, there was just a single ACGME, that's it. And so MDs and DOs were going to be in the same pool, regardless. And essentially, that's why I had to take step one, was because now I had to essentially prove to residencies who were not familiar with DOs that, hey, I can score just as well as they can. And so that was essentially the reason for taking USMLE. Now, when you get to residency, you know, you're with MDs, you're with DOs. I have an MD in my co-resident class, my cohort, I work with MDs. And so, there really is no difference when it comes to the real training, right? I would argue residency is where you really, truly learn to become a physician, you know, more than medical school. You look back at medical medical school and you're like, what did I really pay those four years for? But intern your onwards is like, okay, this is kind of where the action takes place and what I need to do. And so, you're, you know, you're side by side with your MD colleagues. Yeah. A couple of things to follow, just so for those not falling, step is the alopathic exam, right? Whereas complex, as you mentioned, I forget if you said that already, I apologize. You might be wondering, well, why the hell are there two separate exams? As I mentioned, or, you know, you mentioned that you do have anywhere from two to 400 extra hours, maybe even more than depending on your situation, of training that you're doing. And if the alopaths aren't getting that training, it would be unfair to put that, like, those are not testable concepts for them. Whereas the osteopaths, these are highly testable concepts, both from a philosophical standpoint, but also specifically treatment, setup, that kind of stuff. And so, do I foresee it ever being one exam? Now, because there's also a huge revenue generator and nobody wants to give them money up, so let's, let's be serious about that as well. It is a lot of BS. We agree with that. One good thing is, actually, I don't know if it's good or bad, but the examinations have shifted over from a scoring system to a pass fail. So all of the, the first steps of the examinations are pass fail. And I, I probably, I think, don't quote me on this in the next year or two, the second would probably go to that as well. And so there are challenges with that. But I do not foresee there being one exam where everybody's, I mean, maybe, but probably not for the reasons I already mentioned. The other interesting thing that you bring about is, like, you know, having co-resistant, we've all, I think everybody of our generation, again, in my mid-30s, you're younger, but everybody of our generation, we have osteopaths and alipads integrated in almost every single specialty. We ever shouldn't say ever, but particularly us, right? We have alipad, actually, osteopath favorable specialty. So I've never thought about, at least not in a serious manner, my alipad, the catalyst, oh, he's an alipad or she's an alipad or he's this person to osteopath and that kind of stuff. Maybe an jokingly thing just, you know, to make light of the situation. So what's interesting is, like, we don't care. And I know my students and my trainees don't care, the generation after me doesn't care. You know, it's the people 25 years who graduated 25 years ago that give a crap about this. And it's just one of those things is, like, you know, you're the one who complaining about EMRs and it's like, we know EMRs made, it's just a lot, lot better. So yeah, I don't know where we're going to go from there, but certainly it's time for you to move on. Whoever wrote that email, so, so let's come back to this tweet that we highlighted, right? So this 30 year, again, I won't name her, but people can easily look this up. So I guess it sounds like she was planning her away rotations. So for those who don't know what that means is right, you have a home institution and you might have a hub site where you do majority of your quote unquote core rotations, you'll spend majority of that time. And really the end of 30 year beginning of fourth years all about quote unquote audition rotations or sub internships where it's an audition, right? Like you go spend some time at institutions that you might be really interested in because it's expensive and it's your time that you're giving them and you get a chance to like all the job interview that place and showcase your skills and see if it might be a good fit fit. Excuse me, because the math system is also another horrible, horrible system, but we'll save that for a different day. And so you're trying to figure out if you're going to rank or you're going to interview this. So my guess is this person, I mean, maybe you know this, this person reached out because she was considering doing an away rotation at that place. Is that correct? Yes. I'm not entirely sure, right? Because when you're looking for away rotations, I don't know why they would email saying we're not looking at you for a residency, right? And so I'm thinking is she just emailing to understand like in the future, but I will tell you, I know when it comes to away rotations, some programs that like Colorado and Utah, if you're a DO, you have to pay like $4,000 just to do an away rotation there when it's free for an MD student. And so it's, yeah, there's some institutions out west that they'll do that. And so that bias is just inherently there. Like why would anyone spend $4,000 just to do an away rotation unless, you know, that is the program of your choice. But that right there is telling you like trying to deter you basically saying, hey, if you're a DO, we probably won't even consider you for a residency spot. So that, yeah, there's a lot of strange things that all do that is criminal. So talk about inequity to the next, right? Is hey, we're going to create that. That is, you got to tell me off line who that is, and I don't know, I'm almost inclined to like blast them all the things, but yeah, we won't do that here, but, uh, like people know about this. I mean, it's on Reddit. It's on student doctor network. And like, even when you go on their website, it's like, if you're a DO applicant, $4,000, you know, in addition to the BSAS, which is like, you know, the application that you have to use for these auditions and stuff. So yeah, it's absolutely ridiculous that they do that. Yeah. Okay. So, uh, a couple of notable, notable examples, I think recently, when did the Hussin Menage thing happen? Was he on Fallon when he did that? I think about a couple of years ago, yeah, I think he was on Fallon explaining about his situation. And you know, he did on his stand-up, yeah. So yeah, it's not on Fallon when he went to a stand-up. So we'll link for people to see that because I do think it was kind of funny. Um, that was, so I think in a nutshell, what happened is Hussin Menage had an osteopathic physician who might have been his friend, right? I think it was his friend. Yeah, it was his friend. And he was like a gerologist, by the way, I think. And so I think Hussin Menage was somewhat open about his issues with infertility and that kind of stuff. And so his friend helped him conceive. And so he made light of that situation. And during Fallon mentioned that his friend was a DO and friends like, I don't, or Fallon said, didn't, wasn't aware. And so then the way he chose to explain it, the analogies he used was, you know, DOs are RC cola and MDs are Coca-Cola. And so, you know, basically off brand doctor, I think those are, those are the words he used. And so this became a huge thing, of course, AOA ran with it. I don't know if he ended up giving an apology or if it was like part of the, what happened then? Yeah. So what he said during his stand-up, yeah, what he said during his stand-up was essentially like, listen, guys, I know you're smart. I know you guys are good doctors, but you don't have to be insecure about your MCAT score, right? So like, he was basically just playing on it, like continuing, yeah, building on it. And I get it. He's a comedian. It's funny. He knows there's a lot of South Asian doctors going to be in the audience. So for him, it just makes so much more sense. But for the rest of the population, it was like, dude, come on, man. But I love that. So that didn't, like, I love that. So that's his job. Like him saying that doesn't bother me one bit at all because he's a comedian, right? And if obviously, clearly he's appreciative of his doctor, his doctor, I think in that story that he shared, this was something he was insecure about deeply, right? Deeply personally, he's shared with an obviously this friend, and it's his friend, right? So presumably, he likes him and he respects him and he respected his opinion. But this guy's a comedian, and so that was just more material for him and it's fantastic. Now I will highlight this. I tell people because there is some truth to that joke about the MCAT score. Historically, it has been easier to get in, to get accepted into osteopathic school. So a lot of times people will use it as a backup option or, you know, if they didn't first get into an alopathic school, they might try to go to an osteopathic school as their backup option. And then the Caribbean schools in theatories do the easiest one to get into, and they'll take anybody to take your money and their dropout reads as high, again, does that mean somebody who graduated from Caribbean school as a bad doctor? Absolutely not. Absolutely not. And so, so there is some merit to that, and I've told people this, I haven't reconsidered this opinion quite some time, but I've told I was, you know, typically it's easier to get into osteopathic school, but a lot harder to get out because you have to do more work because of all the extra hours that you mentioned, and you might end up having to take two board examinations. All my current mentees are taking two board examinations. That's twice the money, blah, blah, blah, blah, all that stuff, and you have to, you have to have a pale battle, like what we're talking about right now. So something for people to consider, but there are distinct advantages, which we've some already highlighted, some in other episodes with other guests that we've had. But anyways, like the, the comedian aspect doesn't bother me whatsoever. I think those people who are really changing lives and affecting people's lives in a negative manner such as this program who told this person that hey, we're not even going to consider you just because of the degree that you have. It's, I mean, this is, it might be a very strong take to say, but it's not too off the color of your skin or what part of the country that you come from and stuff. It's not too far off that, right? This is discrimination at its finest. And the example that you said about the having to pay extra in equity and discrimination at its finest. So no space for it, no space for an academic medicine, no space for it in medicine, really no space for it in this world, inexcusable. Yeah, I'll share my journey here too. The story has the wide deal for me. And I think people who have followed my journey might know that I was in a seven year med program at Temple. I was supposed to go straight to Temple Medical School. And so all I knew was MD and I really didn't research anything else because I thought hey, that program was going to be a straight shot for me. Next thing you know, my GPA was actually pretty low. And so I ended up at like a three five and living in the Northeast for people who want to understand academia, Northeast have the most competitive schools across the nation. And so all the Ivy schools obviously and because of that effect, you have other schools trying to ramp up their programs. And so it's notoriously difficult to get into the Northeast programs. So it took me three application cycles and I was just not getting accepted. And for people that truly understand there are quotas based off your ethnicity, based off male female for these medical schools. And so being a South Asian male is absolutely going to be tougher to get in. And that's just the truth of it. And so I had to apply out and apply out and keep expanding my region and then finally be calm to get a chance on me. And I got waitlisted from them because that's a whole other story about their email going to my junk box and replying late and essentially got in the next cycle. And I got in there. And that was the only DO school I got into and I was actually waitlisted at an MD school. But I said, you know what? I'm just going to go to this DO school. I resonated with the philosophy. I was interested in kind of my body spirit, you know, obviously I talk a lot about philosophy and things. And so that's how it ended up there. And there's absolutely no regrets now that I'm in PM&R having that skill set. And again, being more marketable has been a huge, huge factor looking at that experience. And so when I talk to medical students, you know, I guess I'll just go into this and they always ask me, hey, how do I choose DO? How do I choose MD? And I always say, listen, like, based off your MCAT and your GPA, it's going to matter or how you select your schools because like you said, it is easier to get into a DO school. And when people use that argument about, well, DOs aren't as smart because it's easier, I point to, you know, Caribbean schools, right? Because it's like, well, that's kind of a fallacy right there that you're talking about because of this. And again, it doesn't mean that you come out as a bad doctor. It's just that this is the truth of getting into medical school. What you do once you get in is a whole different story because undergrad high school is so different than training as a medical doctor. But when students ask me, I typically ask them, do you know what you want to do? If you want to do plastic surgery, if you want to do neurosurgery, if you want to do dermatology, you know you want to get into those very, very competitive specialties, you're probably better off going down the MD route. And not because you're going to be a better doctor, but because one, advice is, it's there. It's not going to go anywhere until we continue to talk about it. Yes, it's getting a little bit better. There are some DOs going into these fields, but still very disproportionate. And two, your MD schools are typically attached to a medical school, more professors, more research. And in order to get to those specialties, you need to do a lot of research as a medical student to set yourself apart, and you're just not getting as much of that at a DO school. DO schools are very good for primary care, intral medicine, family medicine, pediatrics, physical medicine rehab, I'd argue too, because of the skill set. So it really depends on what you want to do. But as I tell everyone, once you're in there, it comes down to how you want to shape your future in the end. Couldn't agree more. I think unfortunately, despite it being wrong, it is the world we live in right now. So for those listening and considering, I mean, these are conversations you have to have yourself. Ideally, you find a really strong mentor who can have these conversations, somebody such as yourself, right, who can point somebody, hey, listen, I think these are the reasons osteopathic medicine is better, but this is just the reality of the situation. And this is what we need to consider. I'll say this. I'm optimistic in the sense that I do see a world where those limitations, which are research and what's available and how much that even matters is going to is going to blend a little bit. It's going to fade because primarily for the reason, because as we mentioned earlier, the last couple of years, really every single specialty and or majority of specialty is our shifting to take this holistic approach, right? And whether it's orthopedics or neurosurgery and stuff, we recognize that in those practices, the musculoskeletal field is you recognize that pain is so complicated. And some of these awesome podcasts is one of the reasons for that, right? Neurosurgeons that are taking care of spine and doing those procedures to recognize that hey, maybe pain isn't that you're not going to operate on the pain and to go away. So I think as we move forward and those people, those people with these antiquated philosophies retire or something else happens to them, and basically they're not in medicine anymore. And you know, the next generation comes up and go into leadership positions, they're going to have a slightly different mindset, a better mindset and more progressive mindset. So until then, there's pros and cons and I think somebody going into it should have those conversations and really deep look in the mirror too. The other thing, you know, when I think about that program, who charges $4,000, I would strongly consider if I want to be an institution like that with those types of philosophy. If I want to learn, if I, we talk about culture a lot, you and I, and we've talked about this quite a bit. I mean, that, that stuff is infectious, right? So if you live in that area where that's the culture, that's the mentality, that's, that's going to, it's going to be hard not to kind of cash that disease a little bit, right? So yeah. Yeah enough, totally agree, cultures, everything. And that's why I tell all the medical students who come through Penn State and they rotate with us and they always ask, how do I rank and, you know, looking back at my experience, it comes down to culture. You need to be a place where you're happy where you don't feel like there's, you know, that bias against you that you can't learn to your true potential. So yeah, totally agree. The one point I want to make otherwise was, you know, how pervasive this is becoming, right? I mean, I remember going through school, DO school, VCOM and like not hearing much about it. And now since social media has really been growing and growing, you know, you see Hussam Manage from a comedian standpoint, you see things like this being blasted on Twitter, even Rachel Maddo, right? When Trump was first running for president and, you know, he has to get his health checked and the documents from his doctor and people see DO as his doctor and they're like, oh, what's that? And then you have these news channels saying, oh, well, you know, how can we trust this if he's not a real doctor? And I'm just like, how are you able to broadcast this to the American public as high reputations you could be to say that DOs are not real doctors, like using those words is just absolutely incredible. And so I remember going on my own TikTok trying to educate and people just really giving it back and, you know, using everything that they can to really shut you down and without any type of education, without any type of understanding. So I only expect this, you know, these conversations that happen more and more a way to take a bigger stand as well. But we're going to have to keep continuing to kind of fight the good fight and educate. And I know it kind of wanted me to ask you to have you had any experiences from patients, patients, families, any biases towards yourself as a DO? Fortunately, no. Certainly not since I've been in attending. I think the reason is because we're pretty well known in this area for being an osteopathic school and osteopathic institution. And the referrals that we get are very specific to what it is that we offer. In this area, when somebody needs that manual component and stuff, there's nobody better than us. And so we get a lot of those. And a lot of times people have, you know, chronic debilitating pain and other providers can't manage and they're like, okay, well, why don't you go over there and see what else they can offer? Because they will take an alternative approach. That's the words that they'll sometimes use with us. And I'm like, okay, great. Let's take a step back. And what's funny is sometimes patients will come over and say, hey, I've tried everything and they say that I can try this OMT stuff. I'm like, okay, well, tell me more. I'm like, actually, we can do all of that. All of that. I just had a person yesterday who I was doing trigger points for, you know, his medications being managed elsewhere and something else happening elsewhere. And he wanted to come to me for acupuncture, to acupuncture with my colleague. Well, Alex King was been here asking for acupuncture and me for OMT. And I said, you know, not to take business away from anybody, but to make life easy for you. Like we could do everything if you want. That's convenient for you. Like, please, yeah, yeah, by all means. So yeah, that goes back to being able to offer everything and more, which is helpful. I'd like to close, at least on my part, by just putting this message out there because I want to hold us accountable as well. And by us, I mean us osteopaths. You know, I think everybody gets caught in this little circus, so to speak, where, you know, you'll say, oh, we're better than them because we do a better job or they are not so good. And I think historically, one of the things that osteopaths have done, particularly who engage in osteopathic manipulative treatment is maybe sometimes speak negatively about chiropractors. And that's not great either because just like we've said before, there are great plumbers and there's bad plumbers. There's great interest in every field. So chiropractic, you know, doctors of chiropractor are no different. There is some who are phenomenal and there are some who are just doing some ridiculous things and osteopaths, same thing, alipads, same thing. And so you are not exempt from being a good doctor or a bad doctor or a good provider, a bad provider because of the credentials after your name. And so that's, so I hope that people, when they consider this, they look deeper than just the credentials afterwards. And you know, they have conversations with people, luckily, social media and this stuff, it is easier because everybody has somewhat of an online profile for patients to screen providers, see what they're about, see how they think and, you know, see if that's going to be a good fit for them. That's a good point. You know, our rehab, we get about probably four to five vertebral dissection cases a year from neck cracking, from a chiropractor. And a lot of the NDs, at least, you know, as they're not aware that we learn how to crack necks through OMM and proper technique and all that type of stuff. But they will say, hey, like, you should never ever get your neck cracked and this is why, and this is why we see this. And so, you know, I'll have to go in there and educate them and say, well, it's funny because it's not only chiropractors, I mean, as a DO, we're learning how to do this as well, right? And so, as, you know, our guest Irene Davis said, never say never and never say always, right? And like you said, there's going to be good and bad to every situation and it's context dependent. Depends on their anatomy. Depends on so many different things. So, just doing a more thorough analysis on whether it's appropriate and what it'll do for them is necessary. So. Good way to close. All right, my friend. Let's leave it there. Hopefully, people will just remember to kind of keep it up in mind and be kind, be kind to everybody. Yeah. And if anyone has any questions about the process, if anyone's confusing, if there needs to be more clarification, please reach out, social media, email, whatever it is, love to clear up anything and educate you guys further. So, thanks for, thanks for tuning in. 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