Why don't more physicians use osteopathic manipulative medicine? A cross-sectional study of utilization and referral barriers.

Context: Evidence supports osteopathic manipulative medicine (OMM) as an effective manual therapy, although it remains underutilized by Doctors of Osteopathic Medicine (DOs).

Objectives: Understanding barriers preventing the broader adoption of OMM is essential to expanding access to it as a noninvasive treatment option. We set out to survey both DOs and non-DO clinicians to identify perceived barriers to OMM.

Methods: Survey items were adapted from prior studies utilizing an iterative refinement process that included cycles of pilot testing with revisions. Participants were recruited internally from Mayo Clinic Midwest - a large, multistate, healthcare system in the Midwest region of the United States - utilizing internal email. Participants were given a descriptive survey that was developed with support from the Mayo Clinic Survey Research Center.

Results: The survey was sent out to a total of 952 individuals, including 184 DOs and 768 non-DO clinicians (MD, Bachelor of Medicine, Bachelor of Surgery [MBBS], nurse practitioners, and physician assistants). Respondents included 76 DOs (41.3 % response rate) and 91 non-DOs (11.8 % response rate). Of the 76 DO respondents, 21 (27.6 %) reported utilizing OMM clinically. Commonly reported barriers include time limitations, poor public perception, and lack of training in residency, and time is allocated to other professional interests.

Conclusions: Within a large health system that includes primary care and specialty care, few DOs practice OMM, citing time constraints, lack of residency training, and competing professional interests as primary barriers. These challenges might successfully be addressed through targeted osteopathic manipulative treatment (OMT) education in residency programs, enhanced compensation, and improved referral pathways.