Osteopaths changing the face of health care

If you’re like most health consumers, you probably don’t know what osteopaths are, let alone what sort of medicine they practice. However, osteopathic doctors (DOs) and schools of osteopathic medicine are playing a little known but critical role in stemming the nation’s need for primary care doctors, according to experts at Touro University of California’s College of Osteopathic Medicine in the Bay Area city of Vallejo.

“A lot of medical students are shunning away from [primary care],” said Dr. Michael Clearfield, the school’s dean, noting that osteopathic schools traditionally graduate more primary care physicians, of which the nation is facing a critical shortage.

“It’s just going to get worse as the population gets older and more and more boomers are getting to be Medicare age; there are going to unprecedented demands [for primary care],” he said. 

Since salaries are higher for specialists, Clearfield says, more than half of medical schools with MD programs have made specialty care a priority, which makes the primary care field even smaller.

Touro’s top-ranked College of Osteopathic Medicine says it is situated to help shore up the front lines of patient care with more personalized care.

Osteopathic medicine differs from traditional modern medicine in that it focuses “not only on medicinal medications but also looking at the body as a whole and the intrinsic capability of the body to heal itself,” Clearfield said. 

Osteopathic medicine was developed in 1874 by Dr. Andrew Taylor Still, a physician and Civil War surgeon who pioneered the concept of “wellness” and recognized the importance of treating illness within the context of the whole body, according to the American Association of Colleges of Osteopathic Medicine.

In addition to all of the practices available through modern medicine, including prescription medicine and surgery, osteopathic physicians incorporate a practice known as “osteopathic manipulative treatment,” which uses the hands to diagnose, treat and prevent illness or injury.

“We’re using hands along with other skills and senses, looking and listening, palpating the body to help determine the problem and, if necessary, treat them to get a better effect,” Clearfield said.

Osteopathic medical students also receive classroom training in communicating with patients, according to the American Osteopathic Association. Because of this whole-person approach to medicine, approximately 60 percent of all DOs choose to practice in the primary care disciplines of family practice, general internal medicine and pediatrics.

Clearfield believes that Touro’s strong community focus and commitment to the future of health care gets translated to the students and impacts where they choose to work. U.S. News and World Report rated Touro University of California’s College of Osteopathic Medicine as one of the top 10 osteopathic schools in the nation that produces primary care residents.

Part of the Touro College Network, the Vallejo campus also features a kosher campus, Jewish holidays observed and an on-site chaplain. Of the 1,400 students attending Touro University of California, 15 percent are from Southern California.

Although the majority of students and faculty are not Jewish, Clearfield believes that there is a clear connection through the philosophy of Touro’s founder, Bernie Lander.

“He wanted to improve the world through health care and education. He looked at areas where he could do that, by putting an organization that was based on the principles of Orthodox Judaism out in California,” he said.

Osteopaths undergo four years of medical school, complete three years of residency and are fully qualified to practice medicine and perform surgery.

The attraction of the osteopathic approach, Clearfield believes, is that “it is more personalized … a lot of people are turned off by medicine, feeling more like a widget in an assembly line than a partner in their own health care … so many people don’t ask questions to their doctor, don’t know what they’re taking and why.”

Brandon Stauber, a graduate of UCLA and Touro College of Osteopathic Medicine, said he applied to osteopathic medical schools because he found the philosophy attractive. That is also what led him to his current residency at Oregon Health and Science University in Portland, Ore.

“One of the reasons I came here is that Portland is a very open city when it comes to all types of practitioners,” he said. 

A Sacramento native raised with strong Jewish values, Stauber said he was also drawn to the Jewish roots of Touro’s California location.

He currently works alongside MDs and DOs. In contrast to the MDs, he said, “the DOs get a lot of hands-on experience in our training … by the time we get into residency we’re not afraid to touch people.”

However, Clearfield says that a clear bias against osteopaths exists in many medical establishments.

“That’s been a constant barrage for this profession for 120 some years,” he said. “Our graduates have gone to the most prestigious institutions – Harvard, Stanford, you can name it … [yet] there are physicians that are still biased against our profession and are for the most part misinformed.”

Still, the field is growing rapidly, from six osteopathic schools of medicine in the 1970s to 29 today, Clearfield said. Although the nation’s 80,000 osteopathic physicians practicing in the United States represent one-tenth of the number of MDs, they take on a disproportionate amount of primary care, Clearfield said. 

“As a profession we’ve been community based since inception … which allows students to get wider experience,” he said. “Our students are out in doctor’s offices, clinics … we focus on the first encounter.”

Touro College offers West Coast alternative

By the time Touro College opened in Los Angeles in 2005, five of Esther Lowy’s eight children had already left for college on the East Coast — and stayed there.

Today, her two youngest attend Touro College Los Angeles.

As the first dean of the school, which is a branch of the accredited Touro College New York, Lowy knows how important offering a college option for local Orthodox kids is to the future of the community.

“Unless we keep our children on the West Coast, we’ll lose them,” Lowy said. Already 220 students have attended classes, with close to 120 students enrolled last academic year. Classes meet at Temple Beth El on Crescent Heights Boulevard in West Hollywood.

“I’m glad that I did not have to fly to the East Coast to get a quality education in a Jewish environment,” said student Ilana Adatto, a psychology major concentrating in speech therapy.

For her, Cal State Northridge, Santa Monica College or UCLA wouldn’t have provided what she was looking for in a college education.

“I chose Touro College over other secular colleges in Los Angeles, because I wanted to stay in a Jewish environment and be able to receive my degree from a respectable accredited university,” said Adatto, who is from North Hollywood.

At Touro, students are not exposed to literature or films they would consider immodest or indecent, or to a campus life that challenges Orthodox values. Men and women have separate classes at Touro, and the school follows a Jewish calendar. The college has its own rabbi and students are required to take three credits of Judaic studies each semester.

“You don’t have to be Orthodox or Jewish to come to Touro College. But most non-Jews don’t want to do the three credits of Judaic Studies,” Lowy said.

The college offers something else not found in large universities — an intimate environment and a personalized educational setting.

“I have very good relationships with many of my teachers and feel comfortable seeking their help after class and outside school, when necessary,” Adatto said.

Dr. Michael Hamlin, a psychology professor at Touro, takes a case-based approach to learning that engages students in discussion and involves interaction among the students.

“People need to be active and involved in their learning,” Hamlin said.

Lowy has a personal relationship with the students as well. Five weeks into the semester she meets with them to discuss their progress and goals.

The school tailors course offerings to the needs of the students, Lowy said. “We will give a course for as few as three students,” Lowy said. “If, however, there are not three students interested in a class, we will give it independently.”

Currently students have a choice of two majors, business and psychology. There are four concentrations within the business major — accounting, finance, management and marketing — and three within the psychology major — speech pathology, counseling and education. Lowy said the school is exploring adding more majors and graduate degrees, including master’s degrees in business and education.

Touro College New York opened in 1971 with 35 students and has expanded to more than 23,000 undergraduate, graduate and professional students on more than 29 campuses throughout the world, including Florida, Nevada, Moscow, Berlin, Rome and France. In September 2010, the second Jewish-sponsored Medical School in the country will open in New Jersey.

“Touro students have preferential admissions to the many Touro graduate and professional schools,” Lowy said.

Affiliation with the New York school helped Touro College Los Angeles become accredited by the Western Association of Schools and Colleges before it even had students. However, Touro College Los Angeles is not the only college specifically targeted for the Orthodox population here; Maalot Los Angeles, a women’s college and branch of the Maalot Zaidner Institute in Jerusalem, opened in Los Angeles in 2000 to cater to the Orthodox population. Maalot is currently Middle States Accredited and is hoping to get WASC accreditation in the near future.

Tuition at Touro Los Angeles is $14,000, but Lowy said the school offers financial aid, including the need-based Dean’s Scholarship and an $8,000 merit-based scholarship for students who get above a 1,200 on the SATs.

While Touro College New York helped Touro Los Angeles get its start, Lowy said Touro Los Angeles also looks to the local community for support.

A light unto the Nation (inside the historic Touro Synagogue)

The Maccabees’ legendary oil may have burned for eight days and nights, but at the Touro Synagogue in Newport, R.I., the low-wattage bulb in the ner tamid has lasted more than a century, ever since the building was first electrified in the 1880s.

Built nearly 250 years ago, Touro — the oldest synagogue in the United States and the only one remaining from pre-Revolutionary times — is famous for its longevity, architectural elegance and status as a symbol of American civil liberty.

Any mention of the synagogue (for example, this one) must include a reference to the 1790 letter from George Washington assuring Touro’s congregants and all “Children of the Stock of Abraham” that “happily the Government of the United States … gives to bigotry no sanction, to persecution no assistance.”

Yet for most people, Touro is a tour stop, a footnote in American Jewish history, or at best, a chapter heading. Even Rabbi Mordechai Eskovitz, who had always included Touro (and Washington’s letter) in the history classes he taught, “presumed it was just a museum,” he said, “not a functioning synagogue.”

That is, until he heard they were hiring.

“I thought, ‘What a great opportunity to relive Jewish history,'” said the rabbi, who has led the congregation for the last 12 years.

Congregation Jeshuat Israel, whose forebears built the shul, claims a membership roll of about 130 families. Services are conducted in the Orthodox Sephardic style — men pray from benches arranged 360 degrees around the reading platform while the women’s gallery is located atop the 12 iconic columns representing Israel’s 12 tribes — but the synagogue does not affiliate with any major movement.

“There’s no way to classify us because we change from day to day,” Eskovitz said. “One day, everybody’s wearing black hats, the next, everyone is wearing little kippot srugot [knitted kippot], and the next day Chasidim are sitting next to liberal Jews.”

The synagogue receives about 30,000 visitors a year for its weekday tours, but on the first Shabbat morning of the summer season, about 30 have come to daven. The assembly is a mix of local families, officers from the Newport Naval Station, and observant visitors including a couple staying at the nearby kosher bed-and-breakfast Eskovitz helped establish.

Even on this relatively quiet Shabbat morning, there is no way not to be transported back in history. Set back from Touro Street on one of Newport’s highest points, the classical Georgian-style building is angled to face east toward Jerusalem. In 1759, the Rev. Isaac Touro, a chazzan born in Holland, commissioned Peter Harrison, considered America’s first professional architect, who, according to records never submitted a bill, calling the effort “a labor of love” (for everything else, presumably, Touro needed a building fund).

The early days were some of the glory days for Touro, Eskovitz explains later, as “incredible people” — not just President Washington — passed through Touro on their way to impacting the rest of the country. The prominent Colonial-era minister Ezra Stiles studied Hebrew with the rabbis here, and later, as president of Yale College, made learning the language a requirement for all students. During his tenure, Yale’s valedictory speeches were delivered in Hebrew and the Hebrew inscription he added to the school’s seal (“Urim” and “Tumim”) remains to this day.

In the 20th century, Presidents Eisenhower and Kennedy visited, sitting in the pew of honor where Washington once sat, and Clinton almost did (at the last moment, the Secret Service would not allow him to enter a building with only one exit). In his time here, Eskovitz has played host to numerous “Jewish dignitaries,” from Steven Spielberg to Sen. Joe Lieberman (I-Conn.), a frequent guest. “To this day, there is still a rubbing of shoulders between Touro and people with great influence,” he says.

This year marks the 350th anniversary of the Jewish community in Newport — the second Jewish community in North America, arriving (historians believe) from Curaçao, four years after another boatload of Jewish families had docked at New Amsterdam in 1654. It was the Jews of Rhode Island, however, who immediately flourished in the freedom of the New World, having chosen Roger Williams’ colony because it was founded as a haven of religious tolerance more than a century before the American Revolution.

As the only Jewish site designated a National Historic Shrine by the National Park Service, Touro attracts plenty of people who see it as a place where “their prayers can be answered,” said Eskovitz, who adds that many have contacted him after a visit to thank him for a wish that came true. “I’m very happy for them, though this may have more to do with the power of positive thinking.”

But the rabbi is most touched by the random visitors who walk into the synagogue — the only religious site named by the National Trust for Historic Preservation as “the most beautiful house of worship in America” — and rediscover their own connection to Judaism. He says that numerous Jewish adults with no religious education or background have visited and then requested a bar mitzvah ceremony.

“And we oblige everyone,” he said. “It’s part of our responsibility as an international synagogue. We want to get attention — we want to maintain our past, but also chart our future as well.”

From his office window, he watches as people arrive after hours and, unable to get in to see the building, nonetheless kiss the mezuzah he commissioned for the property’s large stone gateway. He is encouraged that a growing number of Jewish people are building or buying summer homes near the synagogue, and he is also raising money to build a new mikvah to replace the one that functioned here until 50 years ago.

The sanctuary, meanwhile, reopened in 2006 after a complete restoration. On the newly polished candelabra and candlesticks, all original, one can now read the names of those who donated them as far back as the late 1700s. In a glass display next to the Ark stands a 500-year-old Torah scroll brought over from Europe by some of the early members. And also among the “artifacts” uncovered by the crew was the original light bulb from the ner tamid, which, when replaced in its socket, glowed once again — a fitting symbol in a building that has always been a symbol.

“We were once the leaders in [American] Jewish history,” Rabbi Eskovitz said. “Why can’t we do it again?”

Victor Wishna lives and writes in New York City. He can be reached at LetterFromNY@juno.com.