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Underrepresentation of Osteopathic Physicians in the Development of Medical Guidelines
Amendolara, A. [5]
Salazar, S. [2]
Nguyen, T. [5]
Fife, P. [2]
Harris, B. [2]
Rivera, M. [1]
Madrid, K. [2]
Gray, Y. [2]
Stacey, S. [10]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A103-A104. doi: Subito , type of study: descriptive study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

authorship [5]
descriptive study [69]
medical guidelines [1]
osteopathic physicians [203]
representation [11]
USA [1656]

Abstract:

Context: Research and scholarship are core drivers of medicine in the modern era. Evidence-based practice continues to replace expert opinion and long held practice beliefs. Nowadays, guidelines and recommendations are available instantly via services such as UpToDate, DynaMed, or MedScape. This is certainly a step in the right direction – a scoping review from 2023 indicates evidence-based medicine improves patient outcomes and healthcare system return-on-investment [1]. However, conflicts of interest, questionable methods, and biases may be present in guidelines [2]. Despite this, guidelines are hugely influential and are among the most cited papers in medicine [3].Nowadays, guidelines and recommendations are available instantly via services such as UpToDate, DynaMed, or MedScape. While this is likely a step in the right direction – a scoping review from 2023 indicates evidence-based medicine improves patient outcomes and healthcare system return-on-investment [1] – there may be pitfalls present. Conflicts of interest, questionable methods, and biases may be present in guidelines [2]. Despite this, guidelines are hugely influential and are among the most cited papers in medicine [3]. Involvement in the development and writing of these guidelines is critical for DOs to maintain a seat at the academic table. According to the American Osteopathic Association (AOA), 11% of practicing physicians in the US are DOs. This number is growing – nearly 25% of current medical students attend an osteopathic medical school. Without involvement in guideline development, DOs risk giving up control of their own practice of medicine. Objective: To assess the relative contribution of DOs to the body of literature guiding practice, author information was extracted from all US-based guidelines published in the year 2023 and listed in the ECRI Guidelines Trust database. Methods: Authors of US-based guidelines listed in the ECRI Trust database from the year 2023 were counted and categorized into one of three groups based on terminal degree: MD holders, DO holders, and Other-degree holders. Authors whose degrees could not be identified were counted as “Unidentifiable”. Additional data including sponsoring organization, organization type, and specialty were collected. Data was analyzed in R-studio. Additional data collection and analysis for the years 2022 and 2021 is under way. Results: Two-hundred and fifteen guidelines were published by US organizations in 2023, with 184 reporting author information. A total of 2883 authors were counted. Of that total, 2186 held an MD (75.8%), 41 held a DO (1.4%), and 548 held another terminal degree (19.0%). Approximately 3.8% of counted authors did not have an identifiable degree. Conclusion: Based on these results, we conclude that DOs are significantly underrepresented in the development of guidelines. This study is somewhat limited by the inclusion of only one guideline database, and by potential data collection error especially in relation to guidelines that required manual author identification. However, these limitations are unlikely to significantly affect results.

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