Arnold E. Cuenca, D.O., C.A.Q.S.M

D.O.: Doctor of Osteopathic Medicine

M.D.: Doctor of Medicine

D.C.: Doctor of Chiropractic 

Osteopathic Medicine is a system of health care practiced by Doctors of Osteopathic Medicine (D.O.). D.O.'s and allopathic physicians (M.D.) are the only physicians completely trained and licensed, authorized to prescribe medication and perform surgery within the scope of their specialty.

From it's inception in the late 1800's, the emphasis of training for osteopathic physicians has, and always will be, to take a "whole person" approach to medicine. This approach to health care is NOT UNIQUE to D.O.'s, but is one of the most DISTINCTIVE threads running throughout the training of the osteopathic physician. Because the body's structure plays a critical role in its ability to function, osteopathic physicians have extensive training in the musculoskeletal system. They use their eyes and hands to identify structural problems in their patients and then use specific techniques to aid and support the body's natural tendency toward self-healing and health. This system is known as Osteopathic Manipulative Treatment (OMT).

All physicians, D.O. and M.D., are required to pass the state medical board examination in order to obtain a license to practice medicine. Each state board sets its own requirement for the practice of medicine in that state.

There are differences in each fields history of development and manipulation technique, but overall the goal is similar for both disciplines which is to aid the body's innate ability to heal itself.

However, with that being said, there IS A MAJOR DIFFERENCE on the education and practice rights of D.O.s and D.C.s:

            -D.O.s are trained to recognize and treat various medical conditions (utilizing their extensive training in medical and osteopathic fields) and determine if manipulation is appropriate and beneficial as an adjunct or as a replacement for conventional medical treatment

            -D.O.s must pass rigorous medical board examinations to demonstrate their knowledge in  medical, pharmacological, surgical, radiological, and osteopathic fields in order to be LICENSED as a MEDICAL physician EQUAL to their M.D. counterparts

            -D.O.s complete at least a 3-year residency in the specialty field of their choice

            -D.O.s are expected to follow the STANDARD OF CARE EQUAL to M.D.s

            -D.O.s have practice rights to perform surgical procedures within their scope of practice

            -D.O.s have license to prescribe medications

All of the above mentioned are expectations/responsibilities D.C.s DO NOT have.     

The osteopathic medical profession has evolved from a manipulation-only field to one that includes manipulation, medication, surgery, and diagnostic technology to provide an integrated approach to health care.

Have you ever seen a Physical Therapist who works on increasing your range of motion, helps stretch your muscles, or provides hands on therapy to help relax tissues?

Or have you ever seen a Chiropractor who has provided adjustments to your spine?

D.O.s are trained to provide a "hands on" approach to medicine, utilizing techniques similar to those professions mentioned above.

However, D.O.s attended 4 years of medical school, completed a residency program, and are medically licensed physicians. They are trained to first "rule out" any medical causes of musculoskeletal pain before considering the use of OMT.

Osteopathic Manipulative Treatment is the use of the D.O.s hands to help diagnose and treat a patient. The utilization of OMT is dependent on the physical and mechanical findings of the osteopathic physician.  Osteopathic Manipulation serves as an adjunct to, and if appropriate, in replacement of conventional medical treatment. OMT is another tool that the osteopathic physician has to help treat their patients, in addition to their knowledge of pharmacology and surgery.

Residency refers to the supervised training of all newly graduated physicians. The internship year is the first year of training, and residency is the training in its completion which is usually an additional 2-4 years depending on the specialty. Residency training allows physicians to see and do everything within a supervised setting by teaching physicians, also known as "attendings".

Dr. Cuenca served as Chief Resident of his program, placing him in a leadership and supervisory role among his peers.  

A Fellowship is additional training beyond the primary specialty of the physician. For Family Medicine, these areas include Geriatrics, Obstetrics, Pain Management, Sports Medicine, and other subspecialties.

For Dr. Cuenca, he completed a 1-year Sports Medicine Fellowship receiving additional training in the area of Primary Care Sports Medicine.

Board certification is validation of a physician's training in their respective specialty. For Family Medicine/Practice, M.D.s must be board certified through the ABFM (American Board of Family Medicine) and D.O.s are board certified through either the ABFM OR the AOBFP (American Osteopathic Board of Family Physicians) depending on each individual state's requirements.

It is relatively rare for a physician to be board certified through both organizations. Dr. Cuenca is board certifed through BOTH the ABFM and AOBFP.

In addition to the above certifications, Dr. Cuenca is also board certified in Sports Medicine through his earning a Certification of Added Qualifications in Sports Medicine (C.A.Q.S.M.).

Any physician can claim to be a "Sports Medicine" doctor. BUT, this does not always mean he/she had formal training. Even if this type of doctor did not undergo formal training, this does not mean they are incapable of addressing your sports medicine issue. However, if you are specifically seeking a QUALIFIED Sports Medicine physician, some questions to ask include:

• Is the doctor board certified in a primary specialty (such as Family Medicine, Emergency Medicine, Pediatrics, etc.) ?
  
• Did the doctor complete a Sports Medicine Fellowship?
• Is the doctor board certified in Sports Medicine...in other words does he/she possess Certification of Added Qualifications in Sports Medicine (C.A.Q.S.M.)
• What sports medicine events or teams has the doctor provided on-site coverage for?

In general, an HMO plan requires you to be assigned to a primary care physician. If you would like to see a specialist, you would need a referral from your primary care physician. Referrals that are submitted are reviewed by a medical review subcomittee.

For PPO plans, you do not need to have an assigned primary care physician submit a referral to see a specialist. However, your primary care physician can provide you with a "consultation/referral" request so the specialist knows who to contact about your medical care. Many PPO plans have a deductible for medical services, unlike many HMO plans (varies by each individual plan benefits). There are also "in-network" specialists who are contracted with your PPO plan. You can also see an "out-of-network" physician without a referral which will decrease how much your PPO plan covers for medical services rendered.

Indemnity insurance plans are neither HMO or PPO plans. Generally, patients with this plan can choose any physician or hospital they wish for their care. However, there is a deductible that must be met before the insurance company provides coverage for medical services rendered. 

It is ultimately up to the patient to know what medical services are covered, both in the clinic or in the hospital. If you have any questions about your insurance coverage, the best thing to do is to contact your insurance provider. 

Many patients ask if certain aspects of their visit are covered, like procedures.  OMT is a billable "procedure", just like a joint injection, skin tag removal, cryotherapy for warts, or vaccinations.

As there are many different variations of insurance plans, the best way to answer your question is to contact your insurance company and find out the details of your individual plan.

Having a primary care physician take care of you can help you navigate the complex world of health care. Sometimes the medical issue you have can be easily taken care of by your PCP without having to see a new physician. Your PCP can best determine which type of specialist would help you the most.

For example, if you have pain in your "bones", who would you need to see? Would it be a rheumatologist, an orthopedist, an oncologist, or any other type of specialist?

Or is it something that you only need to see your Family Medicine physician for, who knows you better than any other physician?  

In addition, the advantage of having a Family Medicine physician as your primary care physician is the ability of taking care of a patient regardless of age or gender, as well as the entire family.

An "Internist" is an physician who has specialized in Internal Medicine and focuses on the care of adults. Many internists work in the hospital and are called "hospitalists". They also take care of patients in the office. Internists can also specialize in certain fields, becoming for example cardiologists, gastroenterologists, etc.

A Family Medicine physician can also become "hospitalists" if they choose to do so, and takes care of not only adults, but children as well. Family Medicine physicians provide "full spectrum care".

The skill level of an Internist and a Family Medicine physician is dependent on each individual physican's training and experience and BOTH of these types of physicians are trained to take care of adults.