New Beginnings for D.O.s in California

Dr. Norman Vinn, DO interviewed by Dr. Michael Seffinger, DO

at the AOA House of Delegates Meeting in Chicago, Illinois
July 15, 200

  • Dr. Seffinger:  To start off Dr. Vinn, would you tell us when you were born and how you became involved with the osteopathic profession: your schooling and education, like that, and then discuss with us about your impressions of the profession, what you did within the profession, some of your mentors and some of the people you have mentored. You can address questions as we go from there.
  • Dr. Vinn:  I was born on July 3, 1949 at Houston Osteopathic Hospital, by a DO named Dr. Ester Rohr. She was actually a general practitioner. My father was also an osteopathic general practitioner in Houston. He was class of 1941 through Philadelphia College of Osteopathic Medicine. He did originally come to Texas from the east coast. He had done an internship at Sparks Hospital in Dallas and ended up in a small town named Velasco, Texas. It was a suburb of Freeport, Texas, where there was a large strategic chemical plant known as Dow Chemical. He practiced there and hospitalized patients in the front room of his house because he couldn’t get hospital privileges. So I was born into an osteopathic family; went to college at Tulane University in New Orleans and eventually chose to go to Philadelphia College of Osteopathic Medicine; graduated in 1977 and did an internship after that at Botsford Hospital in Farmington Hills, Michigan before I came to California to set-up practice in Long Beach, California.
  • Dr. Seffinger:  About what year was that?
  • Dr. Vinn:  I came to California in August of 1978. I think what I originally noticed that was unique or different about osteopathic medicine, both from the example my father and people during my training and education was the holistic approach of osteopathic practice including bedside manner. How the osteopathic physician looked at the whole patient was key. I also realized during training that osteopathic medicine was a primary care-oriented profession and chose to follow that path.
  • Dr. Seffinger:  When you came to California, what was your impression of osteopathy in the State at that time in 1978?
  • Dr. Vinn:  In 1978 osteopathic medicine was still in a highly re-emerging state since there were twelve years when no new DOs were licensed in California. That period ended in 1974. So at that time there weren’t that many DOs in California, but the profession was starting to grow rapidly. I got involved with DO organizational activities in the state of California because I was practicing out of a hospital named Pacific Hospital of Long Beach. Prior to the 1962 merger, Pacific had been known as Long Beach Osteopathic Hospital, and was now re-emerging as an osteopathic hospital. Several times I went to represent the hospital at the osteopathic licensing sessions in Sacramento and became acquainted with Matt Weyuker, who at that time was the Executive Director of OPSC. He asked if I would be willing to be more involved with the State Osteopathic Medical Association (Osteopathic Physicians and Surgeons of California-OPSC). I was originally appointed to the legislative committee of OPSC, which I did for a couple of years. Then I was asked if I would be willing to serve on the Board, and I accepted that nomination. I served on the Board from about 1982 to 1986. I took a year off of the Board and then I was asked to come back on the Board, I believe in 1987 or early 1988. About a year after that I ascended to President Elect of the Association. I was President of OPSC in 1989-90. I attended my first House of Delegates for the AOA in the summer of 1988 at the Fontainebleau Hotel in Miami. After that I remained on the Board for a number of years. Coincidentally, in the mid to late 1980s we formed a medical group in California whose objective was to become aligned with the changing payer dynamics in California, namely the increasing penetration of managed care. Because of that, our group, which was composed of six osteopathic DO family practitioners and a general surgeon, was able to develop their own independent Physician Association in 1989; and eventually was merged with a large multi-specialty medical group called Mullikin Medical Centers in 1992. Because of the intense exposure to managed care models, I became concerned that the AOA needed to increase its awareness among physicians about managed care delivery models. I went to support Dr. Howard Levine, then Chair of the Bureau of Research of the American Osteopathic Association (AOA), and later President of the AOA (1997). We developed the first managed care task force in 1993. That managed care task force eventually became a standing committee called the Committee on Health Care Delivery Systems, of which I was Vice-Chair and ultimately Chair. It became a permanent committee and was renamed the Committee on Socio-economic Affairs. As far as specific activities about the history of osteopathic medicine in California, the OPSC Board was very involved with re-emerging efforts to discriminate against DOs in California. We noticed that some hospital staffs and managed care organizations such as Kaiser were not allowing DOs on staff. Collectively we were able to get legislation introduced, which I believe was Senate Bill 2480 in the mid-80s. This bill mandated that hospitals and medical groups and other health care organizations consider osteopathic licensure and certification as an equivalent with that of MDs. This opened up numerous opportunities for our members to work within organizations and get on major hospital staffs, including the Kaiser organization. I can’t take individual credit for that. It was a collective effort, but I was there when it happened. I also believe that both in California and nationally we did have a significant role in increasing awareness of the managed care delivery model including pros and cons for the AOA and its membership and helping prepare osteopathic physicians to function more effectively within these payer models. Another thing I was involved with nationally was the crisis that occurred with the AOA building in 1993 when there was a steep real estate market decline in Chicago. The building was extremely burdensome to the AOA. It was affecting the balance sheet, and a committee was formed which I was asked to serve on. We, through a series of discussions came up with a plan to renegotiate the debt load of the building. We achieved this goal and it helped re-stabilize the AOA. This was under the leadership of Dr. Howard Neer. I was only one member in a group of many. But I was there when it happened, which was a very interesting and challenging period in the history of the AOA. I was ultimately elected to the Board of Trustees of the AOA in 2003, serving two terms; one term as Second Vice-President and two terms as First Vice-president. I am currently serving a 3 year term on the Board of Trustees. As far as challenges, it was always a challenge, both in California and nationally, negotiating and advocating for members as a small minority profession. It was, and remains, a challenge for members to understand the concept of member value, the importance of the AOA, and the benefits for all osteopathic physicians. I think there was a question about how we accomplished what we did, and I think it was: (1) through core knowledge of subjects and doing home work; (2) being passionate about what needed to be done; (3) being able to establish strong, continuous long-term relationships; and (4) attempting to communicate and influence, such that there was a movement towards consensus on key goals and objectives. I had a number of mentors early on in the process. In particular Dr. Donald Krpan, who is now past president of the AOA who was a supporter and mentor and advisor from my very first days on the OPSC board; Dr. Earl Gabriel - past president of the AOA (who has since passed away, but was very, very supportive and encouraging to stay involved and to get more involved); and Dr. Ethan Allen, who was certainly an advisor and an encouraging colleague. I’ve mentored several people through the years, one being you, and at some point you had a continuity of care relationship in our office while you were a Family Practice intern at Pacific Hospital. I also mentored Dr. Joseph Zammuto, who is a past president of the OPSC, but originally came to California as a student in my office in his first California rotation. I’d like to think I had some role in helping to mentor Dr. Geraldine O’Shea and Dr. James Lally. Dr. Lally is a past president of OPSC and Dr. O’Shea is current president, and at various times I have been consulted for my opinion and input by a number of Board members and past-presidents of OPSC. I have been an Emeritus Board member of OPSC, since about 1998, but you would have to check the dates on that. I think that one of the biggest challenges for osteopathic medicine in California are somewhat identical with the issues raised by Dr. Marty Morris in his AT Still lecture to the 2006 AOA House of Delegates. We have became victims of our own success as our graduates have been eligible to train and be accepted in more and more allopathic institutions. There has been a dilutional impact on their sense of identification and belonging within the osteopathic profession. And I think that this will be one of our greatest challenges for many years to come, both in California and nationally. If I was asked by some emerging students what advice I would have, I would certainly say to always remember your roots, remember the importance of the osteopathic philosophy in your daily practice (no matter what specialty you are in), and in your hand, heart, and mind always be a DO, no matter where you are; because it is a badge of pride to carry with you. I think you did ask me also who else we should contact who was instrumental in the historical development of osteopathy in California. Dr. Don Dilworth was a very, very early president of OPSC. I think he is down in Escondido. There’s a Dr. Lee, Bob Lee, who’s an obstetrician in Pomona,who you may wish to interview. Another challenge that remains, and is going to be ongoing in California, is the sheer size of the state and the geographic dispersion of the membership. It is hard to have a sense of family when people are as much as a thousand miles apart. On the other hand I think we continue to demonstrate in the AOA that through a sense of pride, a sense of brand identity, that you can make people in the dispersed atmosphere feel they are a part of the same family and share in the same heritage and philosophy. I do think we are going to have to continue to push the limits of leveraging technology to be a constant reminder, and be a connectivity link for DOs, no matter where they are located, about the osteopathic philosophy, the osteopathic model and the role of the AOA in preserving your past and sharing your future.
  • Dr. Seffinger:  Do you have any thoughts about allopathic medical students regarding their relationship to osteopathic medicine in the state?
  • Dr. Vinn:  I’m not sure what you mean.
  • Dr. Seffinger:  Any perspectives from their point of view. There has been a variety of interactions with DOs throughout the last century that ranged from not relating to DOs to a period of relating to DOs in various capacities and now, you know, current medical students often find themselves in the same rotation together, the same residencies together. The MDs and DOs are working together on the staff of many hospitals while the DOs are Chief of Staff at hospitals that are mixed MD/DO staff, so the atmosphere and culture has changed quite a bit since the time you first came to the state. So you have people now who are pre-med and trying to figure out which school to go to; DO school or MD school. You have people that choose to go to MD or get into MD schools and they’re not sure what osteopathy really is or what DOs really are. Do you have anything that to say to them about their interactions with their DO colleagues?
  • Dr. Vinn:  Well, I think that information sharing and learning is typically bilateral and DO/MD students can be mutually supportive in many ways. I do think that the allopathic students, if they are already in med school, can learn from osteopathic post-graduate physicians in a number of ways. I think that healthy curiosity expands one’s knowledge and abilities. I think that it furthers the issue of the Osteopathic paradox of inclusion vs. dilution. It’s not in the tradition of medicine to withhold knowledge that would benefit the population as a whole. Yet, there is clearly a concern that if everybody knows what we know, then how are we different? On the other hand one could also argue that, if what we know and do is the right way to practice, the osteopathic practice should become a universal standard. I think that the debate will continue to unfold. There are ongoing living controversies right now as to how much manipulation allopathic physicians should be taught. If they do manipulation, are they competing with us? Well, we are learning surgery from surgeons that eventually will compete with our surgical residents. So information sharing and knowledge of best practices is a tradition in medicine. I think that it is a road that we are going to have to travel. It’s the high road. I would just encourage allopathic students to learn more about why we think the way we think about patients. They will have to make up their own mind if they feel that is additive to their practice and their style and their base of knowledge.
  • Dr. Seffinger:  Do you have documents that you would like to share, historic documents that are important to help in the understanding of osteopathic medicine in the state of California?
  • Dr. Vinn:  I think the main thing is to research the Antidiscrimination Bill. Also, you might want to research the original resolution from the summer of 1988 that I authored and introduced directly into the House of Delegates. It was about a topic called Freedom of Choice Resolution.
  • Dr. Seffinger:  At the AOA?
  • Dr. Vinn:  At the AOA. Issues emerged in California as doctors moved more and more into preferred provider and managed care contracts that were linked with specific hospitals. It was basically a proposal to establish formal AOA policy that patients have freedom of choice on their selection of physicians or their selection of a hospital, as opposed to selective contracting practices to direct patients to physicians or hospitals where they didn’t really want to go. I believe that may just have been reaffirmed for at least the third time. I just saw something on that, the Health Policies Committee reaffirming freedom of choice. I think that relates back to the same resolution from 1988. That was an early attempt to share lessons learned in California, that potentially affected the profession as a whole.
  • Dr. Seffinger:  Excellent. You are now engaged in a practice style that is reminiscent of DO rural doc style home visit, taking care of patients that are homebound or in their home, have home visits, and house calls. Do you want to talk a little bit about that because I think that is unique and hasn’t had precedents in California for many years?
  • Dr. Vinn:  Well one of the things that happened in the course of my career in relationships is that after I got involved with managed care due to the merger or our own osteopathic medical group (which was called Naples Medical Group in Long Beach, CA) with Mullikin Medical Centers, I was very interested in focusing on something that returned healthcare to its roots; personal service, customer service, and unhurried physician/patient interaction. I was fortunate enough to meet some people who were trying to create a renaissance of house call medicine. That original effort did not survive, but from that I decided to develop my own model, a unique model of care in Orange County, California. We developed a house-call program where we visit frail elderly, home bound people, and end-of-life patients. It is a very flexible model of care that produces a high degree of personal satisfaction. We believe that it embraces a set of best practices and core competencies in effect, a specialty practice. We call our model of care “Residentialist Medicine.”
  • Dr. Seffinger:  Excellent! Wonderful! Okay...
  • Dr. Vinn:  Additionally, it is a highly osteopathic mode of practice. We take a case management approach and really focus on the whole patient, not just their medical problems, but also their nutrition, their hygiene, their safety, their psycho-social issues, prognosis, insight, mental condition, and family and caregiver issues.
  • Dr. Seffinger:  And this is all within the context of family medicine?
  • Dr. Vinn:  It is family medicine, but at this point it is highly focused on geriatrics and the frail elderly, homebound patients.
  • Dr. Seffinger:  If when you look at the transcript anything comes up with details of names, places, people, things that pop into your mind just add-in and send that in so that we have as much of a history as you can recall because you lived in a very interesting time, a very unique time in California. A lot of changes have occurred during your career, I think for the better. But as to the growth of the profession in the state, gosh, when you came in, there were hundreds, and now there are thousands.
  • Dr. Vinn:  There are over 3000 practicing DOs in California.
  • Dr. Seffinger:  3,000. So it has grown quite a bit with two schools now.
  • Dr. Vinn:  That’s right. We’ve gone from a couple of delegates in the AOA House of Delegates to having about 15. California is now the fifth largest state in the profession because there are six larger; you need to check the stats on that.
  • Dr. Seffinger:  Right. They used to be the first or number one for many years and then after the merger went down to the bottom and now it’s coming back up. Great climb! Well thank you very much. A lot of it’s due to your activities.
  • Dr. Vinn:  Well, it’s a team effort.