Balancing act

Q&A: Desire for work-life balance drives Montana DO to specialize in OMT

Relentless pace of primary care conflicted with DO’s plans to have more children and stay active in her church.

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Like many DOs new to practice, roughly half of whom are female, Bethany V. Chernich, DO, strives for equilibrium between her professional and personal life. Giving birth to the first of her three children while serving a family medicine residency in Phoenix, she concluded that the relentless pace of primary care conflicted with her desire to have more children and stay active in her church.

Deeply interested in osteopathic manipulative treatment, Dr. Chernich pursued an OMT specialty practice so she could have a more flexible schedule and spend considerably more time with her patients. A Michigan native who graduated from the A.T. Still University of Health Sciences-Kirksville (Mo.) College of Osteopathic Medicine in 2005, she joined an OMT-based practice in Missoula, Mont., a scenic family-friendly city with numerous recreational and cultural attractions.

For the past three years, Dr. Chernich has performed OMT on patients from all over Montana and neighboring states, a region in which the demand for OMT far exceeds the supply of osteopathic physicians who do it. While she has no trouble finding patients, third-party reimbursement remains a significant challenge.

Continuing to refine her OMT skills, Dr. Chernich feels more than ever that osteopathic medicine’s emphasis on the interrelationship of mind, body and spirit meshes with her Mormon faith.

After training as a family physician, why did you decide to limit your practice to osteopathic manipulative treatment?

Certain aspects of family medicine still appeal to me, from the excitement of never knowing what is going to come through the door to the satisfaction of building long-term relationships with whole families. But by the time I was in my second year of residency, the hectic pace began to overwhelm me. Worse than the long hours was the sense of being rushed—being able to spend only 10 or 15 minutes with each patient, one after the other. Physically and emotionally drained, I had little energy left at the end of the day. When a doctor is run ragged, patient care suffers and so does family life.

By that time, I had my first daughter, and I knew that I wanted more children. Given how tired I was in the evening, I began to envision what it would be like with a larger family, when the children have homework to do and instruments to practice. I also wanted to spend more time with my husband and continue to be active in the Church of Jesus Christ of Latter-day Saints, which is a big part of my life. And I yearned to have something left over for myself, to enjoy hobbies and recreational activities again.

So I threw my arms up in the air and thought, “What could I imagine myself doing that would allow my life to have more balance?” Fortunately, I had a couple of great preceptors during residency who provided the answer. One of them did a little bit of family practice and a whole lot of manipulation, and the other just did manipulation. I chummed around with them, observing how they ran their offices, and noticed that the pace was much more leisurely than what I was used to. These DOs were spending 30 to 45 minutes per patient visit. And they were able to run their practices without much overhead, by having small offices and just one or two employees to help with scheduling and billing.

I’m not fully trained in neuromusculoskeletal medicine, but I did learn many OMT techniques at Kirksville and during my osteopathic residency. I’m well-trained in using OMT to alleviate pain and to treat a variety of musculoskeletal problems. Strongly believing in osteopathic principles and practice, I thought, “I can make this work. I can specialize in manipulation.”

Since coming to Missoula, I’ve been adding to my skills, mentored by the other two DOs in our OMT-based practice: Sam A. Wallace, DO, who started the practice more than 10 years ago, and Lisa L. Pacheco, DO, who practiced for nearly 20 years in Maine as an osteopathic manipulative medicine specialist before moving to Montana.

I practice part time, Tuesday through Friday. On Monday mornings, I volunteer to help in my older daughter’s kindergarten class. I use the rest of my day off to run errands and get other stuff done. I love this flexibility.

As a Michigander who attended osteopathic medical school in Missouri and served a residency in Phoenix, how did you end up practicing in Montana?

When I was a second-year resident, I was doing a little bit of adjunct teaching at the Midwestern University/Arizona College of Osteopathic Medicine in Glendale, helping first- and second-year students with their physical examination skills. Somehow my email address ended up on a huge listserv for the profession. I soon came across what looked like a job posting from Dr. Wallace, who had been looking for someone to help him in his practice. He had a yearlong waiting list of people who wanted to get in to see him, and he was frustrated that he couldn’t meet the demand for osteopathic manipulation in his community.

As a resident, I wasn’t looking for a job at the time, but I happened to click on one of the links and saw beautiful pictures of Missoula. And I thought, “That’s a really nice looking place.” I had always associated Montana with cattle ranches; I didn’t know anything about it really. But I was in Phoenix in the summer and thought this would be a really nice place to visit to get out of the heat.

I arranged to do a two-week rotation with Dr. Wallace. My daughter was 18 months old at the time. And my husband, a high school teacher, was on summer break. So we turned my rotation into a family vacation, and it was really great. Dr. Wallace and I had professional and personal rapport right off the bat. Before I left, he told me that I would have a job waiting after I finished my residency if I was interested. Meanwhile, my husband and I had fallen in love with the area. Besides being beautiful, Missoula is a choice place to raise a family. After thinking about it for awhile, we decided that I should accept the offer.

What have been some of the rewards and challenges of practicing OMM in Missoula?

When I showed up fresh out of residency, I had almost a year’s worth of new patients to work through. In southwestern Montana, I believe we are the only DOs who do manipulation within about 400 miles. Patients from four different states come regularly. We even have patients from the East Coast who are parents of students attending the University of Montana.

So I started off with a long list of patients, which was a big advantage. Many are people who had been to a lot of different physicians, but they don’t like injections, they don’t like surgery, they don’t like pills, and they don’t like being told to “suck it up.” Many are optimistic because they’ve heard stories from people who’ve had OMT and gotten much better.

I’ve been able to help these patients, who are so appreciative. But one challenge is that they come back saying, “You’ve fixed my back. You’ve fixed my neck. Can you do something for my acid reflux, my headaches, my constipation? I was trained to address musculoskeletal problems, but not these other conditions, using manipulation. So I’ve had a steep learning curve at times. But I study the literature, ask questions of my colleagues and dive right in. And I’ve gotten some great results.

Insurance reimbursement has definitely been the worst problem I’ve faced as a new DO. Certain carriers, such as Blue Cross and Blue Shield, pose no problem. They know what OMT is, how it is billed and coded. But there is one Montana-based insurer in particular that just doesn’t get it. Patients have been told flat out that they can’t receive manipulation for their conditions. I’ve appealed to all sorts of people in all sorts of places.

We have considered becoming a cash-only practice but decided against it. I don’t think it would work because Missoula is not a very affluent community. Most people can’t afford to pay out of pocket for OMT. I would say that two-thirds of my patients have insurance. The other third pay cash because either they don’t have insurance or their deductibles are so high that they never meet them. I do not accept Medicare or Medicaid but do accept Healthy Montana Kids, the children’s health insurance program in our state, and TRICARE, the U.S. military’s insurance plan. And I accept almost all private insurance.

When did you first decide to pursue a career in osteopathic medicine?

I grew up wanting to be a doctor. It was a childhood dream that lasted all through high school and during my first years of college at the University of Michigan, where I was a premed student. But when I graduated from college, I wasn’t sure whether I was ready for medical school or even whether I wanted to attend at all.

I worked in a lab at the University of Michigan for a year and then decided to go on an 18-month mission in Belgium. I had converted to the Mormon religion at age 19, the last in my immediate family to do so. I was eager to serve my church and explore my new faith.

In my adult life, my religion has played a big role in how I set goals, in how I treat people, and in the expectations I have of myself and the contributions I can make. My mission work in Belgium convinced me that I had the ability to go and do hard things. I learned that I could be both very compassionate and very goal-oriented. As a missionary, I had an agenda for each day. But throughout the day, I found that I was interacting with people who have not just religious quandaries but also physical problems, financial problems and relationship problems. These insights primed me for the whole-patient approach of osteopathic medicine.

After serving my mission and before applying to medical school, I worked for three years as a medical assistant to Judith S. Moore, DO, of Provo, Utah. A family physician who does a lot of OMT, she has amazing compassion for people who are frustrated with their health and frustrated with all of the inadequate answers doctors often provide. She not only taught me how to properly do a pap smear and other procedures but also gave me an understanding of homeopathic remedies, herbal medicine and nutritional counseling. At every turn, she thinks outside the box.

Dr. Moore was very influential in supporting me, like the mamma bird who pushes the baby bird out of the nest. She finally said, “Are you going to go to medical school or what?” And she gave me a great piece of advice. She said, “You’re going to love half of medical school and you’re going to hate the other half. So savor the half that you love and just tolerate the rest.”

In what respects is osteopathic philosophy in sync with your religious convictions?

I personally get a lot out of my religion. It supports me spiritually, and that helps me in the rest of my life, setting the tone for everything else. I like that osteopathic medicine encourages us to consider that there is more to a person than a physical body. As DOs, we look at patients not as a malignant lesion, a sinus infection or chronic pain. We recognize that each person has feelings and worries and questions about the meaning of life. Religious faith forces us to ponder these issues, and so does osteopathic medicine.

There are amazing healing mechanisms that we understand through science. But then there are many other mechanisms that seem almost miraculous, which we don’t understand yet. Acknowledging the interrelationship of mind, body and spirit, OMT optimizes forces that we don’t fully understand to promote healing.

6 comments

  1. Beau Links

    This was a great article, thank you. As an osteopathic medical student, with an interest in incorporating OMT into my practice, it’s nice to see young physicians making a living, both monetarily and spiritually, using osteopathic techniques.

  2. Jeff

    Thank you! It really helps me to hear a doctor’s perspective on career paths in the medical field(since I am a med student myself).

  3. Diane

    Seems like a very sensible approach to attaining all of her goals. I am a family practise Dr. and do 1-4 OMT appts /day ,and it helps me settle down from the frantic pace of day to day practise.

  4. Julie

    Very uplifting! I am a solo-practitioner, OMM only, who has been feeling the pain from the insurance companies lately. Reading about someone who is happily keeping the DO faith makes me take a deep breath, relax, and remember all the patients who have benefited from the OMM I’ve provided over the years.

  5. Pingback: KCOM alumna featured in THE DO » iconnect – A.T. Still University

  6. James E.Whte, DO, RPh

    Dr. Chernich when you are doing OMM only I’ll bet you have figured out that you still need at least 3 days more training to learn Oral Osteopathy. You got a pretty good introduction on the initial visit with the direct craniofacial OMT supported by an oral appliance integrated with total spinal manipulation. Of course I use the Body Bridge because it saves a lot of work for me.

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