In the second of our in-depth interviews with UCO alumni and other figureheads within the profession, we chat to Austin Plunkett - a practising osteopath, researcher and PhD candidate about his career to date and his vision for the future of osteopathy.
Hi Austin, thank you for agreeing to have a chat with me. I’d like to start off by asking you for a brief overview of your career, where you’re working now, the kind of hours you do, your educational journey and so on.
So, I graduated in 2011 and went and set up my own clinic with some colleagues in Paddington which we ran for about five years. I then became progressively more interested in research, which was something I was keen on pursuing actually since before I became an osteopath. I was always intrigued by research. I then noticed that a position had become open at the National Council of Osteopathic Research (NCOR) and thought “this might be a good way to expose myself to doing research as an osteopath”. I applied for that job and luckily, I got it. So now I spend my time split one day a week working for someone else at a clinic as an associate and five-plus days a week as a full-time PhD student.
Did you always know that you had an interest in research even before you studied to become an osteopath?
I think osteopathy probably appeals to people who have a notion that they’re either going to work for someone else as a clinician or maybe going to set up their own practice as a clinician. Compared to other healthcare careers there have been historically fewer opportunities for osteopaths who are interested in research. I think that is changing, however. The profession is growing and opportunities for osteopaths who are interested in research are developing. I know several of the Osteopathic Educational Institutions (OEIs) employ people at doctoral and post-doctoral levels.
The fact that the UCO degree is awarded at integrated master's level is good for the profession and indicates that people graduating as osteopaths have the academic capacity to go into research, should they wish to.
There’s certainly a growing emphasis on research within the osteopathic community and our own research department at the UCO has certainly expanded over the last few years. Did you feel that the M.Ost (BSc) course prepared you well for further study?
I know several people who have gone on to do postgraduate master’s after the M.Ost in areas like Sports Psychology or Sports Science and I think the osteopathic degree can also set you up for expanding or diverging into those areas if that’s something you want to do.
For me personally, I started when the UCO was still the British School of Osteopathy, and the degree was still at the bachelor’s level. I knew the course was going to develop into master's level and was very pleased for that to happen – It’s a great thing that it’s now a master’s level course.
How else has the profession changed since you graduated?
I think the profession is maturing. As well as working as a clinician and as a student at Queen Mary University London, I'm also a council member, essentially a director at the Institute of Osteopathy and have previously worked at NCOR. This gives me what I hope is a really good cross-section of the profession’s development.
One big marker is the recognition of osteopathy as an Allied Health Profession (AHP) by NHS England.
We can't talk about healthcare without talking about the NHS, and I've seen an increase in osteopaths who are working within and for the NHS in recent years.
The NHS values measures like proven effectiveness, reported outcomes and patient-reported experiences. We as osteopaths are now starting to demonstrate and collect data to provide evidence for what we do and to demonstrate that we are a mature profession capable of thinking in those ways.
If you don’t mind me asking, what are you doing your PhD on?
Ok, so top tip: never ask someone who’s doing a PhD what they’re doing because you’ll be there until the cows come home listening! But in short, I’m looking at computer-assisted evidence summaries for clinicians, and specifically osteopaths. So that’s looking at how the profession can use things like artificial intelligence and machine learning to help deal with the huge amount of primary evidence that is published almost minute by minute – the kind of evidence that's hugely clinically relevant to osteopathy but can be very difficult to stay on top of.
It's easy for people to think the osteopath's job ends when a patient walks out the door. I personally don't think this is the case.
I don’t think the General Osteopathic Council think that’s the case either. We should be staying on top of current and relevant ways to use clinical evidence. That includes conversations between osteopaths and other healthcare clinicians to help osteopaths make sense of other clinical information.
It’s great to hear about this broadening interest in learning from and exchanging clinical data. Lots of our students are school leavers entering the healthcare system for the first time but at the same time, we also have a lot of people who are coming from other careers, other healthcare professions and academic backgrounds – so I think it’s really important to discuss the kind of research opportunities that are available to osteopaths.
That’s great, yes absolutely.
In terms of your clinical experience, what do you find to be the most rewarding part of being a practising osteopath?
I reflect on this a lot, because I invariably think, I leave my clinic feeling better about the world than when I started the day. I hope I've helped people.
That doesn’t always happen of course, and it isn’t always a smooth ride, but I do feel that I give something back, that I help people.
I really enjoy being one-on-one with the patient, but I also really enjoy working with colleagues – osteopaths and non-osteopaths. I enjoyed setting up my own practice…I’ll make no bones about it, it’s not always easy! But I like the business aspects of being master of my own destiny. Of course, sometimes it’s tough, but as my girlfriend always says to me, I wouldn’t have it any other way. It’s challenging but never boring.
Are there any patient interactions that have stuck with you?
Barring awkward miscommunications where I’ve walked in to find a patient waiting completely undressed, there’s been a few that have stuck with me. I have lots of positive ones, but first I’ll talk about one that I reflect on all the time.
I had this patient come to see me in my Paddington clinic a few years ago with really strong expectations about how the appointment was going to go. He had been seen by a chiropractor, or possibly another osteopath on a very regular basis previously. He came in with huge amounts of preconceptions about exactly what was wrong, that there was definitely something wrong in the first place, exactly how it needed to be treated and exactly how long it needed to be treated for. This was basically once a week, in perpetuity, forever. He wanted me to manipulate and mobilise his lower back.
So, he was essentially offering you a regular slot forever?
Yep! Now, obviously part of me thought great, I can book this guy in for tens of pounds every week. But that was absolutely not what I spent five years learning about.
One of the things I love about clinical work is the intellectual challenge of working with the patient.
But I thought ok, this guy’s beliefs are so different from mine. What’s the intersection of our values? How can we find a space where we can communicate about the same thing in the same way such that I’m enjoying my work and he’s getting better? I tried to do this for three or four weeks. In the fourth week, there came a point where we were essentially pushing money back and forth over the desk, with me saying “I really don’t think you need treatment anymore; you don’t need to be paying thousands of pounds a year for treatment. I’ve told you all the things you can do yourself which will be ninety per cent of your improvement.”
I’m not sure how useful that is, but it’s something I regularly reflect on!
Well, I think it is really interesting as a moment where your core beliefs were really tested as an osteopath.
Tested against his beliefs as well. I really tried to find the common ground but just realised it wasn’t there. It shows though, that even when things don’t go as well as they could, you learn something.
A more positive interaction, one I almost wrote up as a case study, was about six or seven years ago with a woman in her late 30s. She was an avid tennis player, not professional, but with a real love for the game. It was a strong part of her identity and social life.
The problem was she had classic tennis elbow – a real tricky one because the prognosis for it isn’t necessarily good. It can take a very long time to go away. Treatment by any means is all fairly experimental. You really have to find what works for the patient. I was quite concerned that there was a risk that I wouldn’t be able to help this lady. I hate telling patients: “you need to stop doing this”, but sometimes it just is appropriate.
Here I was with this woman for whom tennis was such an important part of her identity and I wanted to say, “take a break for six months”. It was never going to wash.
So instead, I got her to bring in her racquet. I took it back to the basics of pathophysiology. I did some hands-on treatment, but a lot of it was about slightly tweaking her tennis playing style. What shots could she change, how could she change her movement - that kind of thing.
So, over a period of six to eight weeks, it slowly improved. Of course, there is a whole thing about causation and correlation to consider – I can’t be sure I definitely cured it, but it was definitely a process of going from thinking: “this is going to be a difficult conversation”, to going back to first principals, working in partnership with the patient and finding a way through it with the patient. It was a really positive outcome.
Austin, as someone who has been an osteopath for over ten years now but came to the profession as a mature student, is there any advice you would give to someone thinking about further study or changing careers by applying to an osteopathic course?
I would say take your time to think: “Is this the right career for me?” The course can be hard, studying is hard! All the fundamentals – your anatomy, your neurology, your pathophysiology, it’s a lot of learning to get your head around. In terms of experience, mine was as a mature student, so I’ll start there by saying:
Your experience in life puts you at a great advantage. You're going to have patient skills even if you don't know it yet just by the dint of having a few more years under your belt.
It can really put you at an advantage when you meet new people. As a mature student, you bring your previous skills and life experience to the job of being a student and trainee clinician which is hugely valuable.
What about from a business perspective? The UCO course has changed over the last few years to better reflect the importance of business and development skills in running an osteopathic practice. Did you feel like you already had some of these skills graduating as a mature student?
Again, as a mature student,` you probably have a sense of wanting to be in control of your own destiny, although I'm sure this is also applicable to many school leaver students as well.
The prospect of running your own business can be really daunting for a lot of people, but also can be really exciting to others. I really believe that whole thing about threats, challenges and opportunities all being somewhat the same - it just depends on how you look at things.
I mean, I still sometimes get that weird imposter syndrome moment where I ask a patient for money and think “ahh this is embarrassing… is that ok? Was that what you were expecting today”. But you’ve got to think about your weaknesses, think about what you’re not comfortable with and then work out ways of mitigating those weaknesses. So, for me, it was things like that – staying on top of accounts, chasing overdue invoices and all the admin.
The solution was hiring a student who would turn up once a month and help out with those bits – earn themselves a bit of experience and a bit of beer money at the same time!
In terms of my silly impostor syndrome about asking for money, you know even that’s manageable because you can get people to pay in advance, you can work with a receptionist and that becomes their duty. One of the things I always say about businesses is that they throw up totally unexpected challenges but it’s always a fun and challenging environment.
Thank you Austin, it’s been great chatting with you!
*Austin graduated in 2011 from the UCO with a distinction. He currently practices at The College Osteopathic Practice in Kentish Town. In 2014, Austin joined NCOR (National Council of Osteopathic Research) and is currently working on NCOR’s ongoing projects including patient-reported outcomes and patient experiences surveys. He is currently a PhD student at QMUL, looking at the role of artificial intelligence in clinical health care and clinician engagement with evidence.