University of New England

OMM’s Advocate: Dr. Bill Papura, UNECOM ’96

[Editor's Note: This profile originally appeared in the November 2006 COMmunicator.]

You don’t talk with Dr. Bill Papura - you saddle up. The conversation starts easily like a cowboy sauntering down a street. Then all of a sudden - with dust swirling and hooves pounding - you’re on your horse and galloping off in pursuit of the bad guys. An hour later, you’re in Tombstone. That’s life in the fast lane with “Doc” Papura.

Born in Amsterdam, New York, a small mill town in the Mohawk River Valley, Bill Papura developed a love for the outdoors and a talent for culture. As a bio major at Siena College, Papura discovered osteopathy, went on to med school at UNECOM, and never looked back. Today, he is assistant professor of OMM at UNECOM and a major proponent of the discipline regionally. He is OMM’s advocate.

From the Bottom of the Pond

As a boy, Bill Papura buried himself in literature, art, and whatever green, oozing goodness he could drag from the bottom of the local pond. Fascinated by life sciences, Papura nabbed amphibians, snatched snakes, and examined forests with forensic zeal. “My parents encouraged my natural abilities and interests,” he recalls, “they supplied paper, gave me support, and welcomed my discoveries.”

He attended Amsterdam Public High, where he took math/science courses and continued to excel in art. “You’ve got to put your finger on creativity,” Dr. Papura says, “and cultivate an energy that you can’t otherwise express.” His well-rounded approach embraced martial arts and oil painting, besides the obvious requirements of biology and physics. In karate, he has achieved the rank of third-degree black belt.

Papura went to Siena College, a Franciscan Catholic institution between Albany and Troy. As a biology major, he cared for the lab animals and came across an osteopathy booklet in a health professions class. “It made total sense,” he says, “with its focus on holism and full-person integration.” His advisor showed Papura a UNECOM brochure with its full-color aerial shot of the campus, and he was sold. “That’s where I want to go!” he exclaimed.

“They Need to be Educated”

UNECOM was everything Dr. Papura had hoped. “I would take Gross Anatomy again,” he says earnestly, “since it gives you such an appreciation for the complexity of the human body.” Humanities professors came in to address the issue of mortality and how to treat cadavers with respect. “That really helped prepare me,” Papura says, “and reinforced the wonderful gift that body donors make.”

He discovered a tremendous support network at UNECOM, where students gave mutual encouragement and helped those who struggled. “That’s rare among institutions of higher learning,” he says. Academically, Papura appreciated the curriculum divided into systems, which made sense to him, and he was delighted by the integration of OMM from his first year onward. To provide balance from the looming burden of academics, Papura oil painted in his apartment and continued to practice karate. He put osteopathic principles into practice in his own life, and found that they worked. That encouraged him to experiment on others. 

“When I went home on breaks,” Dr. Papura recalls, “I would practice OMM on my friends and relatives. They loved it.” He rotated through Brighton Medical Center, as well as Mishawaka in Indiana and St. Elizabeth’s in Utica. Wherever he went, he soon found that students from other osteopathic schools expected UNECOM students to exhibit greater OMM skills than they. “There was this pervading sense that UNECOM students were simply better trained in OMM,” he says, “and I have found that still to be true.”
 
Greater skill did not always translate into greater respect from M.D.s., however. “I was never outright rejected by an M.D.,” he says, “but there was always a need to explain the training I had received and take extra steps to maintain osteopathic distinctives.” He smiles wickedly and adds, “There are ER docs who think that an osteopath will manipulate a patient in cardiac arrest. They need to be educated.”  

Public Invisibility

Why does a 130-year-old accredited profession still encounter such widespread ignorance? There are two primary reasons, Dr. Papura believes. First, post-graduate work sometimes dilutes the distinctiveness of osteopathy and creates public invisibility for the profession. “A lot of D.O.s are trained as allopaths during residency,” he says, “and so the public can’t see the difference. Some D.O.s think that you don’t need to integrate OMM into other specialties, but if you don’t consider OMM, you’re not considering our profession.”

The second reason is more pragmatic. “Medicine is a business,” Papura says, “and no one patents an OMM technique. You’re not making money hand-over-fist by using OMM; you’re simply helping your patients.” Certain HMOs refuse to compensate D.O.s for OMM, and the lack of financial incentive sometimes forces D.O.s to compromise. “I learned that I could make more money when my nurse flushed the earwax from a patient’s ear than I could by treating their back, neck, head, and pelvis,” Dr. Papura says acerbically.

With healthcare costs hooked to a rocket, Dr. Papura believes that D.O.s are obligated to offer OMM as a cost-effective alternative for patients. “If more people used OMM,” he argues, “and if osteopathic principles were stressed, healthcare costs would go way down. Guaranteed.” Not to mention that many patients would find greater relief from their suffering. “Currently,” says Papura, “if HMOs do not reimburse D.O.s for OMM, they essentially mandate inferior healthcare for the patient. That’s sad.”

HMOs in the Dark Ages

In 1999, Dr. Papura completed his family practice residency at St. Clares in Schenectady, New York, and then moved back to Amsterdam to join other D.O.s at a family practice clinic. He met and married his wife during his second year of residency, and they now have a son who will turn seven this November. The clinic was very busy, which was good, but every upstate HMO refused to reimburse for OMM treatments, which was bad. That denial burned Papura, who noted that downstate HMOs covered the treatments without complaint: “New York College of Osteopathic Medicine (NYCOM) is located downstate,” he says, “so politically, the HMOs had to accept OMM.”

It seemed crazy that HMOs within the same state could have such radically different standards. The discrepancy seemed to hearken back to the Dark Ages, when each noble controlled his own fiefdom, imposed his own taxes, and set his own regulations. Dr. Papura began a quest to pass legislation that would require local HMOs to join most of modern medicine in their acceptance of OMM. “I initiated legislation to approve OMM under insurance,” Papura recalls, “but there was not much support for it, politically. No one will win an election on it, so you’ve got to make your own noise.”

Over the next few years, Dr. Papura presented his arguments to local politicians, legislatures, and even to state senators. He tried to stir up the stagnant waters of the HMOs, casting as many well-aimed pebbles as he could, hoping that the ripples might reach a sympathetic ear. Time after time, politicians and administrators agreed that his case was valid, but it was unlikely to win. “One high-level legislative aid to the Assembly Insurance Chairman acknowledged that my case was the best he’d ever seen,” Papura says, “but he said that the legislation would never pass. It simply wasn’t a hot-button issue.”

Several HMOs told Dr. Papura to “up code” his OMM treatments, essentially changing the designation from OMM to surgery or something else. “Up-coding ignores the OMM component and inappropriately increases the charge of the office visit,” he says, “It is totally fraudulent and unethical. Ethics aside, why should I have to hide treatments which are recognized throughout the United States?” One insurance panel asked him for more clinical studies to prove the efficacy of OMM. “There were 20 M.D.s on that board,” he says, “and not one D.O.”

Home State Advantage

After years of frustrating inertia, Dr. Papura decided to return to Maine. “Amsterdam may be my hometown,” he smiles, “but Maine is my home state.” The strong draw of a beautiful Maine coast, the stimulating environment at UNECOM, and the potential to combine his love for teaching with clinical practice was too hard to resist. He took a position in the OMM department where he now teaches several days a week.

Dr. Papura sees his current role as an extension of what he has done for the last ten years. “I want to educate UNECOM students about the importance of OMM and how it helps to set them apart as physicians,” he says. Dr. Papura speaks with a passion, ease, and articulation that bespeak his years of lobbying at the highest levels. More than anything else, he wants current UNECOM students to help carry the flag to their patients and communities. “The best way to educate the general public,” Papura says warmly, “is to make every osteopathic student an osteopathic educator.” The task may seem daunting in an age of general apathy, but Papura is committed to the long haul. “If I can make just one student not only learn OMM,” he says, “but care about it, I have really done my job.”

And with a clash of spurs, OMM’s advocate dashes off in a cloud of dust.

-Steve Smith, RSAS