Osteopathic medicine in the United States

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Osteopathic medicine is a branch of the medical profession in the United States. Osteopathic doctors (DOs) can be licensed to practice medicine and surgery in all 50 states and are recognized to varying degrees in 65 other countries.

Medicine The science and practice of the diagnosis, treatment, and prevention of physical and mental illnesses

Medicine is the science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.

United States Federal republic in North America

The United States of America (USA), commonly known as the United States or America, is a country comprising 50 states, a federal district, five major self-governing territories, and various possessions. At 3.8 million square miles, the United States is the world's third or fourth largest country by total area and is slightly smaller than the entire continent of Europe's 3.9 million square miles. With a population of over 327 million people, the U.S. is the third most populous country. The capital is Washington, D.C., and the largest city by population is New York City. Forty-eight states and the capital's federal district are contiguous in North America between Canada and Mexico. The State of Alaska is in the northwest corner of North America, bordered by Canada to the east and across the Bering Strait from Russia to the west. The State of Hawaii is an archipelago in the mid-Pacific Ocean. The U.S. territories are scattered about the Pacific Ocean and the Caribbean Sea, stretching across nine official time zones. The extremely diverse geography, climate, and wildlife of the United States make it one of the world's 17 megadiverse countries.

Surgery Medical specialty

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.


Frontier physician Andrew Taylor Still founded the profession as a rejection of the prevailing system of medical thought of the 19th century. Still's techniques relied on manipulation of joints and bones, to diagnose and treat illness, and he called his practices "osteopathy." By the middle of the 20th century, the profession had moved closer to mainstream medicine, adopting modern public health and biomedical principles. American "osteopaths" became "osteopathic medical doctors", ultimately achieving full practice rights as medical doctors in all 50 states, including serving in the United States Armed Forces as physicians. [1] [2]

Andrew Taylor Still Founder of Osteopathic Medicine

Andrew Taylor Still, MD, DO was the founder of osteopathy and osteopathic medicine. He was also a physician and surgeon, author, inventor and Kansas territorial and state legislator. He was one of the founders of Baker University, the oldest four-year college in the state of Kansas, and was the founder of the American School of Osteopathy, the world's first osteopathic medical school, in Kirksville, Missouri.

Joint manipulation is a type of passive movement of a skeletal joint. It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

Osteopathy is a type of alternative medicine that emphasizes manual readjustments, myofascial release and other physical manipulation of muscle tissue and bones. Practitioners of osteopathy are referred to as osteopaths. Its name derives from Ancient Greek "bone" (ὀστέον) and "sensitive to" or "responding to" (-πάθεια).

In modern medicine, any distinction between the MD and the DO professions has eroded steadily. Diminishing numbers of DO graduates enter primary care fields, [3] fewer use osteopathic manipulative treatment (OMT), and increasing numbers of osteopathic graduates choose to train in non-osteopathic residency programs. [4] [5] [6] An osteopathic physician (DO) is a fully licensed, patient-centered physician. DO has full medical practice rights throughout the United States and in 44 countries abroad. [7]

In the United States, physicians may hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). MD and DO physicians complete similar residency programs in hospitals, can be licensed in all 50 states, and have rights and responsibilities common to physicians.

Primary care day-to-day health care given by a health care provider

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a nurse practitioner, or a physician assistant. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or a Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting the majority of graduate medical training programs for physicians in the United States. It is a non-profit private council that evaluates and accredits medical residency and internship programs. The ACGME was founded in 1981 and was preceded by the Liaison Committee for Graduate Medical Education, which was established in 1972. The ACGME currently oversees the post-graduate education and training for all MD and the majority of DO physicians in the United States. Plans call for the ACGME to oversee the Unified Accreditation System for all MDs and DOs in 2015.

In the 21st century, the training of osteopathic physicians in the United States is equivalent to the training of Doctors of Medicine (MDs). [8] Osteopathic physicians attend four years of medical school followed by an internship and a minimum two years of residency. They use all conventional methods of diagnosis and treatment. Though still trained in OMT, [9] the modern derivative of Still's techniques, [10] [11] they work in all specialties of medicine. Discussions about the future of modern medicine frequently debate the utility of maintaining separate, distinct pathways for educating physicians in the United States. [6] [12]

Medical school in the United States is most commonly a four-year graduate program with the purpose of educating physicians in the field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the US confer upon graduates a Doctor of Medicine (MD) degree, although some confer a Doctor of Osteopathic Medicine (DO) degree, and a few offer combined programs where graduates earn both a bachelors degree and an MD or DO. Most schools follow a similar pattern of education, with two years of classroom and laboratory based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.

Residency (medicine) type of early-career medical practitioner

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, podiatrist, dentist, or veterinarian who practices medicine, usually in a hospital or clinic, under the direct or indirect supervision of a senior clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. An individual engaged in such training may be referred to as a resident, house officer, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.


Physicians and surgeons who graduate from osteopathic medical schools are known as osteopathic physicians or osteopathic medical doctors. [2] Upon graduation, they are conferred a professional doctorate, the Doctor of Osteopathic Medicine (DO). [13] [14] [15]

Doctor of Osteopathic Medicine is a professional doctoral degree for physicians and surgeons offered by medical schools in the United States. A DO graduate may become licensed as an osteopathic physician, having equivalent rights, privileges, and responsibilities as a physician who has earned the Doctor of Medicine (MD) degree. DO physicians are licensed to practice the full scope of medicine and surgery in 65 countries, and in all 50 US states. They constitute 11% of all US physicians. As of 2018, there were more than 145,000 osteopathic medical physicians and osteopathic medical students in the United States.

Osteopathic curricula in other countries differ from those in the United States. European-trained practitioners of osteopathic manipulative techniques are referred to as "osteopaths": their scope of practice excludes most medical therapies and relies more on osteopathic manipulative medicine and alternative medical modalities. [7] While it was once common for DO graduates in the United States to refer to themselves as "osteopaths", this term is now considered archaic, and those holding the Doctor of Osteopathic Medicine degree are commonly referred to as "osteopathic medical physicians". [16]

Alternative medicine describes any practice which aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested or untestable. In some cases AM treatments are proven ineffective. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon. Alternative therapies share in common that they reside outside medical science, and rely on pseudoscience. Alternative medicine is distinct from experimental medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing evidence of either effect or of no effect. Research into alternative treatments often fails to follow proper research protocol and denies calculalaton of prior probability, providing invalid results. Traditional practices become "alternative" when used outside their original settings without proper scientific explanation and evidence. Frequently used derogatory terms for the alternative are new-age or pseudo, with little distinction from quackery.


Physicians entering US workforce by education, 2005 EnteringPhysiciansByEducation2005.PNG
Physicians entering US workforce by education, 2005

Currently in 2018 there are 35 medical schools that offer DO Degrees in 55 locations [18] across the United States, while there are 141 accredited MD medical schools. [19]

Geographic distribution of osteopathic physicians as a percentage of all physicians, by the state. Locations of osteopathic medical schools are in red.      <3%      3-5%      5-10%      10-15%      15-25% Osteopathic distribution US2.PNG
Geographic distribution of osteopathic physicians as a percentage of all physicians, by the state. Locations of osteopathic medical schools are in red.      <3%     3-5%     5-10%     10-15%     15-25%

Osteopathic physicians are not evenly distributed in the United States. States with the highest concentration of osteopathic medical physicians are Oklahoma, Iowa, and Michigan where osteopathic medical physicians comprise 17–20% of the total physician workforce. [27] The state with the greatest number of osteopathic medical physicians is Pennsylvania, with 8,536 DOs in active practice in 2018. [28] The states with the lowest concentrations of DOs are Washington, DC, North Dakota and Vermont where only 1–3% of physicians have an osteopathic medical degree. [26] [27] Public awareness of osteopathic medicine likewise varies widely in different regions. People living in the midwest states are the most likely to be familiar with osteopathic medicine. [29] In the Northeastern United States, osteopathic medical physicians provide more than one third of general and family medicine patient visits. [30]

Between 2010 and 2015 twelve states experienced greater than 50% growth in the number of DOs—Virginia, South Carolina, Utah, Tennessee, North Dakota, Kentucky, South Dakota, Wyoming, Oregon, North Carolina, Minnesota, Washington. [24]

Osteopathic principles

A physician demonstrates an OMT technique to medical students at an osteopathic medical school. Medical School.jpg
A physician demonstrates an OMT technique to medical students at an osteopathic medical school.

Osteopathic medical students take the Osteopathic Oath, similar to the Hippocratic oath, to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:

  1. The body is a unit; a person is a unit of body, mind, and spirit.
  2. The body is capable of self-regulation, self-healing, and health maintenance.
  3. Structure and function are reciprocally interrelated.
  4. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.

Contemporary osteopathic physicians practice evidence-based medicine, indistinguishable from their MD colleagues. [31]


There are different opinions on the significance of these principles. Some note that the osteopathic medical philosophy is akin to the tenets of holistic medicine, [32] suggestive of a kind of social movement within the field of medicine, one that promotes a more patient-centered, holistic approach to medicine, and emphasizes the role of the primary care physician within the health care system. [33] [34] Others point out that there is nothing in the principles that would distinguish DO from MD training in any fundamental way. One study, published in The Journal of the American Osteopathic Association found a majority of MD medical school administrators and faculty saw nothing objectionable in the core principles listed above, and some endorse them generally as broad medical principles. [31]


19th century, a new movement within medicine

Andrew Taylor Still, founder of osteopathic medicine Andrew Taylor Still 1914.jpg
Andrew Taylor Still, founder of osteopathic medicine

Frontier physician Andrew Taylor Still, MD, DO, founded the American School of Osteopathy (now the A.T. Still University-Kirksville (Mo.) College of Osteopathic Medicine) in Kirksville, Missouri in 1892 as a radical protest against the turn-of-the-century medical system. A.T. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt, and treated effects rather than causes of disease. [35] He founded osteopathic medicine in rural Missouri at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. Some of the medicines commonly given to patients during this time were arsenic, castor oil, whiskey, and opium. In addition, unsanitary surgical practices often resulted in more deaths than cures. [36]

"To find health should be the object of the doctor.
Anyone can find disease."

Andrew Taylor Still, 1874

Dr. Still intended his new system of medicine to be a reformation of the existing 19th-century medical practices. He imagined that someday "rational medical therapy" would consist of manipulation of the musculoskeletal system, surgery, and very sparingly used drugs. He invented the name "osteopathy" by blending two Greek roots osteon- for bone and -pathos for suffering in order to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side-effects of drugs.

Mark Twain was a vocal supporter of the early osteopathic movement. Twain1909.jpg
Mark Twain was a vocal supporter of the early osteopathic movement.

The new profession faced stiff opposition from the medical establishment at the time. The relationship of the osteopathic and medical professions was often "bitterly contentious" [17] and involved "strong efforts" by medical organizations to discredit osteopathic medicine. [37] Throughout the first half of the twentieth century, the policy of the American Medical Association labeled osteopathic medicine as a cult. The AMA code of ethics declared it unethical for a medical physician to voluntarily associate with an osteopath. [33] [38]

"To ask a doctor's opinion of osteopathy is equivalent to going to Satan for information about Christianity."

Mark Twain, 1901

One notable advocate for the fledgling movement was Mark Twain. Manipulative treatments had purportedly alleviated the symptoms of his daughter Jean's epilepsy as well as Twain's own chronic bronchitis. In 1909, he spoke before the New York State Assembly at a hearing regarding the practice of osteopathy in the state." I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven't been able to sleep." Philosophically opposed to the American Medical Association's stance that its own type of medical practice was the only legitimate one, he spoke in favor of licensing for osteopaths. Physicians from the New York County Medical Society responded with a vigorous attack on Twain, who retorted with "[t]he physicians think they are moved by regard for the best interests of the public. Isn't there a little touch of self-interest back of it all?" "... The objection is, people are curing people without a license and you are afraid it will bust up business." [39]

Evolution of osteopathic medicine's mission and identity [1]
YearsIdentity & Mission
1892 to 1950Manual medicine
1951 to 1970Family practice / manual therapy
1971 to presentFull service care / multispeciality orientation

1916–1966, federal recognition

Recognition by the US federal government was a key goal of the osteopathic medical profession in its effort to establish equivalency with its MD counterparts. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the US Military Medical Corps. On May 3, 1966 Secretary of Defense Robert McNamara authorized the acceptance of osteopathic physicians into all the medical military services on the same basis as MDs. The first osteopathic physician to take the oath of office to serve as a military physician was Harry J. Walter. [40] The acceptance of osteopathic physicians was further solidified in 1996 when Ronald Blanck, DO was appointed to serve as Surgeon General of the Army, the only osteopathic physician to hold the post. [38]

1962, California

In the 1960s in California, the American Medical Association (AMA) spent nearly $8 million to end the practice of osteopathic medicine in the state. In 1962, Proposition 22, a statewide ballot initiative in California, eliminated the practice of osteopathic medicine in the state. The California Medical Association (CMA) issued MD degrees to all DOs in the state of California for a nominal fee. "By attending a short seminar and paying $65, a doctor of osteopathy (DO) could obtain an MD degree; 86 percent of the DOs in the state (out of a total of about 2000) chose to do so." [41] Immediately following, the AMA re-accredited the University of California at Irvine College of Osteopathic Medicine as the University of California, Irvine School of Medicine, an MD medical school. It also placed a ban on issuing physician licenses to DOs moving to California from other states. [42] However, the decision proved to be controversial. In 1974, after protests and lobbying by influential and prominent DOs, the California Supreme Court ruled in Osteopathic Physicians and Surgeons of California v. California Medical Association, that licensing of DOs in that state must be resumed. [43] Four years later, in 1978, the College of Osteopathic Medicine of the Pacific opened in Pomona, and in 1997, Touro University California opened in Vallejo. As of 2012, there were 6,368 DOs practicing in California. [44]

1969, AMA House of Delegates approval

Total number of DOs in residency programs, by year.
DO residents in ACGME (MD) programs
DO residents in AOA (DO) programs. DO residents in ACGME total.svg
Total number of DOs in residency programs, by year.
  DO residents in ACGME (MD) programs
  DO residents in AOA (DO) programs.

In 1969, the American Medical Association (AMA) approved a measure allowing qualified osteopathic physicians to be full and active members of the Association. The measure also allowed osteopathic physicians to participate in AMA-approved intern and residency programs. However, the American Osteopathic Association rejected this measure, claiming it was an attempt to eliminate the distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L. Wilbur sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of DO and MD professions. Today, a majority of osteopathic physicians are trained alongside MDs, in residency programs governed by the ACGME, an independent board of the AMA. [47]

1993, first African-American woman to serve as dean of a US medical school

In 1993, Barbara Ross-Lee, DO, was appointed to the position of dean of the Ohio University College of Osteopathic Medicine; she was the first African-American woman to serve as the dean of a US medical school. [48] Ross-Lee now is the dean of the NYIT College of Osteopathic Medicine at Arkansas State University in Jonesboro, Arkansas.

Non-discrimination policies

Recent years have seen a professional rapprochement between the two groups. DOs have been admitted to full active membership in the American Medical Association since 1969. The AMA has invited a representative of the American Osteopathic Association to sit as a voting member in the AMA legislative body, the house of delegates. [49]

2006, American Medical Student Association

In 2006, during the presidency of an osteopathic medical student, the American Medical Student Association (AMSA) adopted a policy regarding the membership rights of osteopathic medical students in their main policy document, the "Preamble, Purposes and Principles."

AMSA RECOGNIZES the equality of osteopathic and allopathic medical degrees within the organization and the healthcare community as a whole. As such, DO students shall be entitled to the same opportunities and membership rights as allopathic students.

PPP, AMSA [50]

2007, AMA

In recent years, the largest MD organization in the US, the American Medical Association, adopted a fee non-discrimination policy discouraging differential pricing based on attendance of an MD or DO medical school. [51]

In 2006, calls for an investigation into the existence of differential fees charged for visiting DO and MD medical students at American medical schools were brought to the American Medical Association. After an internal investigation into the fee structure for visiting DO and MD medical students at MD medical schools, it was found that one institution of the 102 surveyed charged different fees for DO and MD students. [52] The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007.

Our AMA, in collaboration with the American Osteopathic Association, discourages discrimination against medical students by institutions and programs based on osteopathic or allopathic training.

AMA policy H-295.876 [51]
Years in which states passed laws granting DOs medical practice rights equal to MDs
1901-1930 1931-1966 1967-1989 DO states practice rights.PNG
Years in which states passed laws granting DOs medical practice rights equal to MDs
     1901–1930     1931–1966     1967–1989

State licensing of practice rights

In the United States, laws regulating physician licenses are governed by the states. Between 1901 and 1989, osteopathic physicians lobbied state legislatures to pass laws giving those with a DO degree the same legal privilege to practice medicine as those with an MD degree. In many states, the debate was long and protracted. Both the AOA and the AMA were heavily involved in influencing the legislative process. The first state to pass such a law was California in 1901, the last was Nebraska in 1989. [42]

Current status

Osteopathic medical schools
& Plains
AT Still Kirksville
Des Moines COM
Kansas City COM
Michigan State
Midwestern Chicago COM
Ohio COM
Oklahoma State
University of North Texas
University of the Incarnate Word
Northeast Lake Erie COM
New England COM
Philadelphia COM
Rowan SOM
Touro Harlem
Touro Middletown
Southeast Alabama COM
Arkansas COM
Lake Erie COM Bradenton
Lincoln Memorial
Nova Southeastern
Philadelphia COM Georgia
Pikeville KYCOM
Edward Via COM
West Virginia SOM
William Carey COM
West Burrell COM
AT Still Arizona
CHSU California
Midwestern Arizona
Pacific Northwest
Rocky Vista
Touro California
Touro Nevada
Western – Oregon

Education and training

According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of (MD) physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification." [8]

DO-granting US medical schools have curricula similar to those of MD-granting schools. Generally, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine. [4] Some schools of Osteopathic Medicine have been criticized by the osteopathic community for relying too heavily on clinical rotations with private practitioners, who may not be able to provide sufficient instruction to the rotating student. [53] Other DO-granting and MD-granting schools place their students in hospital-based clinical rotations where the attending physicians are faculty of the school, and who have a clear duty to teach medical students while treating patients.

Graduate medical education

Sources of the 24,012 medical school graduates entering US physician training programs in 2004. NewDocsTraining.PNG
Sources of the 24,012 medical school graduates entering US physician training programs in 2004.

Upon graduation, most osteopathic medical physicians pursue residency training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating internship at a hospital approved by the American Osteopathic Association (AOA).

Osteopathic physicians may apply to residency programs accredited by either the AOA or the Accreditation Council for Graduate Medical Education (ACGME). Currently, osteopathic physicians participate in more ACGME programs than in programs approved by the American Osteopathic Association (AOA). [47] By June 30, 2020, all AOA residencies will also be required to have ACGME accreditation, and the AOA will cease accreditation activities. [55]

Osteopathic manipulative treatment (OMT)

Osteopathic manipulative treatment (OMT) involves palpation and manipulation of bones, muscles, joints, and fasciae. Manuellterapi5.jpg
Osteopathic manipulative treatment (OMT) involves palpation and manipulation of bones, muscles, joints, and fasciae.

Within the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. However, a 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey follows many indicators that osteopathic physicians have become more like MD physicians in every respect —few perform OMT, and most prescribe medications or suggest surgery as the first line of treatment. [56] The American Osteopathic Association has made an effort in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation as well as to encourage osteopathic physicians to consistently offer manipulative treatments to their patients. However, the number of osteopathic physicians who report consistently prescribing and performing manipulative treatment has been falling steadily. Medical historian and sociologist Norman Gevitz [33] cites poor educational quarters and few full-time OMT instructors as major factors for the decreasing interest of medical students in OMT. He describes problems with "the quality, breadth, nature, and orientation of OMM instruction," and he claims that the teaching of osteopathic medicine has not changed sufficiently over the years to meet the intellectual and practical needs of students. [57]

In their assigned readings, students learn what certain prominent DOs have to say about various somatic dysfunctions. There is often a theory or model presented that provides conjectures and putative explanations about why somatic dysfunction exists and what its significance is. Instructors spend the bulk of their time demonstrating osteopathic manipulative (OM) techniques without providing evidence that the techniques are significant and efficacious. Even worse, faculty members rarely provide instrument-based objective evidence that somatic dysfunction is present in the first place. [31]

At the same time, recent studies show an increasingly positive attitude of patients and physicians (MD and DO) towards the use of manual therapy as a valid, safe and effective treatment modality. [58] One survey, published in the Journal of Continuing Medical Education , found that a majority of physicians (81%) and patients (76%) felt that manual manipulation (MM) was safe, and over half (56% of physicians and 59% of patients) felt that manipulation should be available in the primary care setting. Although less than half (40%) of the physicians reported any educational exposure to MM and less than one-quarter (20%) have administered MM in their practice, most (71%) respondents endorsed desiring more instruction in MM. [59] Another small study examined the interest and ability of MD residents in learning osteopathic principles and skills, including OMT. It showed that after a 1-month elective rotation, the MD residents responded favorably to the experience. [60]

Professional attitudes

In 1998, a New York Times article described the increasing numbers, public awareness, and mainstreaming of osteopathic medical physicians, illustrating an increasingly cooperative climate between the DO and MD professions. [33]

In 2005, during his tenure as president of the American Association of Medical Colleges, Jordan Cohen described a climate of cooperation between DO and MD practitioners:

"We now find ourselves living at a time when osteopathic and allopathic graduates are both sought after by many of the same residency programs; are in most instances both licensed by the same licensing boards; are both privileged by many of the same hospitals; and are found in appreciable numbers on the faculties of each other's medical schools". [17] [ dead link ] [61]

Elsewhere, he has remarked that osteopathic manipulative medicine (OMT) "can be an aid to the physician in fostering a relationship with the patient." [33]

International practice rights

International practice rights of US trained DOs DOworld.PNG
International practice rights of US trained DOs

Each country has different requirements and procedures for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the US Department of Education recognizes as physicians are graduates of osteopathic medical colleges in the United States. [62] Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. On the other hand, US-trained DOs are currently able to practice in 45 countries with full medical rights and in several others with restricted rights.

The Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) is an independent board of the American Osteopathic Association. The BIOMEA monitors the licensing and registration practices of physicians in countries outside of the United States and advances the recognition of American-trained DOs. Towards this end, the BIOMEA works with international health organizations like the World Health Organization (WHO), the Pan American Health Organization (PAHO) as well as other groups. [63]

The procedure by which countries consider granting physician licensure to foreigners varies widely. For US-trained physicians, the ability to qualify for "unlimited practice rights" also varies according to one's degree, MD or DO. [64] Many countries recognize US-trained MDs as applicants for licensure, granting successful applicants "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained DOs similarly to their MD counterparts, with some success.

Osteopathic Medicine & Osteopathy
Osteopathy in Australia & New Zealand
Osteopathic medicine in Canada
Osteopathy in Europe  · Osteopathy in the UK
Osteopathic medicine in the United States

In over 65 countries, US-trained DOs have unlimited practice rights. [65] In 2005, after one year of deliberations, the General Medical Council announced that US-trained DOs will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an osteopathic physician and an osteopath." [65] The American Medical Student Association strongly advocates for US-trained DO international practice rights "equal to that" of MD-qualified physicians. [50]

Osteopathic medicine and primary care

Trends in primary care as a career choice of osteopathic medical students 4th year students 1st year students OsteoPrimaryCare.PNG
Trends in primary care as a career choice of osteopathic medical students      4th year students     1st year students

Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts. Some osteopathic organizations make claims to a greater emphasis on the importance of primary care within osteopathic medicine. However, the proportion of osteopathic students choosing primary care fields, like that of their MD peers, is declining. [67] Currently, only one in five osteopathic medical students enters a family medicine residency (the largest primary care field). [68] In 2004, only 32% of osteopathic seniors planned careers in any primary care field; this percentage was down from a peak in 1996 of more than 50%. [66]

Criticism and internal debate

First-year enrollment at osteopathic medical schools, 1968-2011 1styear osteopathic enrollment.PNG
First-year enrollment at osteopathic medical schools, 1968–2011


Traditional osteopathic medicine, specifically OMT, has been criticized for many techniques such as cranial and cranio-sacral manipulation. A study performed in the early 2000s questioned the therapeutic utility of osteopathic manipulative treatment modalities. [69] Also, New York University health information website claims that "it is difficult to properly ascertain the effectiveness of a hands-on therapy like OMT." [70]

Research emphasis

Another area of criticism has been the relative lack of research and lesser emphasis on scientific inquiry at DO schools in comparison with MD schools. [71] [72] [73]

The inability to institutionalize research, particularly clinical research, at osteopathic institutions has, over the years, weakened the acculturation, socialization, and distinctive beliefs and practices of osteopathic students and graduates. [71]

Identity crisis

There is currently a debate within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within US health care. [1] [31] [74] [75] [76] [77] [78] [79] [80] JD Howell, author of The Paradox of Osteopathy, [41] notes claims of a "fundamental yet ineffable difference" between MD and DO qualified physicians are based on practices such as "preventive medicine and seeing patients in a sociological context" that are "widely encountered not only in osteopathic medicine but also in allopathic medicine." [81] Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a DO from an MD [82] [83] Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus:

If osteopathy has become the functional equivalent of allopathy [meaning the MD profession], what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic, why should its use be limited to osteopaths? [41]

Rapid expansion

As the number of osteopathic schools has increased, the debate over distinctiveness has often seen the leadership of the American Osteopathic Association at odds with the community of osteopathic physicians.

within the osteopathic community, the growth is drawing attention to the identity crisis faced by [the profession]. While osteopathic leaders emphasize osteopaths' unique identity, many osteopaths would rather not draw attention to their uniqueness. [49]

The rapid expansion has raised concerns about the number of available faculty at osteopathic schools and the role that those faculty play in maintaining the integrity of the academic program of the schools. Norman Gevitz, author of the leading text on the history of osteopathic medicine, recently published,

DO schools are currently expanding their class sizes much more quickly than are their MD counterparts. Unlike MD colleges, where it is widely known that academic faculty members—fearing dilution of quality as well as the prospect of an increased teaching workload—constitute a powerful inhibiting force to expand the class size, osteopathic faculty at private osteopathic schools have traditionally had little or no input on such matters. Instead, these decisions are almost exclusively the responsibility of college administrators and their boards of trustees, who look at such expansion from an entrepreneurial as well as an educational perspective. Osteopathic medical schools can keep the cost of student body expansion relatively low compared with that of MD institutions. Although the standards of the Commission on Osteopathic College Accreditation ensure that there will be enough desks and lab spaces to accommodate all new students, they do not mandate that an osteopathic college must bear the expense of maintaining a high full-time-faculty:student ratio. [5]

The president of the American Association of Colleges of Osteopathic Medicine commented on the current climate of crisis within the profession.

The simultaneous movement away from osteopathic medicine’s traditionally separate training and practice systems, when coupled with its rapid growth, has created a sense of crisis as to its future. The rapid rate of growth has raised questions as to the availability of clinical and basic science faculty and clinical resources to accommodate the increasing load of students. [4]

See also

Related Research Articles

<i>Flexner Report</i>

The Flexner Report is a book-length study of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath.

American Osteopathic Association organization

The American Osteopathic Association (AOA) is the representative member organization for the more than 145,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinois, and is involved in post-graduate training for osteopathic physicians. Beginning in 2015, it began accrediting post-graduate education as a committee within ACGME, creating a unified accreditation system for all DOs and MDs in the United States. The organization promotes public health, encourages academic scientific research, serves as the primary certifying body for D.O.s overseeing 18 certifying boards, and is the accrediting agency for osteopathic medical schools through its Commission on Osteopathic College Accreditation. As of October 2015, the AOA no longer owns the Healthcare Facilities Accreditation Program (HFAP), which accredited hospitals and other health care facilities.

Philadelphia College of Osteopathic Medicine

The Philadelphia College of Osteopathic Medicine (PCOM) is a private medical school college with its main campus in Philadelphia, Pennsylvania, and an additional campus in Suwanee, Georgia. PCOM offers degree programs in osteopathic medicine, pharmacy, physical therapy, psychology, physician assistant studies, and forensic medicine. With 2,418 students (2014–15), PCOM is one of the oldest and largest osteopathic medical schools in the world.

Western University of Health Sciences

Western University of Health Sciences (WesternU) is a private, non-profit graduate school for the health professions, with a main campus located on 22 acres (8.9 ha) in downtown Pomona, California, and an additional medical school campus on 50 acres in Lebanon, Oregon. WesternU offers degrees in osteopathic medicine, dental medicine, optometry, podiatric medicine, nursing, physician assistant studies, physical therapy, pharmacy, biomedical sciences, and veterinary medicine. With an enrollment of 3,833 students (2018–19),WesternU is one of the largest graduate schools for the health professions in California, offering 21 academic programs in nine colleges, and has the broadest array of graduate health sciences colleges in the United States.

History of chiropractic History of chiropractic

The history of chiropractic began in 1895 when Daniel David Palmer of Iowa performed the first chiropractic adjustment on a partially deaf janitor, Harvey Lillard. While Lillard was working without his shirt on in Palmers office, Lillard bent over to empty the trash can. Palmer noticed that Lillard had a vertebra out of position. He asked Lillard what happened, and Lillard replied, "I moved the wrong way, and I heard a 'pop' in my back, and that's when I lost my hearing." Palmer, who was also involved in many other natural healing philosophies, had Lillard lie face down on the floor and proceeded with the adjustment. The next day, Lillard told Palmer, "I can hear that rackets on the streets." This experience led Palmer to open a school of chiropractic two years later. Rev. Samel Weed coined the word "chiropractic" from Greek roots. Chiropractic's early philosophy was rooted in vitalism, naturalism, magnetism, spiritualism and other constructs that are not amenable to the scientific method, although Palmer tried to merge science and metaphysics. In 1896, Palmer's first descriptions and underlying philosophy of chiropractic echoed Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improved health. Palmer distinguished his work by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. He described the effects of chiropractic spinal manipulation as being mediated primarily by the nervous system.

Kansas City University of Medicine and Biosciences (KCU) is a private, non-profit, graduate school for the health professions, with a main campus located on 23 acres in Kansas City, in the U.S. state of Missouri. Founded in 1916, KCU consists of both a medical school and a College of Biosciences.

Osteopathic Physicians & Surgeons v. California Medical Association, 224 Cal. App. 2d 378 was a legal case between two medical associations in the state of California. The case was under review in California state courts from 1962-1964. After numerous appeals, the California Supreme Court ruling found the California Medical Association's refusal to grant osteopathic physicians licensure to practice medicine in the state of California to be unconstitutional.

American Academy of Osteopathy organization

The American Academy of Osteopathy (AAO) is a non-profit organization for osteopathic medical education. Members include osteopathic physicians and medical students, supporters and affiliates, sponsors, and international members.

W. Kenneth Riland, D.O. (1912–1989) was born 7 August 1912, in Camden, New Jersey. An osteopathic physician (D.O.) whose patients included Richard M. Nixon and Nelson A. Rockefeller, he was the cofounder of the New York College of Osteopathic Medicine, in Old Westbury, Long Island, New York.

Rocky Vista University College of Osteopathic Medicine

Rocky Vista University College of Osteopathic Medicine (RVUCOM) is a private, for-profit osteopathic medical school with campus locations in Parker, Colorado and Ivins, Utah. The school opened in 2006 as the only modern for-profit medical school in the United States but has since been joined by California Northstate University College of Medicine. RVUCOM grants the degree of Doctor of Osteopathic Medicine, and admitted its inaugural class of medical students at the Parker, Colorado campus in August 2008.

Osteopathic medicine is a branch of the medical profession practiced primarily in the United States, but has also spread to 65 other countries, with universities throughout Europe and Asia, and including Australia, New Zealand and Canada. The Doctor of Osteopathic Medicine (D.O.) degree in the United States is equivalent to the Doctor of Medicine (M.D.) degree and allows medical doctors to practice medicine and surgery in all 50 states. Outside the U.S., a degree in osteopathy is more similar to physical therapy, and exists as an allied health profession.

Osteopathic medicine in Canada is similar to conventional medicine in Canada, with the addition of osteopathic manipulation to diagnose and treat patients. Osteopathic physicians hold equal practice rights to non-osteopathic physicians (MDs) in Canada. North American osteopathic medicine requires an osteopathic physician to be trained and receive the Doctor of Osteopathic Medicine degree granted by a College of Osteopathic Medicine accredited by the American Osteopathic Association.

The Excellence in Medicine Awards are accolades presented annually by the American Medical Association Foundation to recognize excellence of a select group of physicians and medical students who exemplify the medical profession’s highest values: commitment to service, community involvement, altruism, leadership and dedication to patient care. The AMA Foundation Excellence in Medicine Awards are considered the "Oscars" within the medical community.

College of Osteopathic Medicine of the Pacific

The College of Osteopathic Medicine of the Pacific (COMP) is a private, non-profit medical school for osteopathic medicine located in downtown Pomona, in the U.S. state of California. The college opened in 1977 as the only osteopathic medical school west of the Rocky Mountains. COMP was the founding program of Western University of Health Sciences (WesternU), which now has 8 colleges in addition to COMP, each offering professional degrees in various fields of healthcare. COMP has a single 4-year program, conferring the Doctor of Osteopathic Medicine (D.O.) degree. Graduates are eligible to practice medicine in all 50 states and more than 60 countries.

The Osteopathic Oath is an oath commonly administered to osteopathic physicians who practice osteopathic medicine in the United States. Similar to the Hippocratic Oath, it is a statement of professional values and ethics. The first version of the oath was created in 1938, and the current version of the oath has been in use since 1954. Although taking the oath is not required or legally binding, it is commonly seen as a rite of passage.


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Further reading