Osteopathic medicine in the United States

This is the main article for the category Osteopathic medicine.

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Rod of Asclepius: Symbol of Osteopathic Medicine.

Doctor of Osteopathic Medicine (D.O. or DO) is an academic degree offered in the United States. It is a graduate-level first professional degree for physicians and surgeons, usually requiring four years to complete. Holders of the D.O. degree are known as osteopathic physicians, while holders of the similar, but more common M.D. degree are known as allopathic physicians.

According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification. In addition to traditionally allopathic forms of diagnosis and treatment such as diagnostic radiology, surgery, and pharmacology, Doctors of Osteopathic Medicine receive education and training in Osteopathic Manipulative Medicine (OMM), a form of manual therapy shown to be of some benefit for patients with certain musculo-skeletal disorders.

Currently, there are 27 accredited osteopathic medical schools in the United States and 125 accredited U.S. allopathic medical schools. D.O.'s may be found within any medical specialty but a majority of them work within primary care medical fields: internal medicine, pediatrics, obstetrics, and family practice.

Although U. S. osteopathic medical physicians currently may obtain licensure in 47 countries, osteopathic curricula in countries other than the United States differs. D.O.s outside the U. S. are known as "osteopaths" and their scope of practice excludes allopathic medical therapies and relies more exclusively on osteopathic manipulative medicine and other alternative medical modalities.

See below: International Practice Rights

Osteopathic principles

In addition to the Hippocratic oath, Osteopathic medical students take an 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, and the person represents a combination 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 body unity, self-regulation, and the interrelationship of structure and function.

There are different opinions on the significance of these principles. Some note that the osteopathic philosophy is akin to the tenets of holistic medicine. Others argue that the American Osteopathic Association's emphasis of the core principles amounts to a form of professional propaganda or indoctrination, glorifying osteopathic principles while misrepresenting those of the allopathic community. Still others point out that there is nothing in the principles that would distinguish osteopathic from allopathic training in any fundamental way. One study, published in the Journal of the American Osteopathic Association found a majority of allopathic medical school administrators and faculty saw nothing objectionable in the core principles, and some would even endorse them generally as sound medical principles.

Training of Doctors of Osteopathic Medicine

Main article: Medical education in the United States

DO-granting U.S. 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.

Upon graduation, osteopathic medical physicians may opt to 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).

Further information: [[:Comparison of allopathic and osteopathic medicine]]

History

Osteopathy was founded by Andrew Taylor Still, M.D. (1828 - 1917) in 1874 in reaction to what he perceived as inadequate medical treatment of his day. Specifically, he believed that medications tended to be over prescribed and that such medications were often toxic in nature.

He intended his new system of medicine to be a reformation of the existing 19th century medical practices he knew and 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.

Early in the twentieth century, the American osteopathic profession adopted the use of medicine and surgery. As biomedical science developed, osteopathic medicine gradually incorporated all its proven theories and practices. D.O.'s have been admitted to full active membership in the American Medical Association since 1969.

In the 1960s in California, the American Medical Association (AMA), sensing increased competition from osteopathic medicine, spent nearly $ 8 million to end the practice of osteopathic medicine in the state. With considerable financial support from the AMA, a state-wide referendum was passed (Proposition 22) ending the practice of osteopathic medicine in California. California D.O.s were offered the M.D. degree in exchange for paying $65 and attending a short seminar. The California Medical Association may have been attempting to eliminate osteopathic competition by a process of amalgamation by converting thousands of D.O.s to M.D.s. The College of Osteopathic Physicians and Surgeons became the University of California, Irvine School of Medicine. However, the decision proved to be controversial. In 1974, after protest and lobbying by influential and prominent D.O.s, the California Supreme Court ruled that licensing of D.O.s in that state must be resumed.

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College of Osteopathic Physicians and Surgeons in Los Angeles, c.1920s. From California College of Medicine Records, AS-027 The osteopathic college was eventually absorbed into the University of California system following a state-wide ballot referendum and became the UC Irvine Medical Center.

This decision by the California Medical Association in the 1960s to grant D.O. physicians an M.D. license was one of two turning points for D.O.s in their early struggle for parity; the other being the U.S. Army's decision to allow D.O.s to enter the military as physicians. These two turning points provided the osteopathic community with the stamp of equivalency they desired.

Today, except for a stronger primary care emphasis in most osteopathic medical schools and additional education in musculoskeletal diagnosis and treatment, the training and scope of osteopathic medicine practiced by D.O.'s in the United States is identical to that of allopathic medicine as practiced by M.D.'s.

Further information: [[:History of the relationship of osteopathic and allopathic medicine in the United States]]

Demographics

• In 1960, there were 13,708 D.O.s and five osteopathic medical schools.
• In 2002, there were 49,210 D.O.s and 19 schools.
• The number of D.O.s in the United States has increased 67 percent between 1990 and 2006.
• In 2007, there are 26 schools. One in five medical students in the United States is enrolled in an osteopathic medical school.
• By 2020, the number of D.O.s will grow to 95,400, say expert predictions, according to the American Medical Association.

Current status and scope of practice

While there are approximately 55,000 D.O.s practicing within the United States, this number represents only 6% of all practicing physicians. D.O.'s may obtain licensure in any of the fifty states and practice in all medical specialties including, but not limited to, family medicine, internal medicine, emergency medicine, dermatology, surgery, and radiology. The D.O. degree is the legal and professional equivalent of the M.D. degree and as such there is no difference in compensation between allopathic and osteopathic physicians.

Status of OMM within Osteopathic medicine

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 allopathic physicians in every respect—few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment. The American Osteopathic Association has made an effort in recent years to both support and promote scientific inquiry into the effectiveness of osteopathic manipulation as well as encourage D.O.s to consistently offer manipulative treatments to their patients. However, the number of D.O.s who report consistently prescribing and performing manipulative treatment has been falling steadily. Norman Gevitz, author of numerous articles and book on Osteopathic medicine cites poor educational quarters and few full-time OMM instructors as major factors for the decreasing interest of medical students in OMM. He describes problems with "the quality, breadth, nature, and orientation of OMM instruction." And claims that the teaching of osteopathic medicine has not changed sufficiently over the years to meet the intellectual and practical needs of students.

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.

— Norman Gevitz, J Am Osteopath Assoc

International Practice Rights

Many countries recognize US-trained M.D.s as applicants for licensure, granting successful applicants them "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained D.O.s similarly to their allopathic counterparts, with some success. In 44 countries, US-trained DOs have unlimited practice rights. In 2005, after one year of deliberations, the General Medical Council of Great Britain announced that US-trained DOs will be accepted for full medical practice rights in the United Kingdom. Josh Kerr of the AOA said that "Some countries don’t understand the differences in training between an osteopathic physician and an osteopath." The American Medical Student Association strongly advocates for U.S.-trained D.O. international practice rights "equal to that of Allopathic physicians." The following table lists the practice rights of U.S. D.O.s in selected countries.

Further information: [[:International practice rights of U.S.-trained D.O.s]]

See also Licensure of allopathic and osteopathic physicians in the United States

Criticism

Osteopathic medicine has been criticized for using unproven techniques such as cranial and cranio-sacral manipulation along with traditional medical treatment options. This expanded scope of practice has led to some question as to the therapeutic utility of osteopathic manipulative treatment modalities. Though, there are some ailments for which the benefit of manipulative therapy has "firmly established" scientific support. A New York University health information website claims that "it is difficult to properly ascertain the effectiveness of a hands-on therapy like OM."

Further reading

• The DOs: Osteopathic Medicine in America, Norman Gevitz, 2004 (2nd Edition), paperback, 264 pages, The Johns Hopkins University Press, ISBN 0-8018-7834-9 (An excellent review of the history and development of ostepathic medicine and medical education in the United States)
• Science in the Art of Osteopathy: Osteopathic Principles and Models, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0-7487-3328-0
• An Osteopathic Approach to Diagnosis and Treatment , Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5

External links

US Osteopathic associations and regulatory bodies

• American Academy of Osteopathy
• American Osteopathic Association (Website)
• American Association of Colleges of Osteopathic Medicine (Website)

Journals

• Chiropractic & Osteopathy An online journal published by BioMed Central
• International Journal of Osteopathic Medicine
• Journal of the American Osteopathic Association The official journal of the American Osteopathic Association
• Osteopathic Medicine and Primary Care An online journal published by BioMed Central

Other links

• The History of Osteopathic Medicine - (American Osteopathic Association)