View source for Osteopathic medicine in the United States

{{Short description|Branch of the medical profession}}
{{For|the restricted-scope form of alternative medicine practice, mostly outside of North America|Osteopathy}}
{{Further|Comparison of MD and DO in the United States}}
{{cs1 config|name-list-style=vanc}}
{{Use American English|date=July 2022}}
{{Osteopathic Medicine}}
'''Osteopathic medicine''' is a branch of the [[medicine|medical]] profession in the [[United States]] that promotes the practice of science-based medicine, often referred to in this context as [[allopathic medicine]], with a set of philosophy and principles set by its earlier form, [[osteopathy]].
Osteopathic physicians ([[Doctors of Osteopathic Medicine|DOs]]) are graduates of [[List of osteopathic colleges|American osteopathic medical colleges]] and are licensed to practice the full scope of [[medicine]] and [[surgery]] in all 50 U.S. states. The field is distinct from osteopathic practices offered in nations outside of the U.S.{{em dash}}in which practitioners are generally considered neither parts of core medical staff nor of medicine itself; rather, they are considered [[alternative medicine]] practitioners. The other major branch of medicine in the United States is referred to by practitioners of osteopathic medicine as allopathic medicine.<ref name =indistinguisable>{{Cite web|url=https://www.ama-assn.org/press-center/ama-statements/aoa-and-ama-stand-against-misrepresentation-osteopathic-physicians#:~:text=The%20American%20Osteopathic%20Association%20%28AOA%29%20and%20the%20American,of%20osteopathic%20medicine%20by%20media%2C%20celebrities%20and%20companies.|title=Joint statement from the American Osteopathic Association and American Medical Association: AOA and AMA stand against misrepresentation of osteopathic physicians|website=American Medical Association|date=4 November 2020|access-date=28 May 2021|archive-date=10 May 2021|archive-url=https://web.archive.org/web/20210510195023/https://www.ama-assn.org/press-center/ama-statements/aoa-and-ama-stand-against-misrepresentation-osteopathic-physicians#:~:text=The%20American%20Osteopathic%20Association%20%28AOA%29%20and%20the%20American,of%20osteopathic%20medicine%20by%20media%2C%20celebrities%20and%20companies.|url-status=live}}</ref>

By the middle of the 20th century, the profession had moved closer to mainstream medicine. American "osteopaths" became "osteopathic medical doctors", ultimately achieving full practice rights as medical doctors in all 50 states.<ref name=Reform>{{cite journal | vauthors = Meyer CT, Price A | title = Osteopathic medicine: a call for reform | journal = The Journal of the American Osteopathic Association | volume = 93 | issue = 4 | pages = 473–485 | date = April 1993 | pmid = 8267703 | doi = 10.7556/jaoa.1993.93.4.473 | doi-access = free }}</ref><ref name="guide">{{cite web |url=http://www.aacom.org/resources/bookstore/Documents/Brief-Guide-to-OME_Final.pdf |title=A Brief Guide to Osteopathic Medicine For Students, By Students |vauthors=Wu P, Siu J |date=2012 |publisher=American Association of Colleges of Osteopathic Medicine |access-date=20 August 2013 |archive-date=15 April 2013 |archive-url=https://web.archive.org/web/20130415234748/http://www.aacom.org/resources/bookstore/Documents/Brief-Guide-to-OME_Final.pdf |url-status=live }}</ref>

In modern medicine in the U.S., any [[Comparison of MD and DO in the United States|distinction between the MD and the DO professions]] has eroded steadily. The training of osteopathic physicians in the United States is now virtually indistinguishable from the training of allopathic physicians (MDs).<ref name="Harrisons">{{cite book | vauthors = Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ | chapter-url = http://accessmedicine.com/content.aspx?aID=9106846 | chapter = Chapter 10. Complementary and Alternative Medicine | archive-url = https://web.archive.org/web/20131224095507/http://accessmedicine.com/content.aspx?aID=9106846 | archive-date=2013-12-24 | title = Harrison's Principles of Internal Medicine | edition = 18th | isbn = 978-0-07-174889-6 | publisher = McGraw-Hill | location = New York | date = 2012 }}</ref> Osteopathic physicians attend four years of [[Medical school in the United States|medical school]] like their MD counterparts, acquiring equivalent education in medicine and surgery; DOs also attend the same [[graduate medical education]] programs ([[Accreditation Council for Graduate Medical Education|ACGME]]-accredited residencies and/or fellowships) as their MD counterparts to acquire their [[Medical license|licenses]] as physicians. DOs use all conventional methods of diagnosis and treatment and practice across all [[American Board of Medical Specialties|specialties]] of medicine and surgery. Although osteopathic physicians are still trained in [[Osteopathic medicine in the United States#osteopathic manipulative treatment|osteopathic manipulative treatment]] (OMT),<ref>{{cite journal | vauthors = Lesho EP | title = An overview of osteopathic medicine | journal = Archives of Family Medicine | volume = 8 | issue = 6 | pages = 477–484 | date = Nov 1999 | pmid = 10575385 | doi = 10.1001/archfami.8.6.477 }}
{{dead link|date=September 2017 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> the modern derivative of [[Andrew Taylor Still]]'s techniques,<ref>{{cite web | url = http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358839.html?d=dmtContent | title = Osteopathic Medicine | archive-url = https://web.archive.org/web/20070415182141/http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/34968/358839.html?d=dmtContent | archive-date=2007-04-15 | work = Intelihealth.com. | access-date = 1 December 2007 }}</ref><ref>{{cite book|title=An Osteopathic Approach to Diagnosis and Treatment| vauthors = DiGiovanna EL, Schiowitz S, Dowling DJ |edition=3rd |publisher=Lippincott Williams & Wilkins|date=2004|url=https://books.google.com/books?id=tot78_5FxZwC|isbn=978-0-7817-4293-1}}</ref> during medical school, the majority of practicing physicians with a DO degree do not practice OMT in their daily work.<ref>{{cite journal | vauthors = Healy CJ, Brockway MD, Wilde BB | title = Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States | journal = Journal of Osteopathic Medicine | volume = 121 | issue = 1 | pages = 57–61 | date = January 2021 | pmid = 33512391 | doi = 10.1515/jom-2020-0013 | doi-access = free }}</ref> There are ongoing debates about the utility of maintaining separate, distinct pathways for educating physicians in the United States.<ref name="pmid19474536">{{cite journal | vauthors = Cohen JJ | title = The separate osteopathic medical education pathway: isn't it time we got our acts together? Counterpoint | journal = Academic Medicine | volume = 84 | issue = 6 | pages = 696 | date = June 2009 | pmid = 19474536 | doi = 10.1097/ACM.0b013e3181a3ddaa | doi-access = free }}</ref><ref name="pmid19474535">{{cite journal | vauthors = Chen C, Mullan F | title = The separate osteopathic medical education pathway: uniquely addressing national needs. Point | journal = Academic Medicine | volume = 84 | issue = 6 | pages = 695 | date = June 2009 | pmid = 19474535 | doi = 10.1097/ACM.0b013e3181a3dd28 | doi-access = free }}</ref>

==Nomenclature==
Physicians and surgeons who graduate from osteopathic medical schools are known as osteopathic physicians or osteopathic medical doctors.<ref name="guide" /> Upon graduation, they are conferred a [[Doctor of Osteopathic Medicine]] (DO) [[Medical degree|medical degree]].<ref name="Visible">{{cite journal | vauthors = Gevitz N | title = 'Visible and recognized': osteopathic invisibility syndrome and the two percent solution | journal = The Journal of the American Osteopathic Association | volume = 97 | issue = 3 | pages = 168–170 | date = March 1997 | pmid = 9107129 | doi = 10.7556/jaoa.1997.97.3.168 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Clark RC | title = Increased awareness of osteopathic medicine is essential to the profession's survival | journal = The Journal of the American Osteopathic Association | volume = 100 | issue = 1 | pages = 6–8 | date = January 2000 | pmid = 10693310 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=10693310 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite book | vauthors = Oths KS, Hinojosa SZ |title=Healing by Hand: Manual Medicine and Bonesetting in Global Perspective|chapter-url=https://books.google.com/books?id=hMsKph2uQnsC&q=%E2%80%9Costeopathic+invisibility&pg=PA68|date=2004|publisher=Rowman Altamira|isbn=978-0-7591-0393-1 |chapter=Divergences in the evolution of Osteopathy|pages=67–68}}</ref>

Osteopathic curricula in countries other than the United States 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 medicine|alternative medical modalities]].<ref name="aacom diff">{{cite web |url=http://www.aacom.org/become-a-doctor/about-om/US-vs-abroad |title=The Difference Between U.S.-Trained Osteopathic Physicians and Osteopaths Trained Abroad |publisher=AACOM |access-date=21 August 2016 |url-status=dead |archive-url=https://web.archive.org/web/20160828001709/http://www.aacom.org/become-a-doctor/about-om/US-vs-abroad |archive-date= Aug 28, 2016 }}</ref> While it was once common for DO graduates in the United States to refer to themselves as "osteopaths", this term is now considered archaic. Those holding the DO degree are commonly referred to as "osteopathic physicians", and they learn, train in, and practice the full scope of mainstream evidence-based medicine and surgery.<ref>{{cite web|url=http://www.osteopathic.org/inside-aoa/news-and-publications/media-center/Pages/osteopathic-style-guide.aspx|title=Terminology for Reporting on Osteopathic Medicine |archive-url=https://web.archive.org/web/20130514135333/http://www.osteopathic.org/inside-aoa/news-and-publications/media-center/Pages/osteopathic-style-guide.aspx |archive-date=2013-05-14|work=American Osteopathic Association |access-date=17 May 2012}}</ref>

==Demographics==
[[Image:EnteringPhysiciansByEducation2005.PNG|thumb|left|Physicians entering US workforce by education, 2005<ref name="Cohen">{{cite web | vauthors = Cohen J | url = http://www.aamc.org/newsroom/reporter/april05/word.htm | title = A Word from the President: "Filling the Workforce Gap" | publisher = [[Association of American Medical Colleges|AAMC]] | work = Reporter | date = April 2005 |url-status=dead |archive-url=https://web.archive.org/web/20081026015836/http://www.aamc.org:80/newsroom/reporter/april05/word.htm |archive-date= Oct 26, 2008 }}</ref>]]
{{as of|2023|post=,}} 40 medical schools were offering DO degrees in 64 locations<ref>{{cite web |title=U.S. Colleges of Osteopathic Medicine |url=https://www.aacom.org/become-a-doctor/prepare-for-medical-school/us-colleges-of-osteopathic-medicine |publisher=American Association of Colleges of Osteopathic Medicine |url-status=live |archive-url=https://web.archive.org/web/20230810231605/https://www.aacom.org/become-a-doctor/prepare-for-medical-school/us-colleges-of-osteopathic-medicine |archive-date= Aug 10, 2023 }}</ref> across the United States, while there were 155 accredited [[Doctor of Medicine|MD]] medical schools (2021–2022).<ref>{{cite journal |last1=Barzansky |first1=Barbara |last2=Etzel |first2=Sylvia I. |title=MD-Granting Medical Schools in the US, 2021–2022 |journal=JAMA |date=20 September 2022 |volume=328 |issue=11 |pages=1112–1122 |doi=10.1001/jama.2022.14384|pmid=36125488 |doi-access=free }}</ref>
* In 1960, 13,708 physicians were graduates of the 5 osteopathic medical schools.<ref>{{Cite journal |url=https://stacks.cdc.gov/view/cdc/74047/cdc_74047_DS1.pdf |pmid=14198580|author=Maryland Y. Pennell|title=Statistics on Physicians, 1950-63 |journal=Public Health Reports |date=October 1964|volume=79 |issue=10 |pages=905–910 |doi=10.2307/4592275 |jstor=4592275 |pmc=1915580 |access-date=2024-03-14 |archive-date=2023-02-26 |archive-url=https://web.archive.org/web/20230226114257/https://stacks.cdc.gov/view/cdc/74047/cdc_74047_DS1.pdf |url-status=live }}</ref>
* {{citation needed span|In 2002, there were 49,210 physicians from 19 osteopathic medical schools.|date=August 2023}}
* Between 1980 and 2005, the number of osteopathic graduates per year increased by over 150 percent, from about 1,000 to 2,800. This number was expected to approach 5,000 by 2015.<ref>{{cite journal | vauthors = Salsberg E, Grover A | title = Physician workforce shortages: implications and issues for academic health centers and policymakers | journal = Academic Medicine | volume = 81 | issue = 9 | pages = 782–787 | date = September 2006 | pmid = 16936479 | doi = 10.1097/00001888-200609000-00003 | doi-access = free }}</ref>
* In 2016, there were 33 colleges of osteopathic medicine in 48 locations, in 31<ref>AOA Annual Statistics, 2016</ref> states.<ref>{{cite web | title = AOA Annual Statistics 2016 | url = http://www.aacom.org/become-a-doctor/us-coms | work = U.S. Colleges of Osteopathic Medicine | publisher = American Association of Colleges of Osteopathic Medicine | date = January 2016 | access-date = 2016-01-27 | archive-date = 2016-01-25 | archive-url = https://web.archive.org/web/20160125123325/http://www.aacom.org/become-a-doctor/us-coms | url-status = live }}</ref> One in four medical students in the United States in 2016 was enrolled in an osteopathic medical school.<ref name="OMP2016">{{cite web|url=http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf|title=Osteopathic Medical Profession Report|access-date=28 May 2021|archive-url=https://web.archive.org/web/20170629180616/http://osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf|archive-date=29 June 2017}}</ref>
* {{as of|2018|post=,}} there were more than 145,000 osteopathic physicians and osteopathic medical students in the United States.<ref name=OMP2016/>

[[Image:Osteopathic distribution US2.PNG|thumb|right|Geographic distribution of osteopathic physicians as a percentage of all physicians, by the state. Locations of osteopathic medical schools are in red.<ref name=COMs>{{cite web |url=http://www.aacom.org/about/colleges/Pages/default.aspx |title=U.S. Colleges of Osteopathic Medicine |publisher=Aacom.org |access-date=9 May 2021 |archive-date=26 October 2014 |archive-url=https://web.archive.org/web/20141026184622/http://www.aacom.org/about/colleges/Pages/default.aspx |url-status=dead }}</ref><ref name="AACOM report">{{cite web | url = http://www.aacom.org/resources/bookstore/2006statrpt/Pages/default.aspx | title = 2006 Annual Statistical Report on Osteopathic Medical Education | publisher = American Association of Colleges of Osteopathic Medicine | date = February 2007 | access-date = 2008-03-07 | archive-date = 2008-02-27 | archive-url = https://web.archive.org/web/20080227151207/http://www.aacom.org/resources/bookstore/2006statrpt/Pages/default.aspx | url-status = dead }}</ref>

{{legend0|#E1F5FF|<3%}}
{{legend0|#CEEFFF|3–5%}}
{{legend0|#8AD9FF|5–10%}}
{{legend0|#008BCE|10–15%}}
{{legend0|#0070A6|15–25%}}]]
Osteopathic physicians are not evenly distributed in the United States. States with the highest concentration of osteopathic physicians are [[Oklahoma]], [[Iowa]], and [[Michigan]], where osteopathic physicians comprised 17–20% of the physician workforce in 2011.{{update after|2023|8|22}}<ref name=StateData>{{cite web|title=2011 State Physician Workforce Data Book|url=https://www.aamc.org/download/263512/data/statedata2011.pdf|page=23|publisher=Association of American Medical Colleges|access-date=9 May 2021|archive-date=30 July 2018|archive-url=https://web.archive.org/web/20180730124420/https://www.aamc.org/download/263512/data/statedata2011.pdf|url-status=live}}</ref> The state with the greatest number of osteopathic physicians is [[Pennsylvania]], with 8,536 DOs in active practice in 2018.<ref name="OMP2016"/> The states with the lowest [[concentration]]s of DOs are [[Washington, D.C.]], [[North Dakota]], and [[Vermont]], where only 1–3% of physicians have an osteopathic medical degree.{{when|date=August 2023}}<ref name="AACOM report"/><ref name=StateData /> Public awareness of osteopathic medicine likewise varies widely in different regions. In 2003, people living in Midwest states were the most likely to be familiar with osteopathic medicine.<ref>{{cite journal | vauthors = Licciardone JC | title = Awareness and use of osteopathic physicians in the United States: results of the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II) | journal = The Journal of the American Osteopathic Association | volume = 103 | issue = 6 | pages = 281–289 | date = June 2003 | pmid = 12834101 }}</ref> In the [[Northeastern United States]], osteopathic physicians provided more than one-third of general and family medicine patient visits between 2003 and 2004.{{update after|2023|8|22}}<ref>{{cite journal | vauthors = Licciardone JC | title = A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004 | journal = Osteopathic Medicine and Primary Care Practice | volume = 1 | pages = 2 | date = January 2007 | pmid = 17371578 | pmc = 1805772 | doi = 10.1186/1750-4732-1-2 | doi-access = free }}</ref><ref name="pmid19474535"/>

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, and Washington.<ref name=OMP2016 />

==Osteopathic principles<span class="anchor" id="Osteopathic Principles"></span>==
[[Image:Medical School.jpg|thumb|A physician demonstrates an [[Osteopathic Manipulative Medicine|OMT]] technique to medical students at an osteopathic medical school.]]
{{Contradicts other|Osteopathic Oath|here,there|section|date=August 2023}}
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:
# The body is a unit; a person is a unit of body, mind, and spirit.
# The body is capable of [[homeostasis|self-regulation]], self-healing, and health maintenance.
# Structure and function are reciprocally interrelated.
# 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.<ref name="Center_Periphery"/>

===Significance===
There are different opinions on the significance of these principles. Some note that the osteopathic medical philosophy is 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.<ref name=Zuger/><ref>{{cite web|title=About Osteopathic Medicine|url=http://www.osteopathic.org/osteopathic-health/about-dos/about-osteopathic-medicine/Pages/default.aspx|publisher=American Osteopathic Association|access-date=30 August 2007|url-status=dead|archive-url=https://archive.today/20120906041001/http://www.osteopathic.org/osteopathic-health/about-dos/about-osteopathic-medicine/Pages/default.aspx|archive-date=6 September 2012}}</ref> 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.<ref name="Center_Periphery"/>

==History==

===19th century, a new movement within medicine<span class="anchor" id="19th Century"></span><span class="anchor" id="A new movement within medicine"></span><span class="anchor" id="19th Century, A new movement within medicine"></span>===
[[Image:Andrew Taylor Still 1914.jpg|thumb|upright|Andrew Taylor Still, founder of osteopathic medicine]]
[[Frontier]] physician [[Andrew Taylor Still]], [[Doctor of Osteopathic Medicine|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.<ref>{{cite book | vauthors = Still AT | url = https://archive.org/stream/philosophymechan00stiliala/philosophymechan00stiliala_djvu.txt | title = The Philosophy and Mechanical Principles of Osteopathy | location = Kansas City, Mo | publisher = Hudson-Kimberly Pub Co | date = 1902 | pages = 9–20,185,210,270 }} Version 2.0. Inter Linea Web site. Text version recognised with imperfect OCR.</ref><ref>{{Cite book|url=https://archive.org/details/philosophymechan00stiliala|title=The Philosophy and Mechanical Principles of Osteopathy| vauthors = Still AT |publisher=Hudson Kimberley Pub. Co.|location=Kansas City, Mo.|year=1902}} Web page linking to facsimile images of the original book in several formats, including imperfect OCR text and PDF.</ref> 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.<ref name="Hansen">{{cite journal | vauthors = Hansen GP | title = Beyond OMT: time for a new chapter in osteopathic medicine? | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 3 | pages = 114–116 | date = March 2006 | pmid = 16585374 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16585374 | format = Free full text }}</ref>

{{citation needed span|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 the 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 to communicate his [[theory]] that disease and physiologic dysfunction were [[Etiology|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.|date=August 2023}}

[[Image:Mark Twain 1907.jpg|thumb|upright|left|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"<ref name="Cohen" /> and involved "strong efforts" by medical organizations to discredit osteopathic medicine.<ref name="Cecil">''Chapter 34: Complementary and Alternative Medicine.'' Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders. 2004.</ref> 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.<ref name=Zuger>{{cite news|vauthors=Zuger A|title=Scorned No More, Osteopathy Is on the Rise|url=https://www.nytimes.com/1998/02/17/science/scorned-no-more-osteopathy-is-on-the-rise.html?pagewanted=all|work=The New York Times|date=February 17, 1998|access-date=February 18, 2017|archive-date=August 19, 2016|archive-url=https://web.archive.org/web/20160819142514/http://www.nytimes.com/1998/02/17/science/scorned-no-more-osteopathy-is-on-the-rise.html?pagewanted=all|url-status=live}}</ref><ref name="Military">{{cite journal | vauthors = Gevitz N | title = The sword and the scalpel—the osteopathic 'war' to enter the Military Medical Corps: 1916–1966 | journal = The Journal of the American Osteopathic Association | volume = 98 | issue = 5 | pages = 279–286 | date = May 1998 | pmid = 9615560 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=9615560 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

One notable advocate for the fledgling movement was [[Mark Twain]]. Manipulative treatments had purportedly alleviated the symptoms of his daughter [[Jean Clemens|Jean's]] [[epilepsy]] as well as Twain's own [[Bronchitis#Chronic bronchitis|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."{{citation needed|date=August 2023}} 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?" "...&nbsp;The objection is, people are curing people without a license and you are afraid it will bust up business."<ref name="Twain">{{cite journal | vauthors = Ober KP | title = The pre-Flexnerian reports: Mark Twain's criticism of medicine in the United States | journal = Annals of Internal Medicine | volume = 126 | issue = 2 | pages = 157–163 | date = January 1997 | pmid = 9005751 | doi = 10.7326/0003-4819-126-2-199701150-00012 | s2cid = 32352763 | citeseerx = 10.1.1.695.316 }}</ref>

Following an accreditation survey in 1903, the American Osteopathic Association began requiring 3-year curricula at osteopathic medical schools.<ref name="faculty" /> In 1916, the AOA mandated all DO schools expand programs to four years.<ref name="faculty" /> In 1929, osteopathic medical schools began teaching pharmacology as a part of the curricula.<ref name="faculty" />

===1916–1966, federal recognition<span class="anchor" id="1916–1966"></span><span class="anchor" id="Federal recognition"></span><span class="anchor" id="1916–1966, Federal recognition"></span>===

{| class="floatright" cellpadding="4" style="font-size:105%; background-color: #f8f9fa; padding: 0.2em; border: 1px solid #a2a9b1;"
|+Evolution of osteopathic medicine's mission and identity<ref name=Reform/>
|-  style="text-align:center; background:#ccbcff;"
||'''Years'''
| colspan="2"|'''Identity & Mission'''
|-  style="text-align:center; background:#ccf;"
|| 1892 to 1950
|| Manual medicine
|-  style="text-align:center; background:#ccdcff;"
|| 1951 to 1970
|| Family practice / manual therapy
|-  style="text-align:center; background:#ccecff;"
|| 1971 to present
|| Full service care / multispeciality orientation
|}
Recognition by the [[Federal government of the United States|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 [[Army Medical Department (United States)|US Military Medical Corps]]. On May 3, 1966 [[United States Secretary of Defense|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.<ref>{{cite web|url=http://www.kcumb.edu/academics/college-of-osteopathic-medicine/about-osteopathic-medicine/notable-dos/|title=Notable DOs|publisher=Kansas City University of Medicine and Biosciences|access-date=9 May 2021|archive-date=7 January 2016|archive-url=https://web.archive.org/web/20160107130346/http://www.kcumb.edu/academics/college-of-osteopathic-medicine/about-osteopathic-medicine/notable-dos/|url-status=live}}</ref> The acceptance of osteopathic physicians was further solidified in 1996 when [[Ronald R. Blanck|Ronald Blanck, DO]] was appointed to serve as [[Surgeon General of the United States Army|Surgeon General of the Army]], the only osteopathic physician to hold the post.<ref name="Military"/>

===1962, California<span class="anchor" id="1962"></span><span class="anchor" id="California"></span>===
{{Main|Osteopathic Physicians and Surgeons of California v. California Medical Association}}
In the 1960s in California, the American Medical Association (AMA) spent nearly [[Dollar|$]]8&nbsp;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 [[Doctor of Osteopathic Medicine|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."<ref name="Paradox" /> 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.<ref name="The DO's">{{cite book| vauthors = Gevitz N |title=The DO's: osteopathic medicine in America|date=2004|publisher=Johns Hopkins University Press|location=Baltimore, Maryland|isbn=978-0-8018-7833-6}}</ref> 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.<ref>{{cite journal | vauthors = Crum JF | title = The saga of osteopathy in California | journal = The Western Journal of Medicine | volume = 122 | issue = 1 | pages = 87–90 | date = January 1975 | pmid = 1089010 | pmc = 1130289 }}</ref> 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, California|Vallejo]]. As of 2012, there were 6,368 DOs practicing in California.<ref>{{cite news |title=Part of cure for doctor shortage: Osteopaths |vauthors=Robertson K |url=http://www.bizjournals.com/sacramento/print-edition/2012/03/23/part-cure-for-doctor-shortage-osteopaths.html?page=all |newspaper=Sacramento Business Journal |date=March 23, 2012 |access-date=June 5, 2012 |archive-date=December 18, 2013 |archive-url=https://web.archive.org/web/20131218094148/http://www.bizjournals.com/sacramento/print-edition/2012/03/23/part-cure-for-doctor-shortage-osteopaths.html?page=all |url-status=live }}</ref>

===1969, AMA House of Delegates approval<span class="anchor" id="1969"></span><span class="anchor" id="AMA House of Delegates approval"></span>===
[[Image:DO residents in ACGME total.svg|thumb|290px|Total number of DOs in [[Residency (medicine)#United States|residency programs]], by year:{{legend|#5B8CBE|DO residents in ACGME (MD) programs<ref name="pmid16145028">{{cite journal | vauthors = Brotherton SE, Rockey PH, Etzel SI | title = US graduate medical education, 2004–2005: trends in primary care specialties | journal = JAMA | volume = 294 | issue = 9 | pages = 1075–1082 | date = September 2005 | pmid = 16145028 | doi = 10.1001/jama.294.9.1075 }}</ref>}}
{{legend|#BE5B5B|DO residents in AOA (DO) programs.<ref name = "Shannon_Impact">{{cite web | vauthors = Shannon SC | url = http://www.aamc.org/workforce/pwrc06/shannon.pdf | title = The Impact of Osteopathic Medicine's Growth on Physician Workforce. | archive-url = https://web.archive.org/web/20080411082808/http://www.aamc.org/workforce/pwrc06/shannon.pdf | archive-date=2008-04-11 | publisher = AAMC }}</ref>}}]]
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 (medicine)#United States|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.<ref name="ACGME">{{cite journal | vauthors = Tulgan H, DeMarco WJ, Pugnaire MP, Buser BR | title = Joint clinical clerkships for osteopathic and allopathic medical students: New England's experience | journal = The Journal of the American Osteopathic Association | volume = 104 | issue = 5 | pages = 212–214 | date = May 2004 | pmid = 15176520 }}</ref>

===1993, first African-American woman to serve as dean of a US medical school===
{{anchor|1993|First African-American woman to serve as dean of a U.S. medical school|1993, First African American Woman to Serve as Dean of a U.S. Medical School|1993, first African-American woman to serve as dean of a US medical school|reason=Old section names; if any of these are links, they need to be tracked down and replaced, then this excessive anchor pile-up removed.}}
In 1993, Barbara Ross-Lee, DO, was appointed to the position of dean of the [[Heritage College of Osteopathic Medicine|Ohio University College of Osteopathic Medicine]]; she was the first African-American woman to serve as the dean of a US medical school.<ref>{{cite web |url=https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_279.html |title=Dr. Barbara Ross-Lee |publisher=National Library of Medicine |access-date=9 May 2021 |archive-date=10 March 2016 |archive-url=https://web.archive.org/web/20160310002605/https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_279.html |url-status=live }}</ref> {{citation needed span|Ross-Lee now{{when|date=August 2023}} is the dean of the [[New York Institute of Technology College of Osteopathic Medicine|NYIT College of Osteopathic Medicine]] at [[Arkansas State University]] in [[Jonesboro, Arkansas]]. Ross-Lee is the sister of singer [[Diana Ross]].|date=August 2023}}

===Non-discrimination policies===
Recent{{when|date=August 2023}} 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.<ref name=ACP>{{cite web| vauthors = Wilson JF |title=Osteopathic Medicine's Growing Pains|url=http://www.acpinternist.org/archives/1997/11/osteopat.htm|publisher=ACP Internist|url-status=dead|archive-url=https://web.archive.org/web/20081205090332/http://www.acpinternist.org/archives/1997/11/osteopat.htm|access-date=28 May 2021|archive-date=5 December 2008}}</ref>

====2006, American Medical Student Association<span class="anchor" id="2006"></span><span class="anchor" id="American Medical Student Association"></span>====
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."
{{blockquote|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<ref name="AMSA"/>}}

====2007, AMA<span class="anchor" id="2007"></span><span class="anchor" id="AMA"></span>====
In recent{{when|date=August 2023}} 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.<ref name="ama295">{{cite web |url=http://www.ama-assn.org/resources/doc/council-on-med-ed/cme-report-12a-09.pdf |title=AMA policy H-295.876 |access-date=2012-11-30 |archive-date=2012-11-04 |archive-url=https://web.archive.org/web/20121104030441/http://www.ama-assn.org/resources/doc/council-on-med-ed/cme-report-12a-09.pdf |url-status=live }}</ref>

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.<ref>{{cite web|vauthors=Thomas M|title=Recommendation on Equal Fees for Osteopathic and Allopathic Medical Students|url=http://www.ama-assn.org/ama1/pub/upload/mm/377/a-07cmerpt6.pdf|work=Report of the Council on Medical Education (Report 6-A-07)|publisher=American Medical Association|access-date=1 July 2012|archive-date=12 February 2012|archive-url=https://web.archive.org/web/20120212181048/http://www.ama-assn.org/ama1/pub/upload/mm/377/a-07cmerpt6.pdf|url-status=live}}</ref>  The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007.
{{blockquote|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<ref name="ama295"/>}}

===State licensing of practice rights<span class="anchor" id="State Licensing of Practice Rights"></span>===
[[File:DO states practice rights.svg|thumb|Years in which states passed laws granting DOs medical practice rights equal to MDs:{{citation needed|date=August 2023}}<br />{{legend0|#9E9EFF|1901–1930}}{{legend0|#0080FF|1931–1966}}{{legend0|#80FFFF|1967–1989}}]]

In the United States, laws regulating physician licenses are governed by the states. Between 1896 and 1973, 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 Vermont in 1896, the last was Mississippi in 1973.<ref name="The DO's"/>

==Current status==

===Education and training===
{{Main|Medical school in the United States|Medical education in the United States}}
According to [[Harrison's Principles of Internal Medicine]], "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of ([[Doctor of Medicine|MD]]) physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [[Board certification|[board] certification]]."<ref name =indistinguisable/>

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 [[Clerkship (medicine)|clinical rotations]] through the major specialties of medicine.<ref name="Shannon2" /> 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.<ref>{{cite web| vauthors = Hubbard K | title=Letter to Touro College of Osteopathic Medicine|url=http://www.maops.org/associations/11748/files/Letter%20of%20Comment-Homer%20G..pdf|publisher=Missouri Association of Osteopathic Physicians and Surgeons|date=January 17, 2011|access-date=May 4, 2011}}{{Dead link|date=December 2018 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> {{citation needed span|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.|date=August 2023}}

====Graduate medical education====
[[Image:NewDocsTraining.PNG|thumb|390px|Sources of the 24,012 medical school graduates entering US physician training programs in 2004<ref name = "Shannon_Impact" />]]
{{citation needed span|Upon graduation, most osteopathic medical physicians pursue [[residency (medicine)|residency]] training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating [[internship (medicine)|internship]] at a hospital approved by the [[American Osteopathic Association]] (AOA).|date=August 2023}}
Osteopathic physicians may apply to residency programs accredited by the [[Accreditation Council for Graduate Medical Education]] (ACGME). The AOA ceased graduate medical education accreditation activities in 2020.<ref>{{Cite web|url=http://www.acgme.org/What-We-Do/Accreditation/Single-GME-Accreditation-System|title=Single GME Accreditation System|website=www.acgme.org|access-date=24 May 2016|archive-date=17 June 2016|archive-url=https://web.archive.org/web/20160617093106/http://www.acgme.org/What-We-Do/Accreditation/Single-GME-Accreditation-System|url-status=live}}</ref>

==Osteopathic manipulative treatment (OMT)<span class="anchor" id="Osteopathic manipulative treatment"></span><span class="anchor" id="OMT"></span><span class="anchor" id="Osteopathic Manipulative Treatment (OMT)"></span>==
{{Main|Osteopathic manipulative medicine}}
Within the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for several 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.<ref name=diminishedOMT>{{cite journal | vauthors = Johnson SM, Kurtz ME | title = Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession | journal = Academic Medicine | volume = 76 | issue = 8 | pages = 821–828 | date = August 2001 | pmid = 11500286 | doi = 10.1097/00001888-200108000-00016 | doi-access = free }}</ref>
The [[American Osteopathic Association]] has made an effort in recent{{when|date=August 2023}} 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]]<ref name=Zuger /> 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.<ref name =Center_Periphery>{{cite journal | vauthors = Gevitz N | title = Center or periphery? The future of osteopathic principles and practices | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 3 | pages = 121–129 | date = March 2006 | pmid = 16585378 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16585378 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

{{blockquote|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.<ref name="Center_Periphery"/>}}

[[Image:Manuellterapi5.jpg|right|450px|thumb|[[Osteopathic manipulative treatment]] (OMT) involves [[palpation]] and [[joint manipulation|manipulation]] of [[bone]]s, [[muscle]]s, [[joint]]s, and [[fascia]]e.]]

At the same time, recent{{when|date=August 2023}} studies show an increasingly positive attitude of patients and physicians (MD and DO) toward the use of manual therapy as a valid, safe, and effective treatment modality.<ref name="pmid11837337">{{cite journal | vauthors = Licciardone J, Gamber R, Cardarelli K | title = Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment | journal = The Journal of the American Osteopathic Association | volume = 102 | issue = 1 | pages = 13–20 | date = January 2002 | pmid = 11837337 }}</ref> 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.<ref>{{cite journal | vauthors = Stoll ST, Russo DP, Atchison JW | title = Physicians' and patients' attitudes toward manual medicine: implications for continuing medical education | journal = The Journal of Continuing Education in the Health Professions | volume = 23 | issue = 1 | pages = 13–20 | date = Winter 2003 | pmid = 12739255 | doi = 10.1002/chp.1340230104 | s2cid = 22834761 }}</ref> 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.<ref>{{cite journal | vauthors = Leiber JD | title = Allopathic family medicine residents can learn osteopathic manipulation techniques in a 1-month elective | journal = Family Medicine | volume = 37 | issue = 10 | pages = 693–695 | date = Nov 2005 | pmid = 16273444 | url = http://www.stfm.org/fmhub/fm2005/November-December/James693.pdf | format = Free full text | access-date = 2007-08-31 | archive-date = 2007-09-27 | archive-url = https://web.archive.org/web/20070927043240/http://www.stfm.org/fmhub/fm2005/November-December/James693.pdf | url-status = live }}</ref>

===Professional attitudes===
In 1998, an article in ''[[The New York Times]]'' described the increasing numbers, public awareness, and mainstreaming of osteopathic medical physicians, illustrating an increasingly cooperative climate between the DO and MD professions.<ref name=Zuger />

In 2005, during his tenure as president of the [[Association of American Medical Colleges]], Jordan Cohen described a climate of cooperation between DO and MD practitioners: {{blockquote|"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".<ref name="Cohen"/><ref>{{cite web| vauthors = Cohen J |title=Following in Flexner's Footsteps|url=http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Footsteps2.aspx|archive-url=https://archive.today/20130223183610/http://www.amsa.org/AMSA/Homepage/MemberCenter/Premeds/edRx/Footsteps2.aspx|url-status=dead|archive-date=23 February 2013|publisher=American Medical Association|access-date=14 July 2012}}</ref>}}

===International practice rights===
[[Image:DOworld.PNG|thumb|375px|right|International practice rights of US trained DOs]]
Each country has [[Doctor of Osteopathic Medicine#International variations|different requirements and procedures]] for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the [[United States Department of Education|US Department of Education]] recognizes as physicians are graduates of [[List of medical schools in the United States|osteopathic medical colleges in the United States]].<ref>{{cite web | url = http://www.ed.gov/legislation/FedRegister/other/2005-4/100305b.pdf | title = Notices | date = 3 October 2005 | archive-url = https://web.archive.org/web/20080411082808/http://www.ed.gov/legislation/FedRegister/other/2005-4/100305b.pdf |archive-date=2008-04-11 }} {{Federal Register|70|57571}}</ref>

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.<ref>{{cite web|title=International Practice Rights Map|url=http://www.osteopathic.org/inside-aoa/development/international-osteopathic-medicine/Pages/international-practice-rights-map.aspx|publisher=American Osteopathic Association|access-date=1 July 2012|archive-url=https://web.archive.org/web/20160819104030/http://osteopathic.org/inside-aoa/development/international-osteopathic-medicine/Pages/international-practice-rights-map.aspx|archive-date=2016-08-19|url-status=dead}}</ref>

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, [[Doctor of Medicine|MD]] or [[Doctor of Osteopathic medicine|DO]].<ref name="Int'l table">{{cite web | title = AOA International License Summary | publisher = [[American Osteopathic Association]]. Council on International Osteopathic Medical Education and Affairs | url = http://www.osteopathic.org/inside-aoa/development/licensure/Documents/international-licensure-summary.pdf }} {{dead link|date=January 2018 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> {{citation needed span|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.|date=August 2023}}
{{Osteopathic medicine2}}
According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an [[osteopathic physician]] and an [[osteopath]]."<ref name=AroundWorld>{{cite web |url=http://www.osteopathic.org/osteopathic-health/about-dos/dos-around-the-world/Pages/default.aspx |title=DOs Around the World |publisher=American Osteopathic Association |access-date=12 June 2013 |url-status=dead |archive-url=https://archive.today/20120906011238/http://www.osteopathic.org/osteopathic-health/about-dos/dos-around-the-world/Pages/default.aspx |archive-date=6 September 2012 }}</ref> The American Medical Student Association strongly advocates for US-trained DO international practice rights "equal to that" of MD-qualified physicians.<ref name="AMSA">{{cite web | url = http://www.amsa.org/AMSA/Libraries/Convention/C-9_Principles_Regardng_Osteopathic_Medicine.sflb.ashx | title = Principles Regarding Osteopathic Medicine }}; {{dead link|date=September 2017 |bot=InternetArchiveBot |fix-attempted=yes }} {{cite web | title = Preamble, Purposes and Principles | url = http://www.amsa.org/AMSA/Homepage/Events/Convention/Resolutions.aspx | work = AMSA | date = 2012 | archive-url = https://web.archive.org/web/20120321171102/http://www.amsa.org/AMSA/Homepage/Events/Convention/Resolutions.aspx | archive-date=2012-03-21 | publisher = [[American Medical Student Association]] }}</ref>

{{citation needed span|The International Labor Organization (ILO), an agency of the United Nations, issued a letter affirming that U.S.-trained osteopathic physicians are fully licensed physicians who prescribe medication and perform surgery. The acknowledgment draws a clear separation between American DOs, who are medical doctors, and non-physician osteopaths trained outside of the United States. Within the international standards that classify jobs to promote international comparability across occupations, U.S.-trained DOs are now categorized with all other physicians as medical doctors. This event took place in June 2018 and started a relay of events and opened doors for DO's as more countries started to understand and give full recognition to US-trained medical doctors with the D.O. degree, e.g. the Association of Medical Councils of Africa (AMCOA) approved a resolution in 2019 granting the AOA's request that AMCOA recognizes U.S.-trained DOs as fully licensed physicians with practice rights equivalent to MDs, opening its 20 member countries, which include Botswana, Gambia, Ghana, Kenya, Lesotho, Liberia, Malawi, Mauritius, Namibia, Nigeria, Rwanda, Seychelles, Sierra Leone, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe to DO's.|date=August 2023}}

===In primary care===
[[Image:OsteoPrimaryCare.PNG|thumb|400px|Trends in primary care as a career choice of osteopathic medical students<ref name="Singer">{{cite web | vauthors = Singer AM | url = http://www.aacom.org/resources/bookstore/debt/Pages/default.aspx | title = Debt, Plans and Opinions of Osteopathic Medical Students in 2004. | publisher = American Association of Colleges of Osteopathic Medicine | access-date = 2008-02-14 | archive-date = 2014-03-07 | archive-url = https://web.archive.org/web/20140307003854/http://www.aacom.org/resources/bookstore/debt/Pages/default.aspx | url-status = dead }}</ref> {{legend0|#4A75AD|4th year students}} {{legend0|#9CAED6|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.<ref name="pmid15980090">{{cite journal | vauthors = Cummings M, Dobbs KJ | title = The irony of osteopathic medicine and primary care | journal = Academic Medicine | volume = 80 | issue = 7 | pages = 702–705 | date = July 2005 | pmid = 15980090 | doi = 10.1097/00001888-200507000-00017 | doi-access = free }}</ref> Currently,{{when|date=August 2023}} only one in five osteopathic medical students enters a [[family medicine]] residency (the largest primary care field).{{update after|2023|8|21}}<ref>{{cite journal | title = Osteopathic physicians and the family medicine workforce | journal = American Family Physician | volume = 72 | issue = 4 | pages = 583 | date = August 2005 | pmid = 16127950 | url = http://www.aafp.org/link_out?pmid=16127950 | format = Free full text | last1 = Graham | first1 = Center }}</ref> 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%.<ref name="Singer"/>

==Criticism and internal debate==
{{update section|date=August 2023}}
{{over-quotation|date=August 2023}}

===OMT===
[[Image:1styear osteopathic enrollment.PNG|thumb|right|330px|First-year enrollment at osteopathic medical schools, 1968–2011{{citation needed|date=August 2023}}]]
Traditional osteopathic medicine, specifically OMT, has been criticized for using techniques such as [[craniosacral therapy|cranial and cranio-sacral manipulation]]. CST has been described as [[pseudoscience]] which is not backed up by any scientific evidence.<ref name=ps>* {{cite journal |doi=10.1037/0735-7028.37.5.515 |title=Discredited psychological treatments and tests: A Delphi poll |year=2006 | vauthors = Norcross JC, Koocher GP, Garofalo A |s2cid=35414392 |journal=Professional Psychology: Research and Practice |volume=37 |issue=5 |pages=515–22}}
* {{cite journal | vauthors = Mac Manus M | title = Unproven medical devices and cancer therapy: big claims but no evidence | journal = Biomedical Imaging and Intervention Journal | volume = 4 | issue = 3 | pages = e25 | date = July 2008 | pmid = 21610999 | pmc = 3097732 | doi = 10.2349/biij.4.3.e25 | type = Review }}
* {{cite journal | vauthors = Bledsoe BE | title = The elephant in the room: does OMT have proved benefit? | journal = The Journal of the American Osteopathic Association | volume = 104 | issue = 10 | pages = 405–6; author reply 406 | date = October 2004 | pmid = 15537794 }}
* {{cite journal | vauthors = Hartman SE | title = Cranial osteopathy: its fate seems clear | journal = Chiropractic & Osteopathy | volume = 14 | pages = 10 | date = June 2006 | pmid = 16762070 | pmc = 1564028 | doi = 10.1186/1746-1340-14-10 | doi-access = free }}
* {{cite journal | vauthors = Atwood KC | title = Naturopathy, pseudoscience, and medicine: myths and fallacies vs truth | journal = MedGenMed | volume = 6 | issue = 1 | pages = 33 | date = March 2004 | pmid = 15208545 | pmc = 1140750 }}</ref> Medical research has found no good evidence that either CST or cranial osteopathy confers any health benefit, and they can be harmful, particularly if used on children or infants.<ref name="acs">{{cite book |publisher=[[American Cancer Society]] |title=American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies |chapter-url=https://archive.org/details/americancancerso0000unse |chapter-url-access=registration |edition=2nd |year=2009 |isbn=978-0-944235-71-3 |veditors=Russell J, Rovere A |pages=[https://archive.org/details/americancancerso0000unse/page/187 187–189] |chapter=Craniosacral Therapy}}</ref><ref name="Ferré 481–494">{{cite journal | vauthors = Ferré JC, Chevalier C, Lumineau JP, Barbin JY | title = [Cranial osteopathy, delusion or reality?] | journal = Actualites Odonto-Stomatologiques | volume = 44 | issue = 171 | pages = 481–494 | date = September 1990 | pmid = 2173359 }}</ref><ref name=cass>{{cite book |vauthors=Cassileth BR |title=The Complete Guide to Complementary Therapies in Cancer Care: Essential Information for Patients, Survivors and Health Professionals |chapter-url=https://books.google.com/books?id=XAlqDQAAQBAJ&pg=PA248 |year=2011 |publisher=World Scientific |isbn=978-981-4335-16-4 |pages=247–250 |chapter=Chapter 42: Craniosacral Therapy}}</ref>  The basic assumptions of CST are challenged by some medical doctors, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients.<ref>{{Cite web|vauthors=Ingraham P|date=October 16, 2020|title=Craniosacral Therapy: Does it Work?|url=https://www.painscience.com/articles/craniosacral-therapy.php|work=PainScience.com|language=en|access-date=February 5, 2021|archive-date=August 7, 2019|archive-url=https://web.archive.org/web/20190807070113/https://www.painscience.com/articles/craniosacral-therapy.php|url-status=live}}</ref>

===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.<ref name="pmid11329813">{{cite journal | vauthors = Gevitz N | title = Researched and demonstrated: inquiry and infrastructure at osteopathic institutions | journal = The Journal of the American Osteopathic Association | volume = 101 | issue = 3 | pages = 174–179 | date = March 2001 | pmid = 11329813 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=11329813 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>Kelso A, Townsend A. The status and future of osteopathic research. In: Northup G, ed. Osteopathic Research: Growth and Development. Chicago, Ill: American Osteopathic Association; 1987.</ref><ref name="Licciardone, John C., Osteopathic research: elephants, enigmas, and evidence">{{cite journal | vauthors = Licciardone JC | title = Osteopathic research: elephants, enigmas, and evidence | journal = Osteopathic Medicine and Primary Care | volume = 1 | pages = 7 | date = February 2007 | pmid = 17371583 | pmc = 1808471 | doi = 10.1186/1750-4732-1-7 | doi-access = free }}</ref> {{blockquote|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.<ref name="pmid11329813"/>}}

===Identity crisis===
A debate exists within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within US health care.<ref name=Reform /><ref name="Center_Periphery"/><ref name="Parallel">{{cite journal | vauthors = Gevitz N | title = 'Parallel and distinctive': the philosophic pathway for reform in osteopathic medical education | journal = The Journal of the American Osteopathic Association | volume = 94 | issue = 4 | pages = 328–332 | date = April 1994 | pmid = 8027001 | doi = 10.7556/jaoa.1994.94.4.328 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Teitelbaum HS, Bunn WE, Brown SA, Burchett AW | title = Osteopathic medical education: renaissance or rhetoric? | journal = The Journal of the American Osteopathic Association | volume = 103 | issue = 10 | pages = 489–490 | date = October 2003 | pmid = 14620084 | url = http://www.jaoa.org/content/103/10/489.long | url-status = dead | archive-url = https://web.archive.org/web/20160305003713/http://jaoa.org/content/103/10/489.long | archive-date = 2016-03-05 }}</ref><ref name="pmid16943511">{{cite journal | vauthors = Tatum IV WO | title = AOA needs to reach out more | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 8 | pages = 442–443 | date = August 2006 | pmid = 16943511 | doi = | url = http://www.jaoa.org/cgi/content/full/106/8/442 | archive-url = https://web.archive.org/web/20080125061609/http://www.jaoa.org/cgi/content/full/106/8/442 | archive-date=2008-01-25 }}</ref><ref name="Last DO">{{cite journal | vauthors = Mychaskiw G | title = Will the last DO turn off the lights? | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 5 | pages = 252–253, 302; 253 302–253 | date = May 2006 | pmid = 16717365 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16717365 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite journal | vauthors = Steier KJ | title = Time to accept allopathic physicians into AOA-approved residencies? | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 5 | pages = 250–252 | date = May 2006 | pmid = 16717364 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16717364 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{cite journal | vauthors = Tosca M | title = Future of osteopathic medicine depends on investing in graduate medical education | journal = The Journal of the American Osteopathic Association | volume = 106 | issue = 6 | pages = 319 | date = June 2006 | pmid = 16790537 | url = http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16790537 | format = Free full text }}{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref name="Future1">{{cite journal | vauthors = Shannon SC | url = http://www.aacom.org/resources/e-news/ome/archives/2008/Pages/2008-02.aspx | archive-url = https://web.archive.org/web/20130119041840/http://www.aacom.org/resources/e-news/ome/archives/2008/Pages/2008-02.aspx | archive-date = 19 January 2013 | title = What Does the Future Hold? | journal = Inside Osteopathic Medical Education | volume = 2 | issue = 2 | date = 1 February 2008 | page = 1 }}</ref>  J. D. Howell, author of ''The Paradox of Osteopathy,''<ref name="Paradox" /> 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."<ref>{{cite journal | vauthors = Howell JD | title = Reply: Osteopathic Treatment of Low Back Pain | url = http://content.nejm.org/cgi/content/full/342/11/817 | journal = New England Journal of Medicine | volume = 342 | pages = 817–820 | issue = 11 | date = 16 March 2000 | doi = 10.1056/NEJM200003163421112 | pmid = 10722333 | doi-access = free | access-date = 5 November 2007 | archive-date = 18 February 2003 | archive-url = https://web.archive.org/web/20030218224338/http://content.nejm.org/cgi/content/full/342/11/817 | url-status = live }}</ref> Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a DO from an MD.<ref>{{cite journal | vauthors = Johnson SM, Kurtz ME | title = Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts | journal = Social Science & Medicine | volume = 55 | issue = 12 | pages = 2141–2148 | date = December 2002 | pmid = 12409127 | doi = 10.1016/S0277-9536(01)00357-4 }}</ref><ref>{{cite journal | vauthors = Licciardone JC | title = A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003–2004 | journal = Osteopathic Medicine and Primary Care | volume = 1 | pages = 2 | date = January 2007 | pmid = 17371578 | pmc = 1805772 | doi = 10.1186/1750-4732-1-2 | doi-access = free }}</ref> Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus:

{{blockquote|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?<ref name="Paradox">{{cite journal | vauthors = Howell JD | title = The paradox of osteopathy | journal = The New England Journal of Medicine | volume = 341 | issue = 19 | pages = 1465–1468 | date = November 1999 | pmid = 10547412 | doi = 10.1056/NEJM199911043411910 }}</ref>}}

====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.
{{blockquote|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.<ref name=ACP />}}

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, wrote in 2009,

{{blockquote|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.<ref name="faculty">{{cite journal | vauthors = Gevitz N | title = The transformation of osteopathic medical education | journal = Academic Medicine | volume = 84 | issue = 6 | pages = 701–706 | date = June 2009 | pmid = 19474540 | doi = 10.1097/ACM.0b013e3181a4049e | doi-access = free }}</ref>}}

The president of the American Association of Colleges of Osteopathic Medicine commented on the current climate of crisis within the profession.  {{blockquote|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.<ref name="Shannon2">{{cite journal | vauthors = Shannon SC, Teitelbaum HS | title = The status and future of osteopathic medical education in the United States | journal = Academic Medicine | volume = 84 | issue = 6 | pages = 707–711 | date = June 2009 | pmid = 19474542 | doi = 10.1097/ACM.0b013e3181a43be8 | doi-access = free }}</ref>}}

==See also==
* [[Comparison of MD and DO in the United States]]
* [[Doctor of Osteopathic Medicine]]
* [[List of osteopathic colleges]]
* [[:Category:Osteopathic medical schools in the United States|Osteopathic medical schools in the United States]]
* [[:Category:Osteopathic medical associations in the United States|Osteopathic medical associations in the United States]]
* [[Osteopathy]]

==References==
{{Reflist}}

== Further reading ==
{{refbegin}}
* {{cite book | title = The DOs: Osteopathic Medicine in America | vauthors = [[Norman Gevitz|Gevitz N]] | date = 2004 | edition = 2nd | publisher = The Johns Hopkins University Press | isbn = 0-8018-7834-9 }}
* {{cite book | title = Science in the Art of Osteopathy: Osteopathic Principles and Models | vauthors = Stone C, Thornes N | date = 1999 | publisher = Nelson Thornes | isbn = 0-7487-3328-0 }}
* {{cite book | title = An Osteopathic Approach to Diagnosis and Treatment | vauthors = DiGiovanna E | publisher = Lippincott Williams and Wilkins | date = 2004 | isbn = 0-7817-4293-5 }}
{{refend}}

{{Osteopathic medicine3|state=uncollapsed}}
{{Osteopathic medical schools}}
{{Medical education in the United States}}
{{Medicine}}

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[[Category:Osteopathic medicine|.]]
[[Category:Osteopathy in the United States]]
[[Category:Medical education in the United States]]