Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of science-based medicine along with a philosophy and set of principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are graduates of American osteopathic medical colleges. They 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., whose practitioners are generally considered neither part of the core medical staff nor of medicine itself; rather, they are considered alternative medicine practitioners. Osteopathic physicians sometimes refer to the other major branch of medicine as allopathic medicine.
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.
In modern medicine in the U.S., any 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). The most notable difference in their training is that DOs spend an additional 300-500 hours studying pseudoscientific hands on musculoskeletal manipulation techniques. Osteopathic physicians attend four years of medical school like their MD counterparts, acquiring equivalent education in medicine and surgery; DOs also attend the same graduate medical education programs (ACGME-accredited residencies and fellowships) as their MD counterparts to acquire their licenses as physicians. DOs use all conventional methods of diagnosis and treatment and practice across all specialties of medicine and surgery. Although osteopathic physicians are still trained in osteopathic manipulative treatment (OMT), the modern derivative of Andrew Taylor Still's techniques, during medical school, the majority of practicing physicians with a DO degree do not practice OMT in their daily work. There are ongoing debates about the utility of maintaining separate, distinct pathways for educating physicians in the United States.
Nomenclature Physicians and surgeons who graduate from osteopathic medical schools are known as osteopathic physicians or osteopathic medical doctors. Upon graduation, they are conferred a Doctor of Osteopathic Medicine (DO) medical degree.
Osteopathic curricula in the United States differ from those in other countries. European-trained practitioners of osteopathic manipulative techniques are referred to as "osteopaths": their scope of practice excludes most medical therapies, relying instead on osteopathic manipulative medicine and alternative medical modalities. 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.
Demographics
40 medical schools were offering DO degrees in 64 locations across the United States, while there were 155 accredited MD medical schools (2021–2022). In 1960, 13,708 physicians were graduates of the 5 osteopathic medical schools.
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. In 2016, there were 33 colleges of osteopathic medicine in 48 locations, in 31AOA Annual Statistics, 2016 states. One in four medical students in the United States in 2016 was enrolled in an osteopathic medical school. there were more than 145,000 osteopathic physicians and osteopathic medical students in the United States.
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. The state with the greatest number of osteopathic physicians is Pennsylvania, with 8,536 DOs in active practice in 2018. The states with the lowest concentrations of DOs are Washington, D.C., North Dakota, and Vermont, where only 1–3% of physicians have an osteopathic medical degree. 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. In the Northeastern United States, osteopathic physicians provided more than one-third of general and family medicine patient visits between 2003 and 2004.
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.
Osteopathic principles
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 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.
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. 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 that a majority of MD medical school administrators and faculty saw nothing objectionable in the core principles listed above, and some endorsed them generally as broad medical principles.
History
19th century, a new movement within medicine
Frontier physician Andrew Taylor Still, MD 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. Version 2.0. Inter Linea Web site. Text version recognised with imperfect OCR. Web page linking to facsimile images of the original book in several formats, including imperfect OCR text and PDF. 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.
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 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.
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" and involved "strong efforts" by medical organizations to discredit osteopathic medicine.Chapter 34: Complementary and Alternative Medicine. Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders. 2004. 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 physician to associate with an osteopath voluntarily.
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."
Following an accreditation survey in 1903, the American Osteopathic Association began requiring 3-year curricula at osteopathic medical schools. In 1916, the AOA mandated that all DO schools expand programs to four years. In 1929, osteopathic medical schools began teaching pharmacology as a part of the curriculum.
1916–1966, federal recognition
+Evolution of osteopathic medicine's mission and identityYearsIdentity & Mission 1892 to 1950 Manual medicine 1951 to 1970 Family practice / manual therapy 1971 to present Full service care / multispeciality orientation 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. 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.
1962, California