View source for Osteopathic medicine in the United States

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{{see also|Osteopathy}}

[[Image:Osteo_general11225.jpg|framed|''Osteopathic physicians on rounds in a US teaching hospital'']]

'''Osteopathic Medicine''' (also known as '''osteopathy''') is a system of [[medicine]] in the [[USA]] that applies osteopathic [[philosophy]], [[principles]], and treatment to standard [[biomedical]] care. With a strong emphasis on the inter-relationship of the body's [[nerves]], [[muscles]], [[bones]], [[connective tissue]] and [[organ (anatomy)]], Doctors of Osteopathic Medicine, or D.O.s, apply the philosophy of treating the whole person ([[holistic]] approach) to the [[prevention (medical)]], [[diagnosis]] and treatment of [[illness]], [[disease]] and [[injury]] using traditional medical practice such as [[medication|drugs]] and [[surgery]], along with [[manual therapy]] ([[Osteopathic Manipulative Medicine|OMM]]). 

Like Doctors of Medicine ([[M.D.]]s), Doctors of Osteopathic Medicine ([[D.O.]]s) [[educated]] in the [[United States]] are fully [[licensed]] [[physicians]] and [[surgeons]] who practice the full scope of medicine. In most other parts of the world, D.O.s are not medically trained practitioners. Currently, there are 21 accredited D.O.-granting U.S. [[medical schools]] and 125 accredited M.D.-granting U.S. medical schools. Because of the abundance of M.D. schools, many people are more familiar with them; however, osteopathic medicine is growing at an unprecedented rate. Many new schools are planned to open in the coming years and existing schools have expanded enrollment to meet the increased [[demand]] for the physician [[workforce]], particularly as [[baby boomers]] age. The majority of entering U.S. osteopathic medical students hold [[bachelor's degrees]] and some also hold [[master's degrees]] (M.S., M.A.) or other [[doctorate]] degrees (Ph.D., J.D.). 

M.D. and D.O.-granting U.S. medical schools have similar [[curricula]]. Generally the first two years are classroom-based, with certain programs providing patient contact, while third and fourth years consist of rotations through the different major specialties of medicine. Upon graduation, M.D. and D.O. physicians pursue [[residency (medicine)]] training programs. Depending on state licensing laws, osteopathic physicians may also be required to complete a 1 year rotating internship. Osteopathic physicians also have the opportunity to pursue [[allopathic]] (M.D.) residency programs; however, the converse is not allowed. Within the U.S., osteopathic physicians practice in all medical specialties including, but not limited to, [[internal medicine]], [[dermatology]], [[surgery]], [[radiology]], etc. There is no distinction in pay between allopathic (M.D.) and osteopathic (D.O.) physicians; however, physician [[salaries]] differ noticeably among the various medical specialties.  

Osteopaths educated in countries outside of the U.S. do not follow the same curriculum as U.S. trained D.O.s and are referred to as "non-physician osteopaths". Their scope of practice is limited mainly to [[musculoskeletal]] conditions and treatment of some other conditions using [[manual treatment]] (OMM), not unlike [[chiropractors]] in the [[USA]].

== History ==
(see also [[Osteopathy]])
Osteopathy was founded by [[Andrew Taylor Still]], M.D., D.O., who was born in [[1828]] in [[Virginia]] in reaction to what he perceived as inadequate medical treatment of his day. Specifically, he believed that other conventionally trained physicians over-prescribed to patients harsh and often toxic [[medications]]. He invented the name "osteopathy" by blending two Greek roots "osteon-" for bone and "-pathos" for suffering in order to communiciate 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. 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]] (e.g. antiseptics, ointments, or laxatives).

Osteopathic medical practice began approximately 120 years ago in the [[Midwest]] of the [[United States]], just before [[chiropractic]]. From its very inception, early practitioners embraced the movement's philosophy and theories to varying degrees. Some held steadfastly to its core [[tenets]] while others were more apt to "blend" features of osteopathy with other conventional or competing [[schools of medicine]]. Thus, early in the [[twentieth century]], the [[United States|American]] osteopathic profession adopted the use of medicine and surgery, whereas [[chiropractor]]s continue to use strictly manipulative techniques. Outside of the USA, osteopaths tended to stay closer to their traditional approach. As [[biomedical]] [[science]] developed, osteopathy gradually incorporated all its proven theories and practices. Today, except for a stronger [[primary care]] emphasis in most osteopathic medical schools and additional education in muscoskeletal diagnosis and treatment, the training and scope of osteopathy in the United States is identical to that of allopathic or [[bio-medicine]].

== Current status and scope of practice ==
Because of the varying degrees of acceptance of osteopathic theories and principles among early practitioners, there are two divergent scopes of practice within the osteopathic world.  Though they are so different as to be considered two separate [[professions]], there have been attempts in the last few years to enhance exchange and [[dialogue]] between them. In other parts of the world, especially the [[United Kingdom]], [[Australia]], and [[New Zealand]], D.O.'s have a narrower scope of practice limited to manual therapy.

=== Osteopathic medicine in the USA ===
In the [[United States]] osteopathic physicians (D.O.'s) are medically trained practitioners. Because only 6% of physicians in the USA are D.O.'s, many [[patients]] are unaware that the D.O. degree is the legal and professional equivalent of the M.D. degree and that those holding it practice in all specialties from [[cardiothoracic surgery]] to [[General practitioner|family medicine]]. Acceptance by traditional M.D.s and their institutions was once an issue for osteopathic practitioners. Today D.O.s and M.D.s work side by side in the [[health care]] setting. 

In the [[1960s]] in [[California]], the [[American Medical Association]] (AMA) spent some $8 million to end the practice of osteopathy in the state. After passing Proposition 22 which was backed by the AMA, D.O.s were granted an M.D. in exchange for paying $65 and attending a short seminar. The College of Osteopathic Physicians and Surgeons became the [[University of California, Irvine]], College of Medicine. However, the decision proved quite controversial. In [[1974]], primarily due to the efforts of Viola M. Frymann, D.O., FAAO, the [[California Supreme Court]] ruled that licensing of D.O.s in that state must be resumed.

[[Image:COPSLA2.jpg|framed|''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 become 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 struggle for acceptance, the other being the [[U.S. Army]]'s decision to allow D.O.s to enter the [[military]] as physicians.  The California Medical Association may have been attempting to eliminate the osteopathic [[competition]] by converting thousands of their physicians to M.D.s.  While most Californian D.O.s did take the opportunity to become M.D.s in order to improve their access to mixed-staff [[hospitals]] and enjoy wider professional recognition, in other parts of the country it provided the osteopathic [[community]] with the stamp of equivalency they desired. In [[1974]], the California Medical Association was challenged in the state supreme court and Proposition 22 was declared unconstitutional. The last state to grant D.O.s equal practice rights as a fully licensed physician was [[Mississippi]], in [[1973]].

The scientific merit of manipulative medicine continues to be [[controversial]]. Within the osteopathic medical curriculum in the USA, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. 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. The reasons for this are poorly understood, but are believed to be related to changes in the general financing and delivery of [[health care]], fewer D.O.s training in exclusively osteopathic post-graduate [[residency (medicine)]] training programs, and a lack of perceived relevance to a number of specialties and sub-specialties that D.O.'s pursue.

Still, there is no doubt that osteopathic medicine, as a progressive [[social movement]], has influenced the general practice of American [[medicine]]. Indeed, some osteopathic medical schools in the USA have opened basic courses in osteopathic manual therapy for their M.D. colleagues. Many continuing medical education programs in osteopathic manipulation are also offered to M.D.'s and [[physical therapist]]s.

== Future challenges ==
Osteopathic medicine first developed its unique and proprietary treatment modalities in the early [[19th century]] as a distinct alternative to conventional medical practice. These modalities moved through stages of discovery, development, refinement, and translation in order to be integrated into a modern biomedically-oriented osteopathic educational curriculum. This curriculum was instituted in largely free-standing educational institutions, community hospitals, and clinics that were relatively isolated from well-established scientific and medical training centers. Both internal and external competing interests shaped this process in a largely serendipitous fashion. 

Osteopathic medical schools have been criticized for being less focused on [[research]] and scientific discovery than [[allopathic]] schools, although this trend is changing. Critics also have highlighted the lower average academic attainment of students who matriculate to osteopathic schools--[[Grading_in_the_United_States#Grade_point_average|GPA]], 3.46 for osteopathic vs 3.63 for allopathic matriculants, and [[Medical College Admission Test|MCAT]] scores, an average of 24.6 for osteopathic vs 30.2 for allopathic matriculants. While the GPA and MCAT scores are indeed lower at osteopathic medical schools, some have argued that this difference really reflects osteopathic admission committees' emphasis on a variety of non-academic factors and personal characteristics combined with the active recruitment of non-traditional applicants who have historically not performed as well on the [[MCAT]] compared to traditional college graduates from natural and biological science backgrounds. It is important to note that average MCAT and GPAs of osteopathic medical students are comparable to allopathic medical students who choose primary care residency programs. 

In the [[United States]] osteopathic medicine has been criticized for including therapies such as [[craniosacral therapy|cranial and cranio-sacral manipulation]], and for having a greater tolerance for [[Alternative medicine|alternative medical practices]]. Because the field of osteopathic medicine encompasses all conventional medical practices, it has been subject to the same [[Medicine#Criticism|criticisms]]. And, in other countries where osteopathy does not encompass conventional medical practices, it is subject to the same criticisms leveled at many [[alternative medicine]] modalities.

Osteopathic medicine’s negotiation of its professional [[identity (social science)]] and [[social status]] provides an interesting example of the professional integration of [[alternative medicine]] theories and practices into the conventional delivery of medical care and [[health services]]. Over 120 years after its founding, the field continues to struggle with core [[identity (social science)]] issues. While it interfaces, cooperates, and allies itself with the standard biomedical enterprise and [[industries]], it simultaneously retains and defends its own distinct professional identity if for no other reasons than historical or sentimental ones.

Recently the movement, including its [[professional organization]]s, [[colleges]], and specialty societies, has gone to great lengths to define itself in terms of its [[holistic]] system of [[diagnosis]] and treatment. Critics point out that such a definition implies that the field is somehow separate from mainstream medicine and question if this definition is in reality a false distinction. Others prefer to view the field as being complementary to mainstream medicine by offering a form of patient care and health services that encompasses and extends usual medical practice. This duality does not invalidate it as a medical philosophy, but it makes it difficult for researchers and policy makers to measure its overall contribution to the [[health care system]]. 

In either case, given its recent unprecedented growth and expansion, osteopathic medicine is about to embark on a new phase in its evolution. It has tenuously positioned itself as a bridge between medical care that is conventionally considered standard, "[[evidence based medicine]]" versus complementary and alternative. It has developed and implemented a network of [[colleges]], post-graduate training institutions, professional organizations, federally-recognized [[professional certification]] standards, [[hospitals]] and health care networks in order to deliver a package of health services based on a distinct philosophy of patient care. 

However, to secure its relevance in a modern, integrated health care system, its success will depend upon conscientious organizational [[leadership]], the stewardship of its [[academic]] community, and continued long-term investment in research infrastructure. This will be needed in order to demonstrate cost-effective, positive treatment effects for the services it provides. In order to sustain and perpetuate itself as a [[social movement]] within medicine and the health care industry, it will need to attract and garner the support of recent osteopathic medical graduates comprising a [[generation]] of osteopathic [[physicians]] who have benefited from widespread acceptance, unrestricted practice opportunities, and post-graduate training and [[mentorship]] that has occurred, to a large degree, outside of the osteopathic profession.

== See also ==
* [[Osteopathy]]
* [[Allopathic medicine]]
* [[Medicine]]
* [[Chiropractic]]
* [[Naturopathy]]
* [[Complementary and alternative medicine]]

==Further reading==
* <cite>The DOs: Osteopathic Medicine in America</cite>, Norman Gevitz, 2004 (2nd Edition), paperback, 264 pages, The Johns Hopkins University Press, ISBN 0801878349 (''An excellent review of the history and development of ostepathic medicine and medical education in the United States'')
* <cite>Science in the Art of Osteopathy: Osteopathic Principles and Models</cite>, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0748733280
* <cite>An Osteopathic Approach to Diagnosis and Treatment </cite>, Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0781742935

==External links==
* [http://www.aacom.org/ American Osteopathic Association]
* [http://www.aacom.org/ American Association of Colleges of Osteopathic Medicine]

===US osteopathic medical schools===
* [http://www.aacom.org/colleges/ Directory of Colleges of Osteopathic Medicine in the U.S.]
* [http://www.atsu.edu/ A.T. Still University of Health Sciences Kirksville College of Osteopathic Medicine]
* [http://www.midwestern.edu/azcom/ Arizona College of Osteopathic Medicine of Midwestern University]
* [http://www.midwestern.edu/ccom/ Chicago College of Osteopathic Medicine of Midwestern University]
* [http://www.dmu.edu/com/ Des Moines University College of Osteopathic Medicine]
* [http://www.kcumb.edu/ Kansas City University of Medicine and Biosciences: College of Osteopathic Medicine]
* [http://www.lecom.edu/ Lake Erie College of Osteopathic Medicine]
* [http://www.com.msu.edu/ Michigan State University College of Osteopathic Medicine]
* [http://iris.nyit.edu/nycom/ New York College of Osteopathic Medicine of New York Institute of Technology]
* [http://medicine.nova.edu/ Nova Southeastern University College of Osteopathic Medicine]
* [http://www.oucom.ohiou.edu/ Ohio University College of Osteopathic Medicine]
* [http://www.healthsciences.okstate.edu/college/index.htm Oklahoma State University Center for Health Sciences College of Osteopathic Medicine]
* [http://www.pcom.edu/ Philadelphia College of Osteopathic Medicine]
* [http://pcsom.pc.edu/ Pikeville College School of Osteopathic Medicine]
* [http://www.tu.edu/indexca.php Touro University College of Osteopathic Medicine  - California]
* [http://www.tu.edu/indexnv.php Touro University College of Osteopathic Medicine  - Nevada]
* [http://som.umdnj.edu/index.htm University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine]
* [http://www.une.edu/com/ University of New England College of Osteopathic Medicine]
* [http://www.hsc.unt.edu/education/tcom/ University of North Texas Health Science Center at Fort Worth - Texas College of Osteopathic Medicine]
* [http://www.vcom.vt.edu/ Edward Via Virginia College of Osteopathic Medicine]
* [http://www.wvsom.edu/ West Virginia School of Osteopathic Medicine]
* [http://www.westernu.edu/comp.html Western University of Health Sciences College of Osteopathic Medicine of the Pacific]

===Apply to US osteopathic medical schools===
* [https://aacomas.aacom.org/ American Association of Colleges of Osteopathic Medicine Application Service]

===Canadian osteopathic college===
* [http://www.osteopathiecollege.com/ Canadian College of Osteopathy]

===US Osteopathic associations and regulatory bodies===
* [http://www.osteopathic.org/ American Osteopathic Association]
* [http://www.soma.org/ Student Osteopathic Medical Association] (U.S. students)
* [http://www.aacom.org/ The American Association of Colleges of Osteopathic Medicine]
* [http://www.osteopathic.org/index.cfm?PageID=lcl_assoc U.S. Osteopathic State & Regional Associations]
* [http://www.cosgp.aacom.org/ The (American) Council of Osteopathic Student Government Presidents]
* [http://www.oialliance.org/ International Osteopathic Alliance]
* [http://www.cranialacademy.org/ The Cranial Academy]
* [http://www.academyofosteopathy.org/ American Academy of Osteopathy]

===Journals===
* [http://www.jaoa.org/ Journal of the American Osteopathic Association]
* [http://www.intl.elsevierhealth.com/journals/ijos/ International Journal of Osteopathic Medicine]
* [http://www.chiroandosteo.com/ Chiropractic & Osteopathy] An online journal published by BioMed Central

===Other links===
* [http://history.aoa-net.org/ The History of Osteopathic Medicine (American Osteopathic Association)]
* [http://www.osteopathiccenter.org/ The Osteopathic Center For Children (U.S.)]
* [http://www.osteopathic-research.com/ Osteopathic Research Information - Vienna School of Osteopathy]
* [http://content.nejm.org/cgi/content/short/341/19/1465 An article supportive of osteopathic medicine: The Paradox of Osteopathy]
* [http://www.spine-health.com/topics/conserv/do/do01.html Osteopathic medicine and back pain]
* [http://www.pubmed.gov PubMed Literature Search] (valuable search engine for articles on topic)
* [http://www.osteodoc.com/ Osteopathy: Art of Practice]
[[Category:Medicine]]
[[Category:Manipulative therapy]]

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