Osteopathy, or osteopathic medicine as it is known today, is one of the fastest-growing health professions in the world. Doctors of osteopathic medicine (DOs), like doctors of medicine (MDs), are licensed in the United States as physicians to practice any of the medical or surgical specialties after the completion of their training. Currently, there are more than 60,000 DOs in the United States, representing approximately 8% of the total number of active physicians. However, the growth in the number of colleges of osteopathic medicine over the past decade (from 19 schools in 1998 to 28 in 2009) has resulted in osteopathic medical students’ representing more than 19% of the current freshman medical school class (MD and DO programs) in this country.
Osteopathic medicine, a uniquely American transformation in health care, traces its roots back to Dr. Andrew Taylor Still, an apprenticeship-trained rural country doctor.1 In 1864, Still and other physicians he summoned were unable to save the lives of his three children stricken with meningitis. This tragedy led him to question the cause and treatment of all disease. He began a long, unconventional journey that included the intense study of anatomy and its relationship to the various physiologic functions of the human body. His studies led him to develop the basic precepts that define the unique aspects of osteopathic medicine to this day:
1. The human person is a dynamic unit of function.
2. The body possesses self-regulatory mechanisms that are self-healing in nature.
3. Structure and function are interrelated and mutually interdependent at all levels.
4. A rational treatment regimen is based on these principles.2
Osteopathic medicine incorporates these philosophical precepts into the unrestricted practice of medicine and surgery, but these precepts also form the rationale behind a unique diagnostic and therapeutic modality of the profession, that of osteopathic manipulative medicine (OMM). This philosophical difference and its potential for application across all areas of the practice of medicine and surgery differentiate osteopathic medicine from allopathic medicine as a distinct medical profession.
In the official Glossary of Osteopathic Terminology, OMM is further defined as “the application of osteopathic philosophy, structural diagnosis and the use of Osteopathic Manipulative Therapy (OMT) in the diagnosis and management of the patient.” The glossary further defines OMT as “the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.”3 There are as many varied styles and methods of approaching the body with OMT as there are to approach the body with medications or surgery. All osteopathic physicians are trained in the basic principles and practices of a broad range of OMT, as they are similarly trained in the basics of pharmacology or surgery. However, despite this added training, only a small minority of osteopathic physicians regularly incorporate OMT into their practices.4
This holistic philosophy of medical practice is thought to be the foundation of the postgraduate training choices that are made by osteopathic physicians: principally that of choosing a primary care specialty (family medicine, pediatrics, or general internal medicine) more frequently than do allopathic physicians (45.6% of DO physicians versus 29.5% of MD physicians).5 DOs also tend to practice in geographically rural areas more frequently than do their MD colleagues (29.3% compared with 23.0%).6 With the continued growth of the osteopathic profession, osteopathic physician workforce decisions made by DOs have the potential to affect the relative and actual shortages of physicians in specific specialties as well as the geographic maldistribution seen today in the United States.
This issue of Academic Medicine presents nine articles that describe the osteopathic profession’s origins; an overview of the profession’s impact today, especially regarding its growth; challenges related to both undergraduate and graduate education; accreditation issues; focused research into uniquely osteopathic principles and practices (i.e., OMT and OMM); and issues of the physician workforce and access to care.
In the first article, Gevitz offers insight and perspective into the origin of osteopathy, its evolution into osteopathic medicine, and the growth of osteopathic colleges and postdoctoral programs. Shannon and Teitelbaum follow and examine the current state of osteopathic medical education, its unique promise, and future challenges. Krueger and colleagues look at the similarities between osteopathic and allopathic clinical undergraduate education as well as key differences, including osteopathic schools’ emphasis on primary care education, training in osteopathic manipulative medicine, and the reliance on community-based hospitals for clinical training.
Next, Wood and Hahn examine the similarities and differences in accrediting osteopathic medical schools by the American Osteopathic Association’s (AOA) Commission on Osteopathic College Accreditation (COCA) and allopathic medical schools by the Liaison Committee on Medical Education (LCME). Both accrediting bodies meet standards and criteria set by the U.S. Department of Education. Teitelbaum then explores the key issues related to osteopathic medical students’ selection of a primary care specialty training upon graduation. This article is followed by Peska and colleagues who describe osteopathic postdoctoral training institutions (OPTIs), a, unique form of graduate medical education (GME) administration. Cummings and Sefcik next document the growing number of DO graduates enrolled in residency programs under the aegis of the Accreditation Council for Graduate Medical Education (ACGME) and the implications of this trend to future DO and MD college enrollment. In the penultimate article. Stoll and colleagues discuss the development of the National Osteopathic Research Center and its mandate to stimulate productivity in uniquely osteopathic research. To complete this series, Licciardone and colleagues examine patient visits to DOs and MDs and their provision of ambulatory primary care services at academic health centers (AHCs) and non-AHC sites.
The topics, ideas and analyses presented in this collection should enhance deeper understanding and engender wider discussion of the role of the osteopathic profession in academic medicine and in the physician workforce of the United States. Hopefully, this issue will also facilitate greater collaboration between osteopathic and allopathic medical educators and physicians alike in their shared goal of producing well-trained physicians and surgeons to better serve the health care needs of the American people.
I wish to thank Peggy Smith-Barbaro, PhD, RN, associate professor of biomedical sciences and director of strategic research initiatives, and Dawn Kingdon, senior executive assistant, Office of the Dean, both at the University of North Texas Health Science Center in Fort Worth, Texas, who greatly assisted me as guest editor in the logistical oversight of article selection and submission for this issue of Academic Medicine.
Marc B. Hahn, DO, Guest Editor
At the time Dr. Hahn solicited the nine articles on osteopathic medicine and medical education published in this issue, he was senior vice president for health affairs and dean, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas. He is now. Scholar in Residence at both the American Association of Colleges of Osteopathic Medicine, Chevy Chase, Maryland, and the Association of American Medical Colleges, Washington, D.C.
1 Still AT. The Autobiography of Andrew Taylor Still—With a History of Discovery and Development of the Science of Osteopathy. Kirksville, Mo: AT Still; 1897.
2 Glossary Review Committee, Educational Council on Osteopathic Principles, American Association of Colleges of Osteopathic Medicine. “Osteopathic philosophy” definition. In: Glossary of Osteopathic Terminology. Available at: (http://www.interlinea.org/glossary/aoa_glossary.pdf
). Accessed February 23, 2009.
3 Glossary Review Committee, Educational Council on Osteopathic Principles, American Association of Colleges of Osteopathic Medicine. Glossary of Osteopathic Terminology. Available at: (http://www.interlinea.org/glossary/aoa_glossary.pdf
). Accessed February 16, 2009.
4 Johnson SM, Kurtz ME, Kurtz JC. Variables influencing the use of osteopathic manipulative treatment in family practice. J Am Osteopath Assoc. 1997;97:80–87.
5 Brotherton SE, Etzel SI. Graduate medical education, 2007-2008. JAMA. 2008:300: 1228–1243.
6 Smart DR, Sellers J. Physician Characteristics and Distribution. 2008 ed. Chicago: Ill: American Medical Association; 2008.