MarketOsteopathic medicine in the United States
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Osteopathic medicine in the United States

Osteopathic medicine is a branch of the 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 (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.

Nomenclature
Physicians and surgeons who graduate from osteopathic medical schools are known as osteopathic physicians or osteopathic medical doctors. 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. It relies more 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==
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 31 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. 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 principles
technique to medical students at an osteopathic medical school. 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. 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==
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. 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" 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. 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. 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. 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. As of 2012, 6,368 DOs were practicing in California. 1969, AMA House of Delegates approval , by year: 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 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 the 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. 1993, first African-American woman to serve as dean of a US medical school In 1993, Barbara Ross-Lee, DO, was appointed as the dean of the Ohio University College of Osteopathic Medicine; she was the first African-American woman to serve as the dean of a US medical school. Ross-Lee is the sister of singer Diana Ross. 2006, American Medical Student Association 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." 2007, AMA In recent years, the largest MD organization in the US, the American Medical Association, adopted a fee non-discrimination policy discouraging differential pricing based on attending an MD or DO medical school. 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. The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007. State licensing of practice rights 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 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. ==Current status==
Current status
Education and training According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of (MD) physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and Board certification|[board] certification." 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. Graduate medical education Image:NewDocsTraining.PNG|thumb|390px|Sources of the 24,012 medical school graduates entering US physician training programs in 2004 ==Osteopathic manipulative treatment (OMT)==
Osteopathic manipulative treatment (OMT)
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. The American Osteopathic Association has made an effort in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation and to encourage osteopathic physicians to offer manipulative treatments to their patients consistently. However, the number of osteopathic physicians who report consistently prescribing and performing manipulative treatment has been falling steadily. Medical historian and sociologist Norman Gevitz (OMT) involves palpation and manipulation of bones, muscles, joints, and fasciae. At the same time, recent 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. 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. 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. 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. 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. 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, MD or DO. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an osteopathic physician and an osteopath." The American Medical Student Association strongly advocates for US-trained DO international practice rights "equal to that" of MD-qualified physicians. In primary care Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts. Some osteopathic organizations claim they emphasize the importance of primary care within osteopathic medicine more strongly. However, the proportion of osteopathic students choosing primary care fields, like that of their MD peers, is declining. Currently, only one in five osteopathic medical students enters a family medicine residency (the largest primary care field). 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%. ==Criticism and internal debate==
Criticism and internal debate
OMT Traditional osteopathic medicine, specifically OMT, has been criticized for using techniques such as cranial and cranio-sacral manipulation. CST has been described as pseudoscience, which lacks supporting scientific evidence. 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. The basic assumptions of CST are challenged by some medical doctors, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients. Research emphasis Another area of criticism has been the relative lack of research and lesser emphasis on scientific inquiry at DO schools compared with MD schools. Identity crisis A debate exists within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within US health care. J. D. Howell, author of The Paradox of Osteopathy, Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a DO from an MD. Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus: Rapid expansion As the number of osteopathic schools has increased, the debate over distinctiveness has often left the leadership of the American Osteopathic Association at odds with the osteopathic physician community. The rapid expansion has raised concerns about the number of available faculty at osteopathic schools and the role those faculty play in maintaining the integrity of academic programs. Norman Gevitz, author of the leading text on the history of osteopathic medicine, wrote in 2009, The president of the American Association of Colleges of Osteopathic Medicine commented on the current climate of crisis within the profession. ==See also==
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