View source for Osteopathic medicine in the United States

'''Editor-In-Chief:'''DrATStill [mailto:andrewtaylorstill@yahoo.com]




{{otheruses4|a branch of the medical profession in the United States| the form of [[complementary medicine]] practiced worldwide|Osteopathy}}
{{Osteopathic medicine}}

'''Osteopathic medicine''' is a branch of the medical [[profession]] '''in the United States,'''<ref>[http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm/ ''Physicians & Surgeons'' Occupational Outlook Handbook, 2016-17 Edition, Bureau of Labor Statistics, US Department of Labor, accessed February 27, 2017]</ref> founded by [[A.T. Still]] MD, DO, in 1874 (see ''History''). [[Osteopathic medicine]] in the US is a complete system of medical training, much like allopathic (MD)<ref>[http://www.medicinenet.com/script/main/art.asp?articlekey=10981/ ''Definition of Allopathy'' MedTerms Medical Dictionary -[[WebMD]]Reviewed January 25, 2017  |Allopathy: The system of medical practice which treats disease by the use of remedies which produce effects different from those produced by the disease under treatment. MDs practice allopathic medicine.]</ref> training in the US or the British system of medical education, with all of the medical & surgical specialties and subspecialty training available to its graduates.<ref>[http://www.osteopathic.org/inside-aoa/Education/postdoctoral-training/Pages/default.aspx/ ''Postdoctoral Training, '' American Osteopathic Association, accessed February 27, 2017]</ref> Osteopathic [[physician]]s, known as [[Doctor of Osteopathic Medicine|DOs]], are licensed to practice [[medicine]] and [[surgery]] in all 50 states and have full scope of medical practice in [[Doctor of Osteopathic Medicine#International practice rights|over 70 countries]].<ref>[http://www.osteopathic.org/inside-aoa/development/international-osteopathic-medicine/Documents/2015%2004%20BIOM%20International%20Slides%20Website.pdf/ ''AOA Initiatives in the Global Osteopathic Profession,'' Bureau of International Osteopathic Medicine 2015, American Osteopathic Association, accessed February 27, 2017]</ref><ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=30/ ''2017 College Information Book Medicine,'' American Association of Colleges of Osteopathic Medicine, page 8]</ref>. There are over 102,000 DOs in the US, accounting for about 7% of the total physician population<ref>[http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf/ ''2016 Osteopathic Medical Profession Report,'' American Osteopathic Association, accessed February 27, 2017]</ref>

==Philosophy of medical practice==

Osteopathic medicine is based on the premise that the primary role of the physician is to facilitate the body’s inherent ability to heal itself.  These are the four major principles of osteopathic medicine:<ref>[http://www.aacom.org/docs/default-source/insideome/got2011ed.pdf?sfvrsn=2/ ''Glossary of Osteopathic Terminology,'' Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised November 2011, p. 33.]</ref>
# The body is a unit – an integrated unit of mind, body, and spirit (Triune of Man - A.T. Still). <ref>{{cite book |last=Still |first=A. T. |date=1899|title=The Philosophy of Osteopathy |url=https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/STILLThePhilosophyofOsteopathy1899.pdf  |location=Ann Arbor, MI |publisher=Edwards Brothers, Inc. |page=26 |isbn=978-3-936679-08-3}}</ref><ref>{{cite book |last=Still |first=A. T. |date=1902|title=Philosophy & Mechanical Principles of Osteopathy |url=https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf |location=Kansas City, MO |publisher=Hudson Kimberly PCB Company |page=20-1 |isbn=978-3-936679-12-0}}</ref>
# The body possesses [[Homeostasis|self-regulatory mechanisms]], having the inherent capacity to defend, repair, and remodel itself. <ref>[https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf/ Still AT. Philosophy & Mechanical Principles of Osteopathy (1902), p. 22.]</ref>
# Structure and function are reciprocally inter-related, as such there is an emphasis on the integral relationship between anatomy and physiology<ref>[https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf/ Still AT. Philosophy & Mechanical Principles of Osteopathy (1902), p. 20-21.]</ref>
# Rational therapy is based on consideration of the first three principles. 

Disease prevention is a central tenet of this philosophy. There is an emphasis on treating the whole person – body, mind and spirit, rather than just the presenting symptoms.

==Education==
{| class="infobox" cellpadding="0" style="font-size:90%; align="left" width:20%"
|-
|align=center colspan=3|'''Osteopathic medical schools'''
|-
|align=center|Region
|align=center|School
|align=center|Website
|-
|bgcolor="#ccccff" align=center rowspan=6| Northeast
|bgcolor="#ccccff" style="font-size:80%" align=center| [[Lake Erie College of Osteopathic Medicine|Lake Erie COM]]
|bgcolor="#ccccff" align=center style="font-size:80%" valign=center|[http://www.lecom.edu/]
|-
|bgcolor="#ccccff" style="font-size:80%" align=center|[[University of New England, Maine|New England COM]]
|bgcolor="#ccccff" align=center style="font-size:80%" valign=center|[http://www.une.edu/com/]
|-
|bgcolor="#ccccff" style="font-size:80%" align=center| [[New York College of Osteopathic Medicine|New York COM]]
|bgcolor="#ccccff" align=center style="font-size:80%" valign=center|[http://iris.nyit.edu/nycom/]
|-
|bgcolor="#ccccff" style="font-size:80%" align=center| [[Philadelphia College of Osteopathic Medicine|Philadelphia COM]]
|bgcolor="#ccccff" align=center style="font-size:80%" valign=center|[http://www.pcom.edu/]
|-
|bgcolor="#ccccff" style="font-size:80%" align=center|[[Touro College of Osteopathic Medicine|Touro Harlem]]
|bgcolor="#ccccff" align=center style="font-size:80%" valign=center|[http://www.touro.edu/med/]
|-
|bgcolor="#ccccff" style="font-size:80%" align=center| [[School of Osteopathic Medicine (UMDNJ)|UMDNJ-SOM]]
|bgcolor="#ccccff" align=center style="font-size:80%" valign=center|[http://som.umdnj.edu/]
|-
|bgcolor="#ccdcff" align=center rowspan=9| Southeast
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[Lake Erie College of Osteopathic Medicine|Lake Erie COM Bradenton]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.lecom.edu/]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[Lincoln Memorial University|Lincoln Memorial]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.lmunet.edu/dcom/]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[University of North Texas Health Science Center at Fort Worth|North Texas COM]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.hsc.unt.edu/]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[Nova Southeastern University College of Osteopathic Medicine|Nova Southeastern]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://medicine.nova.edu/]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[Philadelphia College of Osteopathic Medicine|Philadelphia COM Georgia]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.pcom.edu/General_Information/georgia/georgia.html]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[Pikeville College School of Osteopathic Medicine|Pikeville SOM]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://pcsom.pc.edu/]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[Virginia College of Osteopathic Medicine|Virginia COM]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.vcom.vt.edu/]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[West Virginia School of Osteopathic Medicine|West Virginia SOM]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.wvsom.edu]
|-
|bgcolor="#ccdcff" style="font-size:80%" align=center| [[William Carey University|William Carey COM]]
|bgcolor="#ccdcff" align=center style="font-size:80%" valign=center|[http://www.wmcarey.edu/]
|-
|bgcolor="#ccbcff" align=center valign=center rowspan=7|Midwest <br />& Plains
|bgcolor="#ccbcff" style="font-size:80%" align=center|[[A. T. Still University|AT Still Kirksville]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.atsu.edu/kcom/]
|-
|bgcolor="#ccbcff" style="font-size:80%" align=center| [[Des Moines University|Des Moines COM]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.dmu.edu/com/]
|-
|bgcolor="#ccbcff" style="font-size:80%" align=center| [[Kansas City University of Medicine and Biosciences|Kansas City COM]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.kcumb.edu/]
|-
|bgcolor="#ccbcff" style="font-size:80%" align=center| [[Michigan State University College of Osteopathic Medicine|Michigan State]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.com.msu.edu/]
|-
|bgcolor="#ccbcff" style="font-size:80%" align=center| [[Midwestern University|Midwestern Chicago]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.midwestern.edu/ccom/]
|-
|bgcolor="#ccbcff" style="font-size:80%" align=center| [[Ohio University|Ohio COM]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.oucom.ohiou.edu/]
|-
|bgcolor="#ccbcff" style="font-size:80%" align=center| [[Oklahoma State University - Center for Health Sciences|Oklahoma State]]
|bgcolor="#ccbcff" align=center style="font-size:80%" valign=center|[http://www.healthsciences.okstate.edu/]
|-
|bgcolor="#ccecff" align=center rowspan=7| West
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[A. T. Still University|AT Still Arizona]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.atsu.edu/soma/]
|-
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[Midwestern University|Midwestern Arizona]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.midwestern.edu/azcom/]
|-
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[Pacific Northwest University of Health Sciences|Pacific Northwest]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.pnwu.org/]
|-
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[Rocky Vista University College of Osteopathic Medicine|Rocky Vista]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.rockyvistauniversity.org/]
|-
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[Touro University California|Touro California]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.tu.edu/departments.php?id=43]
|-
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[Touro University Nevada|Touro Nevada]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.tu.edu/departments.php?id=44]
|-
|bgcolor="#ccecff" align=center style="font-size:80%" align=center| [[Western University of Health Sciences|Western]]
|bgcolor="#ccecff" align=center style="font-size:80%" valign=center|[http://www.westernu.edu/xp/edu/comp/recruitment.xml]
|}

Physicians who graduate from US osteopathic medical schools may be referred to as physicians or osteopathic physicians. Graduates hold a [[professional doctorate]], the D.O. or [[Doctor of Osteopathic Medicine]] degree<ref>[http://www.aacom.org/docs/default-source/insideome/got2011ed.pdf?sfvrsn=2/ ''Glossary of Osteopathic Terminology,'' Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised November 2011, p. 12.]</ref> and have the same have the same rights, privileges and responsibilities as their [[Doctor of Medicine|MDs]] counterparts.<ref>[https://searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2Fdirectives.xml-0-1397.xml/ American Medical Association Policy ''Definition of a Physician D-405.989'']</ref><ref>[https://searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2FHODGOV.xml-0-159.xml/ American Medical Association Policy, ''Membership Strategy: Osteopathic Medicine. G-635.053'']</ref>

Currently, there are 33 colleges of osteopathic medicine in 48 locations,<ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=30/ ''Colleges of Osteopathic Medicine, 2017 College Information Book,'' American Association of Colleges of Osteopathic Medicine]</ref> which are accredited by the [[American Osteopathic Association]]’s [[Commission on Osteopathic College Accreditation]] (COCA).<ref>[http://www.insidehighered.com/news/2011/06/09/naciqi_meets_to_evaluate_accreditors/ ''More Scrutiny for Accreditors,'' Inside HigherEd, June 9, 2011.]</ref> One in 4 medical students in the United States is attending an osteopathic medical school.<ref>[http://osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf/ ''2016 Osteopathic Medical Profession Report,'' American Osteopathic Association, Page 6.]</ref>
 
In terms of general coursework, the osteopathic medical school curriculum closely mirrors those of allopathic ([[Doctor of Medicine|MD]]) medical schools.<ref>Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Kurt J. Isselbacher, Eds. ''Chapter 10. Complementary and Alternative Medicine'' Harrison's Principles of Internal Medicine, 16th Ed. 2005. McGraw Hill.</ref><ref>''Chapter 34: Complementary and Alternative Medicine.'' Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders.  2004.</ref> The first two years focus on the biomedical and clinical sciences, followed by core clinical training in the clinical specialties. Osteopathic medical school accreditation standards require training in internal medicine, obstetrics /gynecology, pediatrics, family practice, surgery, psychiatry, emergency medicine, radiology, preventive medicine and public health.<ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=30/ ''2017 College Information Book,'' American Association of Colleges of Osteopathic Medicine, page 11.]</ref> In addition to the usual course of medical study, osteopathic medical students spend an added 300-500 hours studying the musculoskeletal system as it relates to functional ability, as well as osteopathic manual medicine treatment methods to aid in the restoration of their patients’ health.<ref>[https://www.nlm.nih.gov/medlineplus/ency/article/002020.htm/  ''Doctor of Osteopathy (D.O.),'' MedLine Plus, National Library of Medicine, National Institutes of Health, accessed February 27, 2017]</ref> Osteopathic principles & practices are both taught as a distinct discipline and integrated throughout the four-year curriculum. Students are trained to use osteopathic techniques for physical diagnosis and treatment of disease. The curriculum emphasizes the relationship of body systems, holistic patient care and disease prevention.<ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=38 / ''College Information Book 2017'' American Association of Colleges of Osteopathic Medicine]</ref>

Admission standards are comparable between DO and MD medical schools, with the average GPA of 3.56<ref>[http://www.aacom.org/docs/default-source/data-and-trends/2016-aacomas-applicant-amp-matriculant-profile-summary-report.pdf?sfvrsn=8/ ''AACOMAS Profile: Applicant & Matriculant Summary Report Entering Class 2016'' AACOM, January 2017, page i]</ref> and a mean old MCAT score of 27.33<ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=38/ ''College Information Book 2017,'' American Association of Medical Colleges]</ref>  and a mean new MCAT score of 502.17 for matriculants.<ref>[http://www.aacom.org/docs/default-source/data-and-trends/2016-aacomas-applicant-amp-matriculant-profile-summary-report.pdf?sfvrsn=8/ ''AACOMAS Profile: Applicant & Matriculant Summary Report Entering Class 2016,'' AACOM, January 2017, page i]</ref> The American Association of Medical Colleges lists the average grades and scores of entering students of the medical schools in the annual Medical School Admission Requirements book.<ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=38/ ''College Information Book 2017,'' American Association of Colleges of Osteopathic Medicine]</ref> whereas, the American Association of Colleges of Osteopathic Medicine lists the minimum requirements that may be considered by the individual colleges listed in its annual College Information Book<ref>[http://www.aacom.org/docs/default-source/data-and-trends/2015_mat.pdf?sfvrsn=8/ American Association of Colleges of Osteopathic Medicine]</ref> which has led some to mistakenly believe there is a great disparity between the two education systems. Approximately 46% of matriculants to both DO and MD schools are women.<ref>[https://www.aamc.org/download/321532/data/factstableb2-2.pdf/ ''U.S. Medical School Matriculants by Gender, U.S. Medical School Applicants and Students 2011-2012 to 2015-2016,'' © 2016 AAMC]</ref><ref>[http://www.aacom.org/docs/default-source/data-and-trends/2016-aacomas-applicant-amp-matriculant-profile-summary-report.pdf?sfvrsn=8/ ''AACOMAS Profile: Applicant & Matriculant Summary Report Entering Class 2016'' AACOM, January 2017]</ref>

While the osteopathic medical profession has its own basic board examinations (NBOME/COMLEX-USA),<ref>[http://www.nbome.org/docs/Flipbooks/ComlexBOI/index.html#p=1/ ''2016-2017 Bulletin of Information,'' National Board of Osteopathic Medical Examiners]</ref> hospital accreditation,<ref>[http://www.hfap.org/ Healthcare Facilities Accreditation Program]</ref> specialty training programs<ref>[http://opportunities.osteopathic.org/index.htm/ AOA Approved Internship & Residency Programs]</ref> and specialty board examinations, <ref>[http://www.osteopathic.org/inside-aoa/development/aoa-board-certification/Pages/aoa-specialty-boards.aspx/ AOA Specialty Certifying Boards]</ref> American osteopathic student physicians (DO) may also choose to sit for the [[USMLE]]. <ref>[http://www.usmle.org/pdfs/bulletin/2017bulletin.pdf/ US Medical Licensing Exam – 2017 General Information Bulletin, ''Eligibility,'' p. 4-5.]</ref> However, if osteopathic students have taken COMLEX, the USMLE may or may not be needed, depending on the individual institution’s program requirements;<ref>[http://www.jgme.org/doi/pdf/10.4300/JGME-D-13-00302.1?code=gmed-site /  Lee AS, Chang L, Feng E, Helf S. ''Reliability and Validity of Conversion Formulas Between Comprehensive Osteopathic Medical Licensing Examination of the United States Level 1 and United States Medical Licensing Examination Step 1'' Journal of Graduate Medical Education, 2014; 6:280-283.]</ref> the majority of ACGME programs accept COMLEX (72%)<ref>[http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf/ National Resident Match Program Directors’ Survey 2016]</ref>COMLEX- USA is likely to become further accepted as the US goes to a single accreditation graduate medical education training system. First-time USMLE pass rates for DO vs. MD students are as follows: Step 1: 93% and 94%,<ref>[http://www.usmle.org/performance-data/default.aspx#2015_step-1 / ''2015 USMLE Performance Data,'' 2015 National Board of Medical Examiners Annual Report (2016).]</ref> Step 2 CK: 92% and 94%,<ref>[http://www.usmle.org/performance-data/default.aspx#2015_step-2-ck/ ''2015 USMLE Performance Data,'' 2015 National Board of Medical Examiners Annual Report (2016).]</ref> and Step 2 CS: 90% and 96%. Step 3 results tend to suffer from small sample size (n<30) as osteopathic students may only be required by their schools to take the COMLEX Level 2 and USMLE Step 2 to graduate; however, a weighted average of the last 4 years of results shows a pass rate of 94% and 96%,<ref>[http://www.usmle.org/performance-data/ National Board of Medical Examiners, accessed February 27, 2017]</ref>respectively. Given that DO graduates have performed competitively with their US trained MD counterparts, the trend is now overwhelmingly towards acceptance of COMLEX. 

DO graduates may participate in the National Resident Matching Program’s Electronic Residency Application Service for ACGME accredited residencies,<ref>[http://offers.aamc.org/hubfs/AAMC_Roadmap_to_Residency.pdf?t=1487777336000/ ''Roadmap to Residency,'' Association of American Medical Colleges, 2015.]</ref><ref>[https://aamc-orange.global.ssl.fastly.net/production/media/filer_public/26/7a/267a51ae-0765-484e-a462-5169ba9b71a4/myeras_residency_user_guide_2017.pdf/ ''My ERAS Residency User Guide,'' National Residency Matching Program]</ref><ref>[http://jaoa.org/article.aspx?articleid=2093263/ Bulger JB. ''Approval of ACGME Training as an AOA-Approved Internship: History and Review of Current Data,'' JAOA, 2006;106(12):708-713.]</ref> both the former allopathic and now the newly ACGME-accredited osteopathic programs. DO graduates may also participate in the AOA Match Program, <ref>[http://www.osteopathic.org/inside-aoa/Education/students/Pages/electronic-residency-application-service.aspx/ ''Electronic Residency Application Service,'' American Osteopathic Association, last accessed February 27, 2017.]</ref> administered by the National Matching Services<ref>[http://www.natmatch.com/aoairp/ ''AOA Intern/Resident Registration Program,'' National Matching Services, Inc.]</ref> through the class of 2019, after which time it will be dissolved.<ref>[http://osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/single-gme-student-faqs.aspx#md-do/ ''Single GME: Student Questions Answered,'' American Osteopathic Association, accessed February 2017.]</ref> At that time, there will be a single graduate medical education accreditation agency, ACGME, for both allopathic and osteopathic originating programs. On February 26, 2014, a memorandum of understanding was signed between the ACGME, the AOA and AACOM; the transition process began in April of 2015 and it is scheduled to be complete by 2020.<ref>[http://osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/single-gme-student-faqs.aspx#md-do/ ''Single GME: Student Questions,'' American Osteopathic Association, last accessed February 27, 2017.]</ref><ref>[http://www.acgme.org/What-We-Do/Accreditation/Single-GME-Accreditation-System/ ''Single GME System,'' ACGME, last accessed February 27, 2017.]</ref><ref>[http://www.acgme.org/Portals/0/PDFs/Nasca-Community/Executive_Summary_of_the_Agreement_between_ACGME_and_AOA.pdf/ ''Executive Summary of the Agreement among ACGME, AOA, and AACOM, ACGME website,'' last accessed February 28, 2017.]</ref> In 2016, 46% of osteopathic medical graduates chose to complete allopathic graduate medical education programs<ref>[http://www.aacom.org/docs/default-source/data-and-trends/2016-match-report.pdf?sfvrsn=20/ ''Report on Osteopathic Medicine Placements in 2016 Matches,'' American Association of Colleges of Osteopathic Medicine, prepared April 28, 2016, last accessed February 27, 2017.]</ref> and then take allopathic or osteopathic specialty board exams.<ref>[http://services.aamc.org/publications/showfile.cfm?file=version78.pdf&prd_id=183&prv_id=222&pdf_id=78/ ''Roadmap to Residency: From Application to the Match and Beyond,'' Association of American Medical Colleges, 2015, last accessed February 27, 2017.]</ref> In recent years, there has been an increasing trend toward residency programs that are dually-certified by the AOA and ACGME.<ref>[http://jaoa.org/article.aspx?articleid=2093779/ Burkhart DN, Lischka TA. ''Dual and Parallel Postdoctoral Training Programs: Implications for the Osteopathic Medical Profession,'' JAOA, 2009; 109(3):146-153.]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/9597532/ Johnson RK, Racsek JA, Meyer D. ''Integrating osteopathic training into family practice residencies,'' Family Medicine, 1998;30(5):345-9.]</ref> Previously, some hospitals had parallel (MD & DO) undergraduate and graduate medical education training programs; this is where both AOA and ACGME accredited programs exist in a specialty, but residents are only admitted to one program. <ref>[https://www.ncbi.nlm.nih.gov/pubmed/25629946/ Jolly P, Lischka T, Sondheimer H. Numbers of MD and DO Graduates in Graduate Medical Education Programs Accredited by the Accreditation Council for Graduate Medical Education and the American Osteopathic Association. Acad Med. 2015 Jul;90(7):970-4.]</ref><ref>[http://jaoa.org/article.aspx?articleid=2092953/ Tulgan H, DeMarco WJ, Pugnaire MP, Buser BR. ''Joint Clinical Clerkships for Osteopathic and Allopathic Medical Students: New England's Experience,'' JAOA, 2004;104(5):212-214.]</ref> Osteopathic physicians may be credentialed in any hospital. Because of the additional training DOs receive, until a single GME system was agreed to, there was no pathway for MD colleagues to be admitted to osteopathic graduate medical education training programs or sit for osteopathic specialty board exams. These specialty pathways and the remedial training necessary for MD trainees to meet requirements for ACGME programs with Osteopathic Recognition are currently being created. DOs & MDs are the only two types of complete physicians in the United States.<ref>[https://www.law.cornell.edu/uscode/text/42/1395x/ ''Social Security Administration’s legal definition of a ''physician'' 42 USC §1395x(r)(1)'']</ref> The osteopathic medical education system is recognized as on par with allopathic (MD) training by their colleagues,<ref>[https://searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2Fdirectives.xml-0-1397.xml/ ''D-405.989 Definition of a Physician,''  AMA Policy, accessed February 27, 2017.]</ref><ref>[https://searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2Fdirectives.xml-0-814.xml/ ''D-295.326 Recognition of Osteopathic Education & Training,'' AMA Policy, last accessed February 27, 2017.]</ref><ref>[https://www.ama-assn.org/sites/default/files/media-browser/specialty group/washington/ama-bylaws-2017.pdf/ ''Active Membership,'' AMA Bylaws]</ref><ref>[http://www.amsa.org/wp-content/uploads/2015/03/2016-PPP.pdf/ ''2016 AMSA Preamble, Principles & Purposes, Principles regarding Osteopathic Medicine,'' American Medical Students Association, p. 136.]</ref> medical institutions,<ref>[https://www.urac.org/forms/uploadFiles/2BC7610000007D.filename.Core_presentation.pdf/ ''Utilization Review Accreditation Council (URAC) Requirements for Accreditation, CORE 31 – Senior Clinical Staff Requirements'']</ref> professional organizations,<ref>[https://searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2FHODGOV.xml-0-159.xml / ''G-635.053: AMA Membership Strategy: Osteopathic Medicine,'' AMA Policy, last accessed February 27, 2017.]</ref><ref>[https://www.ama-assn.org/sites/default/files/media-browser/specialty%20group/washington/ama-bylaws-2017.pdf/ AMA Bylaws 2017, pages 7 & 8, last accessed February 27, 2017.]</ref> educational accreditation bodies,<ref>[http://www.acgme.org/What-We-Do/Accreditation/Single-GME-Accreditation-System/ ''Single GME Accreditation System,'' Accreditation Council for of Graduate Medical Education, accessed February 27, 2017.]</ref> testing examiners,<ref>[http://www.usmle.org/pdfs/bulletin/2017bulletin.pdf/ ''Eligibility,'' USMLE 2017 Bulletin, page 11.]</ref> licensing/regulatory authorities,<ref>[http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/GRPOL_essentials.pdf/ ''Essentials of a Modern Medical and Osteopathic Practice Act,'' Federation of State Medical Boards.]</ref><ref>[http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/GRPOL_Elements_Modern_Medical_Board.pdf/ ''Elements of Modern State Medical & Osteopathic Board,'' Federation of State Medical Boards.]</ref> the US government <ref>[http://www2.ed.gov/admins/finaid/accred/accreditation_pg7.html/ US Department of Education]</ref><ref>[https://www.law.cornell.edu/uscode/text/42/209d/ ''US Code: Recognition that osteopathic physicians can be appointed as commissioned officers in the US Public Health Service, 42 USC §209d'']</ref><ref>[https://www.law.cornell.edu/uscode/text/42/1395x/ ''US Code: Social Security Administration’s recognition of osteopathic postdoctoral training for coverage of in-patient hospital services under Medicare, 42 USC §1395x (b).'']</ref> and military.<ref>[https://www.law.cornell.edu/uscode/text/10/532 / ''US Code: Requirements for appointment of osteopathic physicians as commissioned officers in the Armed Forces Medical Corps, 10 USC §532(b)(1)&(2)'']</ref>

==Demographics==
Osteopathic physicians currently comprise 7% of the total physician population in the US.<ref>[http://www.osteopathic.org/inside-aoa/about/who-we-are/Pages/osteopathic-physicians-in-the-US.aspx/ ''Osteopathic Physicians in the U.S.,''  American Osteopathic Association]</ref> There are currently 33 osteopathic medical schools in 48 locations.<ref>[http://www.aacom.org/docs/default-source/cib/cib_web_full-publication.pdf?sfvrsn=38/ ''2017 College Information Book,''  American Association of Colleges of Osteopathic Medicine, 2016, page 4.]</ref>

DOs have historically been concentrated in a few states like Michigan, Pennsylvania and Ohio. However, in recent years this pattern has decreased and DO populations are increasing distribution throughout all 50 states. In 2016, the states with the largest numbers of DOs are California, Florida, Michigan, Ohio, Pennsylvania, New York and Texas.<ref>[http://osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf/ 2016 Osteopathic Medical Profession Report, AOA Annual Statistics.]</ref> The states with the highest percentage of DOs relative to the total physician population are Oklahoma (24%), Michigan (21%), Iowa (19%), Maine (17%), West Virginia (16%) and Pennsylvania (15%).<ref>[http://www.osteopathic.org/inside-aoa/about/who-we-are/Documents/Osteopathic-Medical-Profession-Report-2010.pdf/ ''Osteopathic Physicians in the U.S.,'' 2010 Osteopathic Medical Profession Report, p.11 American Osteopathic Association.]</ref> The states with the lowest numbers of DO's are North Dakota, Vermont, Wyoming, South Dakota and Louisiana. <ref>[http://www.osteopathic.org/inside-aoa/about/who-we-are/Documents/Osteopathic-Medical-Profession-Report-2010.pdf/ ''State Residence of all DOs – May 2010,'' 2010 Osteopathic Medical Profession Report, p. 11-12, American Osteopathic Association.]</ref>

Osteopathic physicians have historically entered the [[primary care]] fields at a higher rate than their MD counterparts.<ref>[http://journals.lww.com/academicmedicine/Abstract/1990/12000/Osteopathic_medicine_and_primary_care_practice_.36.aspx/ Melnick A. ''Osteopathic Medicine and Primary Care Practice: Plan or Serendipity?'' Academic Medicine, 1990;65(12):S87-89]</ref> Currently, 56% percent of all DOs practice in the primary care specialties of family medicine, internal medicine, osteopathic manipulative medicine/neuromusculoskeletal medicine and pediatrics.<ref>[http://osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/medical-specialties.aspx/ ''OMP Report: Medical Specialties,'' American Osteopathic Association, last accessed February 28, 2017.]</ref> In the 2008-2009 academic year, the percentage of DO residents in AOA or ACGME primary care residencies of family medicine (FP), internal medicine (IM), obstetrics/gynecology & pediatrics (Peds) and combined residencies (FP/ER, FP/OMM, IM/Peds, ER/IM) is 50%, compared to 35% for their MD counterparts. When emergency medicine (including ER/IM, ER/Peds) programs are also considered as primary care, the percentage of osteopathic primary care physicians rises to 61%, compared to 41% for their MD colleagues.<ref>[http://www.jaoa.org/cgi/reprint/110/3/150?maxtoshow=&hits=60&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=3/1/2010&tdate=4/30/2010&resourcetype=HWCIT/  Elizabeth Freeman E, Duffy T and Lischka TA. ''Osteopathic Graduate Medical Education 2010,'' JAOA, 2010;110(3):150-159.]</ref><ref>[http://jama.ama-assn.org/content/302/12/1357.extract/ Brotherton SE, Etzel SI. ''Graduate Medical Education 2008-2009, (Table 2),'' JAMA, 302(12):1357-1372.]</ref> According to US News & Report’s 2017 Graduate Schools: Best Medical Schools rankings, osteopathic medical schools took the top five slots for producing the most primary care residents: #1 Michigan State University, College of Osteopathic Medicine (80%), #2 Lincoln Memorial University (DeBusk) (78%), #3 Kansas City University of Medicine and Biosciences (73%), #4 University of Pikeville, Kentucky College of Osteopathic Medicine (73%) and #5 West Virginia School of Osteopathic Medicine  (70%).<ref>[http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/primary-care-residents-rankings/ ''Which schools turn out the most primary care residents?'' US New & World Report 2017.]</ref> 

Osteopathic physicians are still more likely to practice in rural and medically underserved areas than their MD counterparts; osteopathic physicians “represent 22% of all physicians practicing in rural and underserved parts of the United States.” <ref>[http://commdocs.house.gov/committees/judiciary/hju27608.000/hju27608_0.htm/ ''Testimony of John B. Crosby JD, Executive Director of the American Osteopathic Association, regarding the Physicians in Underserved Areas Act, Committee on the Judiciary, US House of Representatives,'' 109th US Congress, Second Session, May 18, 2006, p.34]</ref><ref>[http://journals.lww.com/academicmedicine/Fulltext/2010/06000/Which_Medical_Schools_Produce_Rural_Physicians__A.23.aspx/ Chen F, Fordyce M, Andes S, and Hart LG. ''Which medical schools produce rural physicians? A 15-year update.'' Academic Medicine, 2010;85:594–598.]</ref> As John Crosby JD, Executive Director of the AOA, in his testimony before Congress may have described why this is:

:Medical schools and colleges of osteopathic medicine traditionally place significant emphasis on an applicant's academic achievement-grade point average, undergraduate degree program, and scores on the Medical College Admission Test (MCAT). While I would never suggest that the academic standards required for admittance be lowered, I do recommend that the nation's medical education institutions begin evaluating ''other'' factors. An evaluation of the student's life, including an evaluation of where the student was raised, attended high school, and location of family members, provides an indication of where a future physician may practice. For example, an applicant from Princeton, New Jersey is less likely to practice in a rural community than an applicant from Princeton, Indiana. If the two applicants are equally qualified, we should encourage our schools to matriculate the student from Princeton, Indiana, an individual more likely to return to rural southwest Indiana once education and training is completed. <ref>[http://commdocs.house.gov/committees/judiciary/hju27608.000/hju27608_0.htm/  ''Testimony of John Crosby JD, Executive Director of the American Osteopathic Association, regarding the Physicians in Underserved Areas Act, Committee on the Judiciary, US House of Representatives,'' 109th Congress, Second Session, May 18, 2006, p.37]</ref> 

The osteopathic medical profession has been more likely to start medical schools and training programs in such areas as part of its core mission. <ref>[http://commdocs.house.gov/committees/judiciary/hju27608.000/hju27608_0.htm/ ''Testimony of John Crosby JD, Executive Director of the American Osteopathic Association, regarding the Physicians in Underserved Areas Act, Committee on the Judiciary, US House of Representatives,'' 109th Congress, Second Session, May 18, 2006, p.34.]</ref><ref>[http://www.ama-assn.org/amednews/2008/05/26/prsb0526.htm/ Croasdale M. ''Study: Med schools can boost rural physician supply,'' American Medical News, May 26, 2008.]</ref><ref>[http://www.ama-assn.org/amednews/2008/07/07/edlt0707.htm/ Ajluni PB. ''AOA president: DOs are responding to the need for more rural care.'' American Medical News. July 7, 2008.]</ref><ref>[http://jchc.virginia.gov/PDFFiles/October%2017/October%2017%20color/V%20Edward%20Via%20Virginia%20College%20revised.pdf/ Tooke-Rawlins D. ''Report to the Joint Commission on Healthcare, Edward Via Virginia College of Osteopathic Medicine,'' October 17, 2007.]</ref> The West Virginia School of Osteopathic Medicine had the highest number of graduates, 41%, (among MD or DO schools) practicing in rural areas<ref>[http://journals.lww.com/academicmedicine/Fulltext/2010/06000/Which_Medical_Schools_Produce_Rural_Physicians__A.23.aspx/ Chen F, Fordyce M, Andes S, and Hart LG. ''Which medical schools produce rural physicians? A 15-year update.'' Academic Medicine, 2010;85:594–598.]</ref> and was recently ranked ninth in the country for its rural medicine program.<ref>[http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/rural-medicine-rankings/ ''Best Medical Schools: Rural Medicine,'' US News & World Report-2011]</ref><ref>[http://www.jaoa.org/cgi/reprint/100/11/723/ Stookey JR, Baker HH, Nemitz JW. ''How West Virginia School of Osteopathic Medicine achieves its mission of providing rural primary care physicians,'' JAOA, 2000;100(11):723-6.]</ref>

''It is important to note that medical schools rankings in general have not been without their critics.''<ref>[http://journals.lww.com/academicmedicine/Fulltext/2001/10000/America_s_Best_Medical_Schools__A_Critique_of_the.5.aspx/  McGaghie WC; Thompson JA. ''America's Best Medical Schools: A Critique of the U.S. News & World Report Rankings,'' Academic Medicine, 2001;76(10):985-992.]</ref>

==History==
[[Image:Andrew Taylor Still 1914.jpg|thumb|upright|Andrew Taylor Still, founder Osteopathic medicine]]
[[Frontier]] physician & surgeon,<ref>[http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=693&REC=1/ ''Medical Registration for Macon County, MO as of March 27, 1874,'' Missouri Digital Heritage, Secretary of State of Missouri.]</ref><ref>[http://cdm.sos.mo.gov/cdm4/item_viewer.php?CISOROOT=/atsu&CISOPTR=759&CISOBOX=1&REC=2/ ''Medical registration for Adair County, MO dated July 28, 1883,'' Missouri Digital Heritage, Secretary of State of Missouri.]Note: The state of Missouri did not have legislation requiring medical registration until March 27, 1874.</ref><ref>[http://www.atsu.edu/museum/journals/index.htm/ ''A Brief Outline of the Work & Life of A.T. Still,'' Journal of Osteopathy, May 1894, p. 3.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol1No11894May.pdf</ref> inventor<ref>[https://www.atsu.edu/museum/collections/pdfs/finding_aidsATSIntro.pdf/  A.T. Still patents improved butter churn, circa 1871]</ref><ref>[http://snom.pastperfect-online.com/32879cgi/mweb.exe?request=record:id=A5132449-3D8B-4706-8269-024349528498;type=301/ ''Patent No. 95223 for Furnace Burner,'' issued to A.T. Still April 26, 1910, United States Patent Office.]</ref><ref>[http://snom.pastperfect-online.com/32879cgi/mweb.exe?request=record:id=4BDD6584-73C1-4B97-A34B-365348875707;type=301/ ''Blue printed cutaways of invention,'' image file: 023\199704329]</ref><ref>[http://snom.pastperfect-online.com/32879cgi/mweb.exe?request=record:id=D1FBDF9D-8833-4EAD-9186-928410267333;type=301/ ''Blue printed cutaways,'' image file:023\199704328]</ref><ref>[http://snom.pastperfect-online.com/32879cgi/mweb.exe?request=record:id=3B8F861B-ABA6-490D-A5D1-273619261656;type=301/ ''Blue printed cutaways,'' image file:023\199704327]</ref> & Kansas legislator,<ref>[http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=685&REC=2/ ''Six Survivors of First Free State Legislature in Kansas,'' Topeka Daily Capital, Missouri's Digital Heritage, Secretary of State of Missouri.]</ref> [[Andrew Taylor Still]], [[Doctor of Medicine|MD]], [[DO]], founded the American School of Osteopathy (now the [[A.T. Still University]] College of Osteopathic Medicine) in [[Kirksville]], MO, as a reformation of the American medical system. This is the second university Dr. Still founded; he was also one of the founders of [[Baker University]] in [[Baldwin, Kansas]].  “But...when I asked the privilege of explaining Osteopathy in [[Baker University]] the doors of the structure I helped build were closed against me."<ref> [https://www.atsu.edu/museum/subscription/pdfs/still,%20a.t/andrewtaylorstillbio1908.pdf/ Still AT. ''Autobiography of A.T. Still,'' Kirksville, Missouri, 1908, p. 96-97.]</ref> A.T. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt, and treated effects rather than causes of disease.<ref>[http://www.atsu.edu/museum/journals/index.htm/ Still AT. ''The Philosophy and Mechanical Principles of Osteopathy.'' Kansas City, Mo: Hudson-Kimberly Publishing Co (1902), p. 9–20, 36, 185, 210, 270.] Log in - https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf </ref> “Baldwin, my old home was never very kind to me. It was there you know I lost my three children (due to meningitis) and decided that drugs were deficient in many things. I advocated bloodless surgery-that there was no efficacy in drugs and they laughed at me.”<ref>[http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=685&REC=2/ ''Osteopathy founded by Dr. Andrew Still at Baldwin,'' Topeka Daily Capital, December 7, 1907.]</ref><ref>[http://www.kshs.org/p/kansas-historical-markers/14999#d/ ''Baldwin, Historical marker – 1 mi E on Highway 56,'' Kansas State Historical Society & State Highway Commission, Kansas State Library.]</ref> Still demanded that treatments be shown to be efficacious, he said, "It has been the object of myself and also of my teachers to direct and be guided by the compass that points to nothing but demonstrative truth.”<ref>[https://www.atsu.edu/museum/subscription/pdfs/still,%20a.t/andrewtaylorstillbio1908.pdf/Still AT, ''Autobiography of A.T. Still,'' Kirksville, Missouri, 1908, p. 400.</ref>

Still believed that many of the medicines of his day were useless or harmful. The material medica (drugs) commonly included [[arsenic]], [[castor oil]], [[whiskey]], and [[opium]]. Osteopathic medicine was founded at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. In addition, unsanitary surgical practices often resulted in more deaths than cures. Dr. Still was in good company regarding his views of the material medica of the day. Sir William Osler, the father of modern medicine and a contemporary of Still’s, (although there is no evidence the two men ever met). <ref>[http://jaoa.org/article.aspx?articleid=2093135/  Calabrese LH. ''Sir William Osler Then & Now: Thoughts for the Osteopathic Profession,'' JAOA, 2005; 105(5):245-249.]</ref> Osler also advocated for the very limited use of drugs.<ref>[http://journals.sagepub.com/doi/pdf/10.1258/RSMSMJ.51.1.51/  Balint GP, Kean WF, BuchananWW. ''Sir William Osler (1849-1919): His Opinion of Modern Therapeutics,'' Scottish Medical Journal, 2006;50(1):51-53]</ref><ref>[ http://jaoa.org/article.aspx?articleid=2092227/ Littlejohn JM. ''Osteopathy an independent system co-extensive with the science and art of healing.'' 1901 (Historic reprint), JAOA, 2000;100(1):14.]</ref> He said, “One of the first duties of a physician is to educate the masses not to take medicine.”<ref>Bean RB. ''Sir William Osler: Aphorisms from his bedside teachings & writings,'' Charles C Thomas - Publisher, Springfield, IL, (1961) p.105</ref>Early osteopathic medical educators advocated using Osler’s Principles and Practice of Medicine, “the instructor therefore simply has to replace Osler’s drug nihilism by osteopathic procedure based upon the causative lesion and the thing is complete.”<ref>[http://www.atsu.edu/museum/journals/index.htm/ ''On the Choice of Textbooks in Osteopathic Schools,'' Journal of Osteopathy, January 1909, p. 22-23.]Login to access - https://www.atsu.edu/museum/subscription/pdfs/JO-1909/TheJournalofOsteopathyJanuary1909.pdf</ref> 
{{Quote box
|width = 25%
|align=left
|quote = "To find health should be the object of the doctor. Anyone can find disease."
|source = [[Andrew Taylor Still]], ''Philosophy of Osteopathy,'' 1899, page 28. 
}}

Dr. Still moved to Missouri, and in 1892, founded the American School of Osteopathy (now [[A.T. Still University]]), in [[Kirksville, MO]]. 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]].<ref>[http://www.atsu.edu/museum/journals/index.htm/ Still AT. ''Philosophy & Mechanical Principles of Osteopathy'' (1902), Hudson-Kimberley PCB Co. Kansas City, MO, p. 39-40.] Login to access – https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf/ </ref> “We expect to educate our students to a complete preparation, and to use all the time necessary in that preparation in surgery, obstetrics, and general practice…Qualified merit is the best thing a man can possibly possess. We want a full share of that.”<ref>[http://www.atsu.edu/museum/journals/index.htm/ Still AT. ''Philosophy & Mechanical Principles of Osteopathy'' (1902), Hudson-Kimberley PCB Co. Kansas City, MO, p. 23.] Login to access – https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf</ref>

The American School of Osteopathy was chartered under the laws of the state of Missouri in 1892 and appended October of 1894. <ref>[https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol4No21897June.pdf/ Potter W. ''Dr. Still and His Work,'' Journal of Osteopathy, June 1897, p. 92-95.]</ref> The charter specifically states. “The object...is to establish a College of Osteopathy, the design of which is to improve our present system of surgery, obstetrics, and treatment of diseases generally, and place the same on a more rational and scientific basis, and to impart information to the medical profession and to grant and confer such honors and degrees of are usually granted and conferred by reputable medical colleges…”<ref>https://www.atsu.edu/museum/subscription/pdfs/still,%20a.t/andrewtaylorstillbio1908.pdf/ Still AT. ''Autobiography of A.T. Still,'' Kirksville, Missouri, 1908, p. 142-147.</ref> Under the charter, ASO was entitled to award the MD degree to its graduates; however, Dr. Still wanted to issue a new degree representing a new philosophy of healing. 

He invented the name "osteopathy" to describe his new philosophy. He blended two Greek roots ''os'' for bone and ''pathology''<ref>American Heritage Dictionary</ref> for a study of the nature of disease and its causes, processes, development, and consequences – the anatomic or functional manifestations of disease – in order to communicate his original [[theory]] that [[disease]] and physiologic dysfunction were grounded in a disordered anatomy, beginning with the musculoskeletal system. Thus, by diagnosing, treating and restoring order to the system, he believed that physicians could treat a variety of diseases and spare patients the negative side-effects of drugs.<ref>[https://www.atsu.edu/museum/subscription/default.aspx/ Still AT. ''Osteopathy!'' Journal of Osteopathy, March 1901, p. 67-68.] Login to access -https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathy1901March.pdf/</ref>

“Like every other name given to a new science it does not include all the new science embraces, but indicates the germinal point from which the new science started. Osteopathy represents a new view of the science of therapeutics…Osteopathically, it means the discovery of the cause or causes of disease and the correction or removal of the cause or causes of disease…”<ref>[http://www.atsu.edu/museum/journals/index.htm/ Littlejohn JM. ''Osteopathy in line of apostolic succession with medicine,'' Journal of Osteopathy, February 1899, p. 423]</ref>

Still placed a strong emphasis on the study of anatomy and physiology. “For fear a student will not comprehend what I mean by the books pertaining to a complete knowledge of anatomy, I will give something of an approximate list as follows: Descriptive anatomy, by the very best and latest authors; demonstrative anatomy, human physiology, histology and chemistry…With correct knowledge of the form and functions of the body an all its parts, we are then prepared to know what is meant by a variation in a bone, muscle, ligament, or fiber or any part of the body, from the least atom to the greatest bone or muscle. By our mechanical skill, preceded by our intelligence in anatomy, we can detect and adjust both hard and soft substances of the system. By our knowledge of physiology we can comprehend the requirements of the circulations of the fluids of the body as to time, speed and quantity, in harmony with the demands of normal life.”<ref>[http://www.atsu.edu/museum/journals/index.htm/ Still AT. ''The Philosophy & Mechanical Principles of Osteopathy'' (1902), Hudson-Kimberley PCB Co. Kansas City, MO, p. 23.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf</ref>

==The States & Federal Government==
===State licensing of practice rights===

In the United States, laws regulating physician licenses are governed by the individual states. Both the [[American Osteopathic Association]] and the [[American Medical Association]] were heavily involved in influencing the legislative process.<ref>[http://coursesa.matrix.msu.edu/~hst425/readings/Berliner.htm/ Berliner HS. ''A Larger Perspective on the Flexner Report,'' International Journal of Health Services, 1975, 5:573-592.]</ref> In many states, the debate was long and protracted. The first state to pass legislation placing osteopathic medicine on “equal grounds with other schools of healing and treatment of the sick” was [[Vermont]]<ref>[https://www.atsu.edu/museum/subscription/default.aspx/ ''States which have recognized Osteopathy.'' Journal of Osteopathy. June 1898, p. 26.]Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol5No11898June.pdf </ref> in 1896.<ref>[http://www.osteopathic.org/inside-aoa/Education/students/Documents/tips-tactics-and-truths-student-guide.pdf/ ''Tips, Tactics & Truths: A guide to making the most of your osteopathic medical education,'' p. 2, AOA.]</ref> By 1973, DOs had full scope of medical practice rights in all 50 states and the District of Columbia.<ref>[http://history.osteopathic.org/laws.shtml/ ''Years States Passed Unlimited Practice Laws,'' History of Osteopathic Medicine Virtual Museum, American Osteopathic Association, Accessed April 4, 2011.]</ref> That same year, [[Michigan State University College of Osteopathic Medicine]], the first publically supported osteopathic medical school, graduated its first class.<ref>[http://history.osteopathic.org/educate.shtml/ ''Education Firmly Established,'' AOA, Accessed August 4, 2011.]</ref><ref>[http://www.com.msu.edu/osteomed/history.html/ ''Brief History of MSUCOM'']</ref>
 
===Federal recognition===
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. 

During the World War I, the AOA protested the fact that osteopathic physicians were not included in plans to expand the military medical corps as the war escalated. The Surgeon General of the Army, William C. Gorgas (AMA President 1909-1910),<ref>[http://www.ama-assn.org/ama/pub/about-ama/our-history.full-list-annual-meetings-presidents.page?/ ''Our History - Full list of Annual Meetings & Presidents,'' American Medical Association]</ref> was philosophically opposed to osteopathic medicine, despite osteopathic physicians passing the required medical exams.<ref>[http://www.jaoa.org/cgi/reprint/98/5/279?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Sword+and+the+scalpel+&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT/ Gevitz N. ''The Sword and the Scalpel – The osteopathic ‘war’ to enter the Military Medical Corps:1916-1966,'' JAOA,1998;98(5):279-286.]</ref> On June 30, 1941, President Franklin Delano Roosevelt  signed the Military Appropriations Act which recognized DOs in the nation’s military services, but excluded them from the armed forces medical corps.<ref>[http://www.osteopathic.org/inside-aoa/Education/students/Documents/tips-tactics-and-truths-student-guide.pdf/ ''Tips, Tactics & Truths: A guide to making the most of your osteopathic medical education,'' p. 2, American Osteopathic Association.]</ref> Public law 604, passed in 1946, gave the US President the authority to appoint osteopathic physicians as medical officers in the Navy. <ref>[http://www.do-online.org/TheDO/wp-content/uploads/pdf/pub_do0707military.pdf/ Greenwald B. ''DO Pioneers: The Tug of War,'' The DO Magazine, July 2007, p. 31.]</ref> On July 20, 1956, President Dwight D. Eisenhower, which allowed osteopathic physicians to become commissioned officers in the US Armed Services. This recognition opened the doors to training and service for DOs.<ref>[http://www.jaoa.org/cgi/reprint/101/5/299/ Patterson MM. ''The war years and government recognition of osteopathic physicians,'' JAOA, 2001; 101(5): 299.]</ref> On May 3, 1966 [[United States Secretary of Defense|Secretary of Defense]] [[Robert McNamara]] authorized the acceptance of DO's into all the medical military services on the same basis as MD's. The first DO to enlist and take the oath of office was Harry J. Walter, DO, on July 14, 1966; he was sworn in as a first lieutenant in the Air Force Medical Corps and would go on to receive the Air Force Commendation Medal for his service.<ref>[http://www.do-online.org/TheDO/wp-content/uploads/pdf/pub_do0707military.pdf/ Greenwald B. ''DO Pioneers: The Tug of War,'' The DO Magazine, July 2007, p. 30.]</ref> By 1996, an osteopathic physician, Lt. General [[Ronald R. Blanck|Ronald Blanck, DO]], MCP, 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>[http://www.defense.gov/advisories/advisory.aspx?advisoryid=1445/ ''Press Advisory No. 046-98,'' Lt. Gen. Ronald Blanck, the Army Surgeon General, to Discuss Medical Force Protection, US Department of Defense, March 03, 1998]</ref><ref>[http://armed-services.senate.gov/statemnt/2000/000302rb.pdf/ Posture statement by Lt. Gen. Ronald R Blanck, the Surgeon General, United States Army, before the Committee on Armed Services Subcommittee on Personnel, United States Senate, Second Session,106th Congress, 2 March 2000.]</ref>

The first osteopathic physician to reach flag rank in the [[United States Public Health Service]] Commissioned Corps was RADM Murray Goldstein, DO, MPH. He is also the first DO to serve as a Director for one of the [[National Institutes of Health]], specifically – the  [[National Institute of Neurological Disorders and Stroke]] (1982-1993).<ref>[http://nihrecord.od.nih.gov/newsletters/01_20_2004/retirees.htm/ NIH Record, January 20, 2004]</ref><ref>[http://news.msu.edu/story/2062/&topic_id=7&keyword_search=commencement&keyword_action=exact_phrase&perPage=25 MSU to recognize four with honorary degrees, ''Michigan State University News,'' April 20, 2000.]</ref> Dr. Goldstein would go on to serve as the Assistant Surgeon General of the [[United States Public Health Service]]. In 1997, RADM Joyce M. Johnson DO, MA, was named the Chief Medical Officer & Surgeon General of the United States Coast Guard; she is the first woman to attain flag rank with the USCG, and the first physician & first woman to serve on the board of trustees of the U.S. Coast Guard Academy.<ref>[https://www.msu.edu/unit/msuaa/magazine/w99/ ''Spartan Profiles: Joyce Johnson: Top Medic for the Coast Guard,'' MSU Alumni Magazine, Winter 1999, 16:(2)]</ref>  

====Accreditation recognition ====
1952: The AOA is recognized by the [[United States Department of Health, Education and Welfare]] as the accrediting body for osteopathic medical education. <ref>[http://history.osteopathic.org/educate.shtml/ ''Education Firmly Established,'' AOA, Accessed April 4, 2011.]</ref>

1966: [[Medicare]] accepts the AOA as an accrediting agency for osteopathic healthcare facilities. <ref>[https://www.osteopathic.org/inside-aoa/Education/students/Documents/tips-tactics-and-truths-student-guide.pdf/ ''Tips, Tactics & Truths: A guide to making the most of your osteopathic medical education,'' p. 3, American Osteopathic Association.]</ref> 

1967: The [[Council for Higher Education Accreditation]] (formerly the National Commission on Accrediting) recognizes the AOA as the accrediting agency for all facets of osteopathic medical education. <ref>[http://history.osteopathic.org/educate.shtml/ ''Education Firmly Established,'' AOA, Accessed April 4, 2011.]</ref>

==Osteopathic medicine vs. the medical establishment==

The new profession faced stiff opposition from the medical establishment at the time. The relationship of the osteopathic and allopathic medical professions was often "bitterly contentious" and involved "strong efforts" by the allopathic medicine to discredit other sects, including [[Doctor of Osteopathic Medicine|osteopathic]] medicine.<ref>[http://jama.ama-assn.org/content/XXXV/26/1681.2.extract?sid=90e64956-2b95-4f0e-b3a4-54225413c2b0/ ''Pretenders vs. Humbugs,'' JAMA 1900;XXXV(26):1681.]</ref> 

It was written in the August 1897 edition of the Journal of Osteopathy: “…For more than a century past, the Allopathic doctors of this country, under the plea of alleviating human suffering and regulating their own quacks, have dominated all of the state and national legislatures and monopolized the passage of laws touching the science of medicine. During all this time they have fought the enactment of any law that would interfere with the monopoly of the Allopathic school. Growing bolder with each victory, privilege after privilege has be wrung from the people until the whole has at last culminated in the formation of the greatest trust that now exists in the nation – the medical trust…The American Medical Association or Trust, is the name of the national organization. It has suborganizations in each state. They meet precisely as another business organization would meet, and devise ways and means of securing themselves against honest competition. Under plea that they are the only genuine alleviators of human suffering, they have secured the passage of laws in each state giving to themselves a monopoly in the art of healing, and this is effectually accomplished they fix the prices that the public must pay. In many states they have been so bold as to have the prices that the public must pay by law, as, for instance, in North Dakota, a physician is allowed one dollar for every mile traveled; and the law allows no exemption when it comes to the collection of these exorbitant fees. The doctor has the power to take the bed from under the invalid. Then to make this protection doubly sure, the trust has secured the passage of laws by which any citizen who fails or refuses to employ a physician in case of sickness can be criminally prosecuted is death occurs in the family. The employment of an “irregular” physician well not extenuate the supposed offense; unless a member of the trust be employed at his own exorbitant price a crime has been committed against the state! And yet all these privileges have been granted for the alleged protection of humanity! The farmer, the businessman, the laborer, and the lawyer are all compelled to meet the competition of the world, but the so-called regular physicians are not only given the exclusive right to practice healing, but in many states citizens are compelled to patronize them or suffer severe penalties, and the bills of drug doctors are practically guaranteed by statutory enactment. And all of this in free America!”<ref>[http://www.atsu.edu/museum/journals/index.htm/ Conger AL. ''The Great Medical Trust,'' Journal of Osteopathy, August 1897, p. 170-171.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol4No41897August.pdf/</ref>
{{Quote box
| width = 25%
| align=right
| quote = To ask a doctor's opinion of osteopathy is equivalent to going to Satan for information about Christianity."
| source = [[Mark Twain]], 1901
}}

[[Image:Twain1909.jpg|thumb|upright|left|Mark Twain was a vocal supporter of the early osteopathic movement.]]
One notable advocate for the fledgling movement was [[Mark Twain]].<ref>[https://www.atsu.edu/museum/journals/index.htm/ ''Mark Twain Likes Osteopathy,'' Journal of Osteopathy, March 1901, p.85] Login to access -  https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathy1901March.pdf/</ref><ref> [https://www.atsu.edu/museum/journals/index.htm/ ''Mark Twain Speaks for the Osteopaths,'' Journal of Osteopathy, April 1901, p.114-116.] Login for access -  https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathy1901April.pdf/</ref> Manipulative treatments had purportedly alleviated the symptoms of his daughter [[Jean Clemens|Jean's]] [[epilepsy]] as well as Twain's own [[chronic bronchitis]].<ref>[http://www.ncbi.nlm.nih.gov/pubmed/4582259/ Brashear MM. ''Dr. Still and Mark Twain,'' JAOA, 1973;73(9):67.]</ref><ref>Rasmussen RK. ''Mark Twain A to Z: Essential Reference to His Life & Writings,'' Facts on File Inc. (1995), p. 269.</ref> In 1901, he spoke before the Committee on Public Health of the New York General 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."<ref>[http://www.ncbi.nlm.nih.gov.pubmed/9005751/ Ober KP. ''The pre-Flexnerian reports: Mark Twain’s criticism of medicine in the United States,'' Annuals of Internal Medicine, 1997; 126(2):171-2]</ref><ref>[https://www.atsu.edu/museum/journals/index.htm/ ''Mark Twain Speaks for the Osteopaths,'' Journal of Osteopathy,  April 1901, p. 114-116.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathy1901April.pdf/</ref>

==Osteopathic Medicine & the American Medical Association==

At the end of the 19th century, there were several schools of medical thought in the US including homeopathy, eclectic, physio-medico, osteopathy, Thompsonians, etc. Up through the first half of the twentieth century, the policy of the American Medical Association was to label all other schools of medical thought,<ref>[http://coursesa.matrix.msu.edu/~hst425/readings/Berliner/ Berliner HS. ''A larger perspective on the Flexner report,'' International Journal of Health Services, 1975, 5:573-92.]</ref> including osteopathic medicine, as a [[cult]] and osteopaths, "cultist." 

:“A sectarian or cultist as applied to medicine is one who alleges to follow or in his practice follows a dogma, tenet or principle based on the authority of its promulgator to the exclusion of demonstration and scientific evidence.”<ref>''The Principles of Medical Ethics,'' American Medical Association, December 1954, p. 13-14.</ref>

Determined to establish and maintain its hegemony, the AMA position, since its founding in 1847, was always to declare its means and methods of medical practice “scientific”<ref>[http://jama.ama-assn.org/content/249/18/2475.full.pdf+html?sid=5df682d2-039c-466d-9eb3-075a0cb69dd7/ King LS. ''Medicine in the USA: Historical Vignettes XI. Medicine Seeks to Be "Scientific,"'' JAMA, 1983;249(18):2475-2479.]</ref>and to call everything else “quackery;” their members were “regular doctors” and they referred to any other sect as “irregulars.”<ref>[http://www.ama-assn.org/resources/doc/ethics/1847code.pdf/ ''1847 Code of Medical Ethics,'' p. 74, 118, AMA Website]</ref><ref>[http://coursesa.matrix.msu.edu/~hst425/readings/Berliner.htm/ Berliner HS. ''A Larger Perspective on the Flexner Report,'' International Journal of Health Services, 1975;5:573-592.]</ref> “Regular medicine, it was claimed, embodied science; the sects did not. The assertion proved strikingly irrelevant at the time, for large numbers of regular physicians were appallingly ignorant while large number of sectarians were amazingly successful in practice. The public had not been impressed by claims of science in medicine.”<ref>[http://jama.ama-assn.org/content/251/8/1079.full.pdf+html?sid=44831c0d-7570-4bb4-886e-8d9428d05a16/ King LS, ''Medicine in the USA: Historical Vignettes XX. The Flexner Report of 1910,'' JAMA, 1984;251(8):1079-1086.]</ref> The AMA declared it unethical for a medical physician to voluntarily associate with an osteopath or teach in an osteopathic medical school.<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=3c09395d-a9e0-4acc-8c52-818f56e9b9be/ ''Report of the Committee for the Study of Relations between Osteopathy & Medicine. Proceedings of the Atlantic City Meeting,'' JAMA, 1955;158(9):736-741.]</ref> Osteopathic beliefs, education and practice were misrepresented, mischaracterized, distorted and maligned in the Journal of The American Medical Association.<ref>[http://jama.ama-assn.org/content/XXIV/26/1020.1.full.pdf+html?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopath&searchid=1&FIRSTINDEX=50&resourcetype=HWCIT/ ''A Rival to Perkinsism.'' J Am Med Assoc, Jun 1895;XXIV:1020.]</ref><ref>[http://jama.ama-assn.org/content/XXXVII/14/918.1.full.pdf+html?sid=3339a176-cf88-45de-a891-43020c08496b/ ''Limit Osteopaths to What They Profess,'' JAMA, 1901;XXXVII(14):918.]</ref><ref>[http://jama.ama-assn.org/content/115/26/2321.full.pdf+html?sid=9d38325b-bf90-4ad2-b6d1-b2405f979156 ''Cults: Osteopaths,'' JAMA, 1940;115(26):2321-2374.]</ref><ref>[http://jama.ama-assn.org/content/XLII/14/910.full.pdf+html?sid=8ee042ae-a54f-4cd3-b6df-23209eb869ff/ ''Recognition of Osteopaths,'' JAMA, 1904;XLII(14):910-912.]</ref>

In 1900 the AMA, only represented about 7% of the US physician population.<ref>Burrows J. ''AMA – Voice of American Medicine,'' Johns Hopkins Press Baltimore, 1963.</ref> Its membership was unusual for in that many of its members were medical educators or affiliated with hospitals; many, if not most, had received post-graduate education in Europe, particularly Germany. “Because there were no scholarships at the time, the only people who could afford the European training were the wealthy. Their wealth brought them in close contact with the leaders of industry on a social basis as wll as on a professional basis…Because they were independently wealthy, they were able to involve themselves in extraneous issues such as licensure and educational reform and still survive financially. When new licensing laws started being passed in the 1890s, these physicians, by virtue of their financial ability to serve on boards and their stature as medical educators and researchers, gained seats on the licensing boards...(the AMA established a permanent Council on Medical Education in 1904. The Council surveyed the results of state licensing boards in the country and classified medical schools on the basis of the percentage of graduates passing these exams. The AMA, which by then had members on many of these boards, designed exams so that students trained in the scientific medical schools would fare better than students trained in other medical schools…”<ref>[http://coursesa.matrix.msu.edu/~hst425/readings/Berliner.htm/ Berliner HS. ''A Larger Perspective on the Flexner Report,'' International Journal of Health Services, 1975; 5:573-592.]</ref> It was in this competitive environment that osteopathic medicine had to compete for the right to practice medicine. 

In 1908, the first AMA report on the osteopathic medical education system was given by M. Clayton Thrush PhM, MD before the 59th Annual Session of the AMA, stating that “During recent years a number of cults or sects have sprung into prominence, the cardinal features of the majority being an alleged cure of diseased states by the employment of other means or agents than drugs…Conspicuous among these is a system called osteopathy, and during the past few years, because of attempts to secure legal recognition, it has come into sufficient prominence to attract the notice of the members of the medical profession and the laity throughout the United States, as its disciples can be found in almost every village and hamlet in this country…There are now thirty-eight states that have laws recognizing and regulating the practice of osteopathy, and the medical profession, as a whole, has been disgracefully apathetic and deserves no credit for permitting this official recognition without, most emphatic protest (p. 2135)…They claim to have had originally four terms of five months each, but this has recently been changed to three terms of five months each. The reason for this change has not been given. The total number of hours devoted to the complete course is about the same as the average medical school. They claim to teach everything the same as the regular schools except material medica, for which they substitute the principles of osteopathy (p. 2136)…The osteopath recognizes that disease may be due to toxic or poisonous compounds which may enter the system… in the case of an ingestion of a fatal dose, the osteopath would give the usual antidote and treat accordingly. They have a course in toxicology in their college course, claimed to be properly taught (p. 2137)…Bacteriology is alleged to be taught in every osteopathic school with the same exactness as in the best regular schools. The osteopath has always held to the germ theory as the cause of certain disease, but the osteopath does not use the same means to recover the health of the patient so infected, yet he recognizes that such conditions exist. The osteopath, emphasizing that disease is primarily of mechanical origin, holds, therefore, that germs are generally a secondary factor in the cause, and he believes that so long as the tissue of the body is healthy no germs can infect the body (p. 2137)…It is frequently stated that osteopaths condemn the use of drugs and are opposed to them. A few examples will prove the falsity of such statements… (p.2139)” <ref>[http://jama.ama-assn.org/content/LI/25/2135.full.pdf+html/ Thrush MC. ''Osteopathic versus Drug Treatment,(Read in the section on Pharmacology & Therapeutics of the American Medical Association, at the 59th Annual Section, Chicago, IL, June 1908),'' JAMA, 1908;LI(25):2135-2140.]</ref>

He admits his report is not unbiased. “I presented this paper primarily for three reasons: First, to show…what osteopathy really is (a popular cult – p. 2135) and what constitutes its important principles…Second, to show how dangerous it is. Every one in this room has been asked by a patient whether he should try osteopathy. Often these patients have a disease in which the methods used by osteopaths will do harm and may even cause death. Third, to plead for a one-board medical law…Each man who practices healing, no matter what his cult, should be required to pass the same medical examination and with the same preliminary requirements, etc…”<ref>[http://jama.ama-assn.org/content/LI/25/2135.full.pdf+html/ Thrush MC. ''Osteopathic versus Drug Treatment, (Read in the section on Pharmacology & Therapeutics of the American Medical Association, at the 59th Annual Section, Chicago, IL, June 1908),'' JAMA, 1908;LI(25):2135-2140.]</ref>

===1950s===

In 1952, John W. Cline (AMA President 1951-52)<ref>[http://www.ama-assn.org/ama/pub/about-ama/our-history.full-list-annual-meetings-presidents.page?/ ''Our History - Full list of Annual Meetings & Presidents,'' American Medical Association]</ref>was appointed as Chairman of the Committee for the Study of the Relations between Osteopathy & Medicine by the AMA Board of Trustees(BOT). In 1951, as the president of the AMA, Dr. Cline reported to the BOT that “the relations between medicine and osteopathy presented widespread problems in a majority of states to some degree.” In his remarks to the House of Delegates in June of 1952, the retiring president again called attention to the issue. “…Representatives of the AOA had informed the Committee…that the curriculums of the colleges of osteopathy consisted mainly of courses in medicine and surgery and that the quality of instruction in these colleges could be improved if more doctors of medicine were willing to teach in these colleges. The President further raised the question as to the validity of the classification of modern osteopathy as “cultist” healing.”<ref>[http://jama.ama-assn.org/content/152/9/827.full.pdf+html?sid=b428e440-dde4-4174-a370-570b7493eb89/ ''Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the New York Meeting – June 1-5, 1953,'' JAMA, 1953;152(8):734.]</ref>

The Committee surveyed state and county medical associations and the schools of osteopathic medicine and reported:

:Osteopathy has undergone a process of evolution that has brought it to a point of such similarity to medicine that no marked fundamental differences exist…The entrance requirements for schools of osteopathy and schools of medicine are identical. The curriculums have the same content, except for the inclusion of osteopathic theory, diagnosis, and treatment. The period of instruction in both instances is four years. The clock hours devoted to teaching basic sciences, medicine, and surgery are as great in schools of osteopathy. The level of instruction in basic sciences is demonstrated by the record of osteopathic candidates in examinations in these subjects. [88% of the MD and 84.5% of the DO candidates passed the 1952 state basic science examinations. (p. 737)]… Instruction in all fields of medicine and surgery has been given in some osteopathic schools for 40 years and formally in all osteopathic schools since 1940. Osteopathic teaching is integrated with these courses to some degree…the committee, after careful study and thoughtful consideration, is of the opinion that the teaching in osteopathic schools at the present time, and for some years past, does not constitute "cultist healing" as defined in our Principles of Medical Ethics and that this stigma should be removed. 

:…Doctors of osteopathy render medical care to millions of patients. The objectives of the American Medical Association and its responsibilities are to improve the health and medical care of the American people. The committee is of the opinion that these purposes would be served by making it possible for schools of osteopathy to draw on the services of doctors of medicine as teachers. We should assist improvement in the education of osteopathic physicians.<ref>[http://jama.ama-assn.org/content/152/9/827.full.pdf+html?sid=b428e440-dde4-4174-a370-570b7493eb89/ Report of the  Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the New York Meeting, JAMA, 1953;152(8):734-739.]</ref>

The AMA House of Delegates (HOD) deferred action on the report for 2 years; the principal objection was that it was based to a large extent on indirect information. The AMA Committee proposed to the AOA that it be permitted to conduct site inspections of the osteopathic colleges. Five of the six colleges accepted the proposal, with Philadelphia declining to participate.<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=08631c2f-cc77-49b8-93eb-7d49cdb20d79/ ''Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the Atlantic City,'' JAMA, 1955;158(9):737.]</ref>

Questionnaires patterned after those required of allopathic schools at the time, were distributed to all the participating osteopathic medical schools.

:The purpose was to provide essential basic information concerning organization, authority, administration, finances, facilities, and operation of the college; the organization, personnel, training, authority, and activities of the faculty; the curriculum content; the organization of departments, their objectives, methods of teaching, and equipment; the degree of interdepartmental coordination and cooperation; and details of library facilities and content…”<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=08631c2f-cc77-49b8-93eb-7d49cdb20d79/ ''Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the Atlantic City,'' JAMA, 1955:158(9):737.]</ref> 

:The Committee devoted an average of 14 man days to the study of each of the five colleges and was accorded complete freedom of investigation. The committee attended the classes it wished and had ample opportunity for private conversations with faculty members, students, interns, and residents. The committee was impressed by the frankness, serious purpose, and sincerity of the administrative officers and faculty. The criticisms of the college offered by the committee were accepted in excellent spirit. In most instances the administrative officers concurred in them and means of correcting deficiencies were discussed.<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=08631c2f-cc77-49b8-93eb-7d49cdb20d79/ ''Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the Atlantic City,'' JAMA, 1955; 158(9):736-741.]</ref>

The conclusions of the Committee were as follows:<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=08631c2f-cc77-49b8-93eb-7d49cdb20d79/ Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the Atlantic City, JAMA, 1955;158(9):741.]</ref> 

* Educational requirements for admission to colleges of osteopathy are identical to those of medical schools.
* Current curriculums in colleges of osteopathy include all subjects taught in present-day schools of medicine. In addition, there are courses dealing with the musculoskeletal system and manipulative therapy; there was no evidence that these courses interfered with the achievement of sound medical education.
* All osteopathic colleges face the handicap of insufficient financial support; more endowments and public support is desirable; the proportion of operating funds derived from tuition and student fees is far too high.
* The teaching of some basic science courses, such as anatomy, is well done. Material improvement is needed in others, i.e. pathology.
* In some instances the clinical facilities and clinical material do not justify the numbers of students enrolled. These handicaps are being partially overcome and, when achieved, current plans of expansion will improve the situation. The major deficiency in clinical instruction is the lack of trained clinical teachers. It is difficult for graduates of colleges of osteopathy to obtain (postgraduate) training which would fit them for teaching in clinical fields. These circumstances lead to an "inbred" faculty and impair teaching programs.
* The facts outlined in the three immediately preceding conclusions are recognized by the administrations, faculty members, and some students of the institutions visited. Considerable effort is being expended and some progress is being made in improving the situation. The administrative heads expressed a real desire for the addition of good doctors of medicine to their faculties and for the opportunity for selected young graduates to obtain sound graduate training in medical institutions...
* The teaching in present-day colleges of osteopathy does not constitute the teaching of "cultist" healing.
* The AMA is dedicated to the purpose of improving the health and medical welfare of the American people. The osteopathic profession supplies medical care to millions of Americans. In many areas, the only immediately available medical care is rendered by osteopaths. The American Medical Association must decide whether it will assist in improving the medical care rendered by doctors of osteopathy. The committee believes that the only constructive course which can be followed is to enlarge the medical educational opportunities of the students and graduates of schools of osteopathy by elimination of the classification of teaching in colleges of osteopathy as the teaching of "cultist" healing…
* The number of osteopathic physicians, the scope of licensure, the opportunities for practice, probably the level of practice, and the degree of interprofessional prejudices are extremely variable in different areas. It is obvious that no national policy governing the over-all relationship of doctors of medicine to doctors of osteopathy can be realistic. This should be a function of the several state medical associations and in certain states perhaps of the county medical societies.

Although the majority of the Committee essentially recommended a normalization of relations between the two groups for the good of the American public, one member of the Reference Committee on Medical Education & Hospitals, Milford Rouse, MD(AMA President 1967-1968),<ref>[http://www.ama-assn.org/ama/pub/about-ama/our-history.full-list-annual-meetings-presidents.page?/ ''Our History - Full list of Annual Meetings & Presidents,'' American Medical Association]</ref><ref>[http://www.time.com/time/magazine/article/0,9171,835949-2,00.html/ ''The Doctors: The AMA & Medicare,'' July 8, 1966.]</ref> submitted a minority committee report claiming an appreciable portion curriculum of colleges of osteopathy definitely did constitute the teaching of cultist healing, and is an index that the "osteopathic concept" still persists in current osteopathic practice. He could not in good conscience approve of MDs teaching in schools where cultism is part of the curriculum. He recommended to the House of Delegates:(1) That the report be received & filed, the Committee be thanked & discontinued. (2) If and when the AOA voluntarily abandons the osteopathic concept, with deletion of it from their college catalogs, they may approach the AMA BOT with a request for further discussion, then the said Trustees shall appoint another special committee. The minority report was adopted.<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=08631c2f-cc77-49b8-93eb-7d49cdb20d79/ ''Minority Report of the Reference Committee on Medical Education & Hospitals, Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the Atlantic City,'' JAMA, 1955;158(9):741-2.]</ref> 

===California 1961===
{{Main|Osteopathic Physicians and Surgeons of California v. California Medical Association}}
In the early 1960s in [[California]], the [[California Medical Association]] (CMA) and the [[American Medical Association]] (AMA) sensing increased competition from osteopathic medicine, attempted to assimilate the osteopathic medical profession and end the practice of osteopathic medicine in the state.<ref>[http://www.jaoa.org/cgi/reprint/101/6/354/ Northup GW. ''Signifying what? Signifying nothing (reprint May 1961)'', JAOA, 2001; 101(6):354-355]</ref> It seems the AMA and CMA managed to convince the leadership of the California Osteopathic Association that this would benefit them; however, this would later prove untrue.<ref>[http://www.jaoa.org/cgi/reprint/101/6/350?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=california+incident&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT/ Patterson MM. ''The California Incident,'' JAOA, 2001; 101(6):350.]</ref> In May of 1961, the CMA and COA signed a merger agreement.<ref>[http://history.osteopathic.org/reccalif.shtml/ ''Osteopathic Profession Fights for Recognition in California,'' AOA, Accessed April 4, 2011.]</ref> In 1962, Proposition 22, a statewide ballot initiative in [[California]], was passed. It “continues (the) Board of Osteopathic Examiners with (the) power to enforce certain provisions of the Medical Practice Act as to osteopaths. Provides that qualified osteopaths who elect to designate themselves “M.D.” will be subject to the jurisdiction of the Board of Medical Examiners. Grants Legislature the power to amend the Osteopathic Initiative Act of 1922 and repeal that act and transfer functions to Board of Medical Examiners when there are 40 or less licensed osteopaths.”<ref>[http://traynor.uchastings.edu/ballot_pdf/1962.pdf/ ''Amendment of Osteopathic Initiative Act.'' Submitted by Legislature. Propositions & Proposed Laws, General Election November 6, 1962]</ref> Immediately following, the AMA’s Council on Medical Education & Hospitals re-accredited the former College of Osteopathic Physicians & Surgeons as California School of Medicine (now the [[University of California, Irvine School of Medicine]]), an MD medical school.<ref>[http://www.som.uci.edu/historicalTimeline.html/ UC Irvine School of Medicine Historical Timeline]</ref> Grace Bell, dean of the osteopathic school and professor of biochemistry, was issued the first MD degree from the “new” school on March 7, 1962 and technically becomes its first dean. She is one of the few women in history to be the dean of both an osteopathic and allopathic medical school.<ref>[http://www.som.uci.edu/historicalTimeline.html/ UC Irvine School of Medicine Historical Timeline]</ref> The graduating class of 1962 was issued an MD degree. The “new” California School of Medicine issued [[Doctor of Medicine|MD]] degrees to all [[DO]]s in the state of California. By attending 12 Saturday classes and paying $65, a doctor of osteopathy (DO) could obtain an MD degree; 86 percent of the DO's in the state (out of a total of about 2000) chose to do so.<ref>[http://www.nejm.org/doi/full/10.1056/NEJM199911043411910/ Howell JD. ''The Paradox of Osteopathy,'' N Engl J Med, 1999;341:1465-1468.]</ref>However, these MD degrees were not recognized outside the state.<ref>[http://history.osteopathic.org/reccalif.shtml/ ''Osteopathic Profession Fights for Recognition in California,'' AOA, Accessed April 4, 2011.]</ref> It also effectively placed a ban on issuing new physician licenses to DO's moving to California from other states. “…the California Medical Association did not integrate them into the medical society, but instead isolated (try Ghetto-ized) them into a single "District" society that was statewide and contained all, and only, former DOs—thereby limiting their possible influence in any important matters. It was no longer, "Oh, those DOs," it was "Oh, that's just District X talking."<ref>[http://www.jaoa.org/cgi/content/full/111/2/124/ Melnick, A. ''Communication by degrees,'' JAOA, 2011;111(2):124-125.]</ref>

What initially appeared to be a defeat for the profession proved to be a catalyst for full licensure in all 50 states. Because the conversion of the medical school took place with few curricular changes and no real additional training for DOs, by deduction, osteopathic medicine was equivalent to allopathic medicine.<ref>[http://history.osteopathic.org/reccalif.shtml/ ''Osteopathic Profession Fights for Recognition in California,'' AOA, Accessed April 4, 2011.]</ref><ref>[http://www.jaoa.org/cgi/reprint/101/6/352T/ Northup GW. ''Sixty-five pieces of silver,'' JAOA, 2001(reprint March 1962);101(6):352- 353.] The rationale given by Dr. Northup would prove true and facilitated recognition of DOs into the military.</ref>

On March 19, 1974, after protest and lobbying by influential and prominent DO's in the state and the AOA, the [[California Supreme Court]] overturned Proposition 22 [[Osteopathic Physicians and Surgeons of California v. California Medical Association]], and it was determined that licensing of DO's in the state must be resumed.<ref>[http://scocal.stanford.edu/opinion/damico-v-board-medical-examiners-32955/ ''D’Amico v. Board of Examiners,'' 11Cal3d 1 (Sac. No. 7976. Supreme Court of California; March 19, 1974]</ref><ref>[http://history.osteopathic.org/reccalif.shtml/ ''Osteopathic Profession Fights for Recognition in California,'' AOA, Accessed August 4, 2011.]</ref> In 1977, the [[College of Osteopathic Medicine of the Pacific]] (now part of [[Western University of the Health Sciences]]) was founded in Pomona, CA. 


===Significant developments between the professions===

:1961: The AMA House of Delegates (HOD)  states it is the prerogative of the state medical associations to determine if an individual DO in their jurisdiction bases his practice on scientific principles. If so, voluntary professional associations between the DO & MDs would not be unethical.<ref>[http://jama.ama-assn.org/content/195/10/283.full.pdf/ Holman EJ. ''Osteopathy & the Law,'' JAMA 1966, 195(10), p. 284.]</ref><ref>[http://jama.ama-assn.org/cgi/reprint/177/11/779?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopath&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT/ ''Osteopaths vs. Osteopathy,'' JAMA, 1961;177(11):779.]</ref>

:1966: The AMA Council on Medical Education states that “osteopaths who do not hold the MD degree may serve on hospital staffs…as long as they are not appointed to the ‘teaching staffs’ of such hospitals.” <ref>[http://jama.ama-assn.org/content/195/10/283.full.pdf/ Holman EJ. ''Osteopathy & the Law,'' JAMA, 1966;195(10):284.]</ref>

:1969: The AMA HOD approved a measure allowing qualified osteopathic physicians as 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]]. Six specialty boards declared their intent to accept DOs who have completed AMA approved internships and residencies for board certification. Qualified osteopathic physicians are now eligible for approved residencies in pediatrics, pathology, radiology, internal medicine, preventive medicine, and physical medicine & rehabilitation.<ref> [http://jama.ama-assn.org/content/211/7/1177.2.full.pdf+html?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopathic&searchid=1&FIRSTINDEX=20&resourcetype=HWCIT/ ''AMA Services for Osteopathic Physicians,'' JAMA, 1970; 211(7):1177-1178.]</ref><ref>[http://jama.ama-assn.org/content/209/1/90.full.pdf+html?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopath&searchid=1&FIRSTINDEX=30&resourcetype=HWCIT/ Nunemaker JC. ''Graduate Education,'' JAMA, 1969;209(1):90-93.]</ref> 

:1970: The AOA HOD approves a policy allowing DOs to train in the ACGME system. <ref>[http://www.osteopathic.org/inside-aoa/Education/students/Documents/tips-tactics-and-truths-student-guide.pdf/ ''Tips, Tactics & Truths: A guide to making the most of your osteopathic medical education,'' p. 2, American Osteopathic Association.]</ref> 

:1970: Dwight L. Wilbur, MD (AMA President 1968-1969) sponsored a measure in the AMA's HOD permitting the AMA Board of Trustees' plan for the merger of DO & MD professions. “As further evidence of its intent to ‘provide avenues whereby qualified osteopaths may be assimilated into the mainstream of medicine,’ two additional AMA services have been opened to osteopaths. Effective immediately, the AMA Physicians Placement Service and the AMA Classified Advertising Service are making their resources available to qualified doctors of osteopathy who hold an unrestricted license in the states in which they intend to practice. Guidelines have been adopted to accommodate the inclusion of osteopathic physicians in these services.”<ref>[http://jama.ama-assn.org/content/211/7/1177.2.full.pdf+html?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopathic&searchid=1&FIRSTINDEX=20&resourcetype=HWCIT/ ''AMA Services for Osteopathic Physicians,'' JAMA, 1970;211(7):1177-1178.]</ref>

==Current status==

===Professional relations with the allopathic (MD) profession===

Recent years have seen an increasingly cooperative climate between the DO and MD professions.<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-620.994+/ ''D-620.994 Increased Collaboration between the AMA & AOA,'' AMA Policy, November 2010]</ref> The AOA and AMA each have a delegate’s seat at the other’s House of Delegates.<ref>[https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fBnGnC%2fB-2.17.HTM/ ''B-2.17 Other Delegates,'' AMA Policy, November 2010]</ref> It is common for both groups to work together on issues affecting medical students<ref>[http://search0.ama-assn.org/search/pfonline/?query=H-295.892+/ ''H-295.892 Potential Implications of Attending Non-LCME/AOA Accredited Medical Education Programs,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.933+/ ''D-295.933 Transparency in Medical Schools’ Utilization of Funds from Tuition & Fee Increases,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.944+/ ''D-295.944 Current & Future Availability of Resources to Support the Clinical Education of Medical Students,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.950+/ ''D-295.950 Equal Fees for Osteopathic & Allopathic Medical Students,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.950+&chkALL=ALL/ ''D-295.950 Equal Fees for Osteopathic & Allopathic Students,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-295.876&chkALL=ALL/ ''H-295.876 Equal Fees for Osteopathic & Allopathic Medical Students,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=B-7.30+&chkALL=ALL/ B-7.30 Medical Student Section, AMA Policy, November 2010]</ref> and physicians,<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-405.989+&chkALL=ALL/ ''D-405.989 Definition of a Physician,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-405.991+&chkALL=ALL/ ''D-405.991 Clarification of the Title “Doctor in the Hospital Environment,”'' AMA Policy, November 2010]</ref> particularly on issues regarding quality of education,<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.320+&chkALL=ALL/ ''D-295.320 Factors Affecting the Availability of Clinical Training Sites for Medical Student Education,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.931+&chkALL=ALL/ ''D-295.931 Update on the Availability of Clinical Training Sites for Medical Student Education,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.318+&chkALL=ALL/ ''D-295.318 Competency Based Portfolio Assessment of Medical Students,'' AMA Policy, November 2010]</ref> residency training,<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-310.955+&chkALL=ALL/ ''D-310.955 Resident/Fellows Duty Hours,'' Quality of Physician Training & Patient Safety, AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-310.962+&chkALL=ALL/ ''D-310.962 Evaluation of Increasing Resident Review Committee Requirements,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-310.965+&chkALL=ALL/ ''D-310.965 Credentialing Material: Timely Submission by Residency & Fellowship Programs,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-310.977+&chkALL=ALL/ ''D-310.977 National Resident Matching Program Reform,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-255.974+&chkALL=ALL/ ''H-255.974 Preservation of Opportunities for US Graduates & International Medical Graduates Already Legally Present in the US,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-310.916+&chkALL=ALL/ ''H-310.916 Funding to Support Training of the Healthcare Workforce,'' AMA Policy, November 2010]</ref>  licensing exams,<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-275.985+&chkALL=ALL/ ''D-275.985 Clinical Sills Assessment Exam and the College of Osteopathic Medical Licensing Exam – Physical Exam Implementation,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.939+&chkALL=ALL/ ''D-295.939 Independent Regulation of Physician Licensing Exams,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.965+&chkALL=ALL/ ''D-295.965 Clinical Skills Assessment as part of Medical School Standards,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-275.929+&chkALL=ALL/ ''H-275.929 Additions to the USMLE & COMLEX Examination,'' AMA Policy, November 2010]</ref> licensure,<ref>[http://search0.ama-assn.org/search/pfonline/?query=H-275.934&chkALL=ALL/ ''H-275.934 Alternatives to the Federation of State Medical Board Recommendations on Licensure,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-275.923&chkALL=ALL/ ''H-275.923 Maintenance of Certification/ Maintenance of Licensure,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-275.924&chkALL=ALL/ ''H-275.924 Maintenance of Certification,'' AMA Policy, November 2010]</ref> specialty board exams,<ref>[http://search0.ama-assn.org/search/pfonline/?query=H-275.944+&chkALL=ALL/ ''H-275.944 Board Certification & Discrimination,'' AMA Policy, November 2010]</ref> continuing medical education,<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-300.980+&chkALL=ALL/ ''D-300.980 Opposition to Increased CME Provider Fees,'' AMA Policy, November 2010]</ref> healthcare delivery, <ref>[http://search0.ama-assn.org/search/pfonline/?query=H-475.984+&chkALL=ALL/ ''H-475.984 Office Based Surgery Regulation,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-280.950+&chkALL=ALL/ ''H-280.950 Medicare’s 3-Day Hospital Stay Requirement,'' AMA Policy, November 2010]</ref> public health<ref>[http://search0.ama-assn.org/search/pfonline/?query=+H-410.954+&chkALL=ALL/ ''H-410.954 Support an Independent Clinical Practice Guideline Development Process,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-475.986+&chkALL=ALL/ ''H-475.986 Surgical Assistants other than Licensed Physicians,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-470.971+&chkALL=ALL/ ''H-470.971 Athletic Participation Exams for Adolescents,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-200.982+&chkALL=ALL/ ''H-200.982 Significant Problem of Access to Healthcare in Rural & Urban Underserved Areas,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=D-515.985+&chkALL=ALL/ ''D-515.985 Elder Mistreatment,'' AMA Policy, November 2010]</ref> legal<ref>[http://search0.ama-assn.org/search/pfonline/?query=H-265.994+&chkALL=ALL/ ''H-265.994 Expert Witness Testimony,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-435.951+&chkALL=ALL/ ''H-435.951 Health Court Principles,'' AMA Policy, November 2010]</ref> and other professional issues.<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-360.994+&chkALL=ALL/ ''D-360.994 State Legislative Response to NBME Practice of Using USMLE Step 3 Physician Licensing Exam Questions for Doctors of Nursing Practice Certification,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=G-635.042+&chkALL=ALL/ ''G-635.042 Model Bylaws for State & Component Societies,'' AMA Policy, November 2010]</ref><ref>[http://search0.ama-assn.org/search/pfonline/?query=H-295.995+&chkALL=ALL/ ''H-295.995 Recommendations for the Future Direction of Medical Education,'' AMA Policy, November 2010]</ref>

In 2005, during his tenure as president of the [[American Association of Medical Colleges]], Jordan Cohen described a climate of cooperation between DO and MD practitioners: “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>Cohen, Jordan. A Word from the President: "Filling the Workforce Gap." AAMC Reporter: April 2005.</ref>

===International practice rights===

Currently, US-trained DO's have been recognized with full scope of medical practice rights in over 50 countries. The American Osteopathic Association has assigned responsibility for international activities to the Bureau on International Osteopathic Medical Education and Affairs (BIOMEA), which was founded in 1998.<ref>[http://www.osteopathic.org/inside-aoa/development/internationl-licensure/Pages/international-osteopathic-medicine.aspx/ ''International Osteopathic Medicine,'' American Osteopathic Association]</ref>

BIOMEA monitors the global licensing and registration practices of regulating authorities around the globe, as it affects medical education and advancing the recognition of US- trained DOs. BIOMEA works with various international non-governmental organizations, such as the International Association of Medical Regulating Authorities (IAMRA),<ref>[http://www.iamra.com/memberlist.asp/ International Association of Regulatory Authorities Website]</ref> the [[World Health Organization]] (WHO), the [[Pan American Health Organization]] (PAHO) as well as other groups.<ref>[http://www.osteopathic.org/inside-aoa/development/internationl-licensure/Documents/aoa-international-organizations.pdf/ ''AOA-Involved International Organizations,'' AOA]</ref> In addition, BIOMEA works with US-trained DOs wishing to pursue licensure abroad, supplying information about the profession to the appropriate authorities. The Bureau is also involved in coordinating the international activities of the colleges of osteopathic medicine and specialty colleges. Every year, since 1999, BIOMEA has held an International Seminar at the AOA’s annual Osteopathic Medical Conference & Exposition; updates on current activities and global health research are given. World renown<ref>[http://www.nih.gov/news/health/jul2010/niaid-08a.htm/ ''NIH Funds 10 International Centers of Excellence for Malaria Research,'' NIH News, July 8, 2010]</ref> malaria researcher, Terrie Taylor DO,<ref>[http://blantyremalariaproject.org/testttmalawi/home/ ''Blantyre Malaria Project,'' Queen Elizabeth Central Hospital, Malawi]</ref><ref>[http://news.msu.edu/story/8048/ Research team awarded $9.1 million to battle malaria in Malawi, Michigan State University]</ref><ref>[http://www.niaid.nih.gov/topics/malaria/research/pages/cerebralmalaria.aspx/ ''MRI and Eye Exams Help Doctors in Malawi Diagnose and Treat Children with Cerebral Malaria,'' National Institute of Allergy & Infectious Diseases, National Institutes of Health]</ref>spoke at the 2010 seminar.<ref>[http://www.osteopathic.org/inside-aoa/development/internationl-licensure/Pages/biomea-seminar-2010.aspx/) 12th Annual International Seminar, “Global Health & Osteopathic Challenges,” Bureau on International Osteopathic Medical Education and Affairs (BIOMEA)/OMED 2010 Unified Convention, Oct. 24, 2010, San Francisco, CA.]</ref>

The AOA is strengthening its efforts to work for global osteopathic unity. In the past decade, there has been an increasing need for the osteopathic medical profession to develop an alliance to promote activities of common interest and concern for both US-trained and internationally-trained practitioners.<ref>[http://www.jaoa.org/cgi/reprint/100/5/282 Smith DA. ''Opportunities for the osteopathic medical profession to pursue worldwide acclaim and recognition,'' JAOA, 2000;100(5):282, 329.]</ref> In response, the AOA helped to form the Osteopathic International Alliance (OIA). The OIA represents more than 65,000 osteopathic practitioners around the world and has more than 35 organizational members from a dozen countries.<ref>[http://www.oialliance.org/ Osteopathic International Alliance website]</ref> 

The procedure by which countries grant licensure to foreign physicians varies widely. There are two issues to be considered, one has to do with practice rights, the other with immigration/visas and workforce needs. Immigration issues will not be discussed here. Many countries recognize US-trained MDs for licensure, granting successful applicants "unlimited" practice rights. The AOA has lobbied various national regulatory authorities as its members have increasingly sought to practice abroad. In 2005, after one year of deliberations, the [[General Medical Council of Great Britain]] announced that US-trained DO's will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an [[osteopathic physician]] and an [[osteopath]]."<ref>[http://www.osteopathic.org/osteopathic-health/about-dos/dos-around-the-world/Pages/default.aspx/  ''DO's around the World.'']</ref> The [[American Medical Student Association]], which has student chapters at many of the colleges of osteopathic medicine,<ref>[http://www.amsa.org/AMSA/Libraries/Exec_Docs/CBIA2010.sflb.ashx/ ''ASMA Constitution & Bylaws,'' p. 1-2, 43, 44-49, 54]</ref> strongly advocates for the international practice rights of US-trained DOs as "equal to that" of MD qualified physicians.<ref>[http://www.amsa.org/AMSA/Libraries/Exec_Docs/PPP2010.sflb.ashx/ ''2010 AMSA Preamble, Principles & Purposes, Principles regarding Osteopathic Medicine,'' American Medical Students Association, p. 128.]</ref>
{{further Information [[Doctor of Osteopathic Medicine]]: International Practice Rights}}

==Criticisms==

===For-profit medical education===
The accreditation of [[Rocky Vista University College of Osteopathic Medicine]] (RVUCOM), the nation’s only for-profit medical school, has generated controversy before the school held its first class. <ref> [http://www.ama-assn.org/amednews/2007/10/01/prsc1001.htm/ Croasdale M. ''First for-profit med school nears approval,'' American Medical News. 1 Oct 2007]</ref> RVUCOM currently has provisional accreditation through the [[American Osteopathic Association]]’s (AOA) [[Commission on Osteopathic College Accreditation]] (COCA)<ref>[http://www.aacom.org/resources/bookstore/cib/Documents/2012cib/2012cib-whole.pdf/ ''2012 Osteopathic Medical College Information Book,'' AACOM, p. 3]</ref> and the Colorado Commission on Higher Education.<ref>[http://highered.colorado.gov/Academics/Colleges/privateaccredited.asp/ ''Private Accredited Institutions,'' Colorado Commission on Higher Education]</ref> Critics claim the for-profit school "erodes [the]creditability" of osteopathic medical accreditation.<ref>[http://www.jaoa.org/cgi/content/full/107/7/246-b/ Mychaskiw G. ''COM Accreditation: the Flexner Report Revisited,'' JAOA, 2007;107(7):246-7; 277.]</ref> The [[Liaison Committee on Medical Education]], which accredits the MD-granting US medical schools, states that a medical school "should be, or be part of, a not-for-profit institution."<ref>[http://www.lcme.org/functions2008jun.pdf ''Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree,'' June 2008, Liaison Committee on Medical Education]</ref> 

RVUCOM officials insist the for-profit status of the school will not compromise the integrity of its educational mission.<ref>[http://www.jaoa.org/cgi/content/full/107/10/426/ Martin RB. ''RVUCOM: Striving to Meet the Needs of the Osteopathic Medical Profession,'' JAOA, 2007:107(10):426-8.]</ref><ref>[http://www.jaoa.org/cgi/reprint/108/8/366/ Mychaskiw G. ''Dangers of For-Profit Education: More Than Just Words,'' JAOA, 2008;108(8):366-458.]</ref><ref>[http://www.jaoa.org/cgi/reprint/108/8/366/ Martin RB, Ajluni PB. ''Responses,'' JAOA, 2008;108(8):458-461.]</ref> Peter B. Ajluni, DO, orthopedic surgeon and AOA president (2007-2008) responded by saying:  

:I caution against a priori condemnation of an institution just because of its tax status.<ref>[http://online.barrons.com/article/SB124908669502998405.html/ Blumenthal RG. ''The IRS’ New Target College Endowment,'' August 3, 2009, Barron’s Online]</ref><ref>[http://www.wbur.org/2009/05/12/harvard-future/ Brady-Myerov M. ''As Endowment Tumbles, Harvard Struggles To Preserve Mission,'' WBUR Boston, May 12, 2009]</ref><ref>[http://www.guardian.co.uk/education/2009/mar/10/harvard-endowment-financial-reserves/ Smith H. ''The Midas Touch eludes Harvard,'' The Guardian Newspaper, March 10, 2009]</ref><ref>[http://www.thecrimson.com/article/2009/9/10/harvard-endowment-largest-in-higher-education/ Zhu PF. ''Harvard Endowment, Largest in Higher Education, Plummets by 27%,'' The Harvard Crimson, September 10, 2009.]</ref> There are many socially minded for-profit companies that contribute time, resources, and profits to their communities.<ref>[http://www.forbes.com/2005/11/11/charities-corporations-giving-cx_lm_1114charity.html/ Moyer L. ''The most charitable companies,'' Forbes.com (serial online), November 2005.]</ref> Conversely, the US Congress is now chastising many nonprofit hospitals for not engaging in charitable missions.<ref>[http://www.nytimes.com/2006/03/19/politics/19health.html?pagewanted=print/ Pear R. ''Nonprofit hospitals face scrutiny over practices,'' New York Times, March 19, 2006]</ref> I believe it is the leadership of an organization—for-profit or nonprofit—that determines whether an institution has a larger social mission. Rest assured that I have no support for Caribbean and other offshore schools that do not have the accreditation status or the missions that COMs in the United States now have. And I will strongly oppose any Caribbean school setting up a "DO diploma mill.” As the current AOA president, I will certainly advocate only for the best for the osteopathic medical profession. I encourage AOA members to inform me of anything they believe indicates that RVUCOM—or any other COM—is not meeting its responsibility to osteopathic medicine's mission.<ref>[http://www.jaoa.org/cgi/content/full/107/10/425/ Ajluni PB. ''Nonprofit and For-Profit COMs: Investing in the Future of Osteopathic Medicine,'' JAOA, 2007;107(10):425-6.] </ref>

The AOA will be monitoring the quality of student produced via COCA. The AMA has stated “…in collaboration with the Association of American Medical Colleges (AAMC), the Liaison Committee on Medical Education (LCME), and the Commission on Osteopathic College Accreditation (COCA), (it) will study new and emerging models of medical school organization and governance, including for-profit models and how medical school accreditation standards can protect the quality and integrity of the education…”<ref>[http://search0.ama-assn.org/search/pfonline/?query=D-295.323+&chkALL=ALL/ ''D-295.323 Creation of Domestic For-Profit Medical Schools'']</ref> The first RVUCOM class is set to graduate in the Spring of 2011; time will tell how its graduates perform on standardized board exams.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/01000/A_For_Profit_Medical_School.4.aspx/ ''A For-Profit Medical School,'' Academic Medicine, 2009;84(1):5.]</ref>

===Use of Osteopathic Manipulative Treatment (OMT)===
{{Main|Osteopathic manipulative medicine}}

[[Image:Medical School.jpg|thumb|A physician demonstrates an [[Osteopathic Manipulative Medicine|OMM]] technique to medical students at an osteopathic medical school.]]

Within the osteopathic medical curriculum, osteopathic manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. However, a 2001 study of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients.<ref>[http://www.ncbi.nlm.nih.gov/pubmed/11500286/ Johnson SM, Kurtz ME. ''Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession,'' Academic Medicine, 2001;76(8):821-8.]</ref> The number of DO's who report consistently prescribing and performing manipulative treatment has been falling since the 1950s. Interestingly, the AMA’s 1955 report to the HOD stated “The use of manipulative therapy is decreasing in colleges of osteopathy and is increasing in the orthopedic and physiatry departments of medical schools.”<ref>[http://jama.ama-assn.org/content/158/9/735.full.pdf+html?sid=08631c2f-cc77-49b8-93eb-7d49cdb20d79/ ''Report of the Committee for the Study of the Relations between Osteopathy & Medicine, Proceedings of the Atlantic City,'' JAMA, 1955;158(9):740.]</ref> 

The reasons for the decline are many and varied among osteopathic medical specialists. The greatest usage of OMT is still among family practitioners. In one large study, “Ninety-six percent of the osteopathic physicians…perceived OMT as an efficacious treatment modality, but varied in the extent to which they would prefer to use various treatments…The degree to which practitioners use various techniques may be influenced by many organizational factors, including the educational continuum to which they have been exposed, time available for treating patients requiring OMT, physically and philosophically supportive facilities for OMT, and reasonable reimbursement for the time and effort to provide OMT for selected patients. However, data from this study suggest that the physician’s sense of competence and comfort level with his or her own abilities may be a key factor in determining whether OMT is the treatment of choice as opposed to nonmanipulative options.”<ref>[http://www.jaoa.org/cgi/reprint/103/5/219 ''Osteopathic Manipulative Treatment Techniques Preferred by Contemporary Osteopathic Physicians,'' JAOA, 2003;103(5):223.]</ref> There are concerns in the profession that with about half of osteopathic graduates entering ACGME residency programs, physicians will lose their proficiency in OMT. Innovative programs, such as that of Brown University, have attempted to compensate for this.<ref>[http://www.jaoa.org/cgi/content/full/108/8/404/ Rubeor A, Nothnagle M, Taylor JS. ''Introducing Osteopathic Medical Education in an Allopathic Residency,'' JAOA, 2008;108(8):404-408.]</ref><ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729220/pdf/wjem-10-184.pdf/ Roberge RJ, Roberge MR. ''Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department,'' Western Journal of Emergency Medicine, 2009;10(3):184-189.]</ref>

One area which has been implicated, but not been formally studied regarding the decline in OMT usage among DOs in practice, is the role of reimbursement changes.<ref>[http://www.jaoa.org/cgi/content/full/109/8/409/ Snider KT, Jorgenson DJ. ''Billing and Coding for Osteopathic Manipulative Treatment,'' JAOA 2009; 109(8):409-413.]</ref> Only in the last several years could a DO charge for both an office visit (Evaluation & Management services) and use a procedure (CPT) code when performing OMT; previously, it was bundled.<ref>[http://www.jaoa.org/cgi/reprint/109/11/570/ Snider KT, Doss YL. ''Billing & Coding for OMT,'' JAOA 2009;109(11):570]</ref> "Medical insurance bundling is the process by which payers group separately identifiable charges, as defined by CPT, and then pay for the "bundled" group at a lower rate than the sum of the individual charges." In this case, it was just considered as part of the office visit.<ref>[http://www.jaoa.org/cgi/content/full/109/8/409/ Snider KT, Jorgenson DJ. ''Billing and Coding for Osteopathic Manipulative Treatment,'' JAOA 2009;109(8):409-413.]</ref> If a physician was not getting paid for his/her services,<ref>[http://www.jaoa.org/cgi/reprint/101/9/493/ Fettig LL. ''Has our profession become
its own worst enemy?'' JAOA, 2001;101(9):492.]</ref> it was easier to write a prescription for medication or PT<ref>[http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102273769.html/ Freburger J, Holmes GM, Carey TS. ''Physicians' Referral to Physical Therapy: A Comparison of Primary Care and Orthopedic Physicians' Management of Musculoskeletal Conditions,'' Abstr Acad Health Serv Res Health Policy Meet, 2002;19:21.]</ref> or give an injection (if indicated - the latter of which would be reimbursed as a procedure), rather than take time to give OMT which wasn’t reimbursed. This has been rectified with regard to Medicare and Medicaid, as long as office notes are properly documented. However, some insurers will automatically flag such claims for denial. Although usually rectified on appeal, it makes the billing process more onerous.  Confusion has also arisen among claims processors at insurance companies because OMT an unlimited benefit under health plans, whereas chiropractic or physical therapy are limited to a specific number of visits annually.<ref>[http://www.jaoa.org/cgi/content/full/109/8/409/ Snider KT, Jorgenson DJ. ''Billing and Coding for Osteopathic Manipulative Treatment,'' JAOA, 2009;109(8):409-413.]</ref> This is because the decision to utilize OMT is made by the physician after obtaining a current history & physical examination of the patient on a visit by visit basis.<ref>[http://www.osteopathic.org/inside-aoa/development/practice-mgt/practice-management-notes/Pages/billing-for-omt.aspx/ ''Billing for OMT with E/M: When should they be billed together?,'' American Osteopathic Association Website]</ref>It has not been researched how many physicians changed their practice patterns when they could be compensated for their OMT services. 

Interest in manipulation has increased among allopathic physicians,<ref>[http://www.ncbi.nlm.nih.gov/pubmed/8534388/ Atchison JW, Newman RL, Klim GV. ''Interest in manual medicine among residents in physical medicine and rehabilitation. The need for increased Instruction.'' American Journal of Physical Medicine Rehabilitation, 1995;74(6):439-43.]</ref><ref>[http://www.jaoa.org/cgi/reprint/105/12/551/ Allee BA, Pollak MH, Malnar KF. ''Survey of Osteopathic and Allopathic Residents' Attitudes Toward Osteopathic Manipulative Treatment,'' JAOA, 2005; 105(12):551-561.]</ref> with training being added to residency programs.<ref>[http://stfm.org/fmhub/fm2005/November/James693.pdf/ Leiber JD. ''Allopathic Family Medicine Residents Can Learn Osteopathic Manipulation Techniques in a 1-month Elective, Family Medicine,'' 2005;37(10):693-5.]</ref>Integrative Medicine Residency and Fellowship Programs such as that at the University of Arizona’s Arizona Center for Integrative Medicine<ref>[http://www.ncbi.nlm.nih.gov/pubmed/16728816/ Maizes V, Silverman H, Lebensohn P,Koithan B, Rakel D, SchneiderC, KohatsuW, Hayes M, Weil A. ''The integrative family medicine program: an innovation in residency education,'' Academic Medicine, 2006;81(6):583-9.]</ref> teach osteopathic principles & manual medicine.<ref>[http://integrativemedicine.arizona.edu/education/imer.html/ ''Integrative Medicine Elective Rotation,'' Arizona Center for Integrative Medicine]</ref><ref>[http://integrativemedicine.arizona.edu/education/fellowship/faculty.html/ Faculty, Arizona Center for Integrative Medicine]</ref> (The program co-founded the Consortium of Academic Health Centers for Integrative Medicine - a consortium of academic centers and their deans from Duke, Harvard and other leading medical schools.)<ref>[http://integrativemedicine.arizona.edu/about/index.html/ About the Center-Accomplishments, Arizona Center for Integrative Medicine]</ref> 

Recent studies show an increasingly positive attitude of patients<ref>[http://www.jaoa.org/cgi/reprint/102/1/13/ Licciardone J, Gamber R, Cardarelli K. ''Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment,'' JAOA, 2002;102(1):13-20.]</ref> and physicians (MD and DO)<ref>[http://www.jaoa.org/cgi/content/full/105/12/551/ Allee BA, Pollak MH, Malnar KF. ''Survey of Osteopathic and Allopathic Residents' Attitudes Toward Osteopathic Manipulative Treatment,'' JAOA, 2005;105(12):551-561.]</ref> towards 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.<ref>Stoll ST, Russo DP, Atchison JW. ''Physicians’ and Patients’ attitudes toward manual medicine: implications for continuing medical education,'' Journal of Continuing Education in the Health Professions, 2003;23(1):13-20</ref>

Physical therapy has also benefited from osteopathic physicians willing to train students in osteopathic techniques, leading to their inclusion in the physical therapists’ curriculum.<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620/?tool=pubmed/ Pellman E. ''A History of Manipulative Therapy,'' Journal of Manual & Manipulative Therapy, 2007;15(3):165–174.]</ref><ref>[http://journals.lww.com/jclinrheum/pages/articleviewer.aspx?year=2000&issue=08000&article=00001&type=abstract/ Darzinshki JA, Ostrov BE, Hamann LS. ''Myofascial pain unresponsive to standard treatment: successful use of a strain and counterstrain technique with physical therapy,'' Journal of Clinical Rheumatology, 2000;6(4):169-74]</ref>

Research was conducted in osteopathic medical schools nearly since their inception. ASO was one of the first places west of the Mississippi to have an x-ray machine. In 1898, William Smith MD, DO’s work entitled Skiagraphy and the Circulation: First Delineation of the Arterial System with X-rays Achieved by the American School of Osteopathy, published in the American X-Ray Journal (now the American Journal of Roentgenology), was the first research emanating from an osteopathic institution published in a non-osteopathic journal.<ref>[https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol5No81899January.pdf/ Reprinted in the Journal of Osteopathy, January 1899.]</ref> Louisa Burns, J. Stedman Denslow and Irwin Korr were leaders in the basic research that provided a foundation for the profession.<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808471/pdf/1750-4732-1-7.pdf/ Licciardone, JC. ''Osteopathic research: elephants, enigmas, and evidence,'' Osteopathic Medicine and Primary Care, 2007;1:7]</ref> 
 
Osteopathic manipulative research faces some of the same challenges faced with research in surgical procedures; until relatively recently in medical history, procedure based therapies were not subjected to the randomized, double-blinded clinical trial standard that drug therapies were as the “gold standard for research.<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1422430/pdf/20020200s00021p303.pdf/ Tenery R, Rakatansky H, Riddick FA Jr, Goldrich MS, Morse LJ, O'Bannon JM 3rd, Ray P, Smalley S, Weiss M, Kao A, Morin K, Maixner A, Seiden S. ''Surgical "placebo" controls,'' Annals of Surgery, 2002; 235(2):303-7.]</ref> Procedure based therapies are notoriously difficult to double blind. There are also ethical issues that must be accounted for in such research, when utilizing “sham procedures” versus treatment, so as to harm the patient. And the sham procedure itself may alter the patient’s range of motion, pain perception, etc. <ref>[http://www.jaoa.org/cgi/reprint/105/6/283/ McPartland JM, Giuffrida A, King J, Skinner E, Scotter J, Musty RE. ''Cannabimimetic Effects of Osteopathic Manipulative Treatment,'' JAOA, 2005;105(6):283-291.]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/12838090 Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, et al. ''Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial.'' Spine. 2003;28:1355–1362.]</ref>

The [[American Osteopathic Association]] has stepped up its efforts in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation<ref>[http://www.nejm.org/doi/full/10.1056/NEJM199911043411903#t=article/ Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S. ''A comparison of osteopathic spinal manipulation with standard care for patients with low back pain,'' New Engl J Med,1999;341:1426-1431.]</ref> as well as to encourage DO's to consistently offer manipulative treatments to their patients via competitive grant opportunities offered through the American Osteopathic Foundation (AOF). In 2001 the national Osteopathic Research Center was started at the University of North Texas, Texas College of Osteopathic Medicine. Certainly not the sole research center for the profession, it is preeminent, receiving sponsorship through the AOF, the Osteopathic Heritage Foundation and the National Institutes of Health-National Center for Complementary and Alternative Medicine (NCCAM).<ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/06000/The_National_Osteopathic_Research_Center_at_the.22.aspx/ Stoll ST, McCormick J, Degenhardt BF, Hahn MB. ''The National Osteopathic Research Center at the University of North Texas Health Science Center: Inception, Growth, and Future,'' Academic Medicine, 2009;84(6):737-743]</ref>

All clinical trials currently under way at the ORC are funded by NIH-NCCAM. In 2009, approximately $1.7 million was received from NCCAM for ORC-related projects.<ref>[http://www.hsc.unt.edu/orc/about_sponsors.html/ About Us-Sponsors, Osteopathic Research Center]</ref><ref>[http://www.hsc.unt.edu/orc/research.html ''Current Research,'' Osteopathic Research Center]</ref><ref>[http://www.hsc.unt.edu/orc/research_publications.aspx/ ''List of Publications,'' Osteopathic Research Center]</ref>No longer confined to osteopathic medical institutions, allopathic institutions are now beginning to do OMT research as well.<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/18541041/?tool=pubmed/ Mann JD, Faurot KR, Wilkinson L, Curtis P, Coeytaux RR, Suchindran C, Gaylord SA. ''Craniosacral therapy in migraine: a feasibility study, Craniosacral therapy for migraine: protocol development for an exploratory controlled clinical trial.'' BMC Complement Altern Med, 2008 Jun 9;8:28.]</ref><ref>Craniosacral therapy in migraine: a feasibility study. ClinicalTrials.gov Web site. Available at: http://www.clinicaltrials.gov/ct2/show/NCT00665236.</ref>

===Research emphasis===
Historically, there has been a greater focus on providing an education, and less of a focus on producing research at osteopathic institutions versus their allopathic counterparts.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/06000/The_Separate_Osteopathic_Medical_Education.8.aspx/ Chen C, Mullan F. ''The Separate Osteopathic Medical Education Pathway: Uniquely addressing National Needs,'' Academic Medicine, 2009;84(6):695.]</ref> This has its origins in the 19th century, when the goal of osteopathic medical schools was to produce practitioners rather than academics and researchers, as was common in the leading allopathic institutions. 

AT Still wanted a quality school with teachers who were academically qualified in the subject matter and able to show ''demonstrative truth'' regarding osteopathic principles and practices – the improved or cured patient.  He made arrangements with physicians and scientists, trained in the best European and American schools, many of whom had come to Kirksville to learn Osteopathy, to serve as instructors and deans of his new school. This included William Smith MD, DO; <ref>[http://www.atsu.edu/museum/journals/index.htm/ ''True Fountainhead of Osteopathy,'' Journal of Osteopathy, October 1898, p. 235]</ref> [[John Martin Littlejohn]] PhD, MD, DO; David Littlejohn PhB, MD; J.B. Littlejohn AM, MD; D.M. Desmond AM, MD, etc<ref>[http://www.atsu.edu/museum/journals/index.htm/ ''The American School of Osteopathy,'' Journal of Osteopathy, October 1897, p. 216-224, 254-258.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol4No51897October.pdf </ref><ref>[http://www.atsu.edu/museum/journals/index.htm/ ''Birthplace of Osteopathy: The American School of Osteopathy & the A.T. Still Infirmary & Surgical Sanitarium at Kirksville MO, where Dr. Still Cradled the Infant Science,'' Journal of Osteopathy, May 1899, p. 534-551.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol5No121899May.pdf/</ref> In the first few years, he also set out to build an adequate physical building for the school and an Infirmary and Surgical Sanitarium for patients coming to Kirksville for treatment. Still built the buildings at his own expense from the money earned in clinical practice. <ref>[http://www.atsu.edu/museum/journals/index.htm/ Potter W. ''Dr. Still & His Work,'' Journal of Osteopathy, June 1897, p. 92-95.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol5No51898October.pdf/ </ref><ref>[http://www.atsu.edu/museum/journals/index.htm/ ''Birthplace of Osteopathy:The American School of Osteopathy & the A.T. Still Infirmary & Surgical Sanitarium at Kirksville MO, where Dr. Still Cradled the Infant Science,'' Journal of Osteopathy, May 1899, p. 534-551.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol5No121899May.pdf/</ref>

The leading allopathic (MD) institutions were recruiting faculty for research potential. It was considered “a disgrace to a university to appoint a man as professor chiefly because he was a good teacher…in medical school, for a man to become the head of a department, the only important consideration was the ability to good research. Teaching apparently, would be done by men in lower grades.”<ref>[http://jama.ama-assn.org/content/251/8/1079.full.pdf+html?sid=8fe7944d-a177-47d0-b441-8792f97b76f8%2F/ King LS. ''Medicine in the USA: Historical Vignettes XX. The Flexner Report of 1910,'' JAMA 1984;251(8):1079-1086.]</ref> 
For historical context, Berliner and King extensively document the involvement of private foundations, the Rockefeller Institute,<ref>[http://www.rockefeller.edu/about/history/ ''History'' - Rockefeller University]</ref> the Carnegie Foundation and the AMA regarding the transformation of medicine occurring at this time.<ref>[http://jama.ama-assn.org/content/251/8/1079.full.pdf+html?sid=8fe7944d-a177-47d0-b441-8792f97b76f8/ King LS. ''Medicine in the USA: Historical Vignettes XX. The Flexner Report of 1910,'' JAMA, 1984;251(8):1079-1086.]</ref><ref>[http://coursesa.matrix.msu.edu/~hst425/readings/Berliner.htm/ Berliner HS. ''A Larger Perspective on the Flexner Report,'' International Journal of Health Services, 1975;5:573-592.]</ref> [[William H. Welch]], one of the founders of Johns Hopkins’ Medical School and School of Public Health and president of the Rockefeller  Institute summarized the philosophy of philanthropic institutions, “We believe that such aid should be granted only to certain medical schools which should possess the following characteristics: The school should be upon a university basis, an integral part of an important university, completely controlled by the trustees of the university, the teachers supported by salaries paid by the universities and not by a division of fees of students. The school must already be in possession of laboratories which have been productive in research. It must be clear that the heads of these laboratories and the teaching staff in general are selected primarily for their demonstrated capacity to advance and stimulate research to train young men to become independent investigators…”<ref>Flexner S. & Flexner J. ''William Henry Welch and the Heroic Age of American Medicine.'' Dover, New York, 1966.</ref>

Allopathic schools were aligning themselves with universities, in order to receive gifts, endowments and government funding. <ref>[http://jama.ama-assn.org/content/251/8/1079.full.pdf+html?sid=8fe7944d-a177-47d0-b441-8792f97b76f8/ King LS. ''Medicine in the USA: Historical Vignettes XX. The Flexner Report of 1910,'' JAMA, 1984;251(8):1080.]</ref> Osteopathic medical schools were founded as stand alone institutions, deriving most of their funding from tuition, fees and clinical services. Given the initial opposition from the allopathic community, the profession was forced to build its own hospitals to care for patients and train young physicians. Research was largely self-funded, which tended to limit research abilities given other demands.

In time, osteopathic institutions would tend to add other graduate health programs to complement their medical programs, such as pharmacy, optometry, dentistry, and the allied health professions. These institutions then became universities of the health sciences. Today, “If the nation’s 152 Liaison Committee for Medical Education(LCME) and American Osteopathic Association-accredited medical schools were arrayed on a spectrum from most research intensive at one end to most community based at the other, at no point could one draw a bright line to separate the institutions into two discrete groups. As a reflection of this overlap, the applicant pools from which entrants to MD and DO schools are selected contain a great many of the same students.”<ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/06000/The_Separate_Osteopathic_Medical_Education.9.aspx/ Cohen JJ. ''The Separate Osteopathic Medical Education Pathway: Isn't It Time We Got Our Acts Together?'' Academic Medicine, 2009; 84(6):696.]</ref>

===Rapid expansion===

The osteopathic medical profession expanded fairly rapidly in the early years. By 1916, there were six legitimate osteopathic medical schools in operation: American School of Osteopathy (est. 1892), Kirksville, MO; College of Osteopathic Physicians & Surgeons (1896), Los Angeles, CA; Philadelphia College of Osteopathy (1898), Philadelphia, PA; Des Moines Still College of Osteopathy & Surgery (1898), Des Moines, IA; Chicago College of Osteopathy(1900), Chicago, IL and Kansas City College of Osteopathy& Surgery (1916), Kansas City, MO. 

Because of the rapid early expansion, educators from legitimate osteopathic medical schools were greatly concerned over the effects on the profession from the “pretender” schools.<ref>[https://www.atsu.edu/museum/subscription/default.aspx/ Hannah FW. ''The Business of Osteopathy,'' Journal of Osteopathy, October 1898, p. 242-3.] Login to access -https://www.atsu.edu/museum/subscription/pdfs/JournalofOsteopathyVol5No51898October.pdf/</ref> Meeting in Kirksville in 1898, they organized the Associated Colleges of Osteopathy, now the American Association of Colleges of Osteopathic Medicine]]. “The association set up standards for curriculum, a minimum length of study, guidelines for the selection of faculty and students, and criteria for judging their colleges.”<ref>Walter GA. ''Osteopathic Medicine:  Past & Present,'' Kirksville College of Osteopathic Medicine, Kirksville, MO, p. 9.</ref>

1961, the College of Osteopathic Physicians & Surgeons in Los Angeles was converted to an allopathic medical school and renamed the California School of Medicine (now the [[University of California, Irvine School of Medicine]]). The next school to open and the first publicly supported osteopathic medical school was Michigan State University College of Osteopathic Medicine in 1969.<ref>[http://www.com.msu.edu/osteomed/history.html/ History of Michigan State University College of Osteopathic Medicine]</ref> Eight more schools would open in the 1970s, Nova Southeastern University, College of Osteopathic Medicine alone opened in 1980s. During the 1990s, four more schools or branch campuses opened. From 2000 to 2010, thirteen schools, branch campuses or remote teaching sites were opened; two more are scheduled to open in 2011.<ref>[http://www.aacom.org/data/Documents/number-of-schools.pdf/ U.S. Osteopathic Medical Schools By Year of Inaugural Class]</ref>

Annually, “the American Association of Colleges of Osteopathic Medicine surveys member colleges on planned growth over the coming six years…As of December 14, 2009…based on current projections, 6,297 new students are expected to matriculate into the (current) 26 osteopathic colleges and three branch campuses in fall 2015. This is an increase of 1,193 first-time, first-year medical students over the class that entered in fall 2009 (a 23.4 percent increase). The six public osteopathic colleges project an increase of 177 students (or 17 percent); the 23 private colleges and branch campuses project an increase of 1,016 students (or 25 percent). The projections include one college that will enroll its first class in fall 2010, and two branch campuses or additional teaching sites that are scheduled to open over the next five years.”<ref>[http://www.aacom.org/resources/bookstore/Documents/GrowthRpt2009.pdf/ ''A Report on a Survey of Osteopathic Medical School Growth (2009),'' p. 3, AACOM.]</ref>

The challenge to expanding the physician workforce has been finding clinical rotation sites for medical students, DO or MD. Osteopathic schools have long been able to do this by expanding rotations sites beyond the academic medical centers to community hospitals, while this is a relatively recent phenomena for allopathic schools.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2005/12000/The_Influence_of_Teaching_Setting_on_Medical.21.aspx/  Carney PA, Ogrinc G, Harwood BG, Schiffman JS, Cochran N. ''The Influence of Teaching Setting on Medical Students' Clinical Skills Development: Is the Academic Medical Center the "Gold Standard"?'' Academic Medicine, 2005;80(12):1153-1158.]</ref> A multi-campus clinical configuration leads to challenges in implementing a consistent and standardized flow of learning, this has been overcome by extensive monitoring of student learning outcomes. Learning objectives for both required and clinical rotations are centrally coordinated and locally implemented. “…(T)eaching and learning resources such as student manuals and instructor PowerPoint presentations, introduced specific training in OMM skills into the formal didactic portion of the clinical years…Students' progress is monitored using logs, exit objectives lists, postrotation exams, National Board of Medical Examiners (NBME) shelf exams, end-of-third-year exams, and NBME end-of-rotation exams…” <ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/06000/Osteopathic_Clinical_Training_in_Three.16.aspx/  Krueger PM, Dane P, Slocum P, Kimmelman M. ''Osteopathic Clinical Training in Three Universities,'' Academic Medicine, 2009;84(6):712-717.]</ref> in addition to supplemental telemedicine grand rounds and preceptor evaluations. The flexibility of osteopathic schools has been praised for allowing them to develop schools innovative curriculum models of education in nontraditional locations.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/06000/The_Separate_Osteopathic_Medical_Education.8.aspx/ Chen C, Mullan F. ''The Separate Osteopathic Medical Education Pathway: Uniquely addressing National Needs,'' Academic Medicine, 2009; 84(6):695.]</ref><ref>[http://journals.lww.com/academicmedicine/Abstract/1997/08000/One_program_already_offering_managed_care_training.1.aspx/ Terry MA. ''One Program Already Offers Managed Care Training,'' Academic Medicine, 1997;72(8):657.]</ref><ref>[http://journals.lww.com/academicmedicine/Fulltext/2001/04001/The_Interdisciplinary_Generalist_Curriculum.20.aspx/ Blavo C, Steinkohl, Cohn D. ''The Interdisciplinary Generalist Curriculum Project at Nova Southeastern University College of Osteopathic Medicine,'' Academic Medicine, 2001; 76(4): S104-S108]</ref>

By 2020, the number of osteopathic physicians is projected to be over 100,000, according to the [[American Medical Association]].<ref>[http://www.ama-assn.org/amednews/2003/06/16/prsa0616.htm/ Croasdale M. ''Can-DO strategy: Osteopathic medicine survives, and thrives.'' American Medical News. 16 Jun 2003.]</ref>

The biggest issue facing both DO & MD medical education in the US is developing and maintaining graduate medical education or residency training programs.<ref>[http://jama.ama-assn.org/cgi/reprint/300/10/1174?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopathic&searchid=1&FIRSTINDEX=40&resourcetype=HWCIT/ Salsberg E, Rockey PH,Rivers KL, Brotherton SE, Jackson GR. ''US Residency Training Before and After the 1997 Balanced Budget Act,'' JAMA. 300(10): 1174-1180.]</ref><ref>[http://www.jaoa.org/cgi/content/full/106/5/250/ Steier KJ. ''Time to accept allopathic physicians into AOA-approved residencies?'' JAOA, 2006;106(5):250-2.]</ref>Graduate Medical Education (GME) has been funded by the Centers for Medicare and Medicaid Services (CMS), since Medicare was created in 1965, to compensate the hospitals for the expense of training young physicians.<ref>[http://www.aamc.org/advocacy/library/gme/gme0001.htm/ ''Medicare Direct Graduate Medical Education (DGME) Payments,'' American Association of Medical Colleges]</ref> “…Congress passed a law in 1997 that imposes a hospital-specific limit on the number of residents that Medicare will pay for. In general, the limit is based on the number of residents that a hospital trained in 1996.<ref>[http://www.uth.tmc.edu/med/administration/gme/pdf_files/medicare_payments_gme.pdf/ ''Medicare Payments for Graduate Medical Education,'' American Association of Medical Colleges, 2006.] </ref> At present, there is no way to increase the number of paid residency slots unless Congress changes the 1997 law. 

Both DO and MD schools are increasing admissions, and therefore graduates, in response to the projected physician workforce shortage.<ref>[https://www.aamc.org/newsroom/newsreleases/2008/55450/081021.html/ ''Medical schools Increase Enrollment to Meet Physician Demand,'' AAMC, October 21, 2008.]</ref><ref>[http://www.aacom.org/resources/other/Documents/062008_Shannon_MDAssn.pdf/ Shannon SC. ''The Future of Osteopathic Medical Education: Physician Workforce Projections and the Response of US Colleges of Osteopathic Medicine,'' AACOM, June 20, 2008.]</ref> There are currently enough GME programs to accommodate all osteopathic medical graduates as it is part of the accreditation requirements of osteopathic medical schools.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2006/12000/The_Predicament_of_Osteopathic_Postdoctoral.21.aspx/ Cummings M. ''The predicament of osteopathic postdoctoral education,'' Academic Medicine, 2006;81:1123–1127.]</ref> However, since approximately half of DOs choose ACGME postgraduate training in any given year, there is concern among osteopathic medical educators that they maybe crowded out of training slots if DOs do not continue to create and maintain their own residency training positions.<ref>[http://blogs.do-online.org/aoapresident.php?blogid=3&archive=2010-04 Larry Wickless DO, AOA President (2009-2010), President’s Blog, April 29, 2010]</ref> Current AOA President, Karen Nichols DO, MA, FACOI, is calling for osteopathic specialty colleges to develop and expand residency training programs.<ref>[http://www.osteopathic.org/inside-aoa/Education/OGME-development-initiative/Pages/default.aspx/ ''OGME Development Initiative,'' American Osteopathic Association.]</ref><ref>[http://www.osteopathic.org/inside-aoa/Education/OGME-development-initiative/Documents/OGME-brochure.pdf/ ''OGME Development Initiative Brochure,'' American Osteopathic Association]</ref>

==Brand identity==

The “DO” degree designation has continued to be a debate almost since the inception of the profession. As far back as 1899, it was entered into the notes of the American School of Osteopathy record book by John Martin Littlejohn MD, PhD, DO, the first dean of the first medical school:

:Whereas it is provided in the charter of the American School of Osteopathy that this college “shall grant and confer such honors and degrees as are usually granted and conferred by reputable Medical Colleges,” and “issue diplomas in testimony of the same;” and whereas the title of Diplomat or Doctor of Osteopathy had never been conferred by any medical college; it is hereby resolved that the faculty recommended to the trustees the execution of the power of the charter of the school by hereby conferring this degree of Dr. of medicine and in recognition of osteopathy as an independent school of medicine and system of healing as it is so declared by statue in Missouri and other states that have recognized Osteopathy and the requirements of the charter, that the designation and title shall be hereafter M.D. (Osteopathic).<ref>[http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=1957&REC=2/ ''American School of Osteopathy Record Book, 1897 to 1900,'' p. 70-72, March 22, 1899.]</ref>

:The motion laid on the table at the last meeting event, the degree to be conferred by the school was then taken up for consideration. On motion it was accepted by the faculty and was ordered submitted to the trustees for approval with the strongest recommendation of the faculty that the trustees authorize the proposed change in the diploma and take the necessary steps to carry out the proposed change. <ref>[http://cdm.sos.mo.gov/cdm4/document.php?CISOROOT=/atsu&CISOPTR=1957&REC=2/ ''American School of Osteopathy Record Book, 1897 to 1900,'' p. 74, April 8, 1899.]</ref>

This would later cause a rift between Littlejohn and his brothers, who were also teaching at ASO, and Dr. Still. As a result, Littlejohn left ASO and went on to found the Chicago College of Osteopathy (now [[Midwestern University]]) and then the British School of Osteopathy.<ref>[http://www.bso.ac.uk/mm1ahist.htm/ British School of Osteopathy - ''A Brief History'']</ref>Interestingly, the Chicago school would also confer the Doctor of Osteopathy degree.

The debate continues simply because the profession has not universally established its brand identity in the healthcare marketplace.<ref>[http://www.jaoa.org/cgi/reprint/100/5/282/ Smith DA. ''Opportunities for the osteopathic medical profession to pursue worldwide acclaim and recognition,'' JAOA, 2000;100(5):282.]</ref> Osteopathy has done a better job of proliferating in the global medical community, which in the past has led to some confusion when osteopathic medicine is introduced.<ref>[http://www.jaoa.org/cgi/reprint/107/1/6/ Pandeya NK. ''Osteopathic Degrees Overseas,'' JAOA, 2007;107(1):6-7.]</ref><ref>[http://www.jaoa.org/cgi/reprint/107/1/6/ McNerney J. ''Response,'' JAOA, 2007;107(1):7.]</ref> The establishment of the Osteopathic International Alliance, <ref>[http://www.oialliance.org/ Osteopathic International Alliance website]</ref>this has helped facilitate the distinction, particularly in markets where osteopaths and osteopathy is already a regulated profession. In addition, the AOA’s and NBOME’s participation<ref>[http://www.iamra.com/pdf/Partner_Member_Directory_3-25-10.pdf/ IAMRA Partner Members]</ref> in the International Association of Regulatory Authorities,<ref>[http://www.iamra.com/ IAMRA website]</ref> has helped clarify and validate the training and practice rights of US trained osteopathic physicians. 

Domestically, the osteopathic medical profession is well established in the medical, educational, government and military communities, as previously elucidated. But it has not always so well differentiated itself with the public at large.<ref>[http://www.jaoa.org/cgi/reprint/101/9/493/ Reid T. ''Change professional title for increased recognition of osteopathic physicians,'' JAOA, 2001;101(9):493-494.]</ref> While the profession has long overcome any legal or curricular matters regarding full scope of medical practice, it has not fully resolved its market recognition factor. The issue is geographic and regional; it tends to occur in areas where historically there have been low concentrations of osteopathic physicians. The DO degree designation periodically arises as a subject of debate within the profession.<ref>[http://www.jaoa.org/cgi/reprint/109/7/359/ Bates BR, Mazer JP, Ledbetter AM, Norander S. ''The DO Difference: An Analysis of Causal Relationships Affecting the Degree-Change Debate,'' JAOA, 2009;109(7):359-369.]</ref> Any resolution to the debate is compounded by the fact that there are 50 state legislatures that have laws regarding the profession that would require statutory changes by their respective state legislatures to implement any change.<ref>[http://www.jaoa.org/cgi/reprint/110/4/247/ Boling FW. ''Discrimination Against DOs Alive and Well,'' JAOA, 2010;110(4):247.]Note: Dr. Boling is from Wyoming, one of the smallest states for DOs.</ref>

The current situation is well described by Arnold Melnick DO, MSc, DHL(hon), FACOP,  former president of the [[American Medical Writers Association]] and the American College of Osteopathic Pediatricians, and the founding dean, executive vice chancellor and provost of  [[Nova Southeastern University]] Health Professions Division in a recent JAOA article.
:There has been considerable discussion recently of the advisability of changing the DO degree. Good-willed, well-intentioned DOs have strongly suggested a change, and equally well-meaning and competent osteopathic physicians have opposed it. Admittedly, there are a few—very few, I believe—MD-wannabes, and any discussion of degree modification would not satisfy this extreme group; I am not addressing that here…Historically, we changed our degree some years ago from doctor of osteopathy to doctor of osteopathic medicine, but maintained DO as its abbreviation. The disagreement is really about the abbreviation…in the healing arts, there are 2 professions: Allopathic Medicine and Osteopathic Medicine. Both are recognized by each other, by all government agencies, and by almost all of the population. These are 2 separate (not as much as previously), rather distinct, almost parallel, and in some aspects “competitive” professions offering complete healthcare to the public. Most practitioners in each group want the public to be able to recognize what they are instantly—by means of a degree. Would changing the degree alter the public’s conception of what each is or does? Hardly…No change of degree would change ignorant or prejudiced mind-sets. What it would do is create a new problem—explaining to believers and non-believers alike what the new ABC is... What is an ABC? Is it the same as the DO? Or is it the same as an MD? Or is it something new? We would have to explain carefully this change to all our patients (with patience!)—taking a lot of valuable time…And we would not be able reach all those out there we do not reach now. But it would create more questions, more doubts, and more controversy among the rest of the world. We’ve already arrived—why stir things up? …A homely analogy: zebras, seeing the greater popularity and acceptance of horses and the many ways they resembled horses, might opt to change their names to “horses.” They would still be zebras but would continue calling themselves “horses.” Those people who knew what a horse was and what a zebra was would be totally confused. Those who didn’t know what a horse was and what a zebra was really wouldn’t care.<ref>[http://www.jaoa.org/cgi/reprint/111/2/124/ Melnick A. ''Communication by Degrees,'' JAOA, 2011;111(2):124-125.]</ref>

Given this debate has continued now for over 110 years, it will likely continue until the average man or woman on the street, in any town, in any state is as familiar with the “DO” brand of physician as they are with the “Apple” system of computing; the branding issue must be addressed. A 2001 study of the US population demonstrated that the osteopathic medical profession was halfway there. <ref>[http://www.jaoa.org/cgi/reprint/101/7/374/ Licciardone JC, Herron KM. ''Characteristics, satisfaction, and perceptions of patients receiving ambulatory healthcare from osteopathic physicians: a comparative national survey,'' JAOA, 2001;101(7):374-385.]</ref>

==The DO difference==

Since the profession began in the late 1800s, medicine in America has dramatically changed. Bloodletting, purging, puking and opium are no longer the standard treatments. Medications and vaccination now work. Many of the basic tenets of osteopathic medicine are accepted by allopathic institutions. One study found a majority of MD medical school administrators and faculty saw nothing objectionable in the core principles of osteopathic medicine, and some would even endorse them generally as sound medical principles.<ref> Sirica CM, ed. ''Osteopathic Medicine: Past, Present, and Future.'' New York, NY: Josiah Macy, Jr, Foundation; 1996:83–87.</ref> As with any area of medicine, more research can always be done; however, osteopathic manipulative techniques are utilized by physicians<ref>[http://www.erop.org/ostarzteuropa_eng.shtml/ European Register of Osteopathic Physicians]</ref> and other health professionals around the world.<ref>[http://www.oialliance.org/members.htm/ Osteopathic International Alliance Members]</ref><ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2484829/pdf/jcca00046-0044.pdf/ ''Proceedings,'' Journal of the Canadian Chiropractic Association, 1992;36(2):106-109.]</ref> 

Since DOs have proven themselves equivalent, the question then becomes what is the DO difference? The question has been raised, by DOs<ref>[http://www.jaoa.org/cgi/reprint/103/10/489.pdf/ Teitelbaum HS, Bunn WE, Brown SA, Burchett AW. ''Osteopathic Medical Education: Renaissance or Rhetoric?'' JAOA, 2003; 103(10):489.]</ref><ref>[http://www.jaoa.org/cgi/content/full/106/6/319/ Tosca M. ''Future of osteopathic medicine depends on investing in graduate medical education,'' JAOA, 2006;106(6):319.]</ref><ref>[http://www.om-pc.com/content/1/1/2/ Licchardone JC. ''A comparison of patient visits to osteopathic and allopathic general and family medicine physicians: results from the National Ambulatory Medical Care Survey, 2003-2004,'' Osteopath Med Prim Care, 2007 Jan 12;1:2.]</ref><ref>[http://www.jaoa.org/cgi/reprint/106/8/442?maxtoshow=&hits=10&RESULTFORMAT=&author1=tatum&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT/ Tatum WO. ''AOA Needs to Reach Out More,'' JAOA, 2006;106 (8):442-443.]</ref>
and prominent MDs<ref>[http://journals.lww.com/academicmedicine/Fulltext/2009/06000/The_Separate_Osteopathic_Medical_Education.9.aspx/ Cohen JJ. ''The Separate Osteopathic Medical Education Pathway: Isn’t it time we got our acts together?'' Academic Medicine, 2009;84(6):656.]</ref> - Why maintain a separate system at all? DOs tend to look askew at any attempt to assimilate them into the MD world given the profession’s historical experience; DOs have mistrust for medical hegemony.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2001/08000/Diminished_Use_of_Osteopathic_Manipulative.16.aspx/ Johnson SM, Kurtz ME. ''Diminished Use of Osteopathic Manipulative Treatment and Its Impact on the Uniqueness of the Osteopathic Profession,'' Academic Medicine, 2001; 76(8):821-828.]</ref><ref>[http://www.jaoa.org/cgi/content/full/105/10/442/ Werrell BH. ''The "Big DO,"'' JAOA, 2005; 105(10):442-443.]</ref><ref>''Proud DOs buoyed by growth, affirm medical independence,'' Medical World News. 19:20, August 7, 1978.</ref><ref>[http://jama.ama-assn.org/content/284/4/442.2.full.pdf+html?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=osteopathic&searchid=1&FIRSTINDEX=40&resourcetype=HWCIT/ Hruby RJ. ''JAMA 100 Years Ago and Osteopathy,''JAMA, 2000;284(4):442.]</ref>

A.T. Still repeatedly referred back to the founding charter of the American School of Osteopathy in his writing and speechmaking. Osteopathic medicine as a profession is “to improve our present system of surgery, obstetrics, and treatment of diseases generally, and place the same on a more rational and scientific basis, and to impart information to the medical profession…”<ref>Still AT. ''Autobiography of A.T. Still,'' Kirksville, Missouri, 1908, p. 142-147.</ref>

Due to its minority status, the profession has had to be flexible, adaptive and innovative in an ever-changing healthcare environment. While other schools of medical thought have long gone by the wayside, osteopathic medicine has continued to grow and thrive. Its institutions are willing to look at new methods of instruction, teaching, training and examining students,<ref>[http://journals.lww.com/academicmedicine/Fulltext/2007/09000/A_Three_Year_Accelerated_Medical_School_Curriculum.16.aspx/ Bell HS, Ferretti SM, Ortoski RA. ''A Three-Year Accelerated Medical School Curriculum Designed to Encourage and Facilitate Primary Care Careers,'' Academic Medicine, 2007;82(9):895-899.]</ref> which has won awards from the allopathic profession.<ref>[http://journals.lww.com/academicmedicine/Fulltext/2001/04001/The_Interdisciplinary_Generalist_Curriculum.20.aspx/ Blavo C, Steinkohl, DC. ''The Interdisciplinary Generalist Curriculum Project at Nova Southeastern University College of Osteopathic Medicine,'' Academic Medicine, 2001;76(4): S104-S108.]</ref>

A.T. Still was always looking for a better way of doing things, as evidenced by his inventions & patents; medicine was no different. Finding and fixing the derangements of the musculoskeletal system was just the beginning for the osteopathic physician. He made clear that his definition of anatomy reached to the microscopic and biochemical level, even in the late 1800s.<ref>[http://www.atsu.edu/museum/journals/index.htm/ Still AT. ''The Philosophy & Mechanical Principles of Osteopathy'' (1902), Hudson-Kimberley PCB Co. Kansas City, MO, p. 23.] Login to access - https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf</ref> He advocated for evidence-based medicine as only a man of the 19th century could. His vision was for a work that would go on indefinitely. It has been postulated that the next reiteration of osteopathic medicine will be in leading the way in finding the most clinically-effective, cost-effective medicine.<ref>[http://www.jaoa.org/cgi/reprint/101/3/156/ Smith DA. ''Going global with osteopathic medicine,'' JAOA, 2001;101(3):156-159.]</ref>The profession will remain distinct and relevant if it remains innovative and true to Dr. Still’s greater vision of finding a better way to practice medicine.<ref>[http://www.aacom.org/resources/ome/Pages/default.aspx/ Shannon SC. ''What Does the Future Hold? Inside Osteopathic Medical Education,'' 2008;2(1):1.]</ref>

== References ==
{{Reflist|colwidth=30em}}

== Further reading ==
*<cite>Clinical Review Series: Osteopathic Medicine.</cite> Eli H. Stark and R. McFarlane Tilley. Publishing Sciences Group, Insight Publishing Co., 1975. 
*<cite>The Difference a DO Makes: Osteopathic Medicine in the 20th Century,</cite> Jones BE, Times-Journal Publishing Company, 1978, 109 pages.
*<cite>The Early Years of Research at the Kirksville College of Osteopathic Medicine</cite> J.S. Denslow, Kirksville College of Osteopathic Medicine Press (1982), 24 pages. 
*<cite>Evidence-Based Manual Medicine: A Problem-Oriented Approach.</cite>, Seffinger MA, Hruby RJ, Saunders Elsevier; 2007, 336 pages, ISBN: 1416023844
*<cite>The Neurobiologic Mechanisms in Manipulative Therapy</cite> Irwin M. Korr Plenum Press 1978.
*<cite>History of Osteopathy & 20th Century Medical Practice.</cite> E.R. Booth, The Caxton Press, 1924
*<cite>Manipulation: Past and Present.</cite>Eiler H. Shiotz and James Cyriax, Heinemann Educational Books, 1975, 304 pages, ISBN: 0433070102 
*<cite>An Osteopathic Approach to Diagnosis and Treatment .</cite> Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5
*<cite>Osteopathic Considerations in Systemic Dysfunction.</cite> Michael Kuchera, William A. Kuchera, Greydon Press,1994, paperback, 294 pages, ISBN: 1570741549
*<cite>Osteopathic Medicine: A Reformation in Progress.</cite> R. Michael Gallagher and Frederick J. Humphrey, Churchill Livingstone, 2001, 137 pages, ISBN: 0443079919 
*<cite>Osteopathic Medicine:  Past & Present.</cite>, Georgia A. Walter, Kirksville College of Osteopathic Medicine, Kirksville, MO, 1987, 24 pages,  ISBN: 9992105798 
*<cite>[http://archfami.ama-assn.org/cgi/content/full/8/6/477/ An Overview of Osteopathic Medicine.]</cite>Emil P. Lesho, Archives of Family Medicine, 1999;8(6):477-484. 
*<cite>The Research Status of Spinal Manipulative Therapy,</cite> Murray Goldstein, Department of Health Education & Welfare Publication No(NIH) 76-998. US Government Printing Office, 1975, 310 pages.
*<cite>Science in the Art of Osteopathy: Osteopathic Principles and Models</cite>, Caroline Stone, Nelson Thornes Ltd., 1999, paperback, 384 pages, ISBN 0-7487-3328-0

{{Medical education in the United States}}
{{Osteopathic medical schools}}
{{Medicine}}

{{DEFAULTSORT:Osteopathic Medicine In The United States}}
[[Category:Manipulative therapy]]
[[Category:Osteopathy]]
[[Category:Osteopathic medicine]]
[[Category:Medical education in the United States]]
[[Category:Medical and health organizations based in the United States]]

==See also==
* [[List of Osteopathic Medical Schools]]

== External links ==
{{external links}}
=== US Osteopathic regulatory bodies ===
* [[American Osteopathic Association]] ([http://www.osteopathic.org/ Website])
* [[American Association of Colleges of Osteopathic Medicine]] ([http://www.aacom.org/ Website])
* [http://www.nbome.org/ National Board of Osteopathic Medical Examiners]]
* [http://www.natmatch.com/aoairp/ American Osteopathic Intern/Resident Registration Program]

=== Journals ===
* [http://www.chiroandosteo.com/ Chiropractic & Osteopathy] An online journal published by BioMed Central
* [http://www.intl.elsevierhealth.com/journals/ijos/ International Journal of Osteopathic Medicine]
* [http://www.jaoa.org/ Journal of the American Osteopathic Association] The official journal of the American Osteopathic Association
* [http://www.om-pc.com/ Osteopathic Medicine and Primary Care] An online journal published by BioMed Central
* [http://www.acofp.org/membership/ofpn/current.aspx The Journal of the American College of Osteopathic Family Physicians].

===Student groups===
*  [http://www.studentdo.com/ Student Osteopathic Medical Association]
*  [http://www.osteopathicintegration.org/ Unified Student Movement for Osteopathic Integration]
*  [http://www.osteobook.net/ Osteobook.net]

===Professional associations===
*  [http://www.academyofosteopathy.org/ American Academy of Osteopathy]
*  [http://www.acofp.org/ American College of Osteopathic Family Physicians]
*  [http://www.acoi.org/ American College of Osteopathic Internists]
*  [http://www.amops.org/ Association of Military Osteopathic Physicians and Surgeons]
*  [http://www.aocopm.org/ American Osteopathic College of Occupational & Preventive Medicine]

===Other organizations===
*  [https://www.do-online.org/ DO-Online.org]
*  [http://www.osteopathicheritage.org/ Osteopathic heritage foundation]
*  [http://history.osteopathic.org/ The History of Osteopathic medicine museum]
*  [http://www.atsu.edu/museum/index.htm Still National Osteopathic Museum]
*  [http://www.pohmedical.org/ Pontiac Osteopathic Hospital]
*  [http://www.ohiocore.org/ Centers for Osteopathic Research and Education]
*  [http://www.osteopathiccenter.org/index.html Osteopathic Center for Children & Families]
*  [http://www.aof-foundation.org American Osteopathic Foundation]
*  [http://www.kcom.edu/ Kirksville College of Osteopathic Medicine - A.T. Still University]

{{Osteopathic medical schools}}
{{Medicine}}

[[Category:Manipulative therapy]]
[[Category:Osteopathy]]
[[Category:Osteopathic medicine]]

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[[ru:Остеопатия]]

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