Osteopathic medicine in the United States

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Template:Otheruses4 Template:Osteopathic medicine

Osteopathic medicine is a branch of the medical profession in the United States. [1] Osteopathic medicine in the US is a complete system of medical training, much like allopathic (MD) [2][3] 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.[4] Osteopathic physicians, known as DOs, are licensed to practice medicine and surgery in all 50 states and have full scope of medical practice in over 50 countries. There are over 70,000 DOs in the US, accounting for about 7% of the total physician population.[5]

Philosophy

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:[6]

  1. The body is a unit – an integrated unit of mind, body, and spirit (Triune of Man - A.T. Still)[7][8]
  2. The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself. [9]
  3. Structure and function are reciprocally inter-related, as such there is an emphasis on the integral relationship between anatomy and physiology[10]
  4. 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.


Founded as osteopathy by frontier physician Andrew Taylor Still as a radical rejection of the prevailing system of medical thought of the 19th century, the profession gradually moved closer to mainstream medicine in its practices, and came to be called "osteopathic medicine" within the United States.[11] Today, osteopathic medicine is "no longer considered alternative medicine"[12] and the training of osteopathic physicians is "virtually identical" to that of M.D. physicians.[13] Osteopathic physicians use all conventional methods of diagnosis and treatment but are trained to place additional emphasis on the achievement of normal body mechanics as central to maintaining good health.[14] D.O. physicians receive training in Osteopathic Manipulative Medicine (OMM), a form of manual therapy shown to be of some benefit for patients with certain musculo-skeletal disorders.[15] However, this form of therapy is used by a minority of osteopathic physicians in actual practice.[16] In the United States, osteopathic medicine is considered by some both a profession and a social movement.[17][18]

Although U. S. osteopathic medical physicians currently may obtain licensure in 47 countries, osteopathic curricula in countries other than the United States differs. D.O.s outside the U. S. are known as "osteopaths" and their scope of practice excludes allopathic medical therapies and relies more exclusively on osteopathic manipulative medicine and other alternative medical modalities.

Discussions about the future of osteopathic medicine frequently debate the feasibility of maintaining distinctiveness within the broader U.S. physician community. More recently, the topic of for-profit medical education has become an issue.[19]

Demographics

From its inception, the osteopathic profession has been smaller in numbers than its allopathic counterpart.[20] Currently, there are 25 accredited osteopathic medical schools[21] in 28 locations in the United States and 126 accredited U.S. allopathic medical schools.[22]

File:EnteringPhysiciansByEducation2005.PNG
Physicians entering U.S. workforce by education, 2005.[23]
  • In 1960, there were 13,708 physicians who were graduates of the 5 osteopathic medical schools.
  • In 2002, there were 49,210 physicians from 19 osteopathic schools.
  • Between 1980 and 2005, the number of osteopathic graduates per year increased over 250 percent from about 1,000 to 2,800. This number is expected to approach 5,000 by 2015.[24]
  • In 2007, there were 25 colleges of osteopathic medicine in 28 locations.[25] One in five medical students in the United States is enrolled in an osteopathic medical school.[26]
  • By 2020, the number of osteopathic physicians will grow to 95,400, say expert predictions, according to the American Medical Association.[27]
Further information: [[:Comparison of osteopathic and allopathic demographics]]

Osteopathic principles

File:Medical School.jpg
A physician demonstrates an OMM technique to medical students at an osteopathic medical school.

In addition to the Hippocratic oath, Osteopathic medical students take an oath to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:

  1. The body is a unit, and the person represents a combination of body, mind, and spirit.
  2. The body is capable of self-regulation, self-healing, and health maintenance.
  3. Structure and function are reciprocally interrelated.
  4. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.[28]

Significance

There are different opinions on the significance of these principles. Some note that the osteopathic philosophy is akin to the tenets of holistic medicine.[29] They suggest that osteopathic philosophy is a kind of social movement within the field of medicine, one that promotes a more patient-centered, holistic approach to medicine, and emphasizes the role of the primary care physician within the health care system.[30][17] Stephen Barrett argues that the American Osteopathic Association's emphasis of the core principles amounts to a form of professional indoctrination, glorifying osteopathic principles while misrepresenting those of the allopathic community.[31] Still others point out that there is nothing in the principles that would distinguish osteopathic from allopathic training in any fundamental way. One study, published in the Journal of the American Osteopathic Association found a majority of allopathic medical school administrators and faculty saw nothing objectionable in the core principles, and some would even endorse them generally as sound medical principles.[28]

Further information: [[:Allopathic & osteopathic: Cultural differences]]

History

A new movement within medicine

File:Andrew Taylor Still 1914.jpg
Andrew Taylor Still founder Osteopathic medicine

Frontier physician Andrew Taylor Still, M.D., D.O., founded the American School of Osteopathy (now Kirksville College of Osteopathic Medicine of A.T. Still University of Health Sciences) in Kirksville, MO, in 1892 as a radical protest against the turn-of-the-century medical system. A.T. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt, and treated effects rather than causes of disease.[32] He founded osteopathic medicine in rural Missouri at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. Some of the medicines commonly given to patients during this time were arsenic, castor oil, whiskey, and opium. In addition, unsanitary surgery often resulted in more deaths than cures.[33] Template:Quote box

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. He invented the name "osteopathy" by blending two Greek roots osteon- for bone and -pathos for suffering in order to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side-effects of drugs.

File:Twain1909.jpg
Mark Twain was a vocal supporter of the early osteopathic movement.

The new profession faced stiff opposition from the medical establishment at the time. The relationship of osteopathic and allopathic professions was often "bitterly contentious"[23] and involved "strong efforts" by allopathic organizations to discredit osteopathic medicine.[34] Throughout the first half of the twentieth century, the policy of the American Medical Association labeled osteopathic medicine as a cult and D.O.s were seen as "cultist." The AMA code of ethics made it unethical for an M.D. physician to voluntarily associate with a D.O.[35][17]

Template:Quote box One notable advocate for the fledgling movement was Mark Twain. Manipulative treatments had purportedly alleviated the symptoms of his daughter Jean's epilepsy as well as Twain's own chronic bronchitis. In 1909, he spoke before the New York State Assembly at a hearing regarding the practice of osteopathy in the state. "I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven't been able to sleep." Philosophically opposed to the American Medical Association's stance that its own type of medical practice was the only legitimate one, he spoke in favor of licensing for osteopaths. Physicians from the New York County Medical Society responded with a vigorous attack on Twain, who retorted with "[t]he physicians think they are moved by regard for the best interests of the public. Isn't there a little touch of self-interest back of it all?" "... The objection is, people are curing people without a license and you are afraid it will bust up business."[36]

Evolution of osteopathic medicine's mission and identity[11]
Years Identity & Mission
1892 to 1950 Manual medicine
1951 to 1970 Family practice / manual therapy
1971 to present Full service care / multispeciality orientation

1916-1966, Federal recognition

Recognition by the U.S. federal government was a key goal of the osteopathic medical profession in its effort to establish equivalency with its allopathic counterpart. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the U.S. Military Medical Corp. On May 3rd, 1966 Secretary of Defense Robert McNamara authorized the acceptance of D.O.s into all the medical military services on the same basis as M.D.s. The first D.O. to take the oath of office to serve as a military physician was Harry J. Walter. The acceptance of osteopathic physicians was further solidified in 1996 when Ronald Blank, D.O. was appointed to serve as Surgeon General of the Army, the first osteopathic physician to hold the post.[35]

1962, California

In the 1960s in California, the American Medical Association (AMA), sensing increased competition from osteopathic medicine, spent nearly $8 million to end the practice of osteopathic medicine in the state. In 1962, Proposition 22, a statewide ballot initiative in California, eliminated the practice of osteopathic medicine in the state. The California Medical Association (CMA) issued M.D. degrees to all D.O.s in the state of California for a nominal fee. "By attending a short seminar and paying $65, a doctor of osteopathy (D.O.) could obtain an M.D. degree; 86 percent of the D.O.s in the state (out of a total of about 2000) chose to do so."[12] Immediately following, the AMA re-accredited the formerly-osteopathic University of California at Irvine College of Osteopathic Medicine as University of California, Irvine School of Medicine, an allopathic medical school. It also placed a ban on issuing physician licenses to D.O.s moving to California from other states.[citation needed] However, the decision proved to be controversial. In 1974, after protest and lobbying by influential and prominent D.O.s, the California Supreme Court ruled in Osteopathic Physicians and Surgeons of California v. California Medical Association, that licensing of D.O.s in that state must be resumed.

1969, AMA residencies open to DOs

File:DO residents in ACGME total.jpg
Total number of DOs in residency programs, by year.
  D.O. residents in ACGME (allopathic) programs[37]
  D.O. residents in AOA (osteopathic) programs.[38]

In 1969, the AMA House of Delegates 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 programs. However, the American Osteopathic Association rejected this measure, claiming it was an attempt to eliminate the distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L. Wilbur, M.D. sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of osteopathic and allopathic professions.[citation needed] Today, a majority of osteopathic physicians are trained alongside M.D.s, in residency programs governed by the AMA (ACGME).[39]

1976-1987, Principle 3 and Wilk v. AMA

Main article: Wilk v. American Medical Association

Osteopathic medical schools teach a form of manual therapy called Osteopathic manipulative medicine (OMM). In the past, the AMA considered manual therapy to be an unproven, unscientific method of treatment. Before 1980, Principle 3 of the AMA Principles of medical ethics stated: "A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily professionally associate with anyone who violates this principle." Also, up until 1974, the AMA had a Committee on quackery that openly challenged what it considered to be many unscientific forms of healing, including OMM and chiropractic medicine. The AMA changed its policies towards osteopathic manipulative medicine largely as a result of a court ruling regarding chiropractic medicine, the Wilk case. In that case, the AMA was convicted of unlawful conspiracy in restraint of trade.[40] Following the ruling, Principle 3 was removed from the AMA statement of medical ethics.

Non-discrimination policies

File:Pcom.jpg
Founded in 1899, Philadelphia College of Osteopathic Medicine is one of the oldest and largest osteopathic medical schools.

Recent years have seen a professional rapprochement between the two groups. D.O.s have been admitted to full active membership in the American Medical Association since 1969. The AMA has invited a representative of the American Osteopathic Association to sit as a voting member in the AMA legislative body, the house of delegates.[41]

2006, American Medical Student Association

In 2006, during the presidency of an osteopathic medical student, the American Medical Student Association (AMSA) adopted a policy regarding the membership rights of osteopathic medical students in their main policy document, the "Preamble, Purposes and Principles."

AMSA RECOGNIZES the equality of osteopathic and allopathic medical degrees within the organization and the healthcare community as a whole. As such, D.O. students shall be entitled to the same opportunities and membership rights as M.D. students.

— PPP, AMSA[42]

2007, AMA

In recent years, the largest allopathic organization in the U.S., the American Medical Association, adopted a fee non-discrimination policy discouraging differential pricing based on attendance of an allopathic or osteopathic medical school.[43]

In 2006, calls for an investigation into the existence of differential fees charged for visiting osteopathic and allopathic medical students at American medical schools were brought to the American Medical Association. After an internal investigation into the fee structure for visiting osteopathic and allopathic medical students at allopathic medical schools, it was found that one institution of the 102 surveyed charged different fees for osteopathic and allopathic students.[44] The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007.[citation needed]

H-295.876 Equal Fees for Osteopathic and Allopathic Medical Students

Our AMA, in collaboration with the American Osteopathic Association, discourages discrimination against medical students by institutions and programs based on osteopathic or allopathic training.
— AMA policy H-295.876[45]
File:DO states practice rights.PNG
Years in which states passed laws granting D.O.s medical practice rights equal to M.D.s
Template:Legend0 Template:Legend0 Template:Legend0

Practice Rights from the States

In the United States, laws regulating physician licenses are governed by the states. Between 1901 to 1989, osteopathic physicians lobbied state legislatures to pass laws giving those with a D.O. degree the same legal privilege to practice medicine as those with an M.D. degree. In many states, the debate was long and protracted. Both the AOA and the AMA were heavily involved in influencing the legislative process. The first state to pass such a law was California in 1901, the last was Nebraska in 1989.[46]

Current Status

Osteopathic medical schools
Region School Website
Midwest
& Plains 		AT Still Kirksville [10]
Des Moines COM [11]
Kansas City COM [12]
Michigan State [13]
Midwestern Chicago [14]
Ohio COM [15]
Oklahoma State [16]
Northeast Lake Erie COM [17]
New England COM [18]
New York COM [19]
Philadelphia COM [20]
Touro Harlem [21]
UMDNJ-SOM [22]
Southeast Lake Erie COM Bradenton [23]
Lincoln Memorial [24]
North Texas COM [25]
Nova Southeastern [26]
Philadelphia COM Georgia [27]
Pikeville SOM [28]
Virginia COM [29]
West Virginia SOM [30]
West AT Still Arizona [31]
Midwestern Arizona [32]
Pacific Northwest [33]
Rocky Vista [34]
Touro California [35]
Touro Nevada [36]
Western [37]

Education and training

Main articles: Medical school in the United States and Medical education in the United States

According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of allopathic physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification."[13]

DO-granting U.S. medical schools have curricula identical for the most part to those of MD-granting schools. Generally, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine.

Upon graduation, osteopathic medical physicians may opt to pursue residency training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating internship at a hospital approved by the American Osteopathic Association (AOA). Osteopathic physicians may apply to residency programs accredited by either the AOA or the Accreditation Council for Graduate Medical Education (ACGME). Currently, osteopathic physicians participate in more ACGME programs than in programs approved by the American Osteopathic Association (AOA).[47]

Further information: [[:Comparison of allopathic and osteopathic medicine]]

Manipulative therapy

Main article: Osteopathic manipulative medicine

Within the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for a number of disorders and diseases. However, a 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey follows many indicators that osteopathic physicians have become more like allopathic physicians in every respect—few perform OMT, and most prescribe drugs or suggest surgery as a first line of treatment.[48]

File:Manuellterapi5.jpg
Osteopathic manipulative therapy (OMT) involves palpation and manipulation of bones, muscles, and joints, especially those of the neck and back.

The American Osteopathic Association has made an effort in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation as well as to encourage D.O.s to consistently offer manipulative treatments to their patients. However, the number of D.O.s who report consistently prescribing and performing manipulative treatment has been falling steadily. Medical historian and sociologist Norman Gevitz[17] cites poor educational quarters and few full-time OMM instructors as major factors for the decreasing interest of medical students in OMM. He describes problems with "the quality, breadth, nature, and orientation of OMM instruction," and he claims that the teaching of osteopathic medicine has not changed sufficiently over the years to meet the intellectual and practical needs of students.[28]

“ In their assigned readings, students learn what certain prominent DOs have to say about various somatic dysfunctions. There is often a theory or model presented that provides conjectures and putative explanations about why somatic dysfunction exists and what its significance is. Instructors spend the bulk of their time demonstrating osteopathic manipulative (OM) techniques without providing evidence that the techniques are significant and efficacious. Even worse, faculty members rarely provide instrument-based objective evidence that somatic dysfunction is present in the first place.[28] ”

At the same time, recent studies show an increasingly positive attitude of patients and physicians (allopathic and osteopathic) 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.[49] Another small study examined the interest and ability of allopathic residents in learning osteopathic principles and skills, including OMM. It showed that after a 1-month elective rotation, the M.D. residents responded favorably to the experience.[50]

Professional attitudes

Recent years have seen an increasingly cooperative climate between the osteopathic and allopathic professions. In 1998, a New York Times article described the increasing numbers, public awareness, and mainstreaming of osteopathic physicians, but said that "some aspects of osteopathic practice can still raise eyebrows among conventional doctors." "Leaders of conventional medicine may no longer use the word quack, but many still look askance at the osteopathic system of medical thought, which they feel lacks the intellectual rigor and the scientific underpinnings of their own practice."[17]

In 2005, during his tenure as president of the American Association of Medical Colleges, Jordan Cohen described climate of cooperation between allopathic and osteopathic 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.[23] ”

Elsewhere, he has remarked that osteopathic manipulative medicine (OMM) can be an aid to the physician in fostering a relationship with the patient, while also a source of "skepticism on the part of the allopathic world." In particular, he noted that suggestions that OMM could be used to treat diseases other than back problems, "reinforces lingering feelings among proponents of conventional medicine that osteopathy is simply a less intellectual field all around."[17]

International practice rights

International practice rights of U.S. trained D.O.s
  Practice rights generally recognized as equal to U.S.-M.D.s
  Unlimited practice rights granted, but difficult to obtain
  Limited to manipulation-only
  Unknown or previously denied

Each country has different requirements and procedures for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the U.S. Department of Education recognizes as physicians are graduates of osteopathic medical colleges in the United States.[51] Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. On the other hand, US-trained D.O.s are currently able to practice in 45 countries with full medical rights and in several others with restricted rights.

The Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) is an independent board of the American Osteopathic Association. The BIOMEA monitors the licensing and registration practices of physicians in countries outside of the United States and advances the recognition of American-trained D.O.s. Towards this end, the BIOMEA works with international health organizations like the World Health Organization (WHO), the Pan American Health Organization (PAHO) as well as other groups.[52]

The procedure by which international countries consider granting physician licensure to foreigners varies widely. For U.S. trained physicians, the ability to qualify for "unlimited practice rights" also varies according to one's degree, M.D. or D.O.[53] Many countries recognize US-trained M.D.s as applicants for licensure, granting successful applicants them "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained D.O.s similarly to their allopathic counterparts, with some success. Template:Osteopathic medicine2In 44 countries, US-trained DOs have unlimited practice rights. In 2005, after one year of deliberations, the General Medical Council of Great Britain announced that US-trained DOs 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."[54] The American Medical Student Association strongly advocates for U.S.-trained D.O. international practice rights "equal to that of Allopathic physicians."[42]

Osteopathic medicine and primary care

Template:Expand Osteopathic physicians have historically entered primary care fields at a high rate than their allopathic counterparts. Some osteopathic organizations make claims to a greater emphasis on the importance of primary care within osteopathic medicine. However, the proportion of osteopathic students choosing primary care fields, like that of their allopathic peers, is declining. Most primary care physicians are trained in family medicine residencies. Currently, only one in five osteopathic medical students enters a family medicine residency.[55]

Criticism

Traditional osteopathic medicine, specifically OMM, has been criticized for unproven techniques such as cranial and cranio-sacral manipulation. Some question the therapeutic utility of osteopathic manipulative treatment modalities.[56] A Harvard medical school reviewed website cites numerous studies demonstrating that there are some ailments for which the benefit of manipulative therapy has "firmly established" scientific support.[29] Though a New York University health information website notes that "it is difficult to properly ascertain the effectiveness of a hands-on therapy like OM."[57]

Another area of criticism has been the relative lack of research and lesser emphasis on scientific inquiry at osteopathic schools in comparison to their allopathic counterparts.[58][59]

“ The inability to institutionalize research, particularly clinical research, at osteopathic institutions has, over the years, weakened the acculturation, socialization, and distinctive beliefs and practices of osteopathic students and graduates.[58] ”

Future of osteopathic medicine

Maintaining distinctiveness

There is currently a debate within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within U.S. health care.[11][18][60][28][61][62][63][64] JD Howell, author of The Paradox of Osteopathy,[12] notes claims of a "fundamental yet ineffable difference between allopathic and osteopathic physicians" are based on practices such as "preventive medicine and seeing patients in a sociological context" that are "widely encountered not only in osteopathic medicine but also in allopathic medicine."[65] Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a D.O. from an M.D.[66][67] Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus:

File:1styear osteopathic enrollment.PNG
First-year enrollment at osteopathic medical schools, 1968-2007
“ If osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic, why should its use be limited to osteopaths?[12] ”

As the number of osteopathic schools has increased, the debate over distinctiveness has often seen the leadership of the American Osteopathic Association at odds with the community of osteopathic physicians.

“ within the osteopathic community, the growth is drawing attention to the identity crisis faced by [the profession]. While osteopathic leaders emphasize osteopaths' unique identity, many osteopaths would rather not draw attention to their uniqueness.[41] ”

For-profit medical education

The accreditation of RVUCOM generated some controversy before the school held its first class. Like all osteopathic medical schools, RVUCOM is accredited by a board of the American Osteopathic Association (AOA). Unlike the other 28 osteopathic and 126 allopathic medical colleges in the U.S., RVUCOM is organized as a for-profit corporation.[19] Critics claimed the AOA's approval of a for-profit school "erodes creditability" of osteopathic medical schools, especially in comparison to their allopathic counterparts.[68] The Liaison Committee on Medical Education, which accredits the M.D.-granting (allopathic) U.S. medical schools, has banned for-profit schools.[69] School officials insist the for-profit status of the school will not compromise the integrity of its educational mission.[70] AOA president Peter Ajluni responded, "there are many socially minded for-profit companies that contribute time, resources, and profits to their communities" and "for-profit institutions like RVUCOM can further the cause of osteopathic medicine in the United States."[71]

References

  1. ↑ [ http://www.bls.gov/oco/ocos074.htm/ ‘’Physicians & Surgeons’’ Occupational Outlook Handbook, 2010-11 Edition, Bureau of Labor Statistics, US Department of Labor.]
  2. ↑ Webster's New World™ Medical Dictionary, The MedicineNet.com Doctors 3rd Edition, Wiley Publishing, May 2008. “Allopathy is 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.”
  3. ↑ Physician Education, Licensure & Certification, American Medical Association
  4. ↑ Postdoctoral Training, American Osteopathic Association
  5. ↑ Osteopathic Medical Profession Report 2010, American Osteopathic Association, p. 2-3.
  6. ↑ Glossary of Osteopathic Terminology, Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised April 2009, p. 33.
  7. ↑ Still AT. The Philosophy of Osteopathy (1899), p. 26. Login to access -https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/STILLThePhilosophyofOsteopathy1899.pdf
  8. ↑ Still AT. Philosophy & Mechanical Principles of Osteopathy (1902), p. 16. Login to access - https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf
  9. ↑ Still AT. Philosophy & Mechanical Principles of Osteopathy (1902), p. 22. Login to access - https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf
  10. ↑ Still AT. Philosophy & Mechanical Principles of Osteopathy (1902), p. 20-21. Requires login to access - https://www.atsu.edu/museum/subscription/pdfs/Still,%20A.T/PhilosophyandMechanicalPrincipals1902STILL.pdf
  11. ↑ 11.0 11.1 11.2 Meyer CT, Price A (1993). "Osteopathic medicine: a call for reform". J Am Osteopath Assoc. 93 (4): 473–85. PMID 8267703.
  12. ↑ 12.0 12.1 12.2 12.3 JD Howell, MD PhD. The Paradox of Osteopathy. N Engl J Med. 1999 Nov 4;341(19):1465-8. PMID 10547412
  13. ↑ 13.0 13.1 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.
  14. ↑ Lesho, Emil. An Overview of Osteopathic Medicine. Arch Fam Med. 1999;8:477-484. PMID 10575385
  15. ↑ Osteopathic medicine. Intelihealth.com. accessed Dec 2007.
  16. ↑ Johnson, SM, Kurtz, ME, Kurtz, JC. “Variables influencing the use of Osteopathic Manipulative Treatment in Family Practice.” J Amer Osteopathic Assoc, 1997;97:80-87. PMID 9059002
  17. ↑ 17.0 17.1 17.2 17.3 17.4 17.5 Zuger A. Scorned No More, Osteopathy Is on the Rise. New York Times. 17 Feb 1998.
  18. ↑ 18.0 18.1 Gevitz N (1994). "'Parallel and distinctive': the philosophic pathway for reform in osteopathic medical education". J Am Osteopath Assoc. 94 (4): 328–32. PMID 8027001.
  19. ↑ 19.0 19.1 Croasdale, Myrle. First for-profit med school nears approval. American Medical News. 1 Oct 2007.
  20. ↑ Morzinski J and Henley C.Aligning the Interests of Osteopathic and Allopathic Teachers of Family Medicine. Annals of Family Medicine 4:182-184 (2006) PMID 16569724
  21. ↑ "AACOM Medical School Information". American Association of Colleges of Osteopathic Medicine. Retrieved 2006-08-23.
  22. ↑ "AAMC Medical Schools". Association of American Medical Colleges. Retrieved 2006-12-13.
  23. ↑ 23.0 23.1 23.2 Cohen, Jordan. A Word from the President: "Filling the Workforce Gap." AAMC Reporter: April 2005.
  24. ↑ Salsberg, Edward and Grover, Atul. Physician Workforce Shortages: Implications and Issues for Academic Health Centers and Policymakers. Academic Medicine, Vol. 81, No. 9 / September 2006. PMID 16936479
  25. ↑ Geographic Map of Colleges of Osteopathic Medicine. AACOM.
  26. ↑ About the AOA [1]
  27. ↑ Myrle Croasdale. Can-DO strategy: Osteopathic medicine survives, and thrives. American Medical News. 16 Jun 2003.
  28. ↑ 28.0 28.1 28.2 28.3 28.4 Gevitz, Norman. Center or Periphery? The Future of Osteopathic Principles and Practices. J Am Osteopath Assoc. 2006 Mar;106(3):121-9. PMID 16585378]
  29. ↑ 29.0 29.1 Osteopathic medicine. Intelihealth.com.
  30. ↑ About Osteopathic Medicine. American Osteopathic Association. Accessed 30 Aug 2007. [2]
  31. ↑ Barrett, Stephen M.D. Dubious Aspects of Osteopathy. Quackwatch. 18 Aug 2003.
  32. ↑ Still AT. The Philosophy and Mechanical Principles of Osteopathy. Kansas City, Mo: Hudson-Kimberly Pub Co; 1902:9–20,185,210,270. Version 2.0. Inter Linea Web site. Accessed January 23, 2006.
  33. ↑ Hansen, G. Beyond OMT: Time for a New Chapter in Osteopathic Medicine? J Am Osteopath Assoc 2006 Mar;106(3):114-6. PMID 16585374]
  34. ↑ Chapter 34: Complementary and Alternative Medicine. Goldman: Cecil Textbook of Medicine, 22nd ed. Saunders. 2004.
  35. ↑ 35.0 35.1 Gevitz N (1998). "The sword and the scalpel--the osteopathic 'war' to enter the Military Medical Corps: 1916-1966". J Am Osteopath Assoc. 98 (5): 279–86. PMID 9615560.
  36. ↑ Ober KP (1997). "The pre-Flexnerian reports: Mark Twain's criticism of medicine in the United States". Ann. Intern. Med. 126 (2): 157–63. PMID 9005751.
  37. ↑ Sarah E. Brotherton, PhD; Paul H. Rockey, MD, MPH; Sylvia I. Etzel. US Graduate Medical Education, 2004-2005 Trends in Primary Care Specialties. JAMA. 2005;294:1075-1082. PMID 16145028
  38. ↑ Stephen C. Shannon. The Impact of Osteopathic Medicine’s Growth on Physician Workforce. AAMC
  39. ↑ Tulgan, H (2004). "Joint clinical clerkships for osteopathic and allopathic medical students: New England's experience". J Am Osteopath Assoc. 104: 212–214. PMID 15176520. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  40. ↑ Wilk v. American Medical Ass'n, 671 F. Supp. 1465, N.D. Ill. 1987
  41. ↑ 41.0 41.1 Wilson, Jennifer Fisher. Osteopathic medicine's growing pains. American College of Physicians Observer. November 1997.
  42. ↑ 42.0 42.1 Principles Regarding Osteopathic Medicine. Preamble, Purposes and Principles. American Medical Student Association.
  43. ↑ AMA policy H-295.876 [3]
  44. ↑ Thomas MK (presenter). Recommendation on Equal Fees for Osteopathic and Allopathic Medical Students. Council on Medical Education, American Medical Association. Report 6-A-07.
  45. ↑ AMA policy H-295.876 [4]
  46. ↑ Gevitz N. The D.O.s: osteopathic medicine in America. Baltimore: Johns Hopkins University Press, 1982.
  47. ↑ Tulgan, H (2004). "Joint clinical clerkships for osteopathic and allopathic medical students: New England's experience". J Am Osteopath Assoc. 104: 212–214. PMID 15176520. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  48. ↑ Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76:821 –828. PMID 11500286]
  49. ↑ Stoll ST, Russo DP, Atchison JW. Physicians' and patients' attitudes toward manual medicine: implications for continuing medical education. J Contin Educ Health Prof. 2003 Winter;23(1):13-20. PMID 12739255
  50. ↑ James D. Leiber. Allopathic Family Medicine Residents Can Learn Osteopathic Manipulation Techniques in a 1-month Elective. Fam Med 2005;37(10):693-5. PMID 16273444
  51. ↑ Notices. Federal Register. Vol. 70, No. 190. 3 Oct 2005.
  52. ↑ International. American Osteopathic Association. DO-online.org [5]
  53. ↑ AOA International License Summary. American Osteopathic Association. Council on International Osteopathic Medical Education and Affairs.[6]
  54. ↑ DOs around the World. American Osteopathic Association.[7]
  55. ↑ Ruddy G, Phillips RL, Klein LS, McCann JL, Dodoo MS, Green LA; et al. (2005). "Osteopathic physicians and the family medicine workforce". Am Fam Physician. 72 (4): 583. PMID 16127950.
  56. ↑ Heath D, Gevitz N. The research status of somatic dysfunction. In: Ward RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:1188–1193.
  57. ↑ What Is the Scientific Evidence for Osteopathic Manipulation? NYU Medical Center.
  58. ↑ 58.0 58.1 Gevitz N (2001). "Researched and demonstrated: inquiry and infrastructure at osteopathic institutions". J Am Osteopath Assoc. 101 (3): 174–9. PMID 11329813.
  59. ↑ Kelso A, Townsend A. The status and future of osteopathic research. In: Northup G, ed. Osteopathic Research: Growth and Development. Chicago, Ill: American Osteopathic Association; 1987.
  60. ↑ Teitelbaum HS, Bunn WE, Brown SA, Burchett AW. Osteopathic Medical Education: Renaissance or Rhetoric? J Am Osteopath Assoc. Vol 103;No 10 October 2003.
  61. ↑ Tatum, William O, IV. AOA Needs to Reach Out More. J Am Osteopath Assoc. Vol 106 No 8 p442-443. August 2006.
  62. ↑ Mychaskiw, George. Will the Last DO Turn Off the Lights? Journal of the American Osteopathic Association. Vol 106 No 5 May 2006. 252-302. PMID 16717365
  63. ↑ Steiner, Kenneth. Time to Accept Allopathic Physicians Into AOA-Approved Residencies? Journal of the American Osteopathic Association. Vol 106 No 5 May 2006 250-252. PMID 16717364
  64. ↑ Tosca M. Future of osteopathic medicine depends on investing in graduate medical education. J Am Osteopath Assoc. 106(6):319. June 2006. PMID 16790537
  65. ↑ Howell, JD. Correspondence. New Engl J Med. Volume 342:817-820 Number 11. 16 March 2000.
  66. ↑ Johnson SM, Kurtz ME. Perceptions of philosophic and practice differences between US osteopathic physicians and their allopathic counterparts. Soc Sci Med. 2002; 55:2141 –2148. PMID 12409127
  67. ↑ Licciardone, 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. PMID 17371578
  68. ↑ Mychaskiw G. COM Accreditation: the Flexner Report revisited. J Am Osteopath Assoc. 2007 Jul;107(7):246-7; 277. PMID 17682109
  69. ↑ Mychaskiw G. Future of DO. powerpoint presentation. accessed 7 Nov 2007.
  70. ↑ Martin RB. RVUCOM: Striving to Meet the Needs of the Osteopathic Medical Profession J Am Osteopath Assoc. 2007 Oct;107(10):426-8. PMID 17956994
  71. ↑ Ajluni PB. Nonprofit and For-Profit COMs: Investing in the Future of Osteopathic Medicine. J Am Osteopath Assoc. 2007 Oct;107(10):425-6. PMID 17956993]

Further reading

  • The DOs: Osteopathic Medicine in America, Norman Gevitz, 2004 (2nd Edition), paperback, 264 pages, The Johns Hopkins University Press, ISBN 0-8018-7834-9 (An excellent review of the history and development of ostepathic medicine and medical education in the United States)
  • Science in the Art of Osteopathy: Osteopathic Principles and Models, Caroline Stone, Nelson Thornes, 1999, paperback, 384 pages, ISBN 0-7487-3328-0
  • An Osteopathic Approach to Diagnosis and Treatment , Eileen DiGiovanna, Lippincott Williams and Wilkins, 2004, hardback, 600 pages, ISBN 0-7817-4293-5

See also

External links

Template:External links

US Osteopathic regulatory bodies

Journals

Student groups

Professional associations

Other organizations

Template:Osteopathic medical schools

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