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Special Communication  |   June 2009
Perception of Osteopathic Medicine Among Allopathic Physicians in the Deep Central Southern United States
Author Notes
  • From the G.V. (Sonny) Montgomery VA Medical Center and the University of Mississippi Medical Center School of Medicine, both in Jackson. 
  • Address correspondence to Roy R. Reeves, DO, PhD, Chief of Mental Health, G.V. (Sonny) Montgomery VA Medical Center (11M), 1500 E Woodrow Wilson Dr, Jackson, MS 39216-5116. E-mail: roy.reeves@va.gov 
Article Information
Medical Education / Graduate Medical Education
Special Communication   |   June 2009
Perception of Osteopathic Medicine Among Allopathic Physicians in the Deep Central Southern United States
The Journal of the American Osteopathic Association, June 2009, Vol. 109, 318-323. doi:10.7556/jaoa.2009.109.6.318
The Journal of the American Osteopathic Association, June 2009, Vol. 109, 318-323. doi:10.7556/jaoa.2009.109.6.318
Abstract

Context: Relatively few osteopathic physicians (DOs) practice in the deep central southern geographic region as compared to other parts of the United States.

Objective: To assess the potential effects of underrepresentation on the perception of osteopathic medicine among allopathic physicians (MDs) in this geographic region.

Methods: A 20-item, Likert scale survey was designed to evaluate participant perceptions of the osteopathic medical profession. The instrument was mailed to 468 MDs who reside and practice in the deep central southern region of the United States.

Results: One hundred seven individuals completed the survey for a response rate of 22.9%. Although the majority of respondents (71 [66.3%]) recognized the distinctiveness of the osteopathic medical profession, they were not necessarily able to articulate these differences clearly through their responses to other survey items. In addition, survey participants expressed was a belief that residency training programs accredited by the Accreditation Council for Graduate Medical Education were more beneficial to osteopathic medical graduates than those approved by the American Osteopathic Association (94 [87.8%]). Finally, there was a perception that research efforts supporting “the scientific basis of osteopathic medicine” were inadequate (53 [49.5%]). The one demographic factor that had a statistically significant (P<.001) positive impact on perceptions of osteopathic medicine among these MDs was previous contact with DOs.

Conclusion: Underrepresentation of DOs in the deep central southern region of the United States appears to have an impact on the perception of osteopathic medicine among MDs insofar as direct or indirect contact with osteopathic physicians led to improved perceptions among this cohort.

Although the number of osteopathic physicians (DOs) has increased dramatically during the past decade,1,2 only a small percentage of these individuals choose to practice medicine in the deep central southern region of the United States. It is estimated that osteopathic physicians constitute 3.6% of the physician workforce in Alabama; 1.0%, Louisiana; and 5.3%, Mississippi.2,3 In 1974, Mississippi granted full practice rights to osteopathic physicians—the last state in the nation to do so. 
As a result of this underrepresentation, one might expect that individuals living in this geographic region view osteopathic physicians differently than those who abide in areas where DOs are more well represented. Therefore, we sought to assess perceptions of osteopathic medicine among allopathic physicians (MDs) in the deep central southern United States. 
Methods
Using state medical association records, a two-page, 20-item survey was sent during January 2007 to 468 randomly selected MDs in active practice in Alabama (Mobile and Baldwin counties), Louisiana (Bossier and Caddo parishes), and Mississippi (Hinds, Madison, and Harrison counties). Data were collected for 6 months. A follow-up mechanism was not included in the study protocol. 
Multiple-choice Likert scale responses were provided to assist survey participants indicate their degree of agreement with various statements that address the current status as well as common perceptions (and misperceptions)4 regarding the osteopathic medical profession: 1, strongly disagree; 2, disagree; 3, neither agree nor disagree; 4, agree; and 5, strongly agree. The survey took approximately 5 minutes to complete and was divided into four thematically related sections: 
  • training and qualifications
  • practice activities
  • overall opinion
  • philosophy
Six survey items were devoted to each of the first two topics; four to each of the latter. 
Demographic information was also gathered using a combination of fill-in-the-blank, check box, and yes/no survey items: years in practice; practice type (ie, specialist vs primary care), location (ie, rural vs urban) and setting (ie, academic vs nonacademic); as well as history of contact (ie, direct or indirect) with DOs. To determine each respondent's level of exposure to osteopathic medicine, two yes/no questions were posed: 
  • Have you had significant contact with members of the osteopathic profession?
  • Have you had at least limited personal contact with, or knowledge of, an osteopathic physician?
Results
Of the 468 allopathic physicians asked to participate in the present investigation, a total of 107 individuals returned completed surveys for a response rate of 22.9%. Survey participants represented a broad cross-section of practice types and activities (Table 1). 
Table 1
Characteristics of Survey Participants: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States (N=107)

Characteristic

No. (%)
Years in Practice
□ Fewer than 10 y 42 (39.3)
□ 10 y to 20 y36 (33.6)
□ More than 20 y 29 (27.1)
Practice Type
□ Specialty64 (59.8)
□ Primary care 43 (40.2)
Practice Location
□ Urban56 (52.3)
□ Rural 51 (47.7)
Academic Affiliation
□ No83 (77.6)
□ Yes 24 (22.4)
Direct or Indirect Contact With Osteopathic Physicians
□ No55 (51.4)
□ Yes
52 (48.6)
Table 1
Characteristics of Survey Participants: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States (N=107)

Characteristic

No. (%)
Years in Practice
□ Fewer than 10 y 42 (39.3)
□ 10 y to 20 y36 (33.6)
□ More than 20 y 29 (27.1)
Practice Type
□ Specialty64 (59.8)
□ Primary care 43 (40.2)
Practice Location
□ Urban56 (52.3)
□ Rural 51 (47.7)
Academic Affiliation
□ No83 (77.6)
□ Yes 24 (22.4)
Direct or Indirect Contact With Osteopathic Physicians
□ No55 (51.4)
□ Yes
52 (48.6)
×
Overall, when descriptive analysis was performed (Table 2), we found that the majority of respondents acknowledged the distinctiveness of the osteopathic medical profession but were not necessarily able to articulate these differences accurately through their responses to the remainder of the survey. 
Table 2
Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States: A Survey-Based Study (N=107)


Response, No. (%)
Survey Item
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Training and Qualifications of Osteopathic Physicians
1. The length of medical school education for osteopathic medical students is equivalent to that of MD medical students. 0 5 (4.7) 28 (26.2) 44 (41.1) 30 (28.0)
2. The quality of education for osteopathic medical students is equivalent to that of MD medical students.0065 (60.7)31 (29.0)11 (10.3)
3. The residency training length of osteopathic programs is equivalent to that of MD programs. 0 12 (11.2) 31 (29.0) 44 (41.1) 20 (18.7)
4. The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.17 (15.9)30 (28.0)40 (37.4)15 (14.0)5 (4.7)
5. DOs with osteopathic residency training are equivalent to their MD counterparts. 20 (18.7) 26 (24.3) 38 (35.5) 14 (13.1) 9 (8.4)
6. DOs with MD residency training are equivalent to their MD counterparts.0013 (12.1)61 (57.0)33 (30.8)
Practice Activities of Osteopathic Physicians
7. Osteopathic medicine is different/distinct from chiropractic.003 (2.8)58 (54.2)46 (43.0)
8. Osteopathic medicine involves primarily therapy without drugs. 31 (29.0) 73 (68.2) 1 (0.9) 2 (1.9) 0
9. DOs are mostly family practice or primary care physicians.5 (4.7)010 (9.3)92 (86.0)0
10. DOs practice mostly in rural areas. 5 (4.7) 11 (10.3) 80 (74.8) 11 (10.3) 0
11. DOs use advanced medical technology less than MDs.10 (9.3)31 (29.0)43 (40.2)23 (21.5)0
12. DOs prescribe less medication than MDs. 15 (14.0) 26 (24.3) 54 (50.5) 12 (11.2) 0
Opinion of Current Status of the Osteopathic Profession
13. The osteopathic profession trains and certifies medical and surgical specialists and subspecialists. 0 0 39 (36.4) 43 (40.2) 25 (23.4)
14. Research has been done to gain understanding of the scientific basis of osteopathic medicine.33 (30.8)20 (18.7)42 (39.3)12 (11.2)0
15. Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 11 (10.3) 23 (21.5) 28 (26.2) 44 (41.1) 1 (0.9)
16. Osteopathic medicine is an economic/politically influential force in current medical practice.032 (29.9)49 (45.8)21 (19.6)5 (4.7)
Philosophy of the Osteopathic Profession
17. The osteopathic philosophy is distinct from that of traditional MDs.010 (9.3)26 (24.3)59 (55.1)12 (11.2)
18. Osteopathic medicine is a form of alternative medicine. 30 (28.0) 43 (40.2) 26 (24.3) 7 (6.5) 1 (0.9)
19. The osteopathic philosophy is based primarily on manipulation.2 (1.9)20 (18.7)44 (41.1)17 (15.9)24 (22.4)
20. The osteopathic philosophy is based primarily on a holistic approach to patient care.
10 (9.3)
24 (22.4)
27 (25.2)
43 (40.2)
3 (2.8)
Table 2
Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States: A Survey-Based Study (N=107)


Response, No. (%)
Survey Item
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Training and Qualifications of Osteopathic Physicians
1. The length of medical school education for osteopathic medical students is equivalent to that of MD medical students. 0 5 (4.7) 28 (26.2) 44 (41.1) 30 (28.0)
2. The quality of education for osteopathic medical students is equivalent to that of MD medical students.0065 (60.7)31 (29.0)11 (10.3)
3. The residency training length of osteopathic programs is equivalent to that of MD programs. 0 12 (11.2) 31 (29.0) 44 (41.1) 20 (18.7)
4. The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.17 (15.9)30 (28.0)40 (37.4)15 (14.0)5 (4.7)
5. DOs with osteopathic residency training are equivalent to their MD counterparts. 20 (18.7) 26 (24.3) 38 (35.5) 14 (13.1) 9 (8.4)
6. DOs with MD residency training are equivalent to their MD counterparts.0013 (12.1)61 (57.0)33 (30.8)
Practice Activities of Osteopathic Physicians
7. Osteopathic medicine is different/distinct from chiropractic.003 (2.8)58 (54.2)46 (43.0)
8. Osteopathic medicine involves primarily therapy without drugs. 31 (29.0) 73 (68.2) 1 (0.9) 2 (1.9) 0
9. DOs are mostly family practice or primary care physicians.5 (4.7)010 (9.3)92 (86.0)0
10. DOs practice mostly in rural areas. 5 (4.7) 11 (10.3) 80 (74.8) 11 (10.3) 0
11. DOs use advanced medical technology less than MDs.10 (9.3)31 (29.0)43 (40.2)23 (21.5)0
12. DOs prescribe less medication than MDs. 15 (14.0) 26 (24.3) 54 (50.5) 12 (11.2) 0
Opinion of Current Status of the Osteopathic Profession
13. The osteopathic profession trains and certifies medical and surgical specialists and subspecialists. 0 0 39 (36.4) 43 (40.2) 25 (23.4)
14. Research has been done to gain understanding of the scientific basis of osteopathic medicine.33 (30.8)20 (18.7)42 (39.3)12 (11.2)0
15. Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 11 (10.3) 23 (21.5) 28 (26.2) 44 (41.1) 1 (0.9)
16. Osteopathic medicine is an economic/politically influential force in current medical practice.032 (29.9)49 (45.8)21 (19.6)5 (4.7)
Philosophy of the Osteopathic Profession
17. The osteopathic philosophy is distinct from that of traditional MDs.010 (9.3)26 (24.3)59 (55.1)12 (11.2)
18. Osteopathic medicine is a form of alternative medicine. 30 (28.0) 43 (40.2) 26 (24.3) 7 (6.5) 1 (0.9)
19. The osteopathic philosophy is based primarily on manipulation.2 (1.9)20 (18.7)44 (41.1)17 (15.9)24 (22.4)
20. The osteopathic philosophy is based primarily on a holistic approach to patient care.
10 (9.3)
24 (22.4)
27 (25.2)
43 (40.2)
3 (2.8)
×
With regard to the training and qualifications of osteopathic physicians, survey participants generally had a favorable response to statements designed to determine “equivalent” status for DOs and MDs. In response to the statement that “the length of medical school education for osteopathic medical students is equivalent to that of MD medical students,” the majority of allopathic physicians either agreed (44 [41.1%]) or strongly agreed (30 [28.0%]). When responding to the statement that “the quality of education for osteopathic medical students is equivalent to that of MD medical students,” the majority of survey participants (65 [60.7%]) returned a neutral response. The remainder either agreed (31 [29%]) or strongly agreed (11 [10.3%]) with the statement; none disagreed or strongly disagreed. A majority of respondents were aware that “the residency training length of osteopathic programs is equivalent to that of MD programs,” with 44 (41.1%) expressing agreement and 20 (18.7%) expressing strong agreement. 
However, with regard to residency training options available for osteopathic physicians, survey participants expressed a belief that programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) rather than those approved by the American Osteopathic Association (AOA) were more beneficial generally. The statement that “the quality of residency training in osteopathic programs is equivalent to that of MD residency programs” received a large neutral response (40 [37.4%]) from participants, with the majority of remaining respondents either disagreeing (30 [28%]) or strongly disagreeing (17 [15.9%]). 
In addition, when specifically assessing the skill level of osteopathic vs allopathic physicians, participants agreed that an ACGME-accredited residency program would be far more beneficial for DOs than one approved by the AOA. When responding to the statement “DOs with MD residency training are equivalent to their MD counterparts,” a clear majority responded affirmatively, either agreeing (61 [57%]) or strongly agreeing (33 [30.8%]). In fact, none disagreed with that statement; all other survey participants returned a neutral response (13 [13.1%]). Conversely, when asked to respond to the statement “DOs with osteopathic residency training are equivalent to their MD counterparts,” a decided minority expressed agreement (14 [13.1%]) or strong agreement (9 [8.4%]). 
We found that most MDs in our sample had a good understanding of the practice activities of DOs. The majority of respondents either agreed (58 [54.2%]) or strongly agreed (46 [43%]) that “osteopathic medicine is different/distinct from chiropractic” care. They also clearly understood that osteopathic medicine makes use of pharmacotherapeutic options for patient treatment, disagreeing (73 [68.2%]) or strongly disagreeing (31 [29%]) with the statement that “osteopathic medicine involves primarily therapy without drugs.” In response to the statements that “DOs prescribe less medication than MDs” and “DOs use advanced medical technology less than MDs,” a minority of participants (12 [11.2%]; 23 [21.5%]) agreed. 
A large majority of the MDs who responded to our survey agreed (92 [86%]) that “DOs are mostly family practice or primary care physicians.” A majority of respondents (80 [74.8%]) returned a neutral response to the statement that “DOs practice mostly in rural areas.” 
When queried about their impressions of the current status of the osteopathic medical profession, survey respondents reported opinions with mixed positive and negative elements. The majority of respondents agreed (43 [40.2%]) or strongly agreed (25 [23.4%]) with the statement that “the osteopathic profession trains and certifies medical and surgical specialists and subspecialists.” Likewise, many participants (44 [41.1%]) affirmed the statement “osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems.” Survey data also revealed that MD respondents did not view osteopathic medicine as “a form of alternative medicine.” The majority of physicians surveyed disagreed (43 [40.2%]) or strongly disagreed (30 [28%]) with a statement that attempted to equate them. However, 24.3% of participants returned a neutral response to this statement, neither agreeing nor disagreeing, and 7.4% agreed with it. 
However, in response to the statement “research has been done to gain understanding of the scientific basis of osteopathic medicine,” survey participants were dubious, with the largest group (42 [39.3%]) returning a neutral response and a majority expressing disagreement (20 [18.7%]) or strong disagreement (33 [30.8%]). 
In addition, the largest group of respondents (49 [45.8%]) was neutral toward the statement that “osteopathic medicine is an economic/politically influential force in current medical practice.” 
In response to statements designed to gauge awareness among allopathic physicians of osteopathic principles and practice (OPP), survey participants conveyed the fact that they understood “osteopathic philosophy is distinct from that of traditional MDs.” Fifty-nine participants (55.1%) agreed with this statement; 12 (11.2%) strongly agreed. Unfortunately, a high percentage of MD participants returned either a neutral (44 [41.1%]) or affirmative (17 [15.9%] agree; 24 [22.4%] strongly agree) response to the statement “the osteopathic philosophy is based primarily on manipulation.” 
Data were further analyzed to determine the impact of subject characteristics on survey responses (Table 3). We determined that less-than-favorable responses toward osteopathic medicine were received for a total of seven survey items: 
  • Survey Item 4—The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.
  • Survey Item 5—DOs with osteopathic residency training are equivalent to their MD counterparts.
  • Survey Item 14—Research has been done to gain understanding of the scientific basis of osteopathic medicine.
  • Survey Item 15—Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems.
  • Survey Item 18—Osteopathic medicine is a form of alternative medicine.
  • Survey Item 19—The osteopathic philosophy is based primarily on manipulation.
  • Survey Item 20—The osteopathic philosophy is based primarily on a holistic approach to patient care.
Table 3
One-Way Analysis of Variance: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States by Contact Status With Osteopathic Physicians (N=107) *


Mean (SD)


Survey Item
Contact (n=52)
No Contact (n=55)
F Statistic (df)
P Value
4—The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.1.91 (.78)3.40 (.72)106.171,105<.001
5—DOs with osteopathic residency training are equivalent to their MD counterparts. 1.93 (.79) 3.48 (.96) 83.941,105 <.001
14—Research has been done to gain understanding of the scientific basis of osteopathic medicine.1.75 (.89)2.90 (.82)48.941,105<.001
15—Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 2.45 (1.09) 3.6 (.57) 45.631,105 <.001
18—Osteopathic medicine is a form of alternative medicine2.22 (1.03)2.02 (.80)1.231,105.270
19—The osteopathic philosophy is based primarily on manipulation. 4.00 (.90) 2.73 (.87) 54.981,105 <.001
20—The osteopathic philosophy is based primarily on a holistic approach to patient care.
2.35 (.89)3.79 (.64)92.601,105<.001
 Abbreviations: DO, osteopathic physician; MD, allopathic physician.
 *Two survey items were devoted to determining whether survey participants had contact with osteopathic physicians. The first inquired, Have you had significant contact with members of the osteopathic profession?; the second, Have you had at least limited personal contact with, or knowledge of, an osteopathic physician?
Table 3
One-Way Analysis of Variance: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States by Contact Status With Osteopathic Physicians (N=107) *


Mean (SD)


Survey Item
Contact (n=52)
No Contact (n=55)
F Statistic (df)
P Value
4—The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.1.91 (.78)3.40 (.72)106.171,105<.001
5—DOs with osteopathic residency training are equivalent to their MD counterparts. 1.93 (.79) 3.48 (.96) 83.941,105 <.001
14—Research has been done to gain understanding of the scientific basis of osteopathic medicine.1.75 (.89)2.90 (.82)48.941,105<.001
15—Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 2.45 (1.09) 3.6 (.57) 45.631,105 <.001
18—Osteopathic medicine is a form of alternative medicine2.22 (1.03)2.02 (.80)1.231,105.270
19—The osteopathic philosophy is based primarily on manipulation. 4.00 (.90) 2.73 (.87) 54.981,105 <.001
20—The osteopathic philosophy is based primarily on a holistic approach to patient care.
2.35 (.89)3.79 (.64)92.601,105<.001
 Abbreviations: DO, osteopathic physician; MD, allopathic physician.
 *Two survey items were devoted to determining whether survey participants had contact with osteopathic physicians. The first inquired, Have you had significant contact with members of the osteopathic profession?; the second, Have you had at least limited personal contact with, or knowledge of, an osteopathic physician?
×
We determined that there were no statistically significant differences in responses relative to years in practice, practice type, location, or setting. However, statistically significant results were achieved using one-way analysis of variance comparing the responses of MDs who reported direct or indirect contact with DOs to data received from allopathic physicians who did not. Respondents who reported no previous contact with DOs were significantly more likely to hold the following opinions: 
  • The quality of residency training in osteopathic programs is not equivalent to that of MD residency programs (P<.001).
  • DOs with osteopathic residency training are not equivalent to their MD counterparts (P<.001).
  • Research has not been done to gain understanding of the scientific basis of osteopathic medicine (P<.001).
  • Osteopathic medicine is not as beneficial as the traditional medical approach for most medical problems (P<.001).
  • Osteopathic medicine is based primarily on manipulation (P<.001).
Conversely, respondents who reported some form of contact with DOs were less likely to hold these opinions and more likely to indicate that osteopathic medicine is based primarily on a holistic approach to patient care. 
Comment
The present survey-based study has certain limitations. Although a higher response rate clearly would have been desirable, it is often difficult to get busy professionals to complete and return surveys. 
To minimize the incidence of nonresponse, we kept the survey as brief as possible (ie, approximately 5 minutes to complete). Unfortunately, the necessity of concisely wording survey items may also have inadvertently allowed a certain amount of variability to interpretation among survey respondents, depending on the individual reader's perceptions. For example, the phrase “equivalent to” in six of the 20 survey items may have held a different meaning among survey participants depending on how they subjectively defined the word “equivalent” in their own respective constructs. This turn of phrase, therefore, may have been a confounding factor in our investigation. 
In addition, because the survey was conducted in a geographically limited area, it is unknown whether our results can be extrapolated to a national level. 
Although the results of our survey reveal generally positive perceptions of osteopathic medicine among allopathic physicians in the deep central southern region of the United States, we found that room for improvement exists. 
In our study, the most significant factor that contributed to negative perceptions of osteopathic medicine among MDs was a lack of contact with DOs. Allopathic physicians without this “hands-on” exposure were more likely to hold negative opinions about osteopathic medicine on isolated topics—namely the quality of osteopathic residency training and the effectiveness of osteopathic medical research. In addition, these MDs more frequently had misconceptions about OPP—specifically that OPP is based on manipulation and that osteopathic medicine is not as beneficial as “the traditional medical approach” for most health problems. 
Aside from lack of contact with DOs, no other demographic factor had a statistically significant impact on the opinion of the MDs who completed the survey. This finding suggests that more widespread exposure to osteopathic medicine is crucial to adjusting perceptions within the allopathic community. 
Lack of acceptance for DOs' qualifications within the allopathic community has been noted previously5,6 and continues to be a cause for concern. Alternatively, DOs who receive residency training in ACGME-accredited programs appear to have wide acceptance among survey participants—a fact that implies a belief that the training DOs receive in AOA-approved programs is of a lesser quality. One letter writer5 commented on this assumption noting that it extends to board certification credentials: “In the casual opinion of many in the allopathic world, the AOA specialty boards are widely considered to be `easier' and less credible than the allopathic certifying boards.” He added, “Osteopathic [graduate medical education] programs tend to be in relatively small facilities, which may be sufficient for osteopathic residents in primary care programs but not for residents in other specialties,” noting the desirability of “a large tertiary- or quaternary-care medical center” for anesthesiology residents.5 
More and more osteopathic graduates are serving their residencies in allopathic hospitals,7,8 regularly necessitating policy changes within the profession (Resolution 42 [A/2000], Approval of ACGME Training as an AOA-Approved Internship; Resolution 274 [A/2004], Match Participation and Rotations with Osteopathic Physicians, Proposed Requirements for Osteopathic). Inadequate recognition and acceptance of osteopathic graduate medical education—particularly in many allopathic academic institutions5—is a problem not only of perception within the allopathic profession, it has potentially serious implications for the future of the entire osteopathic medical profession if current trends and circumstances remain unchanged. The diligent maintenance, management, and expansion of well-recognized, high-quality osteopathic graduate medical education programs and training sites is essential. 
The task of educating our allopathic counterparts regarding OPP is important for the continued development and success of the osteopathic medical profession. In 1997, one commentator9 stated: 

At best, only 15% of Americans have heard of DOs and osteopathic medicine, know the scope of osteopathic medical licensure, and can articulate meaningful differences between DOs and other healthcare practitioners.

 
“Osteopathic invisibility syndrome” was the phrase this writer9 coined to describe the status of the osteopathic medical profession as “the best kept secret in US healthcare.” Another commentator9 has argued that the osteopathic medical profession is in need of a clear identity. This increased visibility would certainly lead to increased viability for the profession.4,9 
In a context where fewer than 1 in 8 respondents (11.2%) agreed that an “understanding of the scientific basis of osteopathic medicine” has been achieved through osteopathic medical research, the importance of a renewed emphasis on the profession's research efforts cannot be overstated. 
Less than a quarter of respondents disagreed with the statement “the osteopathic philosophy is based primarily on manipulation.” However, the 2002 proposed tenets of osteopathic medicine and principles for patient care10 place the role of manipulation in a complimentary but slightly more subordinate role in the daily practice of osteopathic medicine. Although those of us in the osteopathic medical profession are well aware of how our heritage in OPP serves as a guiding force in a uniquely holistic approach to patient care, it is disheartening to learn that more than 30% of survey respondents were not familiar with this particular achievement. 
Likewise, it was surprising to see that close to 10% of respondents considered osteopathic medicine a form of alternative medicine. Although this percentage sounds low, it is sobering to realize that this number actually means that approximately 1 of 13 respondents held this opinion. In fact, this result may represent one area where our survey subjects were slightly out of step with the wider allopathic community, which views osteopathic medicine as “mainstream” and perhaps “disproportionately important for the [healthcare] system” as a result of an emphasis in primary care medicine and the agility of its education and training system.4 
Conclusion
The one demographic factor that had a statistically significant (P<.001) impact on negative perceptions of osteopathic medicine among the MDs surveyed was a lack of contact with osteopathic physicians. Therefore, DOs residing and practicing in the deep central southern region of the United States are encouraged to reach out to their allopathic colleagues to increase awareness of OPP within the healthcare professions. 
In addition, we may find that the prominence of osteopathic medicine as a premier health profession may be held in check as a result of misplaced or negative perceptions unless we are able to maintain a culture of research and scholarly endeavor—and to promote an awareness of this culture throughout the medical community. 
Finally, the diligent maintenance, management, and expansion of well-recognized, high-quality osteopathic graduate medical education programs and training sites is absolutely essential to the viability of the profession. 
Sinco P. Numbers are in: profession measures are up...and up...and up. The DO. December 2007;48:48. Available at: https://www.do-online.org/pdf/pub_do1207report.pdf. Accessed June 9, 2009.
American Osteopathic Association. Osteopathic medical profession report. The DO. December 2007;48:49-68. Available at: https://www.do-online.org/pdf/aoa_ompreport.pdf. Accessed June 9, 2009.
American Medical Association. Physician Characteristics and Distribution in the United States, 2007. Chicago, Ill: American Medical Association Press; 2008.
Howell JD. The paradox of osteopathy. N Engl J Med. 1999;341:1465-1468.
Mychaskiw G II. Will the last DO turn off the lights [letter]? J Am Osteopath Assoc. 2006;106:252-253,302. Available at: http://www.jaoa.org/cgi/content/full/106/5/252. Accessed June 9, 2009.
Reeves RR. AOA certifying boards are credible and capable [letter] [published correction appears in J Am Osteopath Assoc. 2006;106:590]. J Am Osteopath Assoc. 2006;106:441. Available at: http://www.jaoa.org/cgi/content/full/106/8/441. Accessed June 9, 2009.
Sinay T. Cost structure of osteopathic hospitals and their local counterparts in the USA: are they any different? Soc Sci Med. 2005;60:1805-1814.
Barr P. Final farewell: Osteopathic Medical Center of Texas closes its doors. Mod Healthc. 2004;34:10 .
Gevitz N. `Visible and recognized': osteopathic invisibility syndrome and the two percent solution. J Am Osteopath Assoc. 1997;97:168-170.
Rogers FJ, D'Alonzo GE Jr, Glover JG, Korr IM, Osborn GG, Patterson MM, et al. Proposed tenets of osteopathic medicine and principles for patient care. J Am Osteopath Assoc. 2002;102:63-65. Available at: http://www.jaoa.org/cgi/reprint/102/2/63. Accessed June 9, 2009.
Table 1
Characteristics of Survey Participants: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States (N=107)

Characteristic

No. (%)
Years in Practice
□ Fewer than 10 y 42 (39.3)
□ 10 y to 20 y36 (33.6)
□ More than 20 y 29 (27.1)
Practice Type
□ Specialty64 (59.8)
□ Primary care 43 (40.2)
Practice Location
□ Urban56 (52.3)
□ Rural 51 (47.7)
Academic Affiliation
□ No83 (77.6)
□ Yes 24 (22.4)
Direct or Indirect Contact With Osteopathic Physicians
□ No55 (51.4)
□ Yes
52 (48.6)
Table 1
Characteristics of Survey Participants: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States (N=107)

Characteristic

No. (%)
Years in Practice
□ Fewer than 10 y 42 (39.3)
□ 10 y to 20 y36 (33.6)
□ More than 20 y 29 (27.1)
Practice Type
□ Specialty64 (59.8)
□ Primary care 43 (40.2)
Practice Location
□ Urban56 (52.3)
□ Rural 51 (47.7)
Academic Affiliation
□ No83 (77.6)
□ Yes 24 (22.4)
Direct or Indirect Contact With Osteopathic Physicians
□ No55 (51.4)
□ Yes
52 (48.6)
×
Table 2
Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States: A Survey-Based Study (N=107)


Response, No. (%)
Survey Item
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Training and Qualifications of Osteopathic Physicians
1. The length of medical school education for osteopathic medical students is equivalent to that of MD medical students. 0 5 (4.7) 28 (26.2) 44 (41.1) 30 (28.0)
2. The quality of education for osteopathic medical students is equivalent to that of MD medical students.0065 (60.7)31 (29.0)11 (10.3)
3. The residency training length of osteopathic programs is equivalent to that of MD programs. 0 12 (11.2) 31 (29.0) 44 (41.1) 20 (18.7)
4. The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.17 (15.9)30 (28.0)40 (37.4)15 (14.0)5 (4.7)
5. DOs with osteopathic residency training are equivalent to their MD counterparts. 20 (18.7) 26 (24.3) 38 (35.5) 14 (13.1) 9 (8.4)
6. DOs with MD residency training are equivalent to their MD counterparts.0013 (12.1)61 (57.0)33 (30.8)
Practice Activities of Osteopathic Physicians
7. Osteopathic medicine is different/distinct from chiropractic.003 (2.8)58 (54.2)46 (43.0)
8. Osteopathic medicine involves primarily therapy without drugs. 31 (29.0) 73 (68.2) 1 (0.9) 2 (1.9) 0
9. DOs are mostly family practice or primary care physicians.5 (4.7)010 (9.3)92 (86.0)0
10. DOs practice mostly in rural areas. 5 (4.7) 11 (10.3) 80 (74.8) 11 (10.3) 0
11. DOs use advanced medical technology less than MDs.10 (9.3)31 (29.0)43 (40.2)23 (21.5)0
12. DOs prescribe less medication than MDs. 15 (14.0) 26 (24.3) 54 (50.5) 12 (11.2) 0
Opinion of Current Status of the Osteopathic Profession
13. The osteopathic profession trains and certifies medical and surgical specialists and subspecialists. 0 0 39 (36.4) 43 (40.2) 25 (23.4)
14. Research has been done to gain understanding of the scientific basis of osteopathic medicine.33 (30.8)20 (18.7)42 (39.3)12 (11.2)0
15. Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 11 (10.3) 23 (21.5) 28 (26.2) 44 (41.1) 1 (0.9)
16. Osteopathic medicine is an economic/politically influential force in current medical practice.032 (29.9)49 (45.8)21 (19.6)5 (4.7)
Philosophy of the Osteopathic Profession
17. The osteopathic philosophy is distinct from that of traditional MDs.010 (9.3)26 (24.3)59 (55.1)12 (11.2)
18. Osteopathic medicine is a form of alternative medicine. 30 (28.0) 43 (40.2) 26 (24.3) 7 (6.5) 1 (0.9)
19. The osteopathic philosophy is based primarily on manipulation.2 (1.9)20 (18.7)44 (41.1)17 (15.9)24 (22.4)
20. The osteopathic philosophy is based primarily on a holistic approach to patient care.
10 (9.3)
24 (22.4)
27 (25.2)
43 (40.2)
3 (2.8)
Table 2
Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States: A Survey-Based Study (N=107)


Response, No. (%)
Survey Item
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
Training and Qualifications of Osteopathic Physicians
1. The length of medical school education for osteopathic medical students is equivalent to that of MD medical students. 0 5 (4.7) 28 (26.2) 44 (41.1) 30 (28.0)
2. The quality of education for osteopathic medical students is equivalent to that of MD medical students.0065 (60.7)31 (29.0)11 (10.3)
3. The residency training length of osteopathic programs is equivalent to that of MD programs. 0 12 (11.2) 31 (29.0) 44 (41.1) 20 (18.7)
4. The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.17 (15.9)30 (28.0)40 (37.4)15 (14.0)5 (4.7)
5. DOs with osteopathic residency training are equivalent to their MD counterparts. 20 (18.7) 26 (24.3) 38 (35.5) 14 (13.1) 9 (8.4)
6. DOs with MD residency training are equivalent to their MD counterparts.0013 (12.1)61 (57.0)33 (30.8)
Practice Activities of Osteopathic Physicians
7. Osteopathic medicine is different/distinct from chiropractic.003 (2.8)58 (54.2)46 (43.0)
8. Osteopathic medicine involves primarily therapy without drugs. 31 (29.0) 73 (68.2) 1 (0.9) 2 (1.9) 0
9. DOs are mostly family practice or primary care physicians.5 (4.7)010 (9.3)92 (86.0)0
10. DOs practice mostly in rural areas. 5 (4.7) 11 (10.3) 80 (74.8) 11 (10.3) 0
11. DOs use advanced medical technology less than MDs.10 (9.3)31 (29.0)43 (40.2)23 (21.5)0
12. DOs prescribe less medication than MDs. 15 (14.0) 26 (24.3) 54 (50.5) 12 (11.2) 0
Opinion of Current Status of the Osteopathic Profession
13. The osteopathic profession trains and certifies medical and surgical specialists and subspecialists. 0 0 39 (36.4) 43 (40.2) 25 (23.4)
14. Research has been done to gain understanding of the scientific basis of osteopathic medicine.33 (30.8)20 (18.7)42 (39.3)12 (11.2)0
15. Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 11 (10.3) 23 (21.5) 28 (26.2) 44 (41.1) 1 (0.9)
16. Osteopathic medicine is an economic/politically influential force in current medical practice.032 (29.9)49 (45.8)21 (19.6)5 (4.7)
Philosophy of the Osteopathic Profession
17. The osteopathic philosophy is distinct from that of traditional MDs.010 (9.3)26 (24.3)59 (55.1)12 (11.2)
18. Osteopathic medicine is a form of alternative medicine. 30 (28.0) 43 (40.2) 26 (24.3) 7 (6.5) 1 (0.9)
19. The osteopathic philosophy is based primarily on manipulation.2 (1.9)20 (18.7)44 (41.1)17 (15.9)24 (22.4)
20. The osteopathic philosophy is based primarily on a holistic approach to patient care.
10 (9.3)
24 (22.4)
27 (25.2)
43 (40.2)
3 (2.8)
×
Table 3
One-Way Analysis of Variance: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States by Contact Status With Osteopathic Physicians (N=107) *


Mean (SD)


Survey Item
Contact (n=52)
No Contact (n=55)
F Statistic (df)
P Value
4—The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.1.91 (.78)3.40 (.72)106.171,105<.001
5—DOs with osteopathic residency training are equivalent to their MD counterparts. 1.93 (.79) 3.48 (.96) 83.941,105 <.001
14—Research has been done to gain understanding of the scientific basis of osteopathic medicine.1.75 (.89)2.90 (.82)48.941,105<.001
15—Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 2.45 (1.09) 3.6 (.57) 45.631,105 <.001
18—Osteopathic medicine is a form of alternative medicine2.22 (1.03)2.02 (.80)1.231,105.270
19—The osteopathic philosophy is based primarily on manipulation. 4.00 (.90) 2.73 (.87) 54.981,105 <.001
20—The osteopathic philosophy is based primarily on a holistic approach to patient care.
2.35 (.89)3.79 (.64)92.601,105<.001
 Abbreviations: DO, osteopathic physician; MD, allopathic physician.
 *Two survey items were devoted to determining whether survey participants had contact with osteopathic physicians. The first inquired, Have you had significant contact with members of the osteopathic profession?; the second, Have you had at least limited personal contact with, or knowledge of, an osteopathic physician?
Table 3
One-Way Analysis of Variance: Perceptions of Osteopathic Medicine Among Medical Doctors in the Deep Central Southern United States by Contact Status With Osteopathic Physicians (N=107) *


Mean (SD)


Survey Item
Contact (n=52)
No Contact (n=55)
F Statistic (df)
P Value
4—The quality of residency training in osteopathic programs is equivalent to that of MD residency programs.1.91 (.78)3.40 (.72)106.171,105<.001
5—DOs with osteopathic residency training are equivalent to their MD counterparts. 1.93 (.79) 3.48 (.96) 83.941,105 <.001
14—Research has been done to gain understanding of the scientific basis of osteopathic medicine.1.75 (.89)2.90 (.82)48.941,105<.001
15—Osteopathic medicine is as beneficial as the traditional medical approach for most common medical problems. 2.45 (1.09) 3.6 (.57) 45.631,105 <.001
18—Osteopathic medicine is a form of alternative medicine2.22 (1.03)2.02 (.80)1.231,105.270
19—The osteopathic philosophy is based primarily on manipulation. 4.00 (.90) 2.73 (.87) 54.981,105 <.001
20—The osteopathic philosophy is based primarily on a holistic approach to patient care.
2.35 (.89)3.79 (.64)92.601,105<.001
 Abbreviations: DO, osteopathic physician; MD, allopathic physician.
 *Two survey items were devoted to determining whether survey participants had contact with osteopathic physicians. The first inquired, Have you had significant contact with members of the osteopathic profession?; the second, Have you had at least limited personal contact with, or knowledge of, an osteopathic physician?
×