Letters to the Editor  |   December 2009
Keeping the Osteopathic Medical Profession Parallel and Distinctive
Author Affiliations
  • Tayson DeLengocky, DO
    Peoria, Illinois
    Specialist in vitreoretinal surgery
Article Information
Evidence-Based Medicine / Neuromusculoskeletal Disorders / Pain Management/Palliative Care / Pediatrics / Preventive Medicine / Professional Issues / Psychiatry / Low Back Pain
Letters to the Editor   |   December 2009
Keeping the Osteopathic Medical Profession Parallel and Distinctive
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 653-654. doi:10.7556/jaoa.2009.109.12.653
The Journal of the American Osteopathic Association, December 2009, Vol. 109, 653-654. doi:10.7556/jaoa.2009.109.12.653
To the Editor:  
The osteopathic and allopathic medical professions share more similarities than differences, with osteopathic medical students and osteopathic physicians often training and working alongside their allopathic colleagues and with both professions becoming increasingly evidence-based. Some DOs fear that the osteopathic medical profession may be losing its distinctiveness1 and may even eventually be called to merge with the allopathic medical profession.2 
The best-known attempt to merge the two medical professions happened in 1962 in California, when the California Osteopathic Association and California Medical Association—believing there was no justification for the continued existence of osteopathic medicine—agreed to grant “academic” MD degrees to DOs who paid a $65 fee.2,3 
I would like to present three reasons that the osteopathic medical profession remain parallel to and distinctive from the allopathic medical profession. 
The first reason is related to the growing public interest in complementary and alternative medicine (CAM). According to data reported in 2007 by the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM),4 approximately 38% of adults in the United States used some form of CAM that year, compared with 36% in 2002. Approximately 12% of children used some form of CAM in 2007.4 
According to the National Center for Health Statistics' 2007 National Health Interview Survey,5 Americans spent $33.9 billion out-of-pocket on CAM during the previous 12 months. The results of that study5 also showed that Americans in 2007 spent approximately $11.9 billion on an estimated 354.2 million visits to CAM practitioners (including, according to the study, acupuncturists, chiropractors, massage therapists, osteopathic physicians, and traditional healers). 
Most allopathic medical schools in the United States have responded to this public interest by offering some forms of elective instructions in CAM.6,7 
Also in response to the public interest in holistic and preventive healthcare approaches, the NCCAM awarded 15 grants to academic institutions for the development of integrative medicine centers and programs from 2000 to 2008.6 In 2003, the Steering Committee of the Consortium of Academic Health Centers for Integrative Medicine—consisting of 23 prestigious academic health centers—endorsed a proposal of adding core competencies in integrative medicine to the undergraduate medical curriculum.8 The proposal was advanced in hope of instilling graduating physicians with the values, knowledge, attitudes, and skills needed to improve physician-patient communication.8 
Furthermore, both the efficacy and safety of CAM are likely to be enhanced if physicians become more versed in integrative and alternative medicine. 
This trend in healthcare presents osteopathic physicians with a unique opportunity to be seen as leaders—thanks to the long tradition in osteopathic medicine of a holistic and preventive philosophy to patient care. This tradition has a firm foundation in osteopathic principles and practice and the following tenets of osteopathic medicine9,10: 
  • The body is a unit.
  • The body possesses self-regulatory mechanisms.
  • Structure and function are reciprocally interrelated.
  • Rational therapy is based on an understanding of body unity, self-regulatory mechanisms, and the interrelationship of structure and function.
The second reason that osteopathic medicine needs to remain parallel and distinctive is that musculoskeletal conditions and injuries are among the most common causes for visits to physicians in the United States. According to the National Center for Health Statistics,11 musculoskeletal conditions were the leading cause of activity limitation among adults aged 18 to 64 years in 2003 and 2004. Twenty-one percent of individuals aged 18 to 44 years, 59% of those aged 45 to 54 years, and 98% of those aged 55 to 64 years reported limitation of activity because of musculoskeletal conditions.11 
According to a 1999 survey by the Steering Committee on Collaboration Among Physician Providers Involved in Musculoskeletal Care,12 the percentages of allopathic physicians who felt adequately prepared to physically assess problems of low back pain and foot pain were, respectively, 31% and 10%. By contrast, the percentages of osteopathic physicians who felt adequately prepared to physically assess low back pain and hand problems were, respectively, 84% and 41%.12 Thus, training in osteopathic medicine appears to position osteopathic physicians at the forefront of addressing major healthcare issues and fulfilling public demands for patient-focused care. 
The third reason that osteopathic medicine needs to remain parallel and distinctive is that the existence of two distinct branches of medicine is politically beneficial—helping to counteract the aggressive legislative activities of other, allied health professions for prescription and surgical privileges. A number of nonphysician professions have upgraded their education and training and awarded themselves with the titles of “doctors.”13-17 
Ophthalmologists are continually facing aggressive political actions from the optometric community, which is seeking to gain surgical privileges at state legislatures.13 Psychologists have obtained prescription privileges in Louisiana and New Mexico.14 Clinical pharmacists have obtained institutional prescription privileges,15 and nurse practitioners and physician assistants often act as primary care providers in so-called “retail clinics.”16 
In 2004, the American Association of Colleges of Nursing (AACN) endorsed the creation of a Doctor of Nursing Practice (DNP) degree by 2015.17 In the meantime—with the purpose of expanding the practice scope of nursing to that of independent primary care providers—the AACN is phasing out all masters programs for advanced nursing.17 
The parallel and distinctive existence of osteopathic medicine helps the medical profession as a whole to be identified as a profession requiring full, formal medical training as essential for the sake of patients' health and safety. By comparison, the allied health professions seek to expand their scopes of practice through legislative processes or through revising their definitions of scopes of practice. 
As medicine becomes increasingly evidence-based, it is important to keep in mind that the art and the philosophy of medical practice should not be discounted. By fully embracing new advances in technology and medicine while retaining its distinctive holistic philosophy, osteopathic medicine can maintain its solid foundation in the healthcare delivery system. The growing public interest in self-care and CAM is conducive to osteopathic medicine playing a leading role in providing the healthcare that the public wants. 
Osborn GG. Taking osteopathic distinctiveness seriously: historical and philosophical perspectives [editorial]. J Am Osteopath Assoc. 2005;105:241-244. Accessed August 24, 2009.
Bates BR, Mazer JP, Ledbetter AM, Norander S. The DO difference: an analysis of causal relationships affecting the degree-change debate. J Am Osteopath Assoc. 2009;109:359-369. Accessed August 24, 2009.
Howell JD. The paradox of osteopathy. N Engl J Med. 1999;341:1465-1468.
The use of complementary and alternative medicine in the United States; updated January 9, 2009. National Center for Complementary and Alternative Medicine Web site. Accessed August 24, 2009.
Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. National Health Statistics Reports, No 18. Hyattsville, MD: National Center for Health Statistics; 2009. Department of Health & Human Services Publication No (PHS) 2009-1250. Accessed August 27, 2009.
Gaylord SA, Mann JD. Rationales for CAM education in health professions training programs [review]. Acad Med. 2007;82:927-933.
Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical schools. JAMA. 1998;280:784-787.
Kligler B, Maizes V, Schachter S, Park CM, Gaudet T, Benn R, et al; Education Working Group, Consortium of Academic Health Centers for Integrative Medicine. Core competencies in integrative medicine for medical school curricula: a proposal. Acad Med. 2004;79:521-531.
Special Committee on Osteopathic Principles and Osteopathic Technic by Kirksville College of Osteopathy and Surgery. The osteopathic concept. J Osteopathy. 1953;60:7-10.
Rogers FJ, D'Alonzo GE Jr, Glover JC, 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. Accessed August 21, 2009.
National Center for Health Statistics. Health, United States, 2006, With Chartbook on Trends in the Health of Americans. Hyattsville, MD: National Center for Health Statistics; 2006:105. Accessed August 24, 2009.
Praemer A, Furmer S, Rice DP. Musculoskeletal Conditions in the United States. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1999.
Carr L. OD's quest to perform surgery. Cataract & Refractive Surgery Today. October 2004:51-53. Accessed August 21, 2009.
Murray B. A brief history of RxP. Monitor on Psychology. October 2003:66. Accessed August 24, 2009.
Pearson G, Yuksel N, Card D, Chin T, Gray M, Hawbold J, et al. An information paper on pharmacist prescribing within a health care facility. Can J Hosp Pharm. 2002;55:56-62.
Scott MK. Health Care in the Express Lane: The Emergence of Retail Clinics. Oakland: California HealthCare Foundation; July 2006. Accessed August 24, 2009.
Frequently asked questions: position statement on the practice doctorate in nursing; updated February 11, 2008. American Association of Colleges of Nursing Web site. Accessed August 24, 2009.