Letters to the Editor  |   May 2012
Thanks, but No Thanks: How Denial of Osteopathic Service in the World Wars Shaped the Profession–2
Author Affiliations
  • Arnold Melnick, DO
    Aventura, Florida
Article Information
Medical Education / Graduate Medical Education / Curriculum
Letters to the Editor   |   May 2012
Thanks, but No Thanks: How Denial of Osteopathic Service in the World Wars Shaped the Profession–2
The Journal of the American Osteopathic Association, May 2012, Vol. 112, 263-264. doi:10.7556/jaoa.2012.112.5.263
The Journal of the American Osteopathic Association, May 2012, Vol. 112, 263-264. doi:10.7556/jaoa.2012.112.5.263
To the Editor: 
I want to congratulate Shawn A. Silver, OMS I, on his outstanding article Thanks, But No Thanks, a history of DOs and military service, in the February issue of JAOA—The Journal of the American Osteopathic Association.1 It is right on target, and it is good to see this type of material in print. 
Perhaps the viewpoint of someone “who was there” can add emphasis to Mr Silver's thesis. I entered the Philadelphia College of Osteopathy (now the Philadelphia College of Osteopathic Medicine) in 1942, at which time 3 to 4 years of undergraduate study were required for admission. I graduated in the fall of 1945, a course compressed because of the war from 4 years into 3. Up front, admittedly, specific memories alone of more than 70 years can be faded or jaded, but generally overall impressions can persist. 
By 1942, the Flexner Report2 had already wielded its influence on medical education and many changes were evident. The osteopathic profession, in its way, always followed the accepted mode of medical education, and so the training I had was very similar to that of MD schools and prepared me well for medical practice. But it must be remembered that a medical school curriculum is not a medical school curriculum is not a medical school curriculum. Many surveys have shown that allopathic schools, all giving good training, had divergent emphases and variable assignment of hours for specific subjects. For example, the American Academy of Pediatrics in the late 1940s did a survey that showed that the number of hours of pediatrics taught varied from just a few to many—often depending on the specialty of the dean. So great variations abound between schools, and between MD and DO schools, without impinging on the quality of education. But my medical education in the 1940s was comparable to that of allopathic schools of that day. 
Unfortunately, Mr Silver includes in a section centering on the 1940s several quotations from Flexner about the poor quality of osteopathic education—comments that Flexner made around 1910, when he did his survey. Our schools were different in 1942. 
However, the greatest deficiency, to my mind, was in graduate medical education, especially in osteopathic residency training programs. For example, the Philadelphia College of Osteopathy, which was one of the major osteopathic institutions in the country, had in 1945 one surgical residency but not even one internal medicine residency. This situation was similar across the country. I sought training in pediatrics, and there were just 2 residencies, both in California. Perhaps this is the educational deficiency alluded to by Mr Silver, and it is correct. 
This deficiency is important in this issue because, as a result of the lack of specialty training, most of our graduates became general practitioners and went directly into practice. Here is where the failure of the armed forces to accept DOs as physicians becomes an important causative factor in the growth—and ultimate acceptance—of osteopathic medicine. As Mr Silver stated, the rejection of DOs had “unwittingly created the perfect situation for osteopathic medicine to grow exponentially.”1 Many neighborhoods in both cities and rural communities were bereft of MD-physician availability. People then went to “those osteopaths,” not because they wanted osteopathic care or because DOs were better physicians, but because there was no other physician available. Some DOs went into practice the day after graduation, others the day after a 1-year internship. And most were flooded with patients—the only doctor sign in the area, friends' recommendations, or a neighbor's reluctant suggestion. So great was the flood that at the universal rate of $2 for an office visit, many “freshman” doctors were reputed to be making $25,000 a year (a lot for those times). 
Well, what did they find at these “new doctors”? Mostly competent, mostly friendly, mostly willing practitioners—and with all due praise and honor to these great pioneers, whom we do not thank enough—eventually a satisfactory substitute for their “old family Doc.” Thus, osteopathic medicine built up a large and impressive following. To me, that was the most important cause of the booming and explosion of the osteopathic profession, and Mr Silver had it right. 
Simultaneously, the osteopathic profession had begun before World War II to follow the lead of allopathic medicine in educating its physicians. This improvement, as pointed out by Mr Silver, was a perfect accompaniment to the huge patient surge, but it was not the cause of it. 
I am of the opinion that this discriminatory act of the armed forces—as painful as it was at the time—was almost totally responsible for the growth and success of the osteopathic profession—something that might have come later anyway, but only after more prolonged struggles. And the tremendous spurt in the number of osteopathic patients—and satisfied patients—provided added public support. As they say, “It's an ill wind that blows nobody any good.” 
At times, I have postulated—as have others—that if the allopathic profession had acted differently, the armed forces could have “devoured” us and either destroyed us or slowed our growth down a considerable number of years. 
So, thanks, Shawn, for reminding us of the keystone of our growth and our progress, and for emphasizing this major factor in our lives. Great job! 
   P.S. Sorry, I cannot verify the World War I factors—I wasn't around.
Silver SA. Thanks, but no thanks: how denial of osteopathic service in World War I and World War II shaped the profession. J Am Osteopath Assoc. 2012;112(2):93-97. [PubMed]
Flexner A. Medical Education in the United States and Canada. New York, NY: Carnegie Foundation for the Advancement of Teaching: 1910.