In the United States, there are two existing types of licensed medical physicians: allopathic (MDs)and osteopathic (DOs). Due to their similarities in providing care, a patient in today’s healthcare system may not even be aware if their physician is a DO or an MD. While MDs and DOs may practice medicine with an equal legal and professional status, there are two main distinctions. The first, more obvious distinction is that in addition to the typical medical school curriculum, a DO receives training in Osteopathic Manipulative Medicine (OMM), a manual manipulative musculoskeletal technique emphasizing the interconnectedness of the body systems (Still, 1892, p. 20). The second distinction, while less obvious, but arguably more important to the current identity of each degree, is the differing central philosophy. Osteopathic medicine bases clinical practice on a holistic approach defined by the body’s inherent ability to maintain health and heal itself along with viewing the patient as a whole in relation to their environment, nutrition, and body systems(Wu & Siu, 2015). This approach differs from allopathic medicine, which focuses on the diagnosis and treatment of disease.
In addition to these two distinctions, osteopathy has a unique history as an alternative form of healthcare in that it became a licensed medical profession after originally being viewed as a radical, pseudoscientific approach. In the development of modern medical practice, as we now know it, there have been many other alternative approaches to mainstream medicine sharing the same pseudoscientific origin. However, no other alternative approach has ever received the same degree of recognition in the medical profession as osteopathy. Osteopathy’s transformation from a cult to science was a result of carefully constructed ways to adapt the approach to fit within the equivalent standards of mainstream medicine yet remain a separate and distinct way of medical practice. Establishment of schools and societies, curriculum changes, and licensing tactics allowed osteopathy to achieve such status and become an evidence-based practice.
Establishment of schools and societies
The challenges for recognition that osteopath’s face arose in the time of Dr. Still. During this period, there were many emerging unorthodox medical practice, and osteopathy was one of them. Still faced opposition from others in the medical community who felt that his methods counteracted those of allopathic healing. They, therefore, rejected his new school of thought. Dr. Still, confident in the benefits of osteopathy, then founded the American School of Osteopathy(ASO) as a means of spreading his ideas (Wu & Siu, 2015). These students then went on to found their osteopathic training institution. One such school, however, had a negative impact on the strides that Dr. Still had made. Founded by two students, Elmer, and Helen Barber, the institution failed to comply with the certification requirements needed to be achieved by its students. The principles taught there were also vastly different from those introduced by Still (Jordan, 2017). This discredited the profession and further delayed the recognition of osteopathy as a valid medical field. It led to an elongated legal battle, one that ended with ASO as the victor. After this incident, a code of ethics was outlined for the profession to ensure that such events would not reoccur.
There are many organizations founded to protect the interests of osteopaths. They include the American Association for the Advancement of Osteopathy and Associated Colleges of Osteopathy. Founded in 1897, these two groups aimed at maintaining educational standards in the field of Osteopathy (Iowa Osteopathic Medical Association, 2018). The American Osteopathic Association has employed great effort to ensure that practitioners of the osteopathic discipline are regarded with the same respect accorded other physicians in the field. It fought to overcome the perception that osteopathy is a cultist and unethical form of healing (Gevitz, 2014). With support from numerous other societies working at local, state and federal level, it has been able to lobby for and facilitate mergers that permit the workings of osteopaths. Today, many states regard MDs and DOs as equals, a feat that is attributable to the efforts of these schools and societies.
In the early onset of osteopathy schools, these institutions produced sub-standard results when compared to their allopathic counterparts. The failure can be attributed to lower entrance standards, limited training, and laboratory facilities and insufficient teachers (Wu& Siu, 2015). The curriculum offered differed significantly from the one followed by allopathic ones. The main difference was that the osteopathic one excluded pharmacology (Chila, 2010). Instead, it focused on anatomy, physiology, and symptomatology (Iowa Osteopathic Medical Association, 2018). This created a rift between lesion osteopaths who abhorred pharmaceutical therapy and broad osteopaths who believed in using all available tools. The AOA brought that debate to rest by ruling in favor of the broad osteopaths. This decision was important as regulations decreed that licenses would be offered only to those with full training. It ended the condemnation that colleges offering drug therapy courses faced, allowing them to integrate comparative therapeutics into their curricula. However, progress in this direction was slowed by the success that various osteopaths had while using drug-free methods.
In addition to this, these colleges raised the standard of their education by raising the admission requirements and adding an extra year to course period (Wu & Su, 2014). There was also increment in their size and budgets, which allowed them to hire the faculty needed to address the new field (Chila, ). Furthermore, the Educational Council on Osteopathic Principles was formed. It consisted of professors from varying institutions whose initial goal was to address the proposed change of a term used in the profession. After several meetings, the discussions of this group evolved into the creation of a uniform glossary of terms and principles to govern the teaching of osteopathy (Chila, ). These adaptations helped raise the qualifications of osteopathic practitioners which further increased their credibility.
At the time when Still was practicing medicine, the laws regulating who could practice medicine were lax. There was no official system of licensing and individuals did not have to possess a medical school diploma to practice (Gevitz, 2014). It allowed him to exercise his unconventional methods freely. His students and followers, however, did not experience such liberties. Licenses were required of them, and they were difficult to obtain. Even after students graduated from his school, they were still denied licenses by the state. Dr. Still overcame this hurdle by lengthening his curriculum to span a total of 20 months. It would increase the students’ proficiency in fields like anatomy, surgery, obstetrics and physiology (Wu & Siu, 2015). These changes swayed the opinions of legislators in the state of Missouri, which henceforth allowed DOs to practice there. The decree accelerated the efforts to normalize osteopathy in the medical field as admission to the school skyrocketed. The issuance of licenses to DOs proved that it was a valid and necessary profession.
Even after obtaining licenses, DOs still struggled for equality. However, when the schools improved their standards, the performance of students in board medical examinations also improved (Gevitz, 2014). In light of these advancements, the state of California allowed qualified DOs to obtain MD licenses without needing any further education. It ended the myth that DOs were unqualified or lacked sufficient training. It also caused a domino effect as other states quickly followed suit. In the coming years, they passed acts that allowed DOs unlimited practice. The US Civil Service Commission went as far as to declare MD and DO to be equal degrees (Gevitz, 2014). Additionally, the AOA was recognized as the governing body over osteopathic hospitals. Before this, DOs with AOA certification were turned away from MD hospitals. The greatest victory came when DOs were finally allowed to serve in the military medical corps.
Osteopathy is a medical practice that is as complex as it is important. Emphasizing the interconnectivity of the body systems, it seeks to maintain health by approaching the patient as a whole. For this branch of medicine, the journey to recognition has been tumultuous. Initially, it was disregarded as a form of cult healing that has no base in science. However, through the combined efforts of its founder and various other parties, it has slowly come to establish its position in the field. These individuals had to employ several tactics to win the freedom of practice that DOs enjoy today. These included establishing their own schools and support agencies, as well as shifting the curriculum of these schools to keep up with the set standards. Obtaining licenses was also a priority as, without them, they could not practice. Without continuity, the profession would have died.
Chila, A. (2010). Foundations of osteopathic medicine. Lippincott, Williams & Wilkins.
Gevitz, N. (2014). From “Doctor of Osteopathy” to “Doctor of Osteopathic Medicine”: A Title Change in the Push for Equality. The Journal of the American Osteopathic Association, 114(06), 486–497. doi:10.7556/jaoa.2014.099
Gevitz, N. (2014). A degree of difference: the origins of osteopathy and the first use of the DO designation. The Journal of the American Osteopathic Association 114(1), 30-40. doi: 10.7556.jaoa.2014.005
Iowa osteopathic Medical Association (2018) AOA history. Retrieved from:
Jordan, L. (2014). Battling a Diploma Mill: The Early Fight to Preserve the Osteopathic Principles of A.T. Still. The Journal of the American Osteopathic Association, 114(9), 722–726. doi:10.7556/jaoa.2014.141
Still, A. T. (1892). The philosophy and mechanical principles of Osteopathy. Original copyright by the author, Kirksville, Mo: 1892. Then, Kansas City, Mo: 1902. Reprinted, Kirksville, MO: Osteopathic Enterprises; 1986.
Wu, P. & Siu, J. (2015). A brief guide to osteopathic medicine. American Association of Colleges of Osteopathic Medicine. Retrieved from https://www.aacom.org/docs/default-source/cib/bgom.pdf