Does osteopathic medicine have a future?
Although osteopathic graduates (D.O.) make up the smallest percentage of practicing physicians, their numbers have been growing exponentially in recent years. It is estimated that by 2020, one in four medical school graduates in the United States will be a D.O.
Does osteopathic medicine have a future?
By Erica Cohen
American doctors can be trained in one of three different ways. Traditional (allopathic) medical schools grant M.D. degrees. Foreign medical schools also grant M.D. degrees but outside of the United States. And osteopathic medical schools grant D.O. degrees.
Osteopathic and allopathic medicine have very different philosophies about medical care. Osteopathic medicine focuses on the idea that all body systems are interrelated and dependent upon one another for good health. Osteopathic physicians use modern medicine to treat their patients, but they add manipulative medicine (OMM), a set of manual techniques to diagnose illness and injury and enhance the body's capacity to heal.
In 2008, there were approximately 780,000 practicing physicians in the U.S., 68% of them M.D.s, 25% international medical graduates (I.M.G.s), and 7% D.O.s. Although D.O. graduates make up the smallest percentage of practicing physicians, their numbers have been growing exponentially in recent years. It is estimated that by 2020, one in four medical school graduates in the United States will be a D.O.
Traditionally, a greater percentage of D.O. physicians (60%) practiced in primary care than M.D. physicians (35%). They treat 16% of patients in communities with fewer than 2,500 residents, which allopathic physicians often avoid.
D.O.s, M.D.s, and I.M.G.s all complete residencies after graduating from medical school, but these have traditionally involved separate programs. M.D.s and I.M.G.s may only attend M.D. residency programs, while D.O.s may attend either M.D. or D.O. programs.
Despite the seemingly large number of practitioners, America faces a looming physician shortage, particularly in primary care. The disjointed arrangement of residencies may be exacerbating the problem by limiting choices for some physicians.
In response, the organizations that accredit medical residencies, the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM), recently announced a plan to combine residency programs and implement a single, uniform accreditation process for D.O.s, M.D.s, and I.M.G.s.
This streamlining of residency programs could – in the long run – reduce costs significantly by eliminating duplicate efforts. Additionally, it could result in one set of uniform regulations for all physicians, rather than separate regulations for M.D.s and D.O.s.
However, some potential benefits of the streamlining are uncertain. For example, while joint accreditation would allow M.D.s and I.M.G.s to enter D.O. residency programs, it is unclear whether they would actually choose to do so – or whether program directors would accept them.
Additionally, it is possible that allowing M.D.s to attend D.O. residency programs could actually reduce the number of primary care physicians. M.D.s who do not get into more competitive specialty residencies often pursue residencies in the less competitive primary care field. However, with the combined programs, those M.D.s may attempt to get into a D.O. specialty residency, instead.
Finally, it is unclear how joint accreditation would work given that D.O. board examinations contain an OMM component and M.D. examinations do not.
It is laudable that the AOA, ACGME, and AACOM are considering ways to reduce the physician shortage and streamline costs and regulations. But it is important that osteopathic medicine remain distinct as an alternative to conventional medicine. It has existed for over a century and served its patients well. This should not be the beginning of its end.
The American Osteopathic Association (AOA) appreciates Erica Cohen’s support and acknowledgement of the difference that DOs (osteopathic physicians) and osteopathic medicine bring to patient care. First, let me point out that there are only two types of physicians in the U.S. able to prescribe medication and perform surgery—DOs and MDs. They are the two types of traditional medical doctors.
Second, what a unified accreditation system for graduate medical education will ultimately do is provide greater opportunity for the AOA and the Accreditation Council for Graduate Medical Education (ACGME) to share best practices in training physicians, including the implementation of quality improvement programs and performance standards that emphasize positive results, which translates to better and more affordable health care for patients.
Third, the transition to a single, unified accreditation system will not include changes to any requirements or processes associated with AOA board certification, the osteopathic licensing examination, or accreditation of osteopathic medical schools.
Fourth, if discussions are successful, current AOA training programs will be accredited by ACGME, but will not abandon osteopathic principles and practices (OPP) as expected competencies for successful completion of these programs.
And, lastly, allowing MDs to enter into osteopathic-focused training programs within the ACGME system will be part of our transition discussions with ACGME. However, if they are allowed into osteopathic-focused programs, we would work with ACGME to identify educational prerequisites or other accomplishments or “check points” expected for MDs to meet in regard to OPP. The same would apply for International Medical Graduates.
More information about the agreement to pursue a single, unified accreditation system can be found at www.osteopathic.org/acgme.
— American Osteopathic Association
Interesting post and follow-up discussion. Isn't there a third group of physicians, namely podiatrists? They seem to have a completely separate structure but to function as full physicians. No?— EdGr- You are all anti-dentite— Dan in Holmesburg
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Robert I. Field, Ph.D., J.D., M.P.H, professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He is the author of Health Care Regulation in America: Complexity, Confrontation and Compromise, a comprehensive overview of the government’s oversight of health care published by Oxford University Press.
Erica Cohen, a third-year law student concentrating in health law at Drexel University Earle Mack School of Law. She graduated from the Scripps School of Journalism at Ohio University with a major in online journalism and minors in business and political science. Prior to attending law school, Erica worked for DKMS Americas, the world's largest bone marrow donor center. She currently works as a legal intern in the office of general counsel at a local hospital.
