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Osteopathic physicians are licensed physicians practicing in all 50 states. This article describes the philosophy of Osteopathic Medicine and reviews the objective support for it. Special emphasis is placed on somatic, visceral, and psychologic interaction. Specific examples of Osteopathic Manipulative Therapy (OMT) are also described.
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The authors investigated the extent to which colleges of osteopathic medicine include evidence-based medicine education in their curricula. Information was obtained through a questionnaire survey, including a Likert scale. The survey was sent to 19 colleges of osteopathic medicine for completion. Twelve responses were received within the time limits of this cross-sectional study, yielding a 63% response rate. Four colleges of osteopathic medicine report that they currently teach evidence-based medicine within their education programs. Variations among the programs included the type of faculty delivering the evidence-based medicine course, the years in which instruction occurs, the number of hours of instruction, and assessment methods used. Seven additional schools have plans to implement evidence-based medicine into their educational programs. Suggestions for the design of an evidence-based medicine course and an evidence-based medicine-based curriculum are discussed in relation to the survey results.
Education and instruction in the care of the patient with peripheral vascular diseases is, at best, fragmented during the first years of medical training. Attention to the issues of peripheral arterial, venous, and lymphatic disorders deserves a more formal approach with respect to physician education, patient evaluation and treatment, knowledge and application of various diagnostic modalities, and involvement of our physician colleagues in complementary disciplines. The vascular medicine internist is an invaluable resource in these areas. The aging of our general population will lead to an increase in manifest peripheral vascular disease within our patient population. Having received additional comprehensive training in the management of the complex patient with peripheral vascular disease, the vascular medicine internist may serve as a complete resource for their care.
Many problems exist within the contemporary medical education process in general and the osteopathic medical profession in particular. Part 2 of this series suggests that the single greatest impediment to solving these problems is an institutional infrastructure that is not congruent with the institution's functions, as defined in its mission statement. (This mission statement generally entails two primary goals: education and research). Two major divisions within the core's infrastructure are suggested: medical education and medical research. By restructuring their infrastructure, colleges of osteopathic medicine can more effectively address and support their primary functions of education and research.
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Osteopathic medicine is strongly identified with primary care. In the past 20 years, several factors have influenced this relationship, resulting in significant changes in the postdoctoral training of doctors of osteopathic medicine (DOs). Growth in colleges of osteopathic medicine spilled over into postdoctoral programs of the Accreditation Council for Graduate Medical Education (ACGME), creating a number of consequences. More than ever, osteopathic physicians are filling voids in ACGME primary care residency positions left vacant by U.S. medical graduates. Many allopathic primary care residencies have created parallel-accredited (American Osteopathic Association/ACGME) programs in hopes of tapping into this supply of DOs. In turn, osteopathic training institutions have shifted their educational emphasis in support of nonprimary care residencies. As a result of these changes, there is a strong element of irony in the underlying reasons for osteopathic medicine's link to primary care, why osteopathic training institutions are emphasizing specialty residencies, and the new responsibility of allopathic programs in training the next generation of primary care DOs.
The osteopathic medical profession was founded in the late 19th century and has become an accepted part of the medical establishment in the United States. Throughout its history, the osteopathic medical profession has attempted to define itself in a way that differentiates osteopathy from other alternative therapies and situates the profession as responsive to the changing health care needs of the American public. This article examines identity within the osteopathic profession by examining the ways in which the profession has created, maintained, and changed its identity in its over century-long existence. The case analysis presented here involves the examination of identity statements culled from several osteopathic data sources. The identity statements represent four specific time periods within the osteopathic profession: the founding statements of A. T. Still, statements from 1915 through 1935 when the scope of osteopathic identity was expanding, statements from 1954 through 1974 in which the osteopathic profession dealt with internal and external threats in developing a "separate but equal" identity, and recent statements from a osteopathic student web site that illustrate current and future views of osteopathic identity. The results of this case analysis highlight the role of the social environment in establishing and changing professional identity, the importance of an occupational founder in shaping the articulation of identity, and the tension between identity and practice within the osteopathic medical profession.
The stand-alone osteopathic hospital was a necessity to the osteopathic medical profession in an era when it was isolated from allopathic medicine. As osteopathic medicine has become increasingly integrated with allopathic medicine, however, an independent osteopathic hospital is no longer a necessity. Moreover, a stand-alone institution seems to be economically out of place in today's market. The Osteopathic Medical Center of Texas in Fort Worth is an example of a stand-alone hospital that was unable to capitalize on the benefits realized by integrated hospital systems. The author believes that this failure contributed to the institution's demise. The market power of a hospital system can be used for more favorable contracting with vendors and providers, as well as facilitating negotiations with payers. System affiliation provides economic efficiency, security, and protection in the highly uncertain, complex, and competitive healthcare market.
The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called 'alternative', 'complementary' or 'holistic' medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?
During the last 30 years the osteopathic profession has undergone a remarkable transformation from osteopathy, characterized by manipulative therapy, to osteopathic medicine, characterized by full-service health care, and in the process it has won acceptance from the government, the military, and physicians. These changes in status have resulted in new problems for the profession, because D.O. graduates are turning increasingly toward M.D. programs for residency training, and osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors advocate that osteopathic medicine return to its original mission of primary care, abandon specialty training or restrict it to those who have completed primary care residencies, abolish its separate-but-equal posture, and establish lines of communication with allopathic medicine and the American Medical Association to facilitate the development of a rational national policy for primary care that considers the potential osteopathy has to offer in meeting the nation's primary care needs.
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During the past 40 years, the osteopathic medical profession has undergone a transformation from "osteopathy" to "osteopathic medicine." The former was characterized by manipulative treatment; the latter, by full-service healthcare. During this transformation, the profession has won acceptance from the government, the military, and MDs. These changes in status have resulted in new problems for the profession because DO graduates are increasingly turning toward allopathic programs for residency training. Thus, osteopathic medicine's primary care orientation is being replaced by an emphasis on specialty training. The authors propose that osteopathic medicine return to its original mission of primary care, abandon or restrict specialty training to those who have completed primary care residencies, and rethink its separate-but-equal posture. They also propose that osteopathic medicine establish lines of communication with allopathic medicine, the American Medical Association, and the government to facilitate the development of a rational national policy for primary care that considers the potential osteopathic medicine has to offer in meeting the nation's primary care needs.
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The Ohio University College of Osteopathic Medicine ranks high among the nation's 19 osteopathic medical schools with respect to the percentage of underrepresented minorities (URMs) in the entering class. The college has strong recruitment and retention programs for URM and disadvantaged students. URM enrollment rose steadily from 11% in 1982-83 to 22% in 1997-98, despite the school's location in a rural, residential public university with few minorities as students or town residents. The college has six programs to support minority students through both undergraduate and medical school: the Summer Scholars Program (1983 to present), an intensive six-week summer program to prepare rising under-graduate seniors and recent graduates to apply to medical school; Academic Enrichment (1987 to present), to support first- and second-year medical students; the Prematriculation Program (1988 to present), an intensive six-week summer program for students who will matriculate in the college; Program ExCEL (1993 to present), a four-year program for undergraduates at Ohio University; the Summer Enrichment Program (1993 to present), an optional six-week program for students who will enter the premedical course at Ohio University; and the Post-baccalaureate Program (1993 to present), a year-long, individually tailored program for URM students who have applied to the medical college but have been rejected. The medical college first focused on supporting students already in the medical school curriculum, then expanded logically back through the undergraduate premedical programs, always targeting learning strategies and survival strategies, peer and faculty support, and mastery of the basic science content. The college plans to create an on-site MCAT preparation program and perhaps expand into secondary education.
Although research is a critical component of academic medicine, it has not been a significant component of osteopathic medicine. For years, leaders in the osteopathic medical profession have called for increased research in osteopathic medical schools. The need for cost-effective clinical practice leading to improved clinical outcomes creates a necessity for conducting well-designed clinical outcomes research related to osteopathic practice. The authors assess the growth in research at osteopathic academic medical centers from 1989-1999. The amounts of extramural funding at each school, sources of funding, types of research funded, departments funded, and investigators' degree types are also assessed. During the 10 years analyzed, total research funding increased 37%. Twenty-five percent of the grants and 55% of the funding to colleges of osteopathic medicine were from the National Institutes of Health. Most (63%) grants were awarded to PhD faculty. Most research was conducted in the basic biomedical sciences. Clinical research related to osteopathic practices appears to be a relatively minor component of research at osteopathic medical centers.