Osteopathic
Medicine Is Gaining Recognition
August 11, 2014
Story at-a-glance
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Medical doctors, MDs, and doctors of osteopathy, known as
DOs, have similar training requiring four years of study in
the basic and clinical sciences, and the successful
completion of licensing exams
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One of the major factors that separates DOs from MDs is that
osteopathic physicians are trained in an approach that
focuses on treating the person as a whole, rather than just
treating individual symptoms
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In addition to the conventional medical curriculum, DOs also
receive in-depth training in manipulating the
musculoskeletal system, which includes nerves, muscles, and
bones
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At present, 22 percent of all new medical school graduates
come out of osteopathic schools
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A majority of DOs end up as primary care and family
physicians. This is becoming increasingly valuable, as
experts predict a shortage of more than 45,000 primary care
physicians in the US by 2020
By Dr. Mercola
While many people are now aware that there are well-trained
health care practitioners specializing in complementary
medicine, many are still unaware that there are two kinds of
allopathic physicians to choose from as well.
Medical doctors, MDs, and doctors of osteopathy, known as
DOs, have similar training requiring four years of study in the
basic and clinical sciences, and the successful completion of
licensing exams.
As you may know, I'm an
osteopathic physician (DO), and DOs, just like MDs, are
licensed to prescribe medication, deliver babies, and perform
surgery in all 50 states in the US. DOs have the identical
license to practice the full range of medicine and surgery as
MDs; there is absolutely no difference in their state license.
I'm also board-certified in family medicine, and served as
the chairman of the family medicine department at St. Alexius
Medical Center for five years. In October 2012, I was awarded
fellowship status by the American College of Nutrition (FACN).
There are some intrinsic differences between MDs and DOs,
however. DOs have frequently been viewed as "less than" a "real"
doctor1—a
view that is simply not true when you consider their training.
Are Osteopaths Real Physicians?
One of the primary distinctions that separates DOs from MDs
is the fact that osteopathic physicians are typically trained in
an approach that treats the person as a whole, rather
than just treating individual symptoms.
In essence, DOs practice "whole person" medicine, and help
patients develop attitudes and lifestyles that not only address
their current illness, but help prevent it. In addition to the
four year conventional medical curriculum, DOs receive in-depth
training in manipulating the musculoskeletal system, which
includes nerves, muscles, and bones.
This training in osteopathic manipulative medicine (OMM)
equips DOs with a comprehensive understanding of how illness or
injury in one part of your body can influence and affect other
parts. DOs are trained to view the human body as an
interconnected system.
OMM involves using your hands to diagnose and/or treat.
Contrary to most conventional MDs who rarely touch their
patients anymore, DOs will palpate and perform physical
manipulation. The featured article in the New York Times2
provides an example of this:
"Growing up on Long Island, [Gabrielle Rozenberg]
suffered from chronic ear infections. Her doctor recommended
surgery. But before committing to an invasive procedure, her
parents took her to a DO — a physician whose skills are
comparable to those of an MD.
In several visits, he performed some twists and turns
of her neck and head, and within days the infection cleared
up. 'The infection happened because of fluid in the ear,'
she explained, 'and the manipulations opened up the ear
canal.'
The infection didn't come back... Many are drawn to
the field for this more personal, hands-on approach and its
emphasis on community medicine and preventive care."
All DOs Are Not Focused or Trained in Natural Medicine...
I opted for a DO instead of getting an MD because I was
attracted to its natural philosophical orientation and its focus
on prevention. However, as beautifully described in a classic
article by
Dr. Joel D. Howell, MD, Ph.D, in reality there's actually
little difference between the two degrees.
Patients frequently believe that ALL osteopaths practice
natural medicine exclusively. Regrettably, this is not the case.
In fact, most fall into the drug and surgical solution trap.
Early in my career, I too prescribed drugs as a first line of
treatment, before I became more fully aware of the risks, and
the viability of natural alternatives.
If you're looking for a physician of natural medicine, you're
best off contacting the American College for Advancement in
Medicine3
(ACAM) for a referral, as most ACAM physicians are at least
oriented towards natural medicine and more open to those
alternatives.
I do, however, believe that the selection process for
osteopathic schools is oriented toward identifying variables
besides grades and test scores, which tend to produce more
empathic and holistically inclined physicians. This is a
factor that is often overlooked in conventional medicine, and
can have a great impact on a patient's outcome.
Osteopathic Schools Becoming Increasingly Popular
After four years of academic study, DOs serve a one-year
internship, gaining hands-on experience in family medicine,
internal medicine, obstetrics-gynecology, pediatrics, and
surgery.
As a result of this experience, the majority of DOs tend to
become primary care physicians—about twice as many DOs as MDs
choose this path—and many end up practicing in small towns and
rural areas, where they often care for entire families and
communities.
DOs who want to go into a particular specialty will complete
an additional residency program in their chosen area, which
typically requires two to six years of additional training. I
completed a two-year family practice residency (three counting
internship) to complete my osteopathic training.
DOs focus on being a doctor first and specialist second is
becoming increasingly valuable, as shortages of doctors are
predicted to worsen in the near future. By 2020, workforce
experts predict a shortage of more than 45,000 primary care
physicians in the US.
As noted in a recent New York Times4
article, 22 percent of all new medical school graduates come out
of osteopathic schools, which is more than double the percentage
when I graduated over 30 years ago. Between 1983 and 2000 alone,
16 new schools of osteopathy were opened. As reported in the
featured article:5
"The boom in osteopathy is striking. In 1980, there
were just 14 schools across the country and 4,940 students.
Now there are 30 schools, including state universities in
New Jersey, Ohio, Oklahoma, Texas, West Virginia and
Michigan, offering instruction at 40 different locations to
more than 23,000 students...
Whatever the reasons for choosing a DO over an MD,
osteopathic medicine has, for decades now and increasingly
so, been accepted as authoritative training by the medical
establishment, including the residency programs that lead to
licensure."
Where Did Osteopathy Come From?
The first osteopath was Andrew Taylor Still, a rural Kansas
physician, back in 1864. After the best medicines available at
the time failed to help his three children, all of whom died
from spinal meningitis, he set out to devise an alternative
modality of healing. This new line of thinking was based on the
idea that health and healing can be achieved by improving blood
flow through manipulation of the spine and neck.
Dr. Still founded the first school of osteopathy in 1892.
Three years later, Daniel David Palmer established chiropractic,
which is yet another treatment modality based on spinal
manipulation. Despite having been around for well over a
century, many Americans are still completely unaware that DOs
even exist. According to a survey by the American Osteopathic
Association:6
- 29 percent of Americans do not know that DOs are
licensed to practice medicine
- 33 percent do not know DOs can prescribe drugs
- 63 percent were unaware that osteopaths can perform
surgery
Originally, osteopathy was created as a very radical
alternative to a failing medical system. Since then, the DOs
path has inched ever closer to that of the MD, and as I stated
earlier, some DOs practice mainly allopathic medicine, focused
primarily on pharmacological principles. As noted by
Dr. Joel D. Howell in his 1999 article in the New
England Journal of Medicine:
"A 1995 survey of 1055 osteopathic family physicians
found that they used manual therapy only occasionally; only
6.2 percent used osteopathic manipulation for more than half
of their patients, and almost a third used it for fewer than
5 percent. The more recent their graduation from medical
school, the less likely practitioners were to use
osteopathic manipulation, a finding consistent with the view
that osteopathic practice is moving closer to allopathic
practice."
New Residency System Will Further Lessen Distinction Between MD
and DO
The distinction between MD and DO accreditation is about to
become even more insignificant. In February of this year, the
accrediting agencies for MDs and DOs agreed to combine the two
into a singular residency and fellowship system. This means
that, starting in 2015, DO residency standards will be the same
as those for MDs. DOs will be accredited by the Accreditation
Council of Graduate Medical Education, which will have
osteopathic representatives on its board and in its review
committees. This change is aimed at providing a more uniform
learning path, thereby lessening the distinction between MDs and
DOs, which will help mitigate the looming shortage of primary
care physicians.
As noted in the featured article:
"Dr. Atul Grover, the association's chief public
policy officer, credits the osteopathic boom to the need for
additional sources of medical training... Dr. Grover
speculates that the new residency system could also lead to
one accreditation for MD and DO schools. At the least, the
new synergy lends an imprimatur to the osteopathic schools,
which by and large lack marquee status. 'It will allow
graduates from two similar but different education systems
to work side by side,' said Dr. John E. Prescott, chief
academic officer of the MD association. 'It's a true step
forward.'"
Redistribution of Federal Funds for Physician Training
Historically, government subsidies for the training of
physicians have disproportionally benefited teaching hospitals
in the northeast United States. A recent report for the
Institute of Medicine (IOM), titled "Graduate Medical Education
That Meets the Nation's Health Needs,"7
calls for redistribution of these funds, amounting to about $15
billion annually. As noted by NPR:8
"The report also called for an end to providing the
money directly to the teaching hospitals and to dramatically
alter the way the funds are paid. The money in question is
for graduate medical education — the training of medical
school graduates that's required before these interns and
residents can be licensed to practice in any state."
About two-thirds of these government funds come from
Medicare, and the IOM report now suggests shifting large
portions of this money away from major teaching hospitals toward
smaller community-based training clinics—some of which do not
treat Medicare patients. This has raised quite a bit of
opposition, especially from the American Medical Association
(AMA) and the Association of American Medical Colleges9
(AAMC). In a recent press release, the AAMC states:
"By proposing as much as a 35 percent reduction in
payments to teaching hospitals, the IOM's recommendations
will slash funding for vital care and services available
almost exclusively at teaching hospitals, including Level 1
trauma centers, pediatric intensive care units, burn
centers, and access to clinical trials... While the current
system can and is being improved to train more doctors in
non-hospital settings, these immediate cuts will destabilize
a system that has produced high-quality doctors and other
health professionals for more than 50 years and is widely
regarded as the best in the world."
In response, Edward Salsberg, a former top official at the
Bureau of Health Workforce at the Department of Health and Human
Services has noted that:10
"The current system is unsustainable. Health care is moving
to the community, but our system of financing graduate medical
education is tied to inpatient care." Osteopathic
physicians will undoubtedly play an important part in shifting
the system into a more community-based and family oriented type
of medicine that places greater weight on health education and
prevention—provided osteopathy doesn't completely lose
its holistic-based orientation in the process of becoming more
integrated with allopathic medicine...
Be Part of the Change by Taking Control of Your Health
Whether the proposed changes will result in more and better
doctors and improved public health remains to be seen. As
always, I urge you to take an active role in your health—no
matter what kind of physician you're working with. After all,
you're the one who must live with the outcome of any chosen
treatment, for better or worse.
If there is one thing I want everyone to understand, it would
be that you have FAR greater control over your health than you
think. Leading a common-sense, healthy lifestyle is your best
bet to achieve a healthy body and mind. And if you struggle with
a health problem, there are almost always simple strategies that
can be enormously beneficial and helpful, if not outright
curative. While conventional medical science may vacillate in
its recommendations, you can take control of your health with
the following approaches:
- Make healthy food choices: For a
comprehensive guide on which foods to eat and which to
avoid, see my
nutrition plan. Generally speaking, you should be
looking to focus your diet on whole, ideally organic,
unprocessed foods. Avoid
sugar, and fructose in particular. All forms of sugar
have toxic effects when consumed in excess, and drive
multiple disease processes in your body, not the least of
which is insulin resistance, a major cause of chronic
disease and accelerated aging.
I believe the two primary keys for successful weight
management are severely restricting carbohydrates (sugars,
fructose, and grains) in your diet, and increasing healthy
fat consumption. This will optimize insulin and
leptin levels, which is key for maintaining a healthy
weight and optimal health.
- Exercise effectively and efficiently.
High-intensity interval-type training is particularly
beneficial for optimal health, as it boosts
human growth hormone (HGH) production.
- Address your stress: You cannot be
optimally healthy if you avoid addressing the emotional
component of your health and longevity, as your emotional
state plays a role in nearly every physical disease -- from
heart disease and depression, to arthritis and cancer.
Meditation, prayer, social support and exercise are all
viable options that can help you maintain emotional and
mental equilibrium. I also strongly believe in using simple
tools such as the
Emotional Freedom Technique (EFT) to address deeper,
oftentimes hidden, emotional problems.
- Drink plenty of
clean water.
- Maintain a healthy gut: About 80
percent of your immune system resides in your gut, and
research is stacking up showing that probiotics—beneficial
bacteria—affect your health in a myriad of ways; it can even
influence your ability to
lose weight. A healthy diet is the ideal way to maintain
a healthy gut, and regularly consuming traditionally
fermented foods is the easiest, most cost effective way
to ensure optimal gut flora.
- Optimize your vitamin D levels:
Research has shown that increasing your
vitamin D levels
can
reduce your risk of death from ALL causes.
- Avoid as many chemicals, toxins, and pollutants
as possible: This includes tossing out your
toxic household cleaners, soaps, personal hygiene
products, air fresheners, bug sprays, lawn pesticides, and
insecticides, just to name a few, and replacing them with
non-toxic alternatives.
- Get plenty of
high-quality sleep:
Regularly catching only a few hours of sleep can hinder
metabolism and hormone production in a way that is similar
to the effects of aging and the early stages of diabetes.
Chronic sleep loss may speed the onset or increase the
severity of age-related conditions such as type 2 diabetes,
high blood pressure, obesity, and memory loss.
Copyright 1997- 2014 Dr. Joseph Mercola. All Rights Reserved.
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