Defining osteopathic medicine

Defining the distinctive practice of osteopathic medicine: Building on the 2019 summit

Without defining ourselves, we run the risk of being defined by others, and the status of distinction we enjoy will devolve to extinction.

John R. Gimpel, DO, MEd

Dr. Gimpel is the President and CEO of the National Board of Osteopathic Medical Examiners.

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Brian Loveless, DO’s, recent piece, “What is Osteopathic Medicine,” was thoughtfully written and quite timely. Dr. Loveless rightly calls for the need to come together on a unified definition of who we are and how we practice.

Indeed, without defining ourselves, we run the risk of being defined by others, and the status of distinction that we enjoy as the osteopathic medical profession will devolve to extinction. Our patients are counting on us.

We at the National Board of Osteopathic Medical Examiners (NBOME), along with the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) have been working on this very issue for more than three years.

In 2019, we held the third United States Osteopathic Medical Regulatory Summit with a group of osteopathic medical students, residents, physicians and members of the licensing, accreditation, graduate medical education (GME) and undergraduate medical education (UME) communities.

The 2019 Summit was supported by the three organizations with additional financial support provided by the Osteopathic Heritage Foundations and the Osteopathic Founders Foundation.

Some of the main topics discussed at the event include growth in the profession, changes in health care delivery, the role of technologies, professional self-regulation and changing demographics within the profession and patient communities, and associated challenges and opportunities for osteopathic medical practice and patients.

While we agreed that osteopathic medicine is a distinctive practice that brings unique, added value to patients, the public and the health care community at large, we also agreed that universal definition and common understanding of that distinctiveness was lacking.

As a result, we recommended convening a task force of groups represented at the summit to develop a succinct, unified and consistent message defining osteopathic distinctiveness, to align the distinctive elements of osteopathic medical education and professional self-regulation across a continuum, and to advance research on care and educational program outcomes which are critical to the future of the osteopathic medical profession.

Immediate follow-up on defining osteopathic distinctive practice ensued through most of 2020, despite the cancellation of our fourth summit in April 2020 due to COVID-19. Considerable input from DOs and learners and other advocates for the profession, including patients and public members, continued, with hundreds of individual contributors.

Thank you to all of the student and resident leaders, DO faculty members and deans, residency program directors and educators, representatives from the accreditation and licensure communities, and others for their contributions to this work.

Unfortunately, the COVID-19 pandemic emergency not only required cancellation of the 2020 Summit but the need for the organizations involved to immediately shift priorities to caring for patients, keeping health care workers safe and supporting learners, as appropriate.

A current draft of the definition was shared with the AOA Board of Trustees and leaders from osteopathic affiliate groups at their midyear meeting in February. While this draft has not yet been finalized by the former task force or any of the organizations involved in the summit, the urgency for our profession unifying in how to define itself, in my opinion, requires moving this forward for additional public commentary.

A 2022 draft definition of the distinctive practice of osteopathic medicine

“Doctors of osteopathic medicine (DOs) are fully licensed physicians in the United States and other countries. Their patient care approach aligns with their distinctive training in comprehensive, evidence-based medical care, summarized as the interconnected ‘body, mind and spirit’ approach to finding, restoring and maintaining health.

“The distinctive osteopathic medical philosophy keeps the patient in charge of their own health and the whole person as the focus of every patient-doctor encounter, such that patient and family goals and beliefs remain at the forefront of medical decision-making and empathy and compassion are imbued throughout. DOs learn specialized skills in hands-on physical diagnosis, the musculoskeletal system and osteopathic manipulative treatment (OMT), which aid in their understanding of the complexities and interconnectedness of the whole patient and guard against reductionist approaches to diagnosis and treatment. Modern treatment approaches common to DOs often emphasize lifestyle and behavioral approaches and avoiding the harms inherent in overtesting and polypharmacy.

“For well over a century, the osteopathic medical model of formation of its physicians has contributed to a physician workforce aligned to the needs of society, helping to address health care disparities. DOs practice in every medical and surgical specialty, though the profession continues to build from strong roots in primary care and emphasize health care delivery models that are primary care-centered. The longstanding emphasis in the osteopathic medical profession on the social determinants of health and significant outreach to rural and underserved regions and populations remain key drivers for the growth of and positive patient care experiences with osteopathic medical care nationally and around the globe.”

Who is the audience?

People often ask, who is the audience for this definition? Is it patients? Potential DO students? Legislators? Faculty? The answer is, it is for ourselves. Many organizations across the profession have continued their own initiatives in defining and branding exercises for differing purposes, most now including the consensus language of “body, mind and spirit” somewhere in their work. But across the osteopathic medical profession, we must come together to support our communities and our patients in body, mind and spirit in the manner that we are known for. 

Disclaimer: John R. Gimpel, DO, MEd, is President and CEO of the National Board of Osteopathic Medical Examiners and a member of the AOA. All opinions expressed herein are those of the author and do not represent those of the NBOME or other organizations noted. Feedback on the definition is welcomed and can be submitted to communications@nbome.org.

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8 comments

  1. James Huang, DO

    In the first line of our definition of Doctors of Osteopathic Medicine (DOs), are we not fully licensed physicians & surgeons in the US & other countries? There are pioneering DOs who are surgeons who have enriched our heritage. We might not want to forget them.

    Reply

    1. Karen Nielsen, DO

      I think “physicians” implies and includes surgeons. As surgeons are also physicians. But I see your point as historically in some places, such as licensing boards it is written out as “physicians and surgeons”

      Reply

  2. Karen Nielsen, DO

    I appreciate the draft and feels it encompasses the unique work we do as DOs. However, it would be nice to have osteopathic manipulative treatment (OMT) recognized as a higher level medical procedure which only physicians can perform. Most insurance companies lump it with alternative medicine. And it is relegated to very low status in the National Correct Coding Initiative often resulting in bundling and very low if any reimbursement for what is a beneficial and time consuming and frequently complex treatment.

    Reply

  3. GENE JACOBS D.O.

    This is like lexapro is to prozac. Doesn’t say anything really different.
    I like mine better:

    An osteopathic physician believes the body/mind is built to work. Occasionally something gets introduced like an injury or trauma or fear that disrupts the equilibrium. The body/mind changes in order to protect itself.
    Those changes re-establish equilibrium. This new equilibrium or norm sustains those initial protective changes despite they are no longer useful as the initial injury is no longer present. This new steady state is not tied into the environment in a flexible feedback loop as was the pre injury or pre – introduced state. We have now a self-sustaining, non-flexible facilitated segment. It isn’t open to change, it is not flexible, it restricts the person from changing or adapting to the local environment.
    An Osteopathic Physician will assess the person as a whole: Body, mind, spirit and individual, relationship, community in order to break facilitated segments and re establish a more functional equilibrium.

    Reply

  4. M. P. Neverauskas DO

    As osteopaths the first step is to fulfill one of Dr A T Stills final requests. “Keep it pure”. I see in our schools that even the labeling of our students and schools lacks a unique identity. Instead of our students being referred to as “osteopathic medical Students “ the “osteopathic” is dropped. Our students are referred to as “medical Students”. When new classes are admitted to a school they are told they are admitted to “medical school” not “Osteopathic School”. We can’t even reference ourselves appropriately. Many of our residents, as time progresses, loose touch even with OMT and it’s day to day application to disease diagnosis and management. As Osteopaths we must first know our identity and core philosophy. Mandatory study of A T Still’s writings need to be at the forefront of our osteopathic education. This will enhance our preservation of our medical distinctiveness. Time teaches the old osteopath the beauty of our founders philosophy. Why should time alone be our teacher? A T Still has left us his thoughts and insights. These writings are the way back home for the modern Osteopath. A home rich in professional pride rooted in the treatment of a patients mind, body and spirit. A holistic approach, based in sound proven scientific principles. A new way, developed at a time , of great strife for our nation.

    Reply

  5. John R. Gimpel, DO

    Thanks, Dr. Huang. As surgeons are physicians I suppose that was inferred but your feedback is appreciated and this is an easy improvement to make, thank you!

    Reply

  6. James Huang, DO

    As DOs, we believe physicians imply surgeons. As for public policy & laws, “physician” is a physician & “surgeon” is a surgeon. Both terms are clearly defined in both federal & state statutes. In my research years ago when we (OPSC) fought the mixing of the Naturopathic Committee & the Osteopathic Medical Board of California, I noted the confusion was in defining the terms “doctor”, “physician”, & “surgeon”. When I educated legislators, staffers, & the community, they understood the difference and passed the bill that corrected the problem within the OMBC.

    We can save ourselves grief if we utilize the correct public policy & legal terminology & definitions. Paying attention to little details will save us as our profession grows.

    Thank everyone the great effort in advancing our Profession!

    Go DO!

    Reply

  7. Karen Melton

    Scholarly discussion of Still’s philosophy is absent from medical school curriculum. In “A.T. Still From the Dry Bone to the Living Man”, referred to as the “definitive biography” we get an insight into Still’s philosophy. For example, the author tells us that Still, “saw that both God and man are perfect”. Lewis boldly tells us that this “undermined the very foundation of the Methodist faith” as it contradicted the doctrine of original sin. Still replaces the idea of a fallen world with the idea of the perfect Health. In addition, Lewis goes on to tell us that Still was leaning toward the idea of the Creator “much like the Shawnee: a Great Spirit”, whose “power pervades the entire Creation imbuing everything animate and inanimate, with infinite wisdom.” This concept of pantheism cannot exist within the dogma of most current religions. So, are we asking people to disregard their faith and their core beliefs? For what? A vagueness that we claim exists. A philosophy that is not taught in schools. Buzz words don’t cut it in the real world. Get a group of theologians and scholars to study A.T. Still’s writing and let’s see what happens. Respectively yours, Karen Melton

    Reply

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