Opinion

Thoughts on defending the osteopathic medical profession

Let’s examine how the osteopathic medical profession has overcome past struggles and challenges, and let’s talk about what those fights can teach us about defending the profession today.

Brian Loveless, DO

Brian Loveless, DO, is the chief medical officer of WesternU Health.

Contact Dr. Loveless

I was planning on writing a column on the evidence for osteopathic manipulative treatment (OMT). However, my trip to the AOA House of Delegates in July inspired me to write a different column. I have tried in my last two columns to make a case for the value of osteopathic care. I have defined osteopathic care as patient centered, health focused and incorporating hands-on diagnostic and therapeutic procedures such as OMT.

I’ve also tried to make the case that those elements of osteopathic care are already being practiced by other providers in the medical community, under different names such as mind-body medicine or lifestyle medicine.

After listening to AOA Past President Robert Juhasz, DO, give his A.T. Still Memorial Lecture and listening to the debates regarding COMLEX as a licensing exam, I realized that this conversation is really not about a definition of osteopathic medicine. It’s really not about whether we can bring other physicians into the fold of osteopathic board certification or osteopathic CME. This discussion is really about whether the osteopathic profession, including our student body, is ready, willing and able to defend the gift we have been given.

In his speech, Dr. Juhasz referred to A.T. Still, DO, MD, as a maverick and linked that identity to the current Top Gun sequel and the character played by Tom Cruise. Specifically, he argued that Dr. Still would have had the same response as Pete Mitchell when accused of going extinct. The answer being, “That may be true, sir, but not today.”

A lengthy history

The osteopathic profession has a long history of struggle. That struggle began with Dr. Still having to move from town to town throughout the Midwest as he was pushed out by physicians and churches alike because of his innovative and effective method of treatment. That struggle led him to Kirksville, Missouri, where he was not only able to set up a successful practice but also open the first school of osteopathic medicine, and it has led us to where we are today.

During World War II, osteopathic physicians were not allowed to practice in the military and thus were not sent off to war. While that was clearly a discriminatory decision on the part of the U.S. government, those osteopathic physicians who remained home were able to expand their practices and create reputations that carried them for decades.

More recently, the osteopathic profession in California was almost eliminated through the machinations of the California Medical Association in collusion with California’s osteopathic association. Through a significant and costly legal battle, osteopathic medicine was rescued, and California now has more licensed osteopathic physicians than any other state.

The fact that DOs in California were able to change their degree to an MD simply by submitting a check and not any further education was used by DOs in many other states to demonstrate to their legislatures that osteopathic training was equivalent to MD training and thus the DOs in those states should have equal practice rights.

Fighting for equality

I’m sure you all have examples you know of where an attempt to discriminate against osteopathic physicians not only was successfully fought, but also led to greater success for those physicians and the physicians who followed them.

What I heard in the debates at the House of Delegates reminded me almost exactly of the reported conversations and emotions felt by osteopathic physicians in California in the 1950s that led directly to the merger with the CMA. Feelings of inadequacy, differential treatment and a belief that there was a path to equality through sublimation of our distinctive identity.

My argument today is that, while those emotions are certainly valid in some situations, the path to equality is not through sublimation of our identity but through vigorous expression of the differences between our two approaches to treatment.

This belief was reinforced for me during a course that I taught with several other DOs where the participants included MD physicians. These physicians did not see us as stigmatized, did not see our approach as lesser, did not see the DOs teaching the course as second-class.

They were in fact coming to us to learn the distinctive approach to care that’s practiced by osteopathic physicians. And their question to us was, “Why don’t the DOs in my area use this type of approach for their patients?” This question should bother us all.

Inspiring mentors and teachers

My mentors and teachers were amazing osteopathic physicians who were proud not just of OMT but of the profession that they were a part of. That pride was manifested in their steadfast refusal to give up on the profession to which they were enjoined.

They fought for equal access, they fought for equal licensure, they fought for equal pay and they instilled in me the notion that if this osteopathic profession has something to add to the practice of medicine, then it is worth fighting for regardless of the cost. They taught me to not give up, to not take a seat. They taught me that when we come across anti-osteopathic bigotry, the way forward is not to acquiesce but to fight with passion, with logic, and with the knowledge that this osteopathic profession has struggled throughout its life and has not been beaten yet.

I challenge everybody reading this, young and old, student, resident or attending, to pick up that banner of osteopathic medicine that A.T. Still, DO, MD, flung to the breeze on June 22, 1874, and give our patients, our colleagues and our profession the best that we can offer.

Related reading:

Is there value in the osteopathic approach to care?

What is osteopathic medicine? A unified definition is desperately needed

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19 comments

  1. Warren Chin DO

    I agree wholeheartedly with Brian! I have been an osteopathic physician, family practice with a specialty in OMT, And I spent the last 40 years perfecting more efficient and effective OMT techniques. They are safer, use less force, and can be incorporated into a 15 minute regular primary care visit. One of the biggest complaints that I hear from residents is that the techniques take too long, And we have to change that. We also need more osteopathic physicians practicing manipulation in their practices, as an example to the medical students and medical residents.

    Reply

    1. Brian Loveless, DO

      Thank you, Dr. Chin, for the support. I agree that there are many lost opportunities in our clinic time to practice hands-on treatment.

      Reply

  2. Michael Schmitz, DO

    In the Top Gun 2 scene, you are referencing, both men were correct. And the understanding was that the age of unmanned fighter jets was, in fact, inevitable. Is that the point to make about a practice you would like to see continue and grow?

    Perhaps a more appropriate movie reference would be from “Up in the Air” — specifically the line “sell it to me; I want you to SELL me osteopathic manipulation.” The point is that to sell the value of something objectively (in the language of science), emphasizing that you believe in it doesn’t, by itself, work. That’s faith-based thinking or moral reasoning and is, in fact, outdated and has fallen out of favor in the house of medicine and for good reason.

    Reply

    1. Brian Loveless, DO

      Thank you for the feedback, Dr. Schmitz. I do not think that the key points of osteopathic philosophy: patient-centered care, a focus on health rather than disease, the unity of mind, body, and spirit (and structure/function), and the self-healing ability of the body are outdated. I think they are becoming more relevant in contrast to today’s overly reductive model of medical care.

      Reply

  3. Guy Farmer DO

    I agree that the Osteopathic profession is unique and in many ways better. Many ways we are equal and inferior. I do not believe we are inferior on the patient care front. We just don’t have the numbers or the research number of colleagues.

    As far as our approach to the sick patient I believe with all my heart that we are better prepared to care for them. What the AOA did to our residency programs is, in my opinion, NOT GOOD. I may be paranoid but it seems to me we are on the way to a three tiered system. NP’ and PA’s in tier 3, DO’s in tier 2, and MD’s in tier 1. I cannot think of one good reason that we did away with our residency program system. It truly breaks my heart.

    Reply

    1. Brian Loveless, DO

      Dr. Farmer: I believe the jury is still out on the overall results of the SAS on residency training. I do agree that in the short term we lost some strong osteopathic training. It is totally within our control, however, whether we make a strong case for Osteopathic Recognition within the ACGME.

      Reply

  4. Tom Hoffman

    I completed a career in the military as a DO physician. I like the Top Gun reference, but DOs are not going away. PAs and NPs are increasing in responsibility and autonomy, and many are outstanding providers, but I don’t think they will replace physicians.

    I appreciate the precedent of excellence set by previous DOs in the military. Myself and other DOs were respected among physicians and patients as equals with MD physicians.
    I did a military MD residency in Family Medicine. I found that our (DO) approach to the patient and OMT skills differentiated me in a positive way from my MD colleagues. In residency we set up an OMT Clinic run by the DO residents and we trained interested MD residents. This enabled me to practice and develop my OMT skills. Of course, we needed a DO on the faculty to precept our OMT patient care.
    I think:
    1. DOs should promote their uniqueness and apply it in their residencies, even if they are not doing an Osteopathic residency.
    2. There should be both DO and MD residencies, but this complicates standardization and promotes duplication of effort. I think more investigation is required to determine the right courses of action.
    3. DOs are respected as equals to MDs in the US medical profession. They are not considered equals in many areas outside the US.

    Thanks for reading this long comment.

    Reply

    1. Brian Loveless, DO

      Dr Hoffman, I agree with your sentiments. Thank you for your service and providing unique care to the soldiers under your watch.

      Reply

  5. James Highley, DO

    Please define a DO without referencing MD’s. The author of this article and those who responded with their enthusiastic support in fact prove my point. Their reference to MD’s in describing and explaining DO’s is fundamental to their arguments. It’s like a MAC team coming along and beating Michigan or Ohio State or Alabama in football on some given Saturday, and declaring to the world “see I told you we are just the same as Michigan or Ohio State, or Alabama.” No, they are not. A residency at a consortium of three, forty bed hospitals is not the same as a residency at a university academic medical center with a thousand bed hospital.

    God bless the DO’s who came before me and fought the battles for recognition, licensing, and practice rights. I am indebted to them pure and simple. But also God bless the DO students who entered the large MD university speciality residencies and not only survived but excelled. It is my unvarnished belief that those young, bold DO physicians are the ones who cemented the Osteopathic professions legitimacy. It’s hard to turn your nose up at DO’s when the Chief Resident of your heretofore all MD Department is a DO!

    Reply

    1. Brian Loveless, DO

      Dr. Highley: I agree with your first statement. Please see my previous column https://thedo.osteopathic.org/columns/what-is-osteopathic-medicine-a-unified-definition-is-desperately-needed/ for a more full explanation of my position.

      As to your second paragraph, I fully agree. I love to see our amazing young physicians taking positions of leadership in all areas of medicine. It is a testament to the quality of their training and all of their hard work.

      Reply

  6. Bill Anderson

    Thanks for the reminder of the value that we bring to the practice os Osteopathic Medicine.
    As one that graduate from an Osteopathic Medical school when we as a profession were veery small and considerated as almost PT, We have come a long ways as I was a part of this OUTSTANDING GROWTH. I would be pleased to share these experiences with students of osteopathic Medicince.

    William G. Anderson, D.O., FACOS Sr. Adviser to Dean MSUCOM

    Reply

    1. Brian Loveless, DO

      Dr. Anderson, thank you for your comments. We are all humbled by your contributions and are indebted to the work you and your colleagues did to bring us equality.

      Reply

  7. NA

    I am a recent DO grad, and I’d like to offer a different perspective. Our profession throws around this idea that AT Still was the god of whatever as evidence for all the pseudoscience that is OMT. Working closely with my MD colleagues now I am happy to say there really is quite a lot more in common than different between our professions. And there are ample students like me who are graduating feeling there is essentially no distinction between MD and DO but rather the osteopathic components of our profession are more a nuisance, a hurdle to overcome and focus on the stuff that actually matters or has evidence to support us learning it.

    I write this today to say that what you are speaking does not resonate with me or many in our field. There has to be a reconciliation for that discrepancy between believers of OMM and the vast majority of DO grads who do not feel that way.

    Reply

  8. Joel D. Stein, DO, FAAO, FAOASM, FACOFP, C-Pain

    So, having been in AOGME for the last 35 years and now to have transitioned to ACGME post doctoral education the last 3-4 years, I find that the AOA has simply shot DOs that actually care about Osteopathic Medicine, Philosophy and treatment ideals, in the foot. Seems like it was really not the way to go and we have diluted ourselves to be complacent with “bean counter” type site visit inspections. Virtual still at this point, but, even our last site visit (inspection in the old AOGME terms) the “inspector” referred to the ACGME protocol as “bean counting”. This means that by far, ACGME considers what you have on paper regarding evaluations, didactics and especially “research” has become so much more important than actual clinical acumen. Our older an much wiser osteopathic approach to inspections was to establish the link between faculty, residents and their adaptation to clinical abilities, whether it was how they thought, were able to create a plan of care, use their hands, or perform procedures. It does not seem this way anymore. OMG, if you didn’t write down that you met with the resident to discuss a case, and get the resident to understand why and how the treatment may have been better done, it simply did not exist and the resident did not learn anything from the experience. But, if you put on paper that the resident learned something, according to ACGME standards, then they did.
    It has become a very frustrating and compromised situation with training.

    Reply

  9. Robert Trafeli,DO

    California has taken over Michigan in having the most DO’s of any state?. So fascinating. Every 2 years, when u go to renew my California license, I get to fill out the California Osteopathic Board questionnaire. I especially love the part where they ask me my specialty. I’m 100%, traditional , hands on Osteopathic manual medicine. Yet, in the 60 or so multiple choice options I have to describe my special area of medicine, let’s see, pediatric oncology? No. Neuro ophthalmology? No. Nuclear medicine? No. Interventional cardiology? No. Hmmm. Osteopathy? Anything about practicing osteopathy as a specialty ? No there isn’t. For the last 27 years as an Osteopathic physician, practicing 100% Osteopathy, I have to check “ other”on the California Osteopathic Medical Boards. “Other”. And you wonder about the future of this profession? I hope you are as infuriated about this as I am. And if you are an “MD wanna be” Osteopath, I wonder if you even care.

    Reply

    1. Brian Loveless, DO

      Dr. Trafeli: Your question made me go back and look at the data again, but yes, based on AOA data, CA has 11,101 practicing DOs while MI has 8,910. It’s been a long time coming for CA to regain that spot after the merger of the 1960’s.

      As to your second point, I can’t agree more. I have the same frustration as you with the list of specialties provided by the OMBC. It shows how much further the osteopathic profession has to go in it’s fight.

      Reply

  10. Maxwell Spence, OMS-II

    As a current DO student, I can’t say that I have seen or experienced anything in my education worth defending or preserving. We are learning the same things as our MD peers with the added burden of OMT, but at the same time we deal with generally worse facilities, fewer faculty, poor research opportunities, and the onerous task of taking two sets of board exams if we want to match into anything resembling a competitive specialty. Instead of anything meaningful like advocating for a single licensure exam or disavowing cranial therapy as quackery, all we are given is platitudes about “patient centered care” and our “distinct approach.” I am grateful to be able to study medicine, allopathic or osteopathic, and I will be proud to be a DO, but I really have not been convinced that we bring anything unique to the table.

    Reply

  11. James Highley

    Maxwell, hang in there. When you graduate (actually before of course) get yourself an MD residency at the best place you can. And don’t be afraid to apply to the top places, Mayo, Harvard, Hopkins, any major university. etc. Get in, get trained and never look back!

    Reply

  12. Brian Loveless, DO

    Student Doctor Spence, thank you for your comment. I am disheartened not only by your experiences with OMT training but in your inability to discern a difference in the way your faculty are preparing you to practice. Perhaps it is simply a factor of being immersed in osteopathic school and not truly knowing what allopathic training is like (the fish who doesn’t know it’s living in water) or perhaps it hasn’t been made clear enough in the first year of school. My hope for you is that when you are out on your clinical rotations your distinctiveness will be more evident.

    Reply

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