“What’s in a Name?”
Stephen C. Shannon, DO, MPH
[Editor’s Note: this piece is reprinted with permission from American Association of Colleges of Osteopathic Medicine. It originally appeared in the February 2014 “From the President” column in AACOM’s monthly Inside OME e-newsletter.]
It is no longer accurate to use the following pairs of terms interchangeably: osteopathy and osteopathic medicine; osteopath and osteopathic physician; college of osteopathy and college of osteopathic medicine. The former term in each of the aforementioned pairs does not properly describe the osteopathic medical profession on a global basis, and the terms “osteopaths” and “colleges (or schools) of osteopathy,” when used to refer to the practitioners and educational system of our profession in the United States, is archaic and has been considered so since before the turn of the century. [1]
There are tens of thousands of non-physician practitioners who trained outside of the United States, practice osteopathy, and are known as osteopaths in their countries and throughout the world. The osteopathic profession arose in the later part of 19th century America, driven by the philosophy enunciated by Andrew Taylor Still, MD, DO, in his efforts to reform the medical profession and define alternative and effective ways to prevent and treat disease using techniques to restore and maintain an individual’s overall state of health and well-being. [2]
These principles and techniques were initially taught only to US practitioners, but quickly spread outside of the United States, predominantly to Europe, in the first half of the 20th century. For historical reasons having to do with the variety of regulatory, legal, and academic structures in the other countries where osteopathic principles and practices took root outside the United States, a profession of non- physician osteopathic practitioners– or osteopaths –was founded. According to the recently published “Osteopathy and Osteopathic Medicine – A Global View of Practice, Patients, Education and the Contribution to Healthcare,” there are over 40,000 osteopaths outside the United States, mostly in France, Germany, Italy, the United Kingdom, Australia, Belgium, and Canada. These practitioners serve as “primary contact health providers with nationally defined practice rights.”
Unlike osteopathic physicians, they may not prescribe pharmaceuticals or perform surgery. Additionally, their educational pathways are different from US-trained DOs. “Across much of Europe, Australia, and New Zealand, the generally accepted norm for training as an osteopath has become a master’s degree level qualification. In some countries, the equivalent of a bachelor’s degree remains the accepted norm or post-professional training is accepted.” [3] Only US colleges of osteopathic medicine produce osteopathic physicians. Graduates of these schools are physicians – Doctors of Osteopathic Medicine, or DOs.
They are fully licensed as physicians, can practice with unlimited medical practice rights, and may pursue any branch of specialized medical care – the same as their MD colleagues. After earning an undergraduate degree, fulfilling all pre-med coursework and Medical College Admission Test requirements, and gaining admission to osteopathic medical colleges, these medical students begin the rigorous four-year journey to earning their Doctor of Osteopathic Medicine degree. After earning their DO, these graduates enter into between 3 and 10 years of specialty residency and fellowship training, complete licensing and specialty board examinations, and pursue a license to practice in the state/s (and/or countries) in which they wish to be established. DOs practice as osteopathic physicians providing medical care in the United States or in one of over 65 countries around the world which grant them full medical practice rights.
In addition to US-trained DOs that have pursued full practice rights outside of the United States, there is another category of osteopathic physician that exists in several countries. There are roughly 5,000 MDs that, after their traditional medical training, pursue additional osteopathic qualifications. They are known as osteopathic physicians in their countries – most prominently in Germany (~2300), France (~1600) and Russia (~1300). [4] In the United States, there are over 87,000 osteopathic physicians [5] and over 23,000 osteopathic medical students – it is one of the fastest growing segments of the US healthcare workforce. [6]
In some countries there may be both osteopaths and osteopathic physicians working in the same healthcare system – Canada being one of them. In order to provide clarity to the regulators of healthcare systems and inform and protect the public, osteopathic practitioners in those countries, and globally, are working to develop common definitions and standards for regulation, education, and registration (or licensure). Thomas Friedman popularized the use of the expression “the world is flat” to describe the increasing globalization of many parts of our lives in the 21st century. In some ways, our national borders mean less and less as information, knowledge, goods, and services traverse the globe at an ever-hastening speed.
As we increasingly adjust to this reality in our nation’s healthcare system, it behooves us to contribute to the understanding of and accuracy of reference to the osteopathic medical profession by using the correct terminology. After all, osteopathic physicians are a key and growing part of the US and world healthcare workforce. So, let’s start with the following: [7]
• Osteopathic Physician — A person with full, unlimited medical practice rights, and who has achieved the nationally recognized academic and professional standards within his or her country to practice diagnosis and provide treatment based upon the principles of osteopathic philosophy. Individual countries establish the national academic and professional standards for osteopathic physicians practicing within their countries.
• Osteopath — A person who has achieved the nationally recognized academic and professional standards within his or her country to independently practice diagnosis and provide treatment based upon the principles of osteopathic philosophy. Individual countries establish the national academic and professional standards for osteopaths practicing within their countries. (Considered to be an archaic term when applied to graduates of US osteopathic medical schools.)
References
- Glossary of Osteopathic Terminology, Education Council on Osteopathic Principles of the American Association of Colleges of Osteopathic Medicine, 2011, http://www.aacom.org/resources/bookstore/Pages/glossary.aspx
- History of Osteopathic Medicine, http://www.aacom.org/about/osteomed/Pages/History.aspx.
- Interested readers should visit the website of the A.T. Still University Museum of Osteopathic Medicine https://www.atsu.edu/museum/
- Osteopathy and Osteopathic Medicine – A Global View of Practice, Patients, Education, and the Contribution to Healthcare,” Osteopathic International Alliance, 2013, http://wp.oialliance.org/?page_id=3741
- Ibid. p 19
- Osteopathic Medical Profession Annual Report, 2013, American Osteopathic Association, http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/default.aspx
- American Association of Colleges of Osteopathic Medicine, http://aacom.informz.net/InformzDataService/OnlineVersion/Individual?mailingInstanceId=2735254&subscriberId=793802754
