This year marks the 125th anniversary of osteopathic medicine’s establishment as a structured discipline. More than 102,000 osteopathic physicians (DOs, or doctors of osteopathic medicine) practice alongside their 821,000 allopathic medical colleagues (MDs, or medical doctors) in every subspecialty — from pediatrics to cardiothoracic surgery — at clinics, hospitals and health systems throughout the nation.
Another 27,500 prospective DOs are studying at 33 schools of osteopathic medicine at 48 locations in 31 states. Indeed, enrollment in osteopathic medical schools has grown by 90 percent within the last decade. Nearly one in four medical students nationwide now attends a four-year postgraduate osteopathic institution.
Osteopathic medicine is among the fastest growing of health professions. Why?
All in the hands
Andrew Taylor Still, founder of the discipline, was the son of a frontier preacher-physician with whom he apprenticed in Kansas, treating Native Americans. During the Civil War, he served as a hospital orderly and “de facto surgeon” in the Union Army. The death of his first wife and five of his children (from childbirth and common epidemic diseases) led to Still’s disillusionment with contemporary medical practice. Much of it did more harm than good, he concluded, especially prescription of the medicinal drugs of his day — opiates, cathartics, diuretics, purgatives — whose efficacy was unproven.
After briefly attending classes at a conventional medical school and resuming the treatment of patients, Still developed a theory that most maladies were expressions of musculoskeletal misalignments that interfere with blood flow and nerve function. Many of them, he maintained, from asthma to paralysis, could be diagnosed and cured by manual adjustment of the spine and other bony processes.
Still called his approach “osteopathy.” He coined it from the Greek words for bone and suffering, although "-pathy" had come to signify a method of treating disease — as in homeopathy, naturopathy and allopathy.
Still worked out a system of manipulative therapeutic techniques and began teaching them in a two-year course at his new school (today the A.T. Still University of Health Sciences in Kirksville, Mo.), along with what he described as “exact, exhaustive, and verifiable knowledge of the structure and function of the human mechanism, anatomical, physiological and psychological, including the chemistry and physics of its known elements.”
His fundamental principle was that the body, mind and spirit are inextricably connected in each human being. Good health is the natural state of the body, which possesses its own complex mechanisms to heal from disease or injury. The goal of medicine is to prevent and if necessary repair breakdown of the body’s self-healing capability. He advocated good nutrition, exercise, a positive attitude and musculoskeletal readjustments when appropriate.
In the decades that followed, osteopathic medical schools, like their allopathic counterparts, adopted a demanding, biomedical science–based, four-year curriculum that included pharmacology, internships and residencies. Training in the two disciplines became almost identical (except for an additional 200 to 300 hours student DOs spend learning osteopathic manipulative treatment, or OMT). And the principles and practice of osteopathic medicine are fully aligned with the holistic, patient-centered care now valued in achieving the Triple Aim.
A crucial role
Fifty-six percent of osteopathic physicians are engaged in primary care — family or internal medicine, or pediatrics. Another 10 percent practice emergency medicine. General surgery, obstetrics/gynecology, anesthesiology and psychiatry are the next most popular specialties.
Many osteopathic medical schools are in smaller towns, and many graduates, having gained experience in local clinics and hospitals, remain committed to “the mission to treat rural, diverse and medically underserved communities,” according to Jason Haxton, D.O. (Hon.), director of ATSU’s Museum of Osteopathic Medicine in Kirksville. “We like that role.”
William Burke, dean and associate professor of family medicine at Ohio University Heritage College of Osteopathic Medicine in Athens notes that “about 60 percent of our graduates stay in the state to practice” and “nearly one-third are serving in federally designated HPSAs — health professional shortage areas. We produce primary care physicians when there is such a need.”
OhioHealth and the Cleveland Clinic have partnered with OU-HCOM to maintain a primary care physician pipeline into their medical groups. “Whether our students choose family practice or a subspecialty, they’re all trained and exposed to a generalist model,” says Burke. “DOs have been leaders in adopting population health and quality measures. This is a generation that grew up with a device in their hand, but we’re teaching them how to avoid letting technology get in the way of relating with patients. Our philosophy of mind, body and spirit means we think of you as someone not just complaining of back pain but as a whole person.”
Meet a few DOs
Osteopathic physicians these days fit into every niche in American medicine.
Roozehra Khan, D.O., is an attending physician in neurocritical care and an assistant professor of clinical medicine at the University of Southern California Keck School of Medicine. As a medical school professor not much older than her students (she’s 34), she’s updating medical education for millennials by, for example, adapting social media — Instagram and Snapchat — to teach young physicians how to do a tracheotomy or use portable ultrasound to suss out internal injuries in emergency situations.
Khan’s counterintuitive insight was that the very ephemerality of Snapchat “stories” (videos are limited to 10 seconds and erased after 24 hours) lends urgency to absorption of the content. Wearing Snapchat Spectacles — video-capturing sunglasses — she can record a procedure from her perspective as the physician performing it: virtual shadowing for students.
Naresh Rao, D.O., travels the world as team physician for the U.S. men’s national water polo squad. In osteopathic medicine he combines his love of sport with his belief in a “whole-person approach” to healing.
The son and brother of MDs, he notes that, in contrast to them, “When someone comes in with a knee issue I don’t just look at the knee. I ask about what’s going on with them ... their psyche, their relationships, what’s going on with their work.
“I use OMT on 80 percent of the patients I see daily,” he estimates. “But it’s not pushing bones into the right place, it’s coaxing the body to be in a position of optimal health. Elite athletes need a lot of attention, but I contend we’re all athletes. Sitting at a desk for eight to 10 hours a day is a marathon for the neck and upper back. The body is meant to move.”
Richard Scheuring, D.O., oversees the strength and conditioning of U.S. and foreign astronauts as a flight surgeon at NASA's Johnson Space Center in Houston. A colonel in the Army, he’s one of about 20 personal physicians to the astronaut corps, keeping them healthy as they train in Texas and Russia, rocket to the International Space Station, sojourn in orbit and return to gravity.
“Astronauts’ spines lengthen from 2 to 6 centimeters in space, and their herniated disc rate is higher than average,” he observes. “They suffer training-related injuries. ... They’re working in a space suit, they’re getting older, they develop osteoarthritis, they need muscular reconditioning after extended weightlessness.”
On the ground, Scheuring says, he uses his hands extensively to diagnose tissue changes and subtle mechanisms of injury. When his patient is encapsulated 250 miles above Earth’s surface traveling at 17,500 miles an hour, Scheuring has to rely for his space-to-ground medical consultations and remote treatment recommendations on the only diagnostic modality the astronauts have at their disposal: ultrasound. “We’ve done that with an astronaut in orbit," he says. "It was a hamstring injury.”
NASA, he says, is “an engineering environment. If an injury occurs, I need to let [the command center] know immediately what the failure is, what the impact is, and I’ve got to offer up a workaround. The whole-person approach we’re trained in [as osteopathic physicians] is really practiced here. We’re the astronauts’ primary advocate. Even in the development of a spacecraft, the flight surgeon has an intricate part. I’ve learned that the more I can think like an engineer thinks, the better I can practice medicine.”
Jay Bhatt, D.O., is the chief medical officer of the American Hospital Association and president of its Health Research & Educational Trust. Like many DOs, he started in a different career, business consulting. Back pain took him to an inspirational physician — an MD, ironically — whose opening words, Bhatt recalls, were "‘tell me about your day-to-day life.’ It became a relational rather than a transactional experience.”
In addition to a doctorate from the Philadelphia College of Osteopathic Medicine, Bhatt holds graduate degrees in public administration and public health from Harvard and the University of Chicago. As CMO of the AHA, his role, he explains, is to provide clinical perspective on care delivery, system transformation and physician leadership. Major initiatives are underway in four areas: creating high-reliability organizations, helping physicians understand how to deliver high-value care, accelerating patient and family inclusion in medical decision-making, and accelerating delivery system innovation.
“Training as an osteopathic physician produces skills that help in the work of extending health care delivery beyond the walls of the hospital,” Bhatt says. “Evidence suggests only one in five medical doctors tends to deal with the social determinants of health. One hundred percent of osteopathic doctors do. They bring a perspective to hospitals and health systems that recognizes that illness and the disease process can be connected to broader issues of the environment, the community, the family, the socio-economic situation.
“When patients come to me with a headache or symptoms,” he says, “I approach things differently from my colleagues who’ve gone to a stroke of the pen. I ask broader questions. ‘Where do you live and work? Oh, you live in a basement? What’s your exposure to irritants? How many buses did you take to get here? Did you miss your last dose? Why?’
“I use OMT probably 75 percent of the time,” he adds. “Even with viral illness, it can help with the lymphatics and circulation, so patients get to homeostasis quicker. But sometimes it’s as simple as holding their hand and looking them in the eye.
“Team-based care and relational leadership are going to be critical in moving the needle on value in health care at lower cost,” Bhatt declares. “And DOs resonate with patients. We can’t redesign the system without physicians playing a key part.”
David Ollier Weber is a principal of The Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN’s website.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.