Doctors of osteopathic medicine (D.O.’s), more commonly referred to as osteopaths, practice a medical discipline that uses refined and sophisticated manipulative therapy based on the late 19th century teachings of American Dr. Andrew Taylor Still. It embraces the idea of “whole person” medicine and looks upon the system of muscles, bones, and joints—particularly the spine— as reflecting the body’s diseases and as being partially responsible for initiating disease processes. Osteopaths are medical doctors with additional specialized training in this unique approach. They practice in a wide range of fields, from environmental medicine, geriatrics, and nutrition to sports medicine and neurology, among others. Approximately 56,000 osteopaths are members of the American Osteopathic Association.
Osteopath Career History
Osteopathy has its roots in the hardships and challenges of 19th-century America. Its developer, Dr. Andrew Taylor Still, was born in 1828 in Virginia, the son of a Methodist minister and physician. There were few medical schools in the United States, so Still received his early medical training largely from his father. As the Civil War began, he attended the College of Physicians and Surgeons in Kansas City, but he enlisted in the army before completing the course.
In 1864, an epidemic of meningitis struck the Missouri frontier. Thousands died, including Still’s three children. His inability to help them underscored his growing dissatisfaction with traditional medical approaches. After much careful study of anatomy, physiology, and the general nature of health, he became convinced that cultivating a deep understanding of the structure-function relationship between the parts of the body was the only path to a true understanding of disease. Eventually, Still came to believe in three basic principles that would form the core of his osteopathic approach to the practice of medicine. First, he saw the body as capable of self-healing, producing its own healing substances. Second, he felt health was dependent upon the structural integrity of the body. And, finally, because of these beliefs, he considered distorted structure a fundamental cause of disease.
A system of physical manipulation was an integral component of Still’s new practice. He began to compare manipulative therapy with other methods then used by doctors, such as drugs and surgery. Often, he found the use of manipulative methods made drugs and operations unnecessary. Instead, he focused on the musculoskeletal system—the muscles, bones, nerves, and ligaments. Recognizing that structural misalignments often occurred in these areas, he emphasized the system’s importance as a major potential factor in disease, ripe for the application of his new manipulative techniques.
Still founded the first college of osteopathy in Kirksville, Missouri, in 1892, basing it upon the fundamental principles of his osteopathic concept. Fewer than 20 men and women graduated from this first osteopathic college in 1894. Today, there are 21 osteopathic schools in the United States. Some are part of major university campuses, and combined, they accept roughly 3,300 new osteopathic students annually.
Andrew Still died in 1917, leaving behind a legacy of enormous importance to the history of medicine. Medicine as we know it was in its infancy in his day, and theories, tools, and techniques we take for granted now— such as the concept of germs, the use of antiseptics, and the diagnostic possibilities presented by radiology—were just beginning. In this challenging environment, Still worked out a practical system of structural therapeutics that has withstood the pressure of later discoveries.
Although practitioners of alternative methods of healing in the United States were—and sometimes still are— seen as a threat by the medical profession, osteopathy has increased in popularity. As the field grew, some students wished to use drugs as well as osteopathic techniques in treating patients. John Martin Littlejohn, for example—a Scotsman who studied with Still—widened the focus of osteopathy by concentrating not only on anatomy, but stressing physiological aspects as well. Unlike Still, Little-john wanted osteopaths to learn all about modern medicine, along with osteopathic principles and practices. Later, Littlejohn returned to Britain, where he founded the British School of Osteopathy. Even so, the training of osteopaths in the United States was, in fact, eventually to merge with the training of orthodox medical physicians.
Osteopath Job Description
Osteopathy and orthodox medicine both use the scientific knowledge of anatomy and physiology, as well as clinical methods of investigation. In this respect, they have a similar language. The greatest differences, however, lie in the way patients are evaluated and in the approach to treatment. As a general rule, the orthodox medical approach focuses on the end result of the problem: the illness. Treatments seek to repair the imbalance presented by the illness through the prescription of drugs or by surgery. In contrast, osteopaths focus on tracing the changes in a patient’s ability to function that have occurred over a period of time. This is done to understand the chain of events that have altered the relationship between structure and function, resulting in the patient’s present complaint. The primary aim of treatment is to remove the obstacles within a patient’s body that are preventing the natural self-healing process from occurring. It’s a subtle difference, but important.
Like most physicians, osteopaths spend much of their day seeing patients in a clinic or hospital setting. Their specialty, of course, may take them to other venues, such as nursing homes or sports arenas.
The osteopath’s first task in evaluating a new patient is trying to understand the cause of the problem that the patient presents. It may sound simple, but it can be very complex. Diagnosis is a fluid art, and treatment programs are reviewed with each patient visit, changing as the patient begins to respond. To arrive at an appropriate diagnosis, osteopaths record and analyze the history of prior treatment. This report will likely be greatly detailed, since osteopaths consider the whole body. Since structure and function are interdependent, and all the parts of the body connect with each other, osteopaths ask questions that appear to have little relevance to the problem at hand. It is precisely that concern for seemingly irrelevant details, coupled with manipulative therapy, which distinguishes the osteopath from the more conventional Doctor of Medicine (M.D.)
One technique that assists in the correct evaluation of patient problems is palpation, a manual means of diagnosis and determination, whereby sensory information is received through the fingers and hands. Along with careful listening and observation, osteopaths use palpitation to assess healthy tissue and identify structural problems or painful areas in a patient’s body.
The osteopath differs from a traditional M.D., or allopathic physician, in one other major aspect: treatment options. For the osteopath, treatment centers on what are called osteopathic lesions, which are functional disturbances in the body that may involve muscles, joints, and other body systems. These lesions are created by mechanical and physiological reactions in the body to various types of trauma. In osteopathy, open, unhindered, and balanced movement is the most important factor in health. The lack of balance plays a major role in the onset of disease and illness. Thus, the many varied techniques employed by osteopaths are concerned primarily with re-establishing normal mobility and removing or reducing the underlying lesions.
The techniques available to treat osteopathic lesions are nearly limitless. Because osteopaths consider the whole body when determining the proper treatment, each application of a particular technique will be unique. Similar lesions in different patients will have different origins and will have been caused by different sorts of forces or events. Thorough evaluation of the patient help guide osteopaths in discerning what sorts of techniques will be most helpful.
Osteopath Career Requirements
Students who plan a career as a physician, either as a D.O. or an M.D., should take a college preparatory program in high school. You’ll need a strong foundation in the sciences, especially biology, chemistry, and physics. In addition, take English, history, foreign languages, and all the math you can. Psychology is a helpful course in preparing you to work well with a wide variety of people coming to you for treatment. Strive to become as well-rounded an individual as possible.
After obtaining a bachelor’s degree, prospective osteopaths must apply to medical school. Students file applications along with their college transcripts and MCAT (Medical College Admission Test) scores. Admission to an osteopathic medical school, like all medical schools, is quite competitive.
The academic program leading to the Doctor of Osteopathy degree involves four years of study, followed by a one-year rotating internship in areas such as internal medicine, obstetrics/gynecology, and surgery. Those interested in a specific specialty must complete an additional two to six years of residency training.
The curriculum in colleges of osteopathic medicine supports Dr. Still’s osteopathic philosophy, with an emphasis on preventive, family, and community medicine. Clinical instruction stresses examining all patient characteristics (including behavioral and environmental) and how various body systems interrelate. Close attention is given to the ways in which the musculoskeletal and nervous systems influence the functioning of the entire body. An increasing emphasis on biomedical research in several of the colleges has expanded opportunities for students wishing to pursue research careers.
Certification or Licensing
At an early point in the residency period, all physicians, both M.D.s and D.O.s., must pass a state medical board examination in order to obtain a license and enter practice. Each state sets its own requirements and issues its own licenses, although some states will accept licenses from other states.
Many osteopathic physicians belong to the American Osteopathic Association (AOA). To retain membership, physicians must complete 150 hours of continuing education every three years. Continuing education can be acquired in a variety of ways, including attending professional conferences, completing education programs sponsored by the AOA, teaching osteopathic medicine, and publishing articles in professional journals.
The AOA offers board certification, which entails passing a comprehensive written exam as a well as a practical test demonstrating osteopathic manipulative techniques. The AOA offers specialty certification in 18 areas. Some osteopathic physicians are certified by both the AOA and the American Medical Association (AMA).
The practice of osteopathy usually involves a lot of personal interaction and a lot of touching, which can make some patients—and some prospective doctors—feel uncomfortable. If you plan to become an osteopathic physician, you will need excellent communication skills to tell patients what to expect and what is happening at any one moment. If patients don’t understand what you are telling them, they may not pursue treatment. For this reason, good communication skills are crucial. You will also need to learn to work well with others and to be perceptive listeners.
Since a large number of osteopaths go into private practice, business and management skills are useful. In addition, good manual dexterity is important. Finally, and most importantly, you must have a real commitment to caring for people in this medically specialized way.
Exploring Osteopath Career
Consider visiting an osteopathic medical college. Tours are often available and can give you extra insight into necessary training and the ways in which life at an osteopathic medical school differs from a “regular” one. If you don’t live close enough to an osteopathic college to visit, write for more information or visit their Web sites.
Check into after-school or summer jobs at your local hospital or medical center. Any job that exposes you to the care of patients is a good one, even jobs you might not think of at first, or ones that aren’t exactly medical, such as working with the janitorial service. Contact the American Osteopathic Association and ask for a list of osteopaths in your area. Talk to as many people as you can, and don’t be afraid to ask questions.
Osteopaths can be found in virtually all medical specialties. More than one-third of all osteopaths go into private practice after completing their training. They also work in hospitals, clinics, nursing homes, and other health care settings. Approximately 56,000 osteopaths are members of the American Osteopathic Association.
Depending on the specialty in which an osteopath is interested, he or she can plan on completing a residency program of two to seven years’ duration. One of the difficulties facing the profession today is that medical schools produce more students than there are available residencies at osteopathic hospitals. As a result, gaining admission to selective osteopathic programs may be challenging. Graduates increasingly find residencies in traditional medical facilities. As awareness of and interest in osteopathy continue to grow, this shortage of open residency positions may change. After completing a residency program, an osteopath can choose to go into private practice or explore positions with a variety of health care employers.
Advancement in the medical professions is dependent on the specific field. Osteopaths in private practice will follow a different career path than those working in a purely clinical setting or in a research position at an academic medical center. As noted earlier, a large percentage of osteopaths go into private or small-group practice. Advancement in private practice comes with increased reputation; mainly through word of mouth, a practice grows with positive referrals.
In contrast, osteopaths in employee positions are more limited in their methods of advancement. Those in an academic setting face the challenge of obtaining tenure to advance from instructor to assistant professor to associate professor to professor. Becoming tenured is an arduous process, involving a combination of patient care, research, publication, and administrative responsibilities. Those who love the academic environment, however, and also want to be a practicing physician usually find their niche in academia.
Osteopaths earn incomes comparable to their M.D. counterparts. The potentially high income that comes with becoming established as a physician can be an enticing perk. According to the American Medical Association (AMA), the median net income for all physicians is $160,000. The middle 50 percent earn between $120,000 and $240,000 a year. There are a number of other factors to keep in mind, however, as described in a recent survey by the AMA. Counting postgraduate education, most physicians are in their early 30s before starting to practice. The Association of American Medical Colleges reports that residency pay is low (first-year medical residents averaged $37,400 a year in 2002), yet residents worked an average of 80 to 100 hours per week. Most physicians incur high educational debt by the time they begin to practice.
Benefits for osteopathic physicians vary, depending on whether they work in private practice or for an employer. The AMA survey indicates that median net income for self-employed physicians is approximately 40 percent higher than that of employee physicians. Many factors contribute to the difference. Self-employed physicians tend to be older, have more years of experience, work more hours, and be more likely to be board certified, all of which are associated with higher earnings. On the other hand, 75 percent of employee physicians receive noncash benefits in addition to their reported income, whereas some self-employed physicians do not. These benefits represent approximately 5 percent of income for employees.
As with the benefits earned, the environment in which an osteopath works can vary. In private practice and employer-based situations, osteopaths work both alone (directly with a patient) and as part of a team. Osteopathy, like all medical professions, is a field of contrasts, requiring both collaboration and personal insight. The primary obstacle to be aware of going into almost any field of medicine is long hours and erratic schedules, particularly during training.
Osteopath Career Outlook
According to the American Association of Colleges of Osteopathic Medicine, the number of osteopathic graduates has increased 50 percent in the last decade, making osteopathic medicine one of the fastest-growing health professions in the country. To meet the growing demand, more than a dozen new osteopathic medical colleges have opened their doors since the mid-1970s. Together, all 21 institutions currently enroll more than 8,000 students annually, of whom nearly 35 percent are women.
Although osteopathic medicine is not strictly an “alternative” approach, the field is benefiting from the current interest in these kinds of therapy. Excellent job opportunities will continue to become available for skilled osteopathic physicians. In addition to specialized practices in areas such as family medicine, increasing interest in biomedical research at the osteopathic colleges also is expanding opportunities for candidates interested in careers in medical research.