Osteopathic medicine is a complete system of health care. Osteopathic physicians, like allopathic physicians (M.D.s) attend four years of medical school, complete two to six additional years in a residency program, and are licensed to practice medicine in all fifty states. Doctors of osteopathy (D.O.s) and allopathic physicians work in the same hospitals, treat the same diseases, belong to the American Medical Association, and practice all aspects of medicine. What differentiates an osteopathic physician from an M.D. is philosophy, emphasis on preventive medicine, and specialized training in the musculoskeletal system and manipulative techniques.
Philosophy
Osteopathy is a system of medicine founded by Dr. Andrew Taylor Still, M.D., in 1874. Dr. Still was dissatisfied with medicine at that time, which was based primarily on surgery and medication. He believed that there was more to health than administering medication, that the body had its own store of chemicals to heal itself. He emphasized the relationship between the musculoskeletal system and the organ systems and viewed the vascular (blood) and nervous systems as the key mechanisms responsible for health. The blood and nervous system is how the body communicates and regulates its organs. The osteopathic philosophy holds that disease disturbances in the spinal column are carried through blood and nerves to different parts of the body where the problem will manifest.
This relationship between structure (spine and nervous system) and function (organs/tissue functions) became the basis of osteopathic medicine.
Osteopathic physicians believe in a holistic philosophy where the patient is seen as a whole person in which mind, body, and spirit work together to influence health. Rather than just treating specific symptoms or illnesses, osteopathic physicians view the patient as an integrated, interrelated whole. They understand how the body's systems work together and pay special attention to the spine and nervous system, which influences the health of all other body systems. This focus gave rise to the osteopathic techniques of structural manipulation. The theory holds that hands-on manipulation of the musculoskeletal system will affect functioning in other areas of the body. Osteopathic physicians use manipulation techniques to increase blood circulation and nerve supply to organs, and this assists in restoring health. They trust the body's natural healing ability and use manipulation, medication, education, counseling, and other techniques to stimulate the body to heal. They believe the body has an innate tendency toward health and will naturally work to return to homeostasis after an illness or trauma. The first goal of the osteopathic physician is to prevent disease by educating patients; the second goal is to facilitate a return to health by stimulating the body's healing abilities.
Types of Patients and Problems
Like allopathic doctors, osteopathic physicians treat patients with all types of health problems, from simple colds to serious conditions. Osteopathic medical schools focus on preparing physicians for family practice because of their belief in preventive medicine. They believe that if family practitioners work with patients to prevent disease, specialists wouldn't be as needed. Thus over half of osteopathic physicians work as primary care or family practitioners. However, osteopathic physicians can specialize in more than seventy broad specialty areas such as pediatrics, internal medicine, sports medicine, surgery, psychiatry, obstetrics, geriatrics, rural medicine, ear/nose/throat, cardiology, and ophthalmology. Osteopathic physicians treat patients of all ages, from newborn to the elderly, and it is common for an osteopath to treat an entire family.
Treatments
"Osteopathy teaches us to use all of our senses. One of the major senses we have is touch, so we can diagnose and treat with our hands. The idea of using hands is a powerful tool, and it facilitates change in a patient at all levels: the spirit, the mind, and the matter."
-Marty Bradbury, D.O.
Like M.D.s, osteopathic physicians use traditional methods such as blood and lab tests, x-rays, and physical exams to diagnose problems. They also use extensive questioning for diagnosing patient problems. Osteopathic physicians spend up to one hour with new patients. During this time, an individual and health history is taken. Osteopathic physicians ask patients about the presenting problem; symptoms; past treatments; use of vitamin supplements; allergies; use of alcohol, drugs, caffeine, and tobacco; level of exercise; stress level; lifestyle; and social life. They seek to understand their patients on the physical, emotional, and mental levels to make accurate diagnosis and treatment plans.
In treating patients, osteopathic physicians use many of the same methods as M.D.s. As complete physicians, osteopathic physicians are trained and licensed to prescribe medication and perform surgery. They also have the freedom to utilize acupuncture, homeopathy, herbal medicine, and other holistic methods because they are licensed physicians. Unique to osteopathic physicians is their use of osteopathic manipulative treatments (OMT) to treat patients. This hands-on skill is used by osteopathic physicians to diagnose and treat health problems. Osteopathic physicians use their hands to manipulate nerves, muscles, and bones to facilitate proper bodily functioning and health. This involves gentle movement of joints, application of pressure on body organs and tissues, body positioning, muscle massage, rapid adjustments, and cranial manipulation. Research has found osteopathic manipulation particularly useful with musculoskeletal problems, chronic pain, arthritis, spinal and joint disorders, stress, sports injuries, rheumatism, fibromyalgia, respiratory infections, headaches, pneumonia, bronchitis, and nerve problems.
It should be noted that not all osteopathic physicians utilize manipulative treatments. Some osteopathic physicians consider manipulation as central to their practice and actively follow the philosophy outlined by Dr. Still. These physicians do not align themselves with traditional M.D.s and believe osteopathy has something uniquely different to offer patients. The other group of osteopathic physicians align themselves with traditional allopathy and uses osteopathic approaches only as a secondary component to allopathic treatments. These physicians appear more like allopathic M.D.s and may or may not use manipulation techniques. Osteopathic education is one route for becoming a licensed doctor. Some choose this route to become licensed but don't emphasize the philosophy or methods in their practice.
Finally, osteopathic physicians educate patients. They teach patients about developing healthy attitudes and lifestyles to prevent illness. This discussion includes nutrition education, stress management, and counseling. Osteopathic physicians spend a lot of time with their patients and are known for providing compassionate and preventive care.
Osteopathic physicians have a strong network of health care providers in their referral system. Being similar to M.D.s in their work and training, they refer to a wide range of traditional medical practitioners and services. With their holistic philosophy, they also make referrals to holistic and mental health practitioners.
Employment Settings and Working Conditions
"There is a group of solo practitioners like myself. Some need camaraderie and people to cover for them, so they end up in group practices. Financially you can take on more of the burden when you have other people helping you, and there is a tremendous amount of nonmedical work that needs to be done."
-Marty Bradbury, D.O.
Osteopathic physicians work in all the same places as M.D.s. They fit into all health care settings and work in hospitals, clinics, private practice, and group practices. Historically, osteopathy has been known for providing primary care in rural and underserved areas. In addition to medical practice, some osteopaths research, write, and teach at medical schools. Since osteopathic medicine is accepted by mainstream medicine and society, osteopathic physicians don't face the same challenges as other holistic health care providers. They have the flexibility to work in any health care arena.
Being trained first as primary care physicians, many osteopathic physicians work in private family practices either individually or with other osteopathic or allopathic physicians. Group practices may also include nutritionists or mental health counselors. Osteopathic physicians in private practice, like any self-employed professional, have responsibilities other than treating patients. They also run a business. They handle advertising and marketing of services, bill patients and insurance companies, keep records, and supervise staff. Most osteopathic physicians have employees working for them and are responsible for office management.
Osteopathic physicians have flexibility to design their work life if they go into individual private practice, but most work typical doctor's office hours plus on-call emergency shifts. Osteopathic physicians working in hospitals and clinics have a more varied schedule, which can require evening and weekend shifts, on-call shifts, and less control over their time. As licensed physicians, osteopaths have many options for finding or creating the work setting they desire.
There is a significant amount of responsibility and stress in this profession because osteopathic physicians are involved in major decisions in people's lives from birth to death.
"The body heals itself by maintaining balance. I try to maintain a balance in my life. Unlike other osteopathic physicians, I decided to have a fairly limited practice in that I work four days per week, I don't carry a beeper, I don't work in hospitals, I make house calls, and I try to work with patients on a more personal level."
-Marty Bradbury, D.O.
The Profession
There are approximately 38,000 osteopathic physicians practicing in the United States compared to 600,000 M.D.s. Osteopathy is expected to grow, estimating 45,000 in practice by the year 2000. More than 50 percent of all osteopathic physicians are in family practice, internal medicine, pediatrics, and obstetrics/gynecology. Many serve areas of need working in small towns and rural areas. Osteopathic physicians are found in every state, with Florida, Michigan, Missouri, New Jersey, Ohio, and Texas having the highest concentration. Osteopathic physicians are licensed to practice in all fifty states.
Training and Qualifications
"Medical school training is the most challenging and stressful thing you are ever going to do in your life. But that's nothing compared to getting out there and doing the work. I like the challenge, autonomy, and constant learning. Each day when I come to work, my patients are my teachers."
-Marty Bradbury, D.O.
Currently there are nineteen schools of osteopathic medicine in the United States. To meet the requirements for admission, students typically have a bachelor's degree with prerequisite courses in biology, physics, chemistry, organic chemistry, English, and psychology. Students from all majors are eligible to apply if the prerequisite requirements are met. The Medical College Admission Test (MCAT) is also required.
Schools look for dedicated, mature, compassionate, and empathic individuals with a strong desire to help people as an osteopathic physician. Many applicants have volunteer or work experience in a health care field. Prospective candidates are interviewed to determine if they are the right match for the school and profession. Superior grades at the undergraduate level and high scores on the MCAT are necessary due to the high level of academic study required.
The third and fourth years focus on hands-on clinical training and research. Students participate in clinical rotations at affiliated hospitals, health centers, clinics, and offices of osteopathic physicians. Under the supervision of osteopathic physicians, students learn to provide patient care in family practice, pediatrics, surgery, internal medicine, rural medicine, obstetrics and gynecology, psychiatry, and other primary care fields.
Upon completion of medical school, students (now D.O.s) serve a one-year internship to enhance their clinical skills in internal medicine, family practice, pediatrics, surgery, and obstetrics/gynecology. The goal of training in these areas is to ensure that osteopathic physicians are trained to handle multiple health needs and practice as primary care physicians.
D.O.s can then choose to take a residency program, which takes two to six years to complete, in a specialty area such as pediatrics, surgery, radiology, pathology, or internal medicine.
To become licensed and eligible to practice, all D.O.s must pass state medical board examinations. Each state sets its own requirements, but typically the four years of training plus three years of clinical work are required.
Job Outlook and Salary
Osteopathic medicine is a growing field with excellent prospects for new professionals. As licensed physicians they have enormous opportunities for medical practice, and licensure provides the freedom to design a practice and influence salaries. Like M.D.s, osteopathic physicians earn a profitable salary ranging from $70,000 to $100,000 for family practitioners. D.O.s working in specialty areas can earn much more. Osteopathic physicians are covered by insurance companies and receive third-party payments. With the growth of health maintenance organizations (HMOs), primary care osteopathic physicians have more career options and higher salaries as HMOs shift away from specialists and require patients go through primary care physicians. This trend is helpful for osteopathic physicians who tend to work in the primary care role.
