The New Generation of Osteopaths: Are we Growing, or Simply Blending In?

Erin N. Syers and Donald C. Carson
SNMA Osteopathic Schools Committee Co-Chairs
DO Candidates 2012
Edward Via College of Osteopathic Medicine

Osteopathic medical education has changed significantly since the days of our esteemed founder, Dr. A.T. Still.  In recent decades, the increasing integration of osteopathic and allopathic training programs caused the two professions to be more alike than ever before.  There are osteopathic physicians working in every medical specialty there is, and an increasing trend to step away from the very thing that makes us different: manipulation.  The future of osteopathic medicine as we know it is in question: do we embrace it, or seek to change it?

the 1990s, most DO (Doctor of Osteopathic Medicine) graduates trained and practiced in a system totally separate from that of our allopathic constituents.  We had our own schools, hospitals, residency programs, and board exams.  However, within the last two decades, most osteopathic, community based hospitals, were either sold, closed or merged into allopathic hospital systems.  This created a shift in clinical training, so that most DO students are now essentially being trained as MD students.

Back then, most DO students pursued residency programs through an AOA (American Osteopathic Association) approved residency program, two-thirds of which were primary care programs.  However, now DO students have several residency pathways to choose from: (1) match directly into an AOA program, (2) match directly into an ACGME (Accreditation Council of Graduate Medical Education) program, or (3) match into an AOA program and then switch to an ACGME program later.  Over the years, there have been an increasing number of DO graduates matching directly into ACGME programs and fewer staying within osteopathic programs.  In 2007, 60% of the 11,140 DOs in postdoctoral programs were in ACGME residencies and fellowships, and only 49% of available osteopathic residency slots were filled.

There are several proposed theories that help explain this growing trend: (1) An increasing number of students are receiving their clinical training in allopathic training programs.  (2) The number of osteopathic college graduates is increasing faster than the slots available in AOA training programs.  (3) There are a higher proportion of DO graduates selecting non-primary care specialty programs, and fewer options for AOA training in these programs.  (4) A lack of available AOA programs in many areas of the country, and personal factors dictating desired location for postgraduate training.  (5) Increased numbers of AOA programs either being dually approved with their ACGME counterparts or existing in parallel within the same institutions.  (6) The loss of the traditional pathway of DO graduates and the collapse of the historically separate training programs.  Lastly, (7) active recruiting of DO graduates by many ACGME programs.

The founding tenets of osteopathic medicine are centered on holistic, patient centered, preventative care.  However, most have come to recognize that these beliefs are present in allopathic medicine as well.  With that being said, it seems as if the only real distinction between the two disciplines is OMT (osteopathic manipulative techniques) which DO’s spend a great deal of time learning their first two years of medical school.  However, even this seems to get lost during the clinical training years.  So in the end, the DO surgical resident training at John’s Hopkins is no different from the MD surgical resident she trains with, right?

So what do we do about it?  Do we embrace the future and the way it’s headed continuing to break down the barriers that separate osteopath from allopath; or do we encourage our schools and residency programs to adapt to these changes, and find ways to incorporate OMT in the clinic whether the program is strictly osteopathic or dually approved? Osteopathic medicine as we know it is in danger of losing sight of the pathway so carefully etched by Dr. Still, over 100 years ago.  If we want to preserve our future, we need to uphold our distinction.

References:
Shannon, Stephen C. DO, MPH, MA; Teitelbaum, Howard S. DO, PhD, MPH. The Status and Future of Osteopathic Medical Education in the United States. Academic Med. 2009;84:707-711.

Filed Under: Global Health

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