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Monday, January 7th 2013

Osteopathic and Allopathic Education in Texas

Osteopathy has an interesting history in the United States. Unlike other ‘opathies’ and rejections or alterations of allopathic medicine which arose in the eighteenth and nineteenth centuries, the history of Dr. Andrew Still’s treatment philosophy, is remarkable in the turn it took back towards biomedical principles and how leaders of osteopathic medicine in the twentieth century fought allopaths and the entrenched medical community to broaden their scope of practice until today when a D.O. degree is an equivalent of an M.D. degree anywhere in the United States.

I’ll ignore whatever debate remains over the benefits of osteopathy and manipulative medicine. Largely because the founding principles of osteopathy are largely nowhere to be found in the everday practices of doctors of osteopathic medicine. Very few D.O.s use manipulative medicine in their practices. And while there are some other distinctions between allopathic and osteopathic medical education in the United States, such continue to shrink. There has been a gradual infolding of osteopathy back into allopathic medicine; an irony of the fact osteopathic leaders at the beginning of this century worked so hard to be accepted by their counterparts in medicine. Nearly 70% of graduates, or perhaps more nowadays, of osteopathic medical schools do residencies sponsored by institutions focused on allopathic education.

No wonder there are irregular questions about the continued necessity of osteopathic medical education. From a 1993 article in the Journal of the American Osteopathic Association,

[T]hese changes…raise a number of disturbing questions for the profession. Foremost is the continued existence of or a need for osteopathic medicine in our society. Why should the United States support parallel medical systems on the assumption that osteopathic medicine is different when, after graduation, most DOs choose to train in the allopathic medical profession?

It’s a legitimate question, still being played out even twenty years after that article. On the one hand the number of osteopathic graduates, as all medical schools, continues to grow and new osteopathic medical schools continue to open. I’m not sure that hints at some unfilled need for osteopathy as it remains most of those graduates will largely shun such in their real world practice. And, on the other hand, slowly schools of osteopathic medicine are looking to award doctors of medicine in addition to, or as replacements of, their current doctor of osteopathic medicine degrees.

Such is the case at the school of osteopathic medicine in Texas. Several years in the works, and somewhat of a political nightmare to this point, the University of North Texas’ Health Science Center Texas College of Medicine is likely to have a bill introduced in the next legislative session to allow the school to offer an M.D. degree. So focused were some at the school on approval for an allopathic track that it created discord over a parallel move to merge the health science center with the University of North Texas at large.

Merger talk became a distraction, with questions raised about whether one effort hinged on the other or one would take precedence over the other.

When the merger issue came before the regents again in November, it was taken off the agenda. Jackson said it’s been tabled indefinitely.

Any change to the governing structure of the Fort Worth and Denton campuses would require approval from the Legislature, governor and Texas Higher Education Coordinating Board.

With the 2013 session starting Jan. 8, [UNT Chancellor] Jackson said

The president of the health science center seems to have voiced such a belief – that asking the legislature for the merger at the same time as asking them to approve the M.D. degree would be a distraction and reduce the chances of approval for the M.D. degree – in his contentious opposition to the merger. Such opposition eventually cost him his job last month.

Seeking permission for the M.D. degree I think heightens the question of purpose that continues to surround osteopathic medicine.

The D.O.s I know are largely excellent physicians. There is nothing in their education that distinguishes them. I also don’t personally know a single D.O. who has ever let it be known to me they routinely use something unique to osteopathy in their everyday practice. I’m not sure why then we continue to pay lip service to osteopathy and to distinguish ostoepaths and allopaths by the letters after their names. Maybe its time we were just all the same. Maybe if UNTHSC wants an M.D. degree for TCOM, then that should also be the end of its D.O. degree.

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