Osteopathic Medicine: 150 Years, and Counting, of Changing the Healthcare Landscape

This June we celebrate the 150th anniversary of the founding of osteopathy. To use the modern term, Dr. Andrew T. Still, the founder of osteopathic medicine, was a disrupter. He saw the flaws in the status quo of medical treatment and was brave enough to offer a different path. Many of his fundamental healthcare principles—a holistic approach, finding ways the body can heal itself, preventive action—while seen as revolutionary and dismissed at first, are now core practices throughout the medical world. In many ways, our healthcare system is again at a crossroads and, like Dr. Still, we must be brave enough to identify and acknowledge the flaws if we hope to fix them. Once again, osteopathic medicine can help lead the way.

Survey after survey reports the dissatisfaction our patients have with healthcare. Increasing medical costs and poor healthcare access affect outcomes and have led to inequity for many. Fragmented care and inadequate mental health services fail to recognize and treat mind, body and spirit. And our patients are not alone in their dissatisfaction. Physicians are feeling more stressed than ever by the onslaught of day-to-day realities of the work. They are mired in billing complexities, struggle to meet strict and difficult-to-navigate requirements and regulations and rush to see patients during ever shortening visits. These factors are compounded by the growing amount of misinformation shared through social media, which has weakened the trust the general public has in their healthcare professionals.

While the situation may seem stuck in a downward spiral, we know that is not true. We know this because the principles Dr. Still first expounded on in 1874 still resonate today. In fact, they are more attractive than ever to patients and prospective physicians. That’s why the number of colleges of osteopathic medicine (COMs) has doubled since 2001. Twenty-five percent of all medical students, more than 36,000, are now being trained at one of 41 COMs, with 66 teaching sites in 35 states. And that number is projected to grow to one-third of all medical students by 2030.

Just as important as the growth of the COMs over the past 150 years is where they’ve grown. The fact is 80 percent of healthcare happens in the 5,000-plus hospitals and community health clinics across America not connected to a large academic medical center. This is where osteopathic medicine has been educating students for more than a century. Our distributive, community-based model of education allows students to experience healthcare on the front lines of patient care. It exposes them to all sizes of communities and teaches them to establish a rapport with patients from all socio-economic backgrounds. Furthermore, we know that where students train plays a major role in determining where they practice. And that is a great benefit for communities in need of healthcare professionals.

Sixty percent of COMs are located in federally designated Health Professional Shortage Areas, and 64 percent require clinical rotations in rural and underserved communities. There are numerous states where COMs are the number one source of overall physicians, primary care physicians and physicians who practice in rural areas. For example, according to a recent study by the National Center for the Analysis of Healthcare Data, since 1985, 73 percent of Michigan State University College of Osteopathic Medicine graduates, 4,776 physicians, currently practice in Michigan—more than any other medical school in the state. And it’s not just primary care. In Michigan, if you live in a community of less than 50,000 people, your ophthalmologist is far more likely to be a DO than an MD. Similarly, the West Virginia School of Osteopathic Medicine has more graduates practicing in the state and its rural areas than West Virginia’s other two medical schools combined.

Newer schools are also having an immediate impact. In Tennessee, 69 percent of graduates from the Lincoln Memorial University - DeBusk COM are reported to be practicing in a primary care specialty, 43 percent are located in an underserved area and 23 percent are located specifically in Appalachia. Edward Via COMs in Blacksburg and Spartanburg continue to see more than 60 percent of their graduates enter practice in a rural or medically underserved area.

With inaugural graduating classes from COMs in rural Louisiana, New York, Texas and California, as well as Oklahoma State University COM at the Cherokee Nation, the first medical school on tribal land, osteopathic medical students are poised to continue the profession’s historic role of treating those most in need.

In 1874, a rural physician dared to think bigger to help his community and his country. Dr. Still's vision, dedication, determination and personal loss motivated him to address the inadequacies he observed in healthcare. After losing his first wife to childbirth, three children to spinal meningitis, another child to pneumonia and recalling his grim experiences as a Civil War doctor, Dr. Still could not ignore the shortcomings of the medical methods he was taught. It is time once again for all of us, DOs and MDs, to do the same. Depending on the study, the United States ranks about 30th in the world in terms of health outcomes. And among the 10 highest-income countries, we rank number 11. We don’t even make the list. We can do better. Our patients need us to do better.

By embracing the founding principles of osteopathic medicine, we can work to improve preventative and primary care and can see our patients beyond just their disease to heal their body, mind and spirit. Just as it was time then for Dr. Still to look beyond the symptoms, we must also expand how we look at health determinants. As a community, we have pledged to look closer at how all patients can use food as medicine, including those who live in food deserts. Similarly, we need to consider how extreme weather impacts the health of communities who do not have the resources to mitigate severe heat and cold conditions.

The medical community needs to face these questions head on and work together to find solutions to all the challenges our nation faces. We need to follow Dr. Still’s example and be disrupters. The osteopathic medical community has grown from a small group in rural Missouri to the fastest growing segment of the medical community. And reconnecting to and enhancing our founding principles and philosophies will not only help improve the lives of millions of patients but will also keep our profession growing and thriving for the next 150 years and beyond.

 

 

 

 

Robert A. Cain, DO
AACOM President and CEO