So let’s talk about osteopathic
medicine in specific.
Osteopathic medicine started in 1874
when A.T. Still flung the banner of
osteopathy into the wind
and started talking about natural healing.
1874 was before antibiotics,
before sterile technique,
and before sterile surgery.
It was a very, very different environment,
and in that environment,
we had eclectic physicians who used
multiple different philosophies.
We had homeopathic physicians
looking at like healing like.
We had allopathic physicians
who trained in the apprentice model
and osteopathic physicians
whom also started off
as an apprentice-based training
which looked at natural healing
and the innate ability of the
body to heal itself,
of working within the individual,
and for the individual.
And this is because A.T. Still wasn’t happy
with the prevailing health of the time,
saying it was too confusing to people,
people didn’t know what to expect,
and he felt having a philosophy—
having a standard mattered.
So, he opened up an osteopathic medical
school in Kirksville, Missouri
shortly after 1874.
He admitted women and
he admitted minorities.
He wanted a holistic class
and a holistic system
where people learned together.
He set up a system where there
was only one class a year,
that became a learning community,
and students taught each other.
He had competition though.
Others started schools that were quicker
and said, “Let’s boil this down to teaching
you only the techniques you need to know
and let’s focus only on the
and he said, “No. This is about thinking.
This is about working through problems
from the individual basis.”
And because of the competition,
he was forced to make changes
and he said, “No longer are you going
to learn only what’s in this book,
we’re going to be science based.
We’re going to change
based on what we learn
and it’s not 500 hours of musculoskeletal
it’s a philosophy that stands
behind the education.”
So in 1897,
osteopathic medicine stated it was science
based and it would change with the times,
and that meant,
while initially surgery was not taught—
in 1910, sterile technique was introduced—
Lister said that you have
to wash your hands
and you have to avoid contaminating
a sterile field.
And by 1926,
it was mandated that every osteopathic
medical school teach surgery.
Pathology was also added at that time
and pharmacology was added as well.
So as these sciences advanced,
they were adopted by osteopathic medicine.
We also developed our own GME
and our own hospitals
because if we were going
to train generalists first
who then specialize
and if we were going to train doctors
who learned how to take care of people,
it was important that we train in environments
where this was valued.
And Flexner, which came
about in the early 1900’s,
said there should not be departments
of family medicine in MD schools,
that education should be specialty based
and osteopathic medicine went the other way
and said, “No. This should be generalist based.
You need to understand the person
before you understand the disease,
and every disease will effect
and people may have different desires.”
So understanding that is important
in having a supportive system
where people who think alike
will work together mattered.
So the osteopathic internship
which was a rotating internship where
you spent time in every field
and you learned to be a general physician
before you could specialize.
So a separate hospital system developed
and there were, at its height, 3000
that served communities,
that did it all for the community.
Then in the 1990’s to 2000,
there was a consolidation of
the healthcare industries
and our hospitals, the osteopathic hospitals,
became part of allopathic hospitals.
They became part of systems
and things changed, and we have
to adopt to the new system.
We had separate licensure
in many states where you can get
licensed as a DO or an MD.
At this point, most states
have joint licensure
where it’s the same requirements
for both MD’s and DO’s,
and osteopathic medical school gives you
full training and licensing
to do everything
any other physician is licensed to do.
The 500 to 600 hours that you were trained
in musculoskeletal medicine is decreasing.
Right now, the average is about 210
and that’s all you get in osteopathic
the rest is saved for residency.
But along with these changes, and the
closure of osteopathic hospitals,
led to a change to where there’s no longer a
requirement for an osteopathic internship.
In 1992, the testing came together
and you could take the osteopathic boards
with training in ACGME hospitals,
and that changed a lot.
So the self-regulation that we have
overlaps with the regulation of the ACGME
and state licensing boards.
We’re still in the transition.
At this point in 2018, there’s still 5 states
that require the osteopathic internship
which would no longer exist
as a freestanding osteopathic
internship after 2020.
So there are a lot of changes
going on right now.
We still have a requirement
that to graduate from an osteopathic
you have to pass the NBOME exams.
So you take the osteopathic
exams to get licensed
and then you have the option of choosing
osteopathic boards for specialization
or the ABMS boards.
The NBME still lets you take board
exams out of sequence
and the flex no longer exists.
That was done away with
and merged within the USMLA
which is part of the NBME.
When you get out into practice,
each hospital and each healthcare facility
will have their own way
of credentialing you,
and credentialing is saying you may
be licensed to do something,
but we want to makes sure that for our
institution you understand how we work,
what resources we have, and
what tools we have
to make sure you’re comfortable doing it.
So if you’re going to deliver
a baby in 1 hospital,
you have to know what their
surgical suites are like
and what tools they have,
and that’s credentialing for
within a particular system.
For DO’s, what do you have to do for EMGs,
or if you want to do nerve conduction
velocities how do you get there.
So credentialing is an individual
not a state issue
and not a professional issue.
So the profession can say
you’re able to do it
but then to do it in a facility
that will support you,
you need to be credentialed.
So again, accreditation is the institution,
certification is the individual,
and credentialing is within the place
you’re doing a procedure
or caring for a specific
person a specific way,
you get credentialed.
So again, “WTF,”
they’re going to credential
you to treat the feet.
They may have different requirements if
you want to treat the abdomen.
So if you want to train in an
it’s typically community settings.
It’s typically outpatient and inpatient.
One of the big differences between
LCME and COCA requirements,
LCME has you train mostly
in academic institutions
and very little time allowed outside in
an office or an outpatient setting.
DO’s train more now in patient settings
and they still have to train
in academic institutions,
but because the majority
of care is achieved
in outpatient settings and offices,
that’s where a lot of training has to occur.
So a lot of DO’s will train in
critical access hospitals,
and smaller areas of practice.
We’ll get to the Tenets and the philosophy
underlying it in the next lecture,
but it is important to understand
the structure and function relationship,
the idea of the body’s innate
ability to heal itself,
and how we look at the
in health and illness.
This becomes much more important
in the current environment where people
want to say what they’re getting
and what kind of care they want
because people want health now.
They want to optimize what
they’re able to do
and that’s part of our Tenets in starting
from where the patient is
and starting from what we can do
to optimize their health
and make their functioning easier
and more comfortable.