By Dr. Mercola
While many people are now aware that there are well-trained health care practitioners specializing in complementary medicine, many are still unaware that there are two kinds of allopathic physicians to choose from as well.
Medical doctors, MDs, and doctors of osteopathy, known as DOs, have similar training requiring four years of study in the basic and clinical sciences, and the successful completion of licensing exams.
As you may know, I'm an osteopathic physician (DO), and DOs, just like MDs, are licensed to prescribe medication, deliver babies, and perform surgery in all 50 states in the US. DOs have the identical license to practice the full range of medicine and surgery as MDs; there is absolutely no difference in their state license.
I'm also board-certified in family medicine, and served as the chairman of the family medicine department at St. Alexius Medical Center for five years. In October 2012, I was awarded fellowship status by the American College of Nutrition (FACN).
There are some intrinsic differences between MDs and DOs, however. DOs have frequently been viewed as "less than" a "real" doctor1—a view that is simply not true when you consider their training.
Are Osteopaths Real Physicians?
One of the primary distinctions that separates DOs from MDs is the fact that osteopathic physicians are typically trained in an approach that treats the person as a whole, rather than just treating individual symptoms.
In essence, DOs practice "whole person" medicine, and help patients develop attitudes and lifestyles that not only address their current illness, but help prevent it. In addition to the four year conventional medical curriculum, DOs receive in-depth training in manipulating the musculoskeletal system, which includes nerves, muscles, and bones.
This training in osteopathic manipulative medicine (OMM) equips DOs with a comprehensive understanding of how illness or injury in one part of your body can influence and affect other parts. DOs are trained to view the human body as an interconnected system.
OMM involves using your hands to diagnose and/or treat. Contrary to most conventional MDs who rarely touch their patients anymore, DOs will palpate and perform physical manipulation. The featured article in the New York Times2 provides an example of this:
"Growing up on Long Island, [Gabrielle Rozenberg] suffered from chronic ear infections. Her doctor recommended surgery. But before committing to an invasive procedure, her parents took her to a DO — a physician whose skills are comparable to those of an MD.
In several visits, he performed some twists and turns of her neck and head, and within days the infection cleared up. 'The infection happened because of fluid in the ear,' she explained, 'and the manipulations opened up the ear canal.'
The infection didn't come back... Many are drawn to the field for this more personal, hands-on approach and its emphasis on community medicine and preventive care."
All DOs Are Not Focused or Trained in Natural Medicine...
I opted for a DO instead of getting an MD because I was attracted to its natural philosophical orientation and its focus on prevention. However, as beautifully described in a classic article by Dr. Joel D. Howell, MD, Ph.D, in reality there's actually little difference between the two degrees.
Patients frequently believe that ALL osteopaths practice natural medicine exclusively. Regrettably, this is not the case. In fact, most fall into the drug and surgical solution trap. Early in my career, I too prescribed drugs as a first line of treatment, before I became more fully aware of the risks, and the viability of natural alternatives.
If you're looking for a physician of natural medicine, you're best off contacting the American College for Advancement in Medicine3 (ACAM) for a referral, as most ACAM physicians are at least oriented towards natural medicine and more open to those alternatives.
I do, however, believe that the selection process for osteopathic schools is oriented toward identifying variables besides grades and test scores, which tend to produce more empathic and holistically inclined physicians. This is a factor that is often overlooked in conventional medicine, and can have a great impact on a patient's outcome.
Osteopathic Schools Becoming Increasingly Popular
After four years of academic study, DOs serve a one-year internship, gaining hands-on experience in family medicine, internal medicine, obstetrics-gynecology, pediatrics, and surgery.
As a result of this experience, the majority of DOs tend to become primary care physicians—about twice as many DOs as MDs choose this path—and many end up practicing in small towns and rural areas, where they often care for entire families and communities.
DOs who want to go into a particular specialty will complete an additional residency program in their chosen area, which typically requires two to six years of additional training. I completed a two-year family practice residency (three counting internship) to complete my osteopathic training.
DOs focus on being a doctor first and specialist second is becoming increasingly valuable, as shortages of doctors are predicted to worsen in the near future. By 2020, workforce experts predict a shortage of more than 45,000 primary care physicians in the US.
As noted in a recent New York Times4 article, 22 percent of all new medical school graduates come out of osteopathic schools, which is more than double the percentage when I graduated over 30 years ago. Between 1983 and 2000 alone, 16 new schools of osteopathy were opened. As reported in the featured article:5
"The boom in osteopathy is striking. In 1980, there were just 14 schools across the country and 4,940 students. Now there are 30 schools, including state universities in New Jersey, Ohio, Oklahoma, Texas, West Virginia and Michigan, offering instruction at 40 different locations to more than 23,000 students...
Whatever the reasons for choosing a DO over an MD, osteopathic medicine has, for decades now and increasingly so, been accepted as authoritative training by the medical establishment, including the residency programs that lead to licensure."
Where Did Osteopathy Come From?
The first osteopath was Andrew Taylor Still, a rural Kansas physician, back in 1864. After the best medicines available at the time failed to help his three children, all of whom died from spinal meningitis, he set out to devise an alternative modality of healing. This new line of thinking was based on the idea that health and healing can be achieved by improving blood flow through manipulation of the spine and neck.
Dr. Still founded the first school of osteopathy in 1892. Three years later, Daniel David Palmer established chiropractic, which is yet another treatment modality based on spinal manipulation. Despite having been around for well over a century, many Americans are still completely unaware that DOs even exist. According to a survey by the American Osteopathic Association:6
- 29 percent of Americans do not know that DOs are licensed to practice medicine
- 33 percent do not know DOs can prescribe drugs
- 63 percent were unaware that osteopaths can perform surgery
Originally, osteopathy was created as a very radical alternative to a failing medical system. Since then, the DOs path has inched ever closer to that of the MD, and as I stated earlier, some DOs practice mainly allopathic medicine, focused primarily on pharmacological principles. As noted by Dr. Joel D. Howell in his 1999 article in the New England Journal of Medicine:
"A 1995 survey of 1055 osteopathic family physicians found that they used manual therapy only occasionally; only 6.2 percent used osteopathic manipulation for more than half of their patients, and almost a third used it for fewer than 5 percent. The more recent their graduation from medical school, the less likely practitioners were to use osteopathic manipulation, a finding consistent with the view that osteopathic practice is moving closer to allopathic practice."
New Residency System Will Further Lessen Distinction Between MD and DO
The distinction between MD and DO accreditation is about to become even more insignificant. In February of this year, the accrediting agencies for MDs and DOs agreed to combine the two into a singular residency and fellowship system. This means that, starting in 2015, DO residency standards will be the same as those for MDs. DOs will be accredited by the Accreditation Council of Graduate Medical Education, which will have osteopathic representatives on its board and in its review committees. This change is aimed at providing a more uniform learning path, thereby lessening the distinction between MDs and DOs, which will help mitigate the looming shortage of primary care physicians.
As noted in the featured article:
"Dr. Atul Grover, the association's chief public policy officer, credits the osteopathic boom to the need for additional sources of medical training... Dr. Grover speculates that the new residency system could also lead to one accreditation for MD and DO schools. At the least, the new synergy lends an imprimatur to the osteopathic schools, which by and large lack marquee status. 'It will allow graduates from two similar but different education systems to work side by side,' said Dr. John E. Prescott, chief academic officer of the MD association. 'It's a true step forward.'"
Redistribution of Federal Funds for Physician Training
Historically, government subsidies for the training of physicians have disproportionally benefited teaching hospitals in the northeast United States. A recent report for the Institute of Medicine (IOM), titled "Graduate Medical Education That Meets the Nation's Health Needs,"7 calls for redistribution of these funds, amounting to about $15 billion annually. As noted by NPR:8
"The report also called for an end to providing the money directly to the teaching hospitals and to dramatically alter the way the funds are paid. The money in question is for graduate medical education — the training of medical school graduates that's required before these interns and residents can be licensed to practice in any state."
About two-thirds of these government funds come from Medicare, and the IOM report now suggests shifting large portions of this money away from major teaching hospitals toward smaller community-based training clinics—some of which do not treat Medicare patients. This has raised quite a bit of opposition, especially from the American Medical Association (AMA) and the Association of American Medical Colleges9 (AAMC). In a recent press release, the AAMC states:
"By proposing as much as a 35 percent reduction in payments to teaching hospitals, the IOM's recommendations will slash funding for vital care and services available almost exclusively at teaching hospitals, including Level 1 trauma centers, pediatric intensive care units, burn centers, and access to clinical trials... While the current system can and is being improved to train more doctors in non- hospital settings, these immediate cuts will destabilize a system that has produced high-quality doctors and other health professionals for more than 50 years and is widely regarded as the best in the world."
In response, Edward Salsberg, a former top official at the Bureau of Health Workforce at the Department of Health and Human Services has noted that:10 "The current system is unsustainable. Health care is moving to the community, but our system of financing graduate medical education is tied to inpatient care." Osteopathic physicians will undoubtedly play an important part in shifting the system into a more community-based and family oriented type of medicine that places greater weight on health education and prevention—provided osteopathy doesn't completely lose its holistic-based orientation in the process of becoming more integrated with allopathic medicine...
Be Part of the Change by Taking Control of Your Health
Whether the proposed changes will result in more and better doctors and improved public health remains to be seen. As always, I urge you to take an active role in your health—no matter what kind of physician you're working with. After all, you're the one who must live with the outcome of any chosen treatment, for better or worse.
If there is one thing I want everyone to understand, it would be that you have FAR greater control over your health than you think. Leading a common-sense, healthy lifestyle is your best bet to achieve a healthy body and mind. And if you struggle with a health problem, there are almost always simple strategies that can be enormously beneficial and helpful, if not outright curative. While conventional medical science may vacillate in its recommendations, you can take control of your health with the following approaches:
1. Make healthy food choices: For a comprehensive guide on which foods to eat and which to avoid, see my nutrition plan. Generally speaking, you should be looking to focus your diet on whole, ideally organic, unprocessed foods. Avoid sugar, and fructose in particular. All forms of sugar have toxic effects when consumed in excess, and drive multiple disease processes in your body, not the least of which is insulin resistance, a major cause of chronic disease and accelerated aging.
I believe the two primary keys for successful weight management are severely restricting carbohydrates (sugars, fructose, and grains) in your diet, and increasing healthy fat consumption. This will optimize insulin and leptin levels, which is key for maintaining a healthy weight and optimal health.
2. Exercise effectively and efficiently. High-intensity interval-type training is particularly beneficial for optimal health, as it boosts human growth hormone (HGH) production.
3. Address your stress: You cannot be optimally healthy if you avoid addressing the emotional component of your health and longevity, as your emotional state plays a role in nearly every physical disease -- from heart disease and depression, to arthritis and cancer. Meditation, prayer, social support and exercise are all viable options that can help you maintain emotional and mental equilibrium. I also strongly believe in using simple tools such as the Emotional Freedom Technique (EFT) to address deeper, oftentimes hidden, emotional problems.
4. Drink plenty of clean water.
5. Maintain a healthy gut: About 80 percent of your immune system resides in your gut, and research is stacking up showing that probiotics—beneficial bacteria —affect your health in a myriad of ways; it can even influence your ability to lose weight. A healthy diet is the ideal way to maintain a healthy gut, and regularly consuming traditionally fermented foods is the easiest, most cost effective way to ensure optimal gut flora.
6. Optimize your vitamin D levels: Research has shown that increasing your vitamin D levels can reduce your risk of death from ALL causes.
7. Avoid as many chemicals, toxins, and pollutants as possible: This includes tossing out your toxic household cleaners, soaps, personal hygiene products, air fresheners, bug sprays, lawn pesticides, and insecticides, just to name a few, and replacing them with non-toxic alternatives.
8. Get plenty of high-quality sleep: Regularly catching only a few hours of sleep can hinder metabolism and hormone production in a way that is similar to the effects of aging and the early stages of diabetes. Chronic sleep loss may speed the onset or increase the severity of age-related conditions such as type 2 diabetes, high blood pressure, obesity, and memory loss.