Osteopathy in the 21st Century

Health and Healthcare CategoryMany people in the United States, and indeed the world, are not aware that there are two types of fully licensed physicians. Allopaths (or M.D.s) have enjoyed being the mainstay of healthcare for hundreds of years along with the luxury of being a 20:1 majority of practicing physicians. Osteopaths (or D.O.s) have been around for about 130 years, and represent one of the fastest growing medical professions according to the American Osteopathic Association. When I was applying to medical school in 2000, there were 19 osteopathic medical schools in the United States. Currently there are 25 schools with 28 campuses, which represents greater than 50% growth in less than 10 years.

HospitalBoth groups of physicians are granted an unlimited license to practice, which means they can prescribe medicine and perform surgery. In fact, M.D.s and D.O.s train side by side in residency programs of all specialties and subspecialties. Of course, the existence of two groups begs the question,

What is the difference between allopaths and osteopaths?

The answer is complicated.

At a fundamental philosophical level, allopathy is a belief in the power of opposites. If the body is diseased in a way that manifests with symptoms, then inducing the opposite of the symptoms is beneficial. As an example, if a patient has a fever and feels hot, then the antidote is to give a medication that lowers the temperature. If the patient’s blood pressure is too high, then the reasonable thing to do is give an antihypertensive to lower that blood pressure. Built into this belief system is an implication that the body is inherently wrong in its response to disease, and external influence is required to return the body back into balance.

In contrast, the philosophy of osteopathy is a belief in the body’s inherent ability to heal itself. Osteopaths believe that structure and function are reciprocally interrelated, meaning that disease is a manifestation of the breakdown of the body’s structure. If the blood supply to the kidney is compromised ever-so slightly because of muscle spasm applying pressure to the artery, then over time this will result in decreased function of the kidney and eventually kidney disease. Therefore, osteopaths strive to identify structural dysfunctions, and help the body overcome them. Once the dysfunction is cleared, osteopathy believes that the body can inherently take care of itself and return to balance. Osteopaths accomplish the task of treating dysfunction by utilizing osteopathic manipulation, which is a group of hands-on techniques to address the musculoskeletal system. In its original state, osteopaths rejected the notion of medication or surgery.

However, through the evolution of medical technology, research, and educational will, osteopaths have come full circle and embraced the entire scope of medical practice. The education and training of current allopathic and osteopathic physicians is almost identical. The main exception is that osteopaths are taught osteopathic manipulation, as well as the philosophy detailed above. In practice, however, less than 5% of osteopathic physicians actually utilize manipulation, making most essentially allopaths with different initials. This interesting JAOA article suggests that regardless of the use of manipulation, osteopathic physicians communicated better with patients than allopathic physicians, although no generalities can be implied from such a small study.

In the end, what is the difference between allopaths and osteopaths? In today’s healthcare culture, the answer is very little. Osteopaths have the ability to utilize manipulation to treat disease in addition to conventional medical practice, but very few do so.


Carey, T.S., Motyka, T.M., Garrett, J.M., Keller, R.B. (2003). Do Osteopathic Physicians Differ in Patient Interaction from Allopathic Physicians? An Empirically Derived Approach. Journal of the American Osteopathic Association, 103(7), 313-318.

Osteopathic Medical Profession Report. (2007) American Osteopathic Association

Sajid Surve, DO

Sajid Surve, DO, is a physiatrist, acupuncturist, and osteopath who specializes in musculoskeletal medicine and integrative medicine.
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