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

  • Dan

    As a Missourian, the first D.O. School was in Kirksville, Missouri, near the Iowa border.

    Great article!

  • Great article. This question is asked so often, and frequently the response is misinformed. I think this explanation does it justice. Wikipedia has a two great articles on this too. Osteopathic medicine in the United States” and Comparison of allopathic and osteopathic medicine.

    Both have tons of great references to articles published on the topic.

    — Touro University Student

  • Anonymous

    great job!

  • Great article.
    One thing I’d like to point out from my experiences with osteopaths, is that they do indeed perform manipulation, but it is not the gross manipulation one associates with work like chiropractic. The D.O.s I have met use much lighter force, working with the body to make necessary changes. While sometimes manipulation is needed, I believe one can accomplish so much more with subtle work that really listens to what the body needs to achieve homeostasis.

    The osteopath I see regularly has training in Cranial Osteopathy (based on the work of William G Sutherland). My D.O. will work from my head for the entire treatment (15-20min) with very, very light force. Yet it is some of the deepest, most relaxing work I receive. (And being a bodyworker, I get a lot of work) His work has effects throughout my entire body from work focused at the cranium.

    I believe his ‘style’ of work is much more in line with Still’s and Sutherland’s principles of listening to and supporting the body’s wisdom for self-correction. I hope the osteopathic community stays true to it’s roots, else who will show people how they can heal themselves?

  • Tom

    Interesting article. As a UK osteopath, we are trained separate from the medical schools. I believe this training allows the focus to be on osteopathic principles and understanding. I can’t get my head around osteopaths training through the medical schools. It’s two completely different models at work.

    True osteopathy is the understanding that you are treating the cause not the symptoms. A problem doesn’t just appear, there is a chain of physiological events prior to the problem (unless it is a trauma). It is the unravelling of these events that a true osteopath is interested in. Supplying medication to “suppress” a symptom is as you mentioned in the article a complete contradiction of this principle.

    Osteopathy is really a preventive medicine; however, our society doesn’t really fit with this. No-one goes for a check up on a regular basis; they wait until there’s a problem and then consult someone. When it gets to this stage then all forms of medicine have their place. Perhaps if more people went to their osteopath for a check up – these problems that require further intervention may never be needed (bold statement I know!). After all we service our cars more regularly than our bodies – what’s more important?

  • SOG

    Interesting ideas… I wonder how the Hollywood media would portray this?

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  • Dr Shahin Pourgol

    June 22nd is the World Osteopathy Day. To celebrate this wonderful day, National University of Medical Sciences (www.numss.com) and National Academy of Osteopathy (www.nationalacademyofosteopathy.com) are offering $1,340,000 in scholarships to 200 students worldwide to study osteopathy.
    NAO offers a diploma program in osteopathy and NUMSS offers 8 degree programs (BSc, MA, MSc, PhD & DO) in osteopathy.
    Our goal is to expand osteopathy to every corner of the world so patients everywhere could have access to this amazing healthcare.
    I would appreciate if you could share the news about these scholarships with friends.
    Thank You.
    Dr Shahin Pourgol
    National University of Medical Sciences

Sajid Surve, DO

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