Osteopathic medicine in the United States

Osteopathic medicine is a branch of the medical profession in the United States. Osteopathic physicians (D.O.) are licensed to practice medicine and surgery in all 50 states and are recognized in fifty-five other countries, including all Canadian provinces.

Frontier physician Andrew Taylor Still founded the profession as a radical rejection of the prevailing system of medical thought of the 19th century. Still’s techniques relied heavily on the manipulation of joints and bones to diagnose and treat illness, and he called his practices “osteopathy“. By the middle of the 20th century, the profession had moved closer to mainstream medicine, adopting modern public health and biomedical principles. American “osteopaths” became “osteopathic physicians”, gradually achieving full practice rights as medical doctors in all 50 states, including serving in the U.S. armed forces as physicians.

In the 21st century, the training of osteopathic physicians in the United States is very similar to that of their M.D. counterparts.[2] Osteopathic physicians attend four years of medical school followed by at least three years of residency. They use all conventional methods of diagnosis and treatment. Though still trained in Osteopathic Manipulative Medicine (OMM),[3] the modern derivative of Still’s techniques,[4][5] a minority of osteopathic physicians use it in actual practice.[6][7]

Osteopathic medicine is considered by some in the United States to be both a profession and a social movement,[8][9] especially for its historically greater emphasis on primary care and holistic health. However, any distinction between the M.D. and the D.O. professions has eroded steadily; diminishing numbers of D.O. graduates enter primary care fields,[10] fewer use OMM, holistic patient care models are increasingly taught at M.D. schools, and increasing numbers of osteopathic graduates choose to train in non-osteopathic residency programs.[11][12][13]

Discussions about the future of osteopathic medicine frequently debate the utility of maintaining a separate, distinct pathway for educating physicians in the United States.[13][14] Studies have repeatedly shown that many recent osteopathic medical graduates are either uninterested in or reluctant to embrace an identity distinct from their M.D. counterparts.[15] There has been a rapid expansion in the number and size of schools and some have raised questions as to the quality of education at certain newer private osteopathic medical schools. [11][12] A contentious topic has been for-profit medical education, which osteopathic accreditors permit.[16]


From its inception, the D.O. profession has been smaller than the older M.D. profession.[23] Currently, there are 29 accredited osteopathic medical schools offering education in 37 locations[24] across the United States and 138 accredited U.S. M.D. medical schools.[25]

Upon graduation, most osteopathic medical physician pursue residency training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating internship at a hospital approved by the American Osteopathic Association (AOA).


The Healthcare Facilities Accreditation Program (HFAP), is a not-for-profit organization dedicated to helping healthcare organizations maintain the highest standards in patient care and comply with ever-changing government regulations and a constantly evolving healthcare environment.[1] Headquartered in Chicago, HFAP is a nationally recognized accreditation organization with deeming authority from Centers for Medicare and Medicaid Services (CMS).[1] HFAP provides accreditation programs for hospitals, clinical laboratories, ambulatory surgical centers / office based surgery (OBS), and critical access hospitals. In addition, HFAP accredits mental health and physical rehabilitation facilities and provides certification for primary stroke centers.[2] HFAP is a program of the American Osteopathic Association,[3] a medical organization representing osteopathic physicians (D.O.).

HFAP was conceived in 1943 and began surveying hospitals in 1945. Initially HFAP provided osteopathic hospitals with an opportunity to be accredited and to ensure that osteopathic residents received training in facilities providing high quality patient care. In the mid-1960s, the United States Congress decided that accredited hospitals would be deemed to meet the conditions of participation and thus could automatically participate in the newly established Medicare and Medicaid programs. HFAP quickly applied for and was granted deeming status.[4]


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