Somatic, semantic distinctions: DOs try to come to terms with manual therapists
The third installment in The DO’s scope-of-practice series, this article focuses on the osteopathic medical profession’s relationships with nonphysicians who perform manual therapy and MDs who practice manual medicine. The first article in the series examined the increasing scope of practice of naturopathic doctors, while the second article concentrated on nurse practitioners.
A licensed acupuncturist and physical therapist in New York boasts of having expertise in “osteopathic physical therapy” and “advanced, post-graduate training” from the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing.
Another PT, licensed in Pennsylvania, touts herself as an “osteopathic physical therapist” (PDF) on her online résumé and claims to have a “certificate in osteopathy” from the Osteopathic College of Ontario (Canada) and the Osteopathic Health and Wellness Institute in Wilmington, Del.
Two licensed massage therapists in Oregon promote “osteopathic manual therapy” on their website and vaunt having studied a range of “osteopathic techniques” under U.S.-trained DOs.
“By what right do these individuals use the term osteopathic?” asks Virginia M. Johnson, DO, the president of the Los Angeles County Osteopathic Medical Association.
Such examples call into question why members of the osteopathic medical profession would instruct non-DOs in the techniques of osteopathic manipulative medicine. “Why do some legitimate DOs believe they can teach our techniques outside the context of a full medical educational background and full ethical and legal responsibility in patient care?” probes Dr. Johnson, who practices neuromusculoskeletal medicine in Santa Monica, Calif.
Like Dr. Johnson, a number of osteopathic physicians decry the hands-on instruction of manual therapists in osteopathic principles and practice as a hazard both to patients and the profession. But some DOs contend that teaching others OPP increases acceptance of osteopathic medicine and improves public health.
Impinging on osteopathic physicians’ sense of professional identity, the debate over teaching OPP to non-DOs raises questions about the distinctiveness of osteopathic manipulative treatment. The issue is further complicated by the profession’s growing collaboration with other health professionals—foreign-trained osteopaths abroad and MDs, chiropractors and physical therapists in the United States.
Whom can DOs teach?
Osteopathic physicians who practice OMM typically regard non-DO practitioners of manual therapy as having entirely different training requirements, perspectives and patient outcomes, yet many DOs and osteopathic medical organizations teach manual therapy techniques and osteopathic philosophy to non-DOs. Though controversial, this is within the ethical guidelines of both the AOA and the American Academy of Osteopathy (AAO) as long as those being trained are learning techniques consistent with their scope of practice, says AAO President Richard A. Feely, DO.
Approved by the AOA House of Delegates in 2002, the AOA and the AAO’s joint position paper on teaching manual therapy encourages the free dissemination of osteopathic philosophy to other health professionals so that they can better coordinate care with and make referrals to DOs. (In July 2010, the House referred back to the submitter a resolution to reassess this position paper.)
But Michael P. Burruano, DO, for one, would like his profession to halt what he believes is the wholesale training of nonphysicians in OMT techniques—even though the term osteopathic manipulative treatment is reserved for U.S.-trained DOs. “As a profession, we have been shooting ourselves in the foot,” insists Dr. Burruano, who practices neuromusculoskeletal medicine in Brewster, N.Y.
Dr. Johnson calls attention to U.S. citizens who are studying nonmedical osteopathy—as opposed to osteopathic medicine—in Canada and other foreign countries and returning to the United States to practice essentially as unlicensed osteopaths, though some of these practitioners may be licensed physical therapists or massage therapists operating outside of their scope of practice. “Some of my patients come to me with untreated, progressing medical conditions—not to mention injuries sustained—after paying out of pocket to see such ‘osteopaths,’ unaware of the differences between these practitioners and DOs. The confusion and the danger to the public are the real issues.”
Dr. Johnson points out that some U.S.-trained osteopathic physicians are exacerbating this problem by teaching in Canadian and other international osteopathy schools that don’t meet the high standards for nonmedical osteopathy advanced by the Osteopathic International Alliance. Some foreign osteopathy schools provide training that is “minimal and incomplete if not outright unscientific,” she says.
Especially worrisome to both Dr. Johnson, the treasurer of The Cranial Academy, and Dr. Burruano, a former president of the Sutherland Cranial Teaching Foundation, has been the proliferation of craniosacral therapists in the United States. Trained by The Upledger Institute in Palm Beach Gardens, Fla., which John E. Upledger, DO, founded in 1985, these individuals include chiropractors, physical therapists, massage therapists and other nonphysicians. Cranial techniques, which require years of training and practice to perform well, can cause serious harm to patients when misapplied by practitioners who have limited experience and perspective, assert Drs. Burruano and Johnson.
But those who train manual therapists in OPP often feel a closer kinship with non-DOs who are enthusiastic about osteopathic philosophy and techniques than with DOs who don’t appreciate OMT, let alone provide it, notes Todd A. Bezilla, DO, an OMM specialist in Wilmington. “The osteopathic medical profession has strayed too far from A.T. Still’s vision,” says Dr. Bezilla, the director of education and curriculum development for the Canadian Academy of Osteopathy and Holistic Health Sciences, a school in Hamilton, Ontario. “Like Dr. Still, I see osteopathy as a powerful tool that diminishes the need for medical interventions, such as medications and surgery, while most DOs nowadays practice like they are MDs.”