Not long after A.T. Still opened the first college of osteopathy, the first US states began to legally license Doctors of Osteopathy (D.O.’s). This meant that graduates of osteopathic colleges were allowed to legally practice medicine in the states which granted them licences. In 1910 the American Medical Association launched a country-wide inspection of all medical training centers. Their goal was to limit funding to only those institutions which fulfilled a specific set of pedagogic criteria. In order to guarantee their economic survival, almost all of the osteopathic colleges at the time changed their curricula to conform to the AMA standards, which were based on traditional medical training, and included training in pharmaceuticals, surgery and obstetrics. By 1930, the American osteopathic profession had adopted a model of education that incorporated all diagnostic and therapeutic practices of conventional medicine, but maintained an approach to health modeled on Still’s philosophy. This is still the case today in the USA: American D.O.’s are fully licensed medical physicians and only those with D.O. licenses are allowed to call themselves osteopaths. There are currently 25 osteopathic colleges in the USA and over 70,000 American-trained D.O.’s practising in the USA and abroad.
The osteopathic profession progressed differently in other parts of the world. Osteopaths in England, France and other countries did not succeed in their efforts to have D.O.’s recognized as medical doctors. While the titles of “D.O.” and “osteopath” were adopted by the European practitioners, their training and scope of practice were quite different than those of their American counterparts. Osteopaths educated outside of the U.S. received training in osteopathic theory and philosophy, but their practical skills were limited to osteopathic manipulation and they were not legally licensed to perform mainstream medical acts, such as prescribing medicine, giving injections or performing surgeries. When the osteopathic profession eventually began to spread across the world, it was modelled mainly on the European profession rather than the American one.
Today, two kinds of osteopaths coexist: the non-physician manual therapists and the full scope of practice osteopathic physicians. The practice of a non-physician osteopath is generally focused exclusively on manual therapy (manipulation), while osteopathic physicians apply all medical practices, in addition to manipulation. The US is the only country that offers a full-scope of practice osteopathic medical education, however in other parts of the world, physicians with a conventional medical training may take additional courses to become osteopathic physicians. In some countries, such as the United Kingdom, France, Australia and New Zealand, both kinds of osteopaths have legal recognition. Governments in these countries have created legal standards of osteopathic education and scope of practice which recognize both kinds of practitioners. In many other countries osteopaths have achieved some form of legal recognition, such as protecting the title of “osteopath” or “osteopathic manual practitioner,” and some countries such as Canada and Spain are currently in the process of negotiating with their governments to have osteopathy legally licensed as a profession. In many other countries, there are no recognized standards of osteopathic education or practice.
At the present moment, practitioners around the world who call themselves “osteopaths” have a wide variety of backgrounds and trainings, ranging from a short course in manipulative techniques to a complete medical education. In 2010, the World Health Organization (WHO) released a document titled Benchmarks for Training in Osteopathy, the result of the efforts of a panel of esteemed osteopaths from all over the world to establish international standards for osteopathic training programs. Other organizations, such as the World Osteopathic Health Organization and the Osteopathic International Alliance, have tried to bring together osteopaths from all corners of the globe and establish global standards of practice and education.
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