DO-ing Medicine: Women in Osteopathic Medicine

Katie Ackerman is a fourth year biochemistry major at Grinnell College.  In the fall she will be attending Pacific Northwest University School of Health Sciences to pursue an osteopathic medical degree.  Apart immersing herself in science, Katie does lots of photography, pottery, and running.

From the first woman to practice medicine in the United States to present day, women have struggled to claim their space in the medical profession.  The first women known to have practiced in the United States was Harriot K. Hunt in 1835.  She established a practice and saw patients, but her peers never acknowledged her as a physician because she had no education, even though most individuals practicing medicine at the time had little or no formal education.  Fourteen years later, in 1849, Elizabeth Blackwell became the first woman to graduate with an MD degree from Geneva Medical School in New York.  Her admission, the result of a vote by students who believed it to be a joke, set an important precedent.  Although few women were admitted to co-education schools, between 1850 and 1895, nineteen women’s medical colleges opened. By 1904, only three remained.

A.T. Still and the American School of Osteopathy (ASO), the first osteopathic medical school which opened in 1893, took a starkly different stance.  A.T. Still Firmly believed that women should be admitted on the same level as men and, in the first class, accepted six women in the class of 21 students [1].

First class photo with 22 students present and A.T. Still
The first class of the American School of Osteopathy (1893).

Osteopathic Medicine was founded on the belief that the body has an innate ability to heal itself and that the physician’s role was to manipulate the body in order to help.  While A.T. Still wanted to avoid drugs and traditional humoral theory treatments common of the time, he still wanted to incorporate germ theory and other important medical advancements in this new branch of medicine.  In addition, Still developed a new type of treatment called Osteopathic Manipulative Medicine.  The curriculum of the new school included anatomy, physiology, histology, toxicology, and, of course, manipulation [2].  In addition to admitting women, Still also employed women as professors, especially focusing on obstetrical and gynecological education.  By 1897, ASO had 100 women enrolled (in a class of 500) [3].  In contrast, Johns Hopkins, the first allopathic, co-educational school to regularly accept women, opened in 1893 with the admission of 3 women [4].

Osteopathic medicine quickly gained popularity, and, by 1900, 16 osteopathic schools opened across the country.  The AMA resisted the spread of osteopathic schools and encouraged states to prevent the licensure of DOs.  Despite this, by 1939, 39 states had passed laws licensing DOs [5].  As osteopathic medicine grew, so did women’s interest in osteopathy.  By 1908 35% of DO graduates were women and, by 1923, 50% of DO graduates were women.  Because allopathic medical schools and the AMA prevented or made it incredibly difficult for women to be admitted to medical school, osteopathic medical schools saw a jump in female enrollment.  Women often received a second-rate education in allopathic medical schools as the overarching belief was that women did not possess the grit to complete medical school.  Osteopathic medical schools ensured that women would receive an equal education to their male peers.

Osteopathic medical schools saw a jump in women physicians as a result of the physician drain after World War I, but after the war this changed.  As a new generation of men began enrolling in medical school and the great depression crippled the economy, female enrollment in medical schools (both MD and DO) dropped significantly until World War II, when their numbers began to rise again. Another drop in both MD and DO female graduates was seen in the 50s and 60s as traditional gender roles were prevalent and the GI bill increased male enrollment in medical school.  By 1965 and 1967, for DO and MD schools respectively, their numbers began to slowly increase until their current enrollment [6].

Today, Osteopathic physicians can serve in the military, are licensed to practice everywhere in the United States and in 45 countries  across the world, and receive an identical education to allopathic schools (with the exception of an additional 200 hours of osteopathic manipulation training) [7,8, 9].  There are approximately 100,000 practicing osteopathic physicians in the United States and, of those, 41% are women.  In addition, 47% of DOs under the age of 45 are women, and are the fastest growing population of osteopathic physicians [10].  The number of female medical students hovers around 50% for both MD and DO schools, but the number of practicing female physicians is 34% (counting for both DO and MD) [11].  These data show that women are drawn to osteopathic medicine in a significant way.

Although Osteopathic medicine has seen many changes since its inception, it has continued its dedication to producing socially competent and holistically minded physicians. Much as women saw homeopathy as a profession that listened and attended to patients’ needs, osteopathic medicine has always appealed to women in this same way [12].  In a profession dominated by men, having a physician who patients could identify with, who could actively listen to their patients, and who avoided many of the toxic and unproven treatments of the 19th and early 20th century was valuable to the population of women needing medical attention.  In this way, women were, and are, drawn to the osteopathic profession in two ways.  Osteopathic medical schools have empowered women from the beginning and provided a space for them to practice medicine and become socially and financially independent.  Osteopathic medicine also appeals to women who prefer a physician that listens and considers the entire patient as a part of the diagnosis and treatment and that focuses on the holistic aspect of disease.  Osteopathic physicians understand, and are educated on the idea that, disease does not operate in isolation within the body or within society.

Despite the similar education, differences can be seen in DO students and practicing osteopathic physicians and their MD counterparts.  Some studies have noted a decrease in empathy in allopathic medical students throughout their time in medical school, but Kimmelman et al. (2012) showed there to be no statistical difference between first and fourth year osteopathic medical students in tests of empathy [13].  In addition, osteopathic physicians are more likely to explain causation of disease to patients and discuss social, family, and emotional impacts of disease [14].  These studies show that, regardless of the many changes medicine and the osteopathic profession have seen, the core of osteopathic medicine remains today.  The American Association of Colleges of Osteopathic Medicine defines the modern profession as using technology, prescription drugs, surgery, and manipulation to diagnose and treat injury and illness.  Osteopathic medicine still focuses on a holistic view of the patient and encourages physicians to play a role in health promotion and disease prevention [15].  Over half of DOs specialize in family medicine, internal medicine, or pediatrics, specialties often considered to be more patient focused.  The other physicians specialized in virtually every other specialty with Emergency medicine, anesthesiology, OB/GYN, and general surgery as the leading specialties among this group [16].  Women tend towards pediatrics, internal medicine, family practice, psychiatry, and OB/GYN, another link between these two groups [17].

Osteopathic medicine appeals to women with dreams of being a physician in another way.  Osteopathic medical schools, in much the same way they look at the patient as a whole person, also take a more holistic look at medical school applicants and value factors such as volunteer experience and extracurricular activities in addition to the traditional MCAT and GPA emphasis [18].  For college students, the medical admissions process is long and arduous.  It begins the first year of college when choosing what extracurricular activities to participate in and what classes to take.  Women often participate in more extracurricular activities and have higher volunteer hours than their male counterparts, indicating that their applications may be looked at more favorably by DO admissions committees [19, 20].  There are many factors affecting academic performance for women in college including institutional discrimination and imposter syndrome.  By examining an applicant’s experiences in addition to grade and test metrics rather than sorting solely based on MCAT and GPA scores, DO schools accept students who have spent their undergraduate years benefiting their community and learning about varying experiences.  This transitions into medical student motivations.  In a study interviewing medical students, DO students self-described as more motivated by socioemotional factors where MD student self-described as motivated by technoscientific factors [21].  While both schools of thought produce competent physicians, DOs have an advantage as the medical profession begins to value patient-centric care.

Osteopathic medicine has been a leader in providing women a place in the medical field from the first catalog of the ASO where AT Still stated “women are admitted on the same terms as men.  It is the policy of the school that there shall be no distinction as to sex, and that all shall have the same opportunities” to placing women in positions of power within the osteopathic medical community [22].  Although women and Osteopathic medicine have made great strides over the last 126 years, there are many inequalities that still exist.  On average, female physicians earn 27.7% less a year (equating to an average of $105,000 a year) [23].  Women are less likely to be in leadership positions and often struggle in competitive, male dominated specialties due to discrimination [24].  In 2015 women represented less than 20% of division chiefs, deans, department chairs or hospital CEOs [25].  A Harvard research study showed that female physicians had better outcomes than their male counterparts in geriatric patients yet bias in medical education and training still exist [26].  The number of women in medicine is increasing and many will choose osteopathic medicine, drawn a philosophy of patient care and education that been a corner stone in osteopathic medicine since its foundation, but there is work still to do.  With gender discrimination and some remaining skepticism of osteopathic practices, women and osteopathic medicine will need to continue to fight for their place in the medical field.  As Roberta Wimer-Ford, DO, elected president of the Osteopathic Women’s National Association in 1922, stated “women physicians and Osteopathy were both pioneers – and being a pioneer gave call for every bit of persistence, versatility, originality, adaptability, diplomacy, and pugnacity one might possess, because each, in turn, was needed” [27].

 

 

[1] Thomas A. Quinn, The Feminine Touch: Women in Osteopathic Medicine. (Kirksville, Missouri: Truman State University Press, 2011)

[2] Emil P. Lesho, “An Overview of Osteopathic Medicine” Archives of Family Medicine, vol 8 (1999): 477-484.

[3] Ibid.

[4] “Women – Or the Female Factor” Johns Hopkins Medicine, (2018) https://www.hopkinsmedicine.org/about/history/history6.html

[5] Ibid.

[6] Ibid.

[7] Ibid.

[8] “International Practice Rights for Osteopathic Physicians.” What Is Osteopathic Medicine. Accessed May 14, 2018. https://www.aacom.org/become-a-doctor/HP-advisors/intl-practice-rights.

[9] Jessica Freedman, “Five Questions, Answers about Attending Osteopathic Medical School” US News and World Report (2014).  https://www.usnews.com/education/blogs/medical-school-admissions-doctor/2014/12/16/5-qustions-answers-about-attending-osteopathic-medical-school

[10] “Osteopathic Medical Profession Report: 2017” American Osteopathic Association, (2017). http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2017-omp-report.pdf

[11] “Professionally Active Physicians by Gender” Kaiser Family Foundation, (2017). https://www.kff.org/other/state-indicator/physicians-by-gender/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[12] Erika Janik, “Dilutions of Health: Homeopathy,” chapter 4 in Marketplace of the Marvelous: The Strange Origins of Modern Medicine (Boston: Beacon Press, 2014), 115-146

[13] Kimmelman, Jackie Giacobbe, Justin Faden, Geetha Kumar, Charlyene Pinckney, and Robert Steer, “Empathy in Osteopathic Medical Students: A Cross-Sectional Analysis” Journal of the American Osteopathic Association: Medical Education, Vol 112, no. 6 (2012): 347-355.

[14] Timothy S. Carey, Thomas M. Motyka, Joanne M. Garrett, Robert B. Keller. “Do Osteopathic Physicians Differ in Patient Interaction from Allopathic Physicians? An Empirically Derived Approach” Journal of the American Osteopathic Association, vol 130, no. 7 (2003): 313-318.

[15] “What is Osteopathic Medicine?” American Association of Collages of Osteopathic Medicine, (2014). http://www.aacom.org/become-a-doctor/about-om#aboutom

[16] “Osteopathic Medical Profession Report: 2017” American Osteopathic Association, (2017). http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2017-omp-report.pdf

[17] Ibid.

[18] Rose Raymond, “Different Kind of Brilliance: Med Schools seeking nontraditional candidates”, The DO, July 9, 2015. https://thedo.osteopathic.org/2015/07/medical-schools-seek-more-well-rounded-candidates/

[19] Sang Hyun Kim, “Extracurricular Activities of Medical School Applicants.” Korean Journal of Medical Education 28, no. 2 (2016): 201-07. doi:10.3946/kjme.2016.25.

[20] Libby Sander, “Colleges Confront a Gender Gap in student Engagement”, Chronicle, October 29, 2012. https://www.chronicle.com/article/Men-Like-to-Chill-Women-Are/135290

[21] Cindy Kuzma, “DO vs MD: Similarities, Differences, and Which One is Better”, Tonic, Feburary 7, 2017. https://tonic.vice.com/en_us/article/3dp5gv/is-a-doctor-with-an-md-better-than-one-with-a-do

[22] Ibid. pg 11

[23] Parija Kavilanz, “The gender pay gap for women doctors is big – and getting worse”, CNN Money, March 14, 2018. http://money.cnn.com/2018/03/14/news/economy/gender-pay-gap-doctors/index.html

[24] Bruce Y. Lee, “Three New Studies Suggest Gender and Racial Bias in Medical Training”, Forbes, March 12, 2017. https://www.forbes.com/sites/brucelee/2017/03/12/three-new-studies-suggest-gender-and-racial-bias-in-medical-training/#4dd0c92d1930

[25] Stephanie Cajigal, Gregg Weiss, Nelson Silva, “Women as Physician Leaders”, Medscape, September 17, 2015. https://www.medscape.com/features/slideshow/public/femaleleadershipreport2015

[26] John Henning Schumann, and Sarah-Anne Henning Schumann. “Patients Cared For By Female Doctors Fare Better Than Those Treated By Men.” NPR. December 19, 2016. Accessed May 14, 2018. https://www.npr.org/sections/health-shots/2016/12/19/506144346/patients-cared-for-by-female-doctors-fare-better-than-those-treated-by-men.

[27] Ibid.

 

Further Reading

On women in medicine:

More, Ellen S. Restoring the Balance: Women Physicians and the Profession of Medicine, 1850-1995. Cambridge: Harvard University Press, 1999.

On the history of women in osteopathic medicine

Walter, Georgia Warner. Women and Osteopathic Medicine: Historical Perspectives. Kirksville, MO: National Center of Osteopathic History, A.T. Still Memorial Library, Kirksville College of Osteopathic Medicine, 1994.

The Feminine Touch. By Thomas A. Quinn. United States: PBS, 2017. https://www.wedu.org/thefemininetouch/.