The DOs: Osteopathic Medicine in America

CHAPTER 4 STRUCTURE & FUNCTION

STRUCTURE & FUNCTION W ith the movement rapidly growing, many DOs thought it desirable to coordinate their efforts and activities. In February of 1897, a small group of American School of Osteopathy alumni met in Kirksville and decided to establish a national organization for this purpose. Graduates of other schools were then invited to take part in the planning, and by April they had collectively launched the American Association for the Advancement of Osteopathy, which was renamed and restructured as the American Osteopathic Association (AOA) four years later.1 The officers of the AOA under its 1901 constitution included a president , two vice-presidents, a secretary, and a treasurer, all chosen for a twelve-month period of service, and a board of trustees whose members were appointed for staggered three-year terms. Members of the board were charged with responsibility for the day-to-day affairs of the association , while the general membership—in reality only those opting to attend the annual convention—elected all officers, including the board, and decided questions of policy.2 As the number of AOA members rose, this last feature of the system proved unwieldy, prompting those participating in the 1909 convention to enlarge the board from eleven to seventeen members and invest it with virtually complete control over policy issues.3 In 1919 a dual form of central government was restored when the House of Delegates was created based on the proportional number of members within each state. These representatives, who were chosen by their respective divisional societies, thereafter selected all other national office holders and acted as the business body of the association during its annual week-long meetings.4 From its inception, the AOA actively worked to secure the conditions 4 STRUCTURE & FUNCTION 55 necessary for the movement to obtain professional recognition. To protect autonomy, it fought for independent boards of registration and examination . Academically, it both significantly lengthened the standard course of undergraduate training and supported ongoing research projects . To improve members’ socioeconomic status, the association championed a code of ethics while combating the proliferation of impostors and imitators. THE INDEPENDENT BOARD At the turn of the century a majority of states were without a specific law governing osteopathy, and in several of the states with such an act, the legal position of the DO was hardly improved as a consequence. Early lobbying campaigns had usually been conducted by individuals speaking for only one segment of the emerging movement, leading to situations such as that in Vermont, which had extended practice rights only to graduates of the American School.5 In other states diverse osteopathic factions had appeared before the legislatures with varying recommendations. This lack of unanimity often resulted in a poorly constructed compromise or no law at all. Several of the early practice acts placed the regulation of osteopathy under the jurisdiction of existing state medical boards. In some states a DO was added to these agencies; in others no representation was granted. Although osteopaths would be examined alongside MDs, taking the same written tests in such subjects as anatomy, physiology, and chemistry, they were exempted from answering questions concerning materia medica or therapeutics. In a few states this arrangement seemed to work out satisfactorily for the DOs, as they found they could do nearly as well as the allopaths in passing examinations and becoming licensed. However, before other similarly constituted boards DOs did not have comparable success, and in certain instances MD officials prevented any comparison between the two groups whatsoever. In Iowa, for example, the legislature granted the medical board the power of accrediting osteopathic schools, with only graduates from approved institutions becoming eligible for licensure. After a cursory look at their catalogs, the board rejected all osteopathic colleges , thereby preventing any DO from legitimately practicing in the state and thus circumventing the intent of the lawmakers.6 In 1901 the AOA created a permanent committee to insure the passage of favorable laws. Toward this end, the Committee on Legislation devised a standard model bill for every state, whose chief feature was the estab- lishment of independent boards of osteopathic examination and registration . In this plan each divisional association would nominate a long list of candidates from which the governor of the state would choose five to seven as members. These individuals, once they had been appointed, would be responsible for testing DO candidates, negotiating reciprocity agreements with other boards, and disciplining errant practitioners.7 With...