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Comments on “Commentary on the globalization of osteopathic medicine”
Dear Dr. Shubrook:
I would like to offer a few comments that I believe are needed to correct errors in “Commentary on the globaliza- tion of osteopathic medicine” (Qureshi and Kusienski) in the May/June 2010 issue of Osteopathic Family Physi- cian. The topic of international outreach is an important one to the membership of the American Osteopathic Association (AOA) and the American College of Osteopathic Family Physicians, and it is encouraging to see an increasing inter- est in practicing outside of the United States, particularly in younger physicians. I would like to congratulate the authors on extending this interest to the readership of this journal.
However, in my mind, it is critical to emphasize that as of this writing (June 1, 2010), the World Health Organiza- tion (WHO) does not have a definition of “osteopathic physician” or “osteopath” as asserted in paragraph three under “History of the British model.” The WHO has not adopted the World Osteopathic Health Organization (WOHO) definitions. It is correct that the WHO has con- sidered this topic and has issued draft guidelines for feed- back, and the version I saw stated quite clearly that they were to be distributed to a limited audience for review only. Nonetheless, the Osteopathic International Alliance and WOHO are well within their rights to adopt the same or very similar language as their own definitions, but it is clearly not a WHO definition at this time.
Paragraph five in the same section states that in Canada, as in the United Kingdom and other countries, “there are registration bodies to which osteopaths must apply . . . In these countries, registered osteopaths must practice under a national registration act, etc.” This is not at all the case in Canada. In Canada, as in the United States, there is no national medical register and each province is free to set its standards for physician registration, including osteopathic physicians. In at least the provinces of British Columbia, Alberta, and Ontario, legislation specifically precludes any- one not registered with the respective “College of Physi- cians and Surgeons” of that province from referring to themselves as an “osteopath.” I suspect that the authors intended this comment to refer to “osteopaths” as defined by the WOHO and not osteopathic physicians; however, in Canada as in the United States, the terms are historically, and in legislation, used interchangeably. In any event, there is no “national registration act” in Canada that would apply to either category.
There is another important error in paragraph four of the next section, “Evolving practice rights for US-trained DOs worldwide.” With respect to Canada, it is correctly noted that practice rights vary by province. However, it is stated that “In Quebec and Ontario, universities typically offer the degree of Doctor of Osteopathy in Manual Practice (DOMP), but even that varies some.” This would leave the reader with the impression that there is University-awarded osteopathic designation of some type available in Canada at present. I can assure your readers that this is not the case. Any such programs currently available in Canada are of- fered by nonaccredited institutions that do not meet the Canadian standards of a College of University and do not issue a “degree” as such. Their graduates do not qualify for any governmentally recognized registry that we are aware of, including osteopathic registries in the United Kingdom, Australia, or elsewhere. Unfortunately, their practice of issuing certificates of course participation in “osteopathy” does lead to a great degree of confusion, as evidenced form the statements of your authors.
There is a minor error in the related Table 4 with respect to Canada, in which it is stated the practice “. . . varies from unlimited rights to strictly OMM to no rights.” I am not aware of any province that has a registration pathway for osteopathic physicians that would limit us to OMM only. The correct summary would be “from unlimited practice rights in eight provinces to no rights in two provinces.” I am pleased to report that our expectation is that within a year or so, there should be only one province left in Canada that does not yet recognize osteopathic physicians— our small- est province of Prince Edward Island. I am also pleased to report that as of this writing, the COMLEX examination is the standard recognized for osteopathic physician registra- tion in five of our 10 provinces, and that there are an increasing number of American-trained DOs doing their postgraduate residency training in Canada.
As noted in this article, the AOA website does maintain information about osteopathic medical practice in Canada through the international summary on the DO-online web- site. Current information with respect to Canada is also available at www.osteopathic.ca.
Sincerely,
Ted Findlay, DO
President, Canadian Osteopathic Association Former Board Member, Osteopathic International Alliance