The Merger
Sibylle Reinsch, Ph.D., Michael Seffinger, D.O., and Jerome Tobis, M.D.
http://www.lib.uci.edu/themerger
The Merger: M.D.s and D.O.s in California
If you are interested in the recent history of the medical professions, this book is for you. If personal narratives of historical events speak to you as a second layer of documentation, this book is for you. If you are aware that in America there exist two separate yet equal, fully licensed physicians, M.D.s and D.O.s, you might be interested in learning about their unique relationship in California. If you know little about D.O.s, this book will give you a picture of their approach to patient care and to their M.D. colleagues.
The osteopathic profession in California has a unique history, as it differs dramatically from the profession’s history in the rest of the nation. More than 100 years ago, a small pioneering group of osteopathic physicians established in Southern California the Pacific School of Osteopathy to graduate physicians and surgeons with the ability to acquire an unlimited license. Since then, the educational, research, and regulatory arenas of osteopathy have seen in California low points of near elimination and high points of recognition.
Cultures are based on firm beliefs in the truth of their understanding of the world. Often they collide with those who respect different truths. Similarly, the medical culture in California went through collisions between osteopathic and allopathic medicine, often in response to competition and antagonism. Which values and beliefs about each other’s profession were held so fervently in California that prompted the unique event of absorbing the osteopathic profession into allopathic mainstream medicine?
This project explores the events, unique to California but with repercussions nation-wide, of a merger between osteopathic and allopathic medicine. In 1962, the relatively small medical organization of fully licensed osteopathic physicians (the California Osteopathic Organization) merged with the much larger mainstream medical profession (the California Medical Association). What were the incentives for a fully licensed parallel healthcare profession to forfeit its identity and philosophy? What key players and leaders emerged? How did the individual practicing physician think and feel about the merger?
While about two thousand osteopathic physicians changed to the M.D. degree, about two hundred California D.O.s did not merge but persevered in their battle to restore the licensing power of their profession in California. What social and personal motivational sources sustained this group for over a decade? How has osteopathy’s unique history affected medical education and professional relations, nation-wide and internationally?
Answers to these questions have emerged in historical narratives by key persons figuring in the events. Most of them have not written about their lives and their social and political surroundings at the time of the merger and its repercussions. Many never learned the long-term outcomes of their endeavors. Our multidisciplinary research team transcribed in-depth interviews to capture the thoughts and feelings among individuals who played significant roles from the 1940s to the ‘70s. With the approval of the Institutional Review Board of the University of California, Irvine for the protection of the participants’ rights, we asked a diverse group, 35 in all, of physicians, administrators, lawyers and lobbyists, to provide their historical narratives and their suggestions for future directions.
Our objective has been to give an unbiased account, listening equally to representatives of allopathy, osteopathy, and politics. Inspired by Dr. Gevitz’ cogent academic analysis of osteopathic medicine in America, this book presents personal perceptions of events, integrated with documented descriptions, stored in archives, to facilitate the reader’s understanding and analysis. The work has been based on the assumption that it is necessary to get inside historical events by capturing the thoughts and feelings of key persons in the context of their time and situation.
Many allopathic and osteopathic physicians contributed to California’s pursuit of a constructive relationship between M.D.s and D.O.s. Yet, their contributions have hardly been acknowledged, nor can this book do justice to their work. We tried to convey what we have learned.
Most participants were involved in creating the history that now provides the foundation for our current and future practice of medicine in California. Our narrators belonged to the responsible parties of California’s recent medical history; without them, the world would be different, and medical relationships in California would be different. They were the movers and shakers of their time. They seized opportunities in a particular place at a particular time, and the world moved through them and because of them, like a vortex of time. They made their imprint on the nature of the two professions in this state. They are not the only ones, but they are those that have been pointed out by others as having made a difference.
Every discussion about politics and medicine at nationwide professional meetings on manual medicine seems to turn to the “merger” in California. People use it for every argument, be it as a warning sign for losing one’s professional allegiance and identity, or be it as a sign of respect and acceptance of each other’s medical tradition.
Often, inaccurate accounts are given, though, that might hinder constructive relations between the professions. A detailed personal description is missing of the social and political climate in California in the 1900s that can facilitate a broader understanding of the complexity of the D.O. – M.D. relationship. How could the merger be shrouded in mystery only 40 years later?
Motives to merge differed among the various forces. Maybe there were disappointments about unexpected outcomes or unfulfilled promises. Maybe time moved on with little opportunity to learn from the professions’ cultural heritage. But people still live who witnessed the merger era and often played key roles in the events. Their medical practice has been shaped by the events, whether they integrated themselves with mainstream medicine or whether they persevered as osteopathic physician and surgeon. They have insights to share that contribute to a fuller understanding of these historical events and their consequences.
We embedded the historical narratives in the documentation of archival texts, including the unpublished “History of Osteopathy in California” by Dain Tasker, D.O. and files maintained by Forest J. Grunigen, M.D. and Louis Chandler, D.O., as well as documents collected by many other key players. The richness of the interviews allows us to liven up these archival historical documents and point toward promising venues for mutual understanding and respect among D.O.s and M.D.s. The narratives provide suggestions for collaboration in education and research. The interview transcripts can be found online at http://www.lib.uci.edu/themerger.
For nearly forty years, the 41st Medical Trust at the University of California, Irvine has aimed to support research on osteopathic manipulation which had been one of the incentives for merging the medical professions. Members of the 41st Medical Trust committee presently include Victor Passy, M.D. as Chair, Jen Yu, M.D., Ph.D., Stanley van den Noort, M.D., Dolores Grunigen, Richard Kammerman, M.D., Robert Steedman, M.D., and Leonard Kitzes, M.D. A grant by the 41st Medical Trust has made possible this documentation of osteopathic and allopathic medicine in California.
Sibylle Reinsch, Ph.D.
Michael Seffinger, D.O.
Jerome Tobis, M.D.
Irvine and Pomona, California, January 2009
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ISBN13 (TP) 978-1-4363-5438-7
ISBN13 (HB) 978-1-4363-5439-4