Osteopathy
There is an even more important change and challenge related to the acceptance of alternative medical practices and the use of “Doctor.” We are now finding growing acceptance of a school of medicine called “osteopathic medicine” (to be distinguished from traditional “allopathic medicine’). This holistic school of medicine is now preparing a majority of “doctors” for practice – particularly in the field of family medicine. These graduates from “less prestigious” (and often foreign) schools of medicine have introduced a more diversified perspective on medical strategies and tools that complement their more holistic (biopsychosocial) orientation to medical diagnosis and treatment. A majority of physicians have been trained in osteopathy in many 21st-century medical systems These nontraditional medical practitioners are called “Doctor” and are often not distinguishable from other “doctors” by patients.
Osteopaths have some status in the medical hierarchy, though not much if they are serving as family physicians. While these doctors might not have a high level of status, they often have considerable power. This comes from the critical role they play as “gatekeepers” in the referral of their patients to specialists for focused treatment. Most medical reimbursement policies now require that a patient first meet with a family or internal medicine doctor before being seen by (and reimbursed for services provided by) a medical specialist. Thus, osteopathic doctors might not have the status of their allopathic colleagues or the specialists to whom they refer patients; however, they have the economic power of referral. A specialist certainly does not want to get on the “wrong side” of a referring osteopathic physician (regardless of how the specialist feels about that “damnable, intrusive osteopathic stuff”).
We find other people in the medical world who also have significant power but not much medical status. These represent the managerial culture (rather than professional culture) in contemporary healthcare. (Bergquist, Guest and Rooney, 2002). We find administrators at the top of this managerial hierarchy (as in all traditional organizations). We then go down the list to department managers, administrative staff, receptionists, billing clerks, etc. They are not called by degree title (be it “doctor,” “masters,” or “bachelorate”); nor are they “allowed” to wear the traditional medical regalia (white coat and perhaps a stethoscope hanging around their neck). Those at the top of the managerial pecking order might have acquired an MBA degree or even an administrative doctorate, but they are rarely allowed to use this title.
Psychological Profession in the United States
The psychology profession in the United States has always lived in the shadow of medicine—at least in the domain of clinical psychology. However, psychology at the doctoral level has also lived in the shadow of academia. While virtually every other professional field has a “practitioner” degree that distinguishes it from a degree focused on research, scholarship, and teaching, the field of psychology for many years had only one degree (Ph.D.) that was awarded both to those running rats in a maze and those doing psychotherapy or clinical assessments. In the field of medicine, there is a practitioner doctorate (Doctor of Medicine: M.D.) alongside an academic degree (usually Ph.D.) in a specialized research area such as epidemiology and neurobiology.
