New colleges are in the process of development in Maine and California. As the names indicate, there are a number of osteopathic colleges which are part of major University campuses. As also indicated, many teach surgery as an integral part of Osteopathic training.

There are, in the U.S.A., a variety of speciality groups including Anaesthesiology, General Practice, Internal Medicine, Neurology and Psychiatry, Nuclear Medicine, Obstetrics and Gynaecology, Ophthaemology and Otorhinolaryngology, Pathology, Paediatrics, Proctology, Radiology, Rehabilitation Medicine, Surgery etc. In all these specialist fields there are skilled physicians approaching their individual areas of disease or dysfunction from an osteopathic viewpoint. The growth in numbers of practitioners and colleges has been paralled by the development of osteopathic hospitals, of which there are hundreds in the U.S.A.

With more and more graduates, with the highest academic qualifications, and the constant voice of the Academy of Applied Osteopathy to remind them of their unique heritage, the 'Old doctor's' proteges would seem to have established themselves in the country of osteopathy's birth.

The Situation in the U.K.
In the U.K. osteopaths practice under common law. There is no legislation governing the right to practice or the scope of practice. Anyone with or without training may establish a practice and style themselves as an osteopath and use the initials D.O. (which in the U.K. stand for Diploma of Osteopathy). There are three colleges offering four year courses (full time) in osteopathy in the U.K. No surgery or pharmacology are taught as subjects for students in the U.K. (where a more limited approach to the health problems of the patient exists than in the U.S.A.).

The British colleges are (in order of seniority):

1. The British School of Osteopathy, whose graduates style themselves 'Registered Osteopaths' and use the initials M.R.O.
2. The British College of Osteopathy and Naturopathy, whose graduates style themselves 'Registered Naturopaths and Osteopaths' and use the initials M.B.N.O.A.
3. Ecole Européene d'Osteopathie, whose graduates style themselves 'Members of the Society of Osteopaths' and use the initials M.S.O.

Apart from these colleges, all of which attract discretionary grants from local authorities, there are a number of colleges and schools, offering part-time and correspondence courses. There is also The London School of Osteopathy which offers a one year post graduate course to qualified medical practitioners.

The rivalry, and lack of co-operation, between the various osteopathic groups in the U.K. until fairly recently would be laughable were it not so sad. Of the estimated three thousand practicing osteopaths in the U.K., no more than 600 are graduates of full-time colleges. The remainder may have had some or no training, and whilst some of these practitioners are skillful, they patently do not have the background knowledge of anatomy and physiology possessed by the more adequately trained practitioners.

A further area of discord results from the strict code of ethics insisted upon by the associations governing the graduates of the full time colleges. Among the rules affecting these practitioners is a prohibition on advertising in any shape or form. The less well qualified osteopaths, who are not elligible for membership of the three main organizations (whose members are identified by the letters M.R.O., M.B.N.O.A., or M.S.O.) can, and do, advertise. The College of Osteopaths, which offers a five-year part-time training also forbids its graduates (M.C.D.) from advertising. Outnumbered by their less well-qualified colleagues it might have been expected that fully trained osteopaths would have aimed for a degree of unity in order to try to persuade government to legislate on the unhappy state of the profession. Instead, for many years, open hostility has existed between the three organizations, who would miss no opportunity to denigrate each other. Force of circumstances has led to a degree of co-operation being discussed, with regard, for example, to joint representation in the face of various legislative developments. One of these involves strict controls over the use of x-ray equipment, in an effort to minimize people's exposure to radiation. Desirable as this is, it has been necessary for osteopaths to attempt to ensure that their interests were taken into account in the formulation of the proposed laws. Obviously the expenses of legal advice and of a parliamentary agent are better shared, rather than duplicated by all the interested parties.