Written by Lee Jarvis. Proofreading and editing by Rosemary Bonnell.
Mr. Robert Johnston is the Principal, founder, and owner of the Canadian Academy of Osteopathy (CAO). Mr. Johnston has trained extensively in Canada as well as internationally and has over 25 years of experience in manual therapy. Rob was also my teacher and the principal for the four years when I was a student at the CAO, a time which I enjoyed so thoroughly that I still struggle to put it into words. At the time he had everyone call him “Rob” when teaching. I asked if I could continue to do so for this article and he agreed as he is one for casual titles when possible. I sat down with Rob in February of 2025 and we talked about many subjects related to Osteopathy. One of the most significant subjects was the performance of Osteopathy in both Canada and in the world..
At the time of writing this article Osteopathy is in a very tumultuous, yet interesting time. Based on Osteopathy’s very colourful history, it seems that it is almost always in some element of trouble/excitement/teetering on the edge of peril. It is entirely possible that this precariousness is the way we like it, and so we carry on, business as usual. To be specific, currently around the world several large Osteopathic schools are undergoing major changes, but not for the better. Large European, British, and Australian schools have not fared well as of recently, in some cases closing their doors immediately or “teaching out” their final classes. These losses do not mean that the practice of Osteopathic Manual Therapy is any less valuable or truthful than previously, provided it is well taught and well done. However, the loss of major educational institutions means that there are less voices of practitioners to speak well of the profession and less practitioners available to help patients. Whether we like it or not, we are affected by both public perception and the size of the practitioner population.
At the same time here in Canada the CAO is doing incredibly well. I want to add that none of this is to gloat, the school and association of practitioners are happy about the following facts but they also understand how much effort it has taken to get there and how much effort it will take to maintain. Currently there are two CAO schools, the first in Hamilton, Ontario and the second in Calgary, Alberta. The Calgary school is the newer of the two schools, but already has four full years of full time students. Each of these schools is an “investment” of practitioners into the field and it is likely that within two years we will reach 700 members in our professional association. When compared to other osteopathic associations around the world 700 members is not a huge amount, but it is evidence that we are growing in significant numbers. On the subject of these Canadian osteopathic practitioners, we can also say that they are gainfully employed and doing well professionally. They are making a living which is enough to support themselves and their families. If you’ve ever been the owner of a certificate or a degree, but lacking a job, you will understand the significance and importance of this last statement.
So this being the case we are left to ask, “What is the difference?“ Why is it that Osteopathy is doing particularly well in Canada? Or more specifically, “Why is the CAO doing so well as an institution?” Arguably we will never truly know, there are so many factors involved in the success of any institution that it can only ever be hypothesized. A few more decades might give us some hindsight. However, we can look at some of the things that Rob suggests allows the CAO to stand out differently and have contributed to the school’s success.
To start, Rob stated that as of recently he is spending a lot of time at Queen’s Park Legislative Building in Toronto the location of the Government of Ontario. Rob is explaining to government officials that OMT is both safe and cost-effective. As a point of clarification, “cost-effective” in this case means that OMT is both effective in its objective of helping the patient as well as being relatively inexpensive when applied at the right time to the right person. Whether in the treatment room, the classroom, or the halls of the legislature, it’s important to be able to communicate so that you are well understood. I feel it is a very good thing when any government is concerned with safety and cost-efficiency, these are reasonable goals that are beneficial to the public. Rob explained that at this point, with the school and the professional association’s size, we now represent a sizeable group that is politically relevant. MPP’s represent the public and if your organization represents a sizeable portion of the public MPP’s tend to be more interested in you. That being said, according to Rob, it’s very important to still stay quiet and polite in all interactions when representing the osteopathic profession.
Though a separate entity from the government, the insurance companies are another presence in the field of Osteopathy and communication with them should be done in a similar manner. For the insurance companies, their main concerns are also safety and cost-effectiveness. Cost-effective for insurance companies means using the smallest amount possible of the allotted insurance money. Insurance companies are a business institution, and though covered therapies can be valuable, a company is concerned with the frivolous (unnecessary) expenditure of money (benefits). We are very lucky to have well established insurance companies in Canada, and though not every single company employee has these benefits they are much more widely spread than in some other countries. Being said another way, spending insurance money just because you have it is not the benefit some believe it to be. We have made great in-roads with the insurance companies through the CAO and our professional association and one of the ways we’ve done that is to show that we can resolve an issue in a short period of time.
Another large differentiating factor for the CAO in Canada was the recognition by and accreditation for OSAP funding in 2021. This may seem like a very simple thing but this form of student funding was a huge step forward for the school. OSAP is the Ontario Student Assistance Program, a government run student loan program that only accredits educational institutions with high standards. OSAP has its own regulatory qualifications and meeting these requirements further legitimizes the CAO as an institution with high educational standards. Without getting too deep into the specifics, the funding to students by OSAP is a loan and therefore does have to be paid back, however, there is no interest accrued on the loan until 6 months after the student graduates. This is a significant difference to a loan that must be immediately paid back in installments with interest while the student is going through school. The capacity for our students to utilize the OSAP program means that many people who would have otherwise not been able to afford to attend the CAO are able to both afford it and pay back this loan much more easily after they graduate.
When it comes to the education of the CAO students, the challenge is a bit different. Rob stated that “the minute you’re not teaching principles you start to lose Osteopathy”. A “principle” is a fundamental truth by definition, something that can be relied upon in situations of reasoning or decision making. In application of Osteopathic Manual Therapy a “principle” could also be said to be “things that we know work” to roughly paraphrase Dr. Still. Examples of this could be the thorough study of anatomy, skilled palpation, calming the tissue through treatment, or even clear and accurate communication. On this Rob stated, “we need to stay true to what we do”, and first and foremost “what we do” is manual Osteopathy that is grounded in anatomy.
In regards to Osteopathy education elsewhere in the world, Rob identified that one of the issues seems to be “outsourcing” of the education process. In this case “outsourcing” is in reference to the utilization of teachers/instructors teaching Osteopathy who are not themselves trained Osteopaths or Osteopathic Manual Therapists. Certainly there is nothing wrong with non-Osteopathic teachers in Osteopathic schools. These teachers are qualified and invaluable for teaching essential sciences such as (but not limited to) physiology, pathophysiology, and nutrition. Often these teachers will be PhD’s in their field and more than qualified to be teaching the subject as they are highly specialized in their subject. That being said, we cannot stray too far from Osteopathic practitioners teaching Osteopathic Manual Therapy otherwise it just becomes manipulation and techniques devoid of the greater Osteopathic style/methodology. The advantages of having a seasoned practitioner teaching Osteopathic students should be obvious, however, aside from that there is an artform and a dedication to well conducted Osteopathic treatment that is not just a technique (I intend to cover this in greater detail in future articles). The CAO has always ensured that the teaching staff is primarily made up of skilled Osteopathic Manual Therapists who are working in the field regularly. These teachers know what is expected of a working graduate on a daily basis and teach to that high standard.
One thing I am personally and professionally certain is different at the CAO is that we take the time to not only teach the basic sciences to a high academic level , but we also take the time to go back (or simultaneously) and teach the Osteopathic interpretation of the subject. I have been teaching the subject of Osteopathic Physiology for five years now, and the course is exactly what it sounds like. We also have a physiology teacher who teaches four years of standard medical physiology (and who is fantastic at it by the way) while at the same time (on a different day of the same week of the course, we’re not both up there talking over each other) I teach how these same physiology lessons apply to Osteopathic Manual Treatment where applicable. Certainly there is some overlap between the standard physiology and the way of looking at it Osteopathically, but I have never met a student who picks up everything the first time through so I cannot see this as a detriment to their educational process. There is always value in having multiple perspectives, and though it is far more effort and expense to run a program this way we ensure that we do not lose the Osteopathy in the process. On that subject Rob stated very pointedly, “We can only blame ourselves for allowing osteopathy to escape”, and this is true of the CAO as well as the world as a whole.
For a local parallel, the CAO is very much a Canadian institution, and even though it’s now in two provinces, it’s still very much a Hamilton institution. Hamilton is a “steel town”, a city whose major industry has always been the production of steel. That steel production capacity and identity is starting to slip away from the city as the steel industry has outsourced parts of their production. As always the outsourcing was originally framed around cost savings by shipping to countries who could do parts of the work for cheaper without the loss of jobs, but as usual this has not been entirely true. Needless to say it is a good analogy for Ostoepathy’s situation.
For any of this to matter at all the CAO must have a very high academic standard in all areas of Osteopathy. This comes in the form of the sciences as mentioned previously, but just as importantly (if not more importantly) in the hands-on training, the manual assessment, and the treatment. In Rob’s words you have to “shuffle the deck regularly.”
I’m going to say this next part carefully, as I know many of my readers are students and they hate this part. I didn’t like this concept as a student either but as a teacher I realize how important this way of educating and testing can be. To “shuffle the deck”, means to regularly rearrange components of the Osteopathic educational process. This can come in the form of changing the order in which you assess parts of the body, changing the position a patient lays in for assessment or treatment, or even changing the way in which you greet and interact with a patient on an initial assessment. These things that are being changed are parts of a thorough processes that the student may have just gotten used to doing and just learned the steps and the purpose of doing them. Then, with little warning, the teacher changes the order of those steps. From the perspective of the teacher the content or purpose of what the student is learning usually doesn’t really change at all. However, as a student I thought these were gigantic, monstrous changes. Changes that were far too much work, completely unnecessary, and left me in disbelief that the teachers would even suggest such changes! Now as a teacher I realize it’s more like changing the order you have breakfast. It’s still milk, cereal, toast, and coffee but what time and the order in which you eat each item is up for debate and each will have their use and situation where they are most relevant. If you truly understand the components and tools of what you’re doing it will be obvious what needs to be done. This is just one example of how this “shuffling” can be done, another example might include changing the position of the patient and handhold used for a certain regional assessment, but the basic premise remains the same.
To clarify, we’re comparing a “shuffling the deck” type of curriculum to a specific and immutable type of curriculum. In a specific and immutable type curriculum parts are scripted and introduced only at a certain time. This “set-in-stone” curriculum means that there is no room for change or reinforcement of understanding. However, classes are made up of people and each one of us has different capabilities and weaknesses. The “shuffling the deck” type of curriculum allows for change. A class could be advanced early if they are ready for it or they could return to previous information that needs clarification. This way of conducting education where things are more flexible is a lot more work but it is one of the best ways to teach and test comprehension. At the end of the four years of education there should be no question whether or not a student can safely and effectively do the job for which they were trained.
According to Rob, all of this, all of these jobs need continuous effort and safeguarding just to retain what we’ve achieved (let alone improve upon them). It would be nice to think that at some point Osteopathy could be in a state that doesn’t require constant protection and damage control but based on my life experiences thus far this may very well be the default state of the universe. Until then we continue to strive to maintain what we have and work to create a better future. As well, whether in the treatment room or the halls of the Legislature, it’s always worth the effort of doing a good job and being kind. Something I recall well from my years as a student was Rob saying (I’m paraphrasing because it was repeated so many times), “Go to work, do a good job, help some people. That alone is enough.”