Osteopathic specialists enjoy the unique advantages of practicing in a profession with the recommended mix of generalists and specialists as healthcare reform heats up. Ironically, market reforms, driven by cost-containment, challenge the infrastructure of osteopathic physician practice, hospital care, and osteopathic education, all of which support the generalist/specialist mix that healthcare reformers are trying to attain. The authors trace the development of specialties in the osteopathic medical profession in response to persecution and isolation, and explain the differences between allopathic and osteopathic medical specialists. They document the rationale of a physician mix favoring an increased proportion of generalists. Finally, they argue persuasively that no one has a stronger motivation to help position the osteopathic medical infrastructure for survival than the osteopathic medical specialist.