ABT: Military Medical Students at Rocky Vista

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Originally Posted by haujun

I am actually more scare about doctors who think they know everything and place their interest before their patients. I also feel that if doctors do not achieve certain minimum standard (both technical and non-technical skills) at end of PGY I, II etc..I agreed that they should not progress and complete their residency. Some doctors may require some more remedial training, but it is more desirable to find them and help them during training period than later.

I believe that this requires some intelligence, but we are NOT talking about Biochemistry or Quantum physics level of thinking here. I would like to encourage medical students and residents not to be scare to make mistakes and learn from them as much as possible during your training.

Having finished residency while back...I think that two most significant traits that doctors should have are compassion and diligence. That is my personal view...

Oooopsie, I just prescribed a toxic combination of medications, misdiagnosed a condition leading to death or disability etc. - but I was compassionate and diligent!

I have medics who are compassionate and diligent - important but not enough. The point isn't that DO's are stupid etc. The point is the more you lower standards - undeniably that is what is happening in the DO world with the addition of new and poorly regulated DO schools - you will without a doubt have weaker applicants and graduates, a fact. These weaker students now are at a significant disadvantage if they don't have the aptitude. My concern has been, and everyone I work with concurs, that the quality of new physicians coming into the military is very poor. Poor to the level that even the most idealistic among us can't figure out how they are going to be safe and fear leaving the hospital at night. This does not bode well for the system.

We have E-5's recruiting doctors who have no goal other than to put a warm body into the military. I've met several who told me they don't even call on MD schools because it is easier to recruit from the DO's schools.

Why would any business, hospital system want to recruit from an unproven, school especially given the very poor track record of the new DO programs? All DO schools are not created equal, some are much better than others, and I should point out some US MD schools also produce fairly poor quality grads. Even DO's concede that graduates from the top tier DO schools ala PCOM (not the metastatic one in Ga) are stronger on average than from the start ups. Again, enough with the PC baloney - recruit from a weak school and you increase your risk of getting substandard doctors. This shouldn't be that hard to figure out.

The real disgrace is that fact that we are ignoring that which is blatantly obvious. The quality of our HPSP grads is not what it was and we are turning a blind eye to it. Some of this (not all) is a DO phenomenon.

Originally Posted by a1qwerty55

Oooopsie, I just prescribed a toxic combination of medications, misdiagnosed a condition leading to death or disability etc. - but I was compassionate and diligent!

I have medics who are compassionate and diligent - important but not enough. The point isn't that DO's are stupid etc. The point is the more you lower standards - undeniably that is what is happening in the DO world with the addition of new and poorly regulated DO schools - you will without a doubt have weaker applicants and graduates, a fact. These weaker students now are at a significant disadvantage if they don't have the aptitude. My concern has been, and everyone I work with concurs, that the quality of new physicians coming into the military is very poor. Poor to the level that even the most idealistic among us can't figure out how they are going to be safe and fear leaving the hospital at night. This does not bode well for the system.

We have E-5's recruiting doctors who have no goal other than to put a warm body into the military. I've met several who told me they don't even call on MD schools because it is easier to recruit from the DO's schools.

Why would any business, hospital system want to recruit from an unproven, school especially given the very poor track record of the new DO programs? All DO schools are not created equal, some are much better than others, and I should point out some US MD schools also produce fairly poor quality grads. Even DO's concede that graduates from the top tier DO schools ala PCOM (not the metastatic one in Ga) are stronger on average than from the start ups. Again, enough with the PC baloney - recruit from a weak school and you increase your risk of getting substandard doctors. This shouldn't be that hard to figure out.

The real disgrace is that fact that we are ignoring that which is blatantly obvious. The quality of our HPSP grads is not what it was and we are turning a blind eye to it. Some of this (not all) is a DO phenomenon.

DO student here, happen to agree with him outside of his rather harsh first post in which he made a gross generalization regarding our inability to be trained and that all DO's were a 'plague on military medicine'...but forgive and forget. there's a big problem right now, with DO schools popping up left and right, schools of...dubious quality that are starting to resemble a lot of the schools in the caribbean where it seems like it's just an extended board prep course. they'd be a lot better served to focus on developing whatever facilities/rotation sites/institutions they have currently than popping off another two or so satellite campuses. I also have come across a few classmates that have shocked me. "Wow they're going to be a doctor someday" and that's scary. However, on the brighter side, I have classmates that continually impress and I have no doubt that they will be fine doctors one day. I'm sure MDs can connect with this as well.

either way, a little off topic, but the "short bus analogy" isn't really necessary/accurate here. No one is questioning that it's easier to get into DO schools, but are you so far removed from the days of applying to forget how much of a crap shoot it was?
My stats weren't perfect, but they weren't below average by any standards, I had a hard time figuring out what I wanted to do with my life at 20, let alone know really why I wanted to go into medicine as a young, immature kid, which led to wasted opportunities and not taking the application process seriously. Sometimes it doesn't happen the way you want it to, but I wasn't about to keep my pride at the expense of my dream. In the end, I'm thankful for DO schools because if they didn't exist, I wouldn't be where I am today.

Making another generalization by de-valuing a DO student for being the top of his class (and destroying the boards) by attributing it to being at a DO school is unnecessary. Using similar logic, a MD student at a top institution with low passes all throughout, barely passing board scores should still be proud because he was lucky enough to get into a place like that in the first place? Pshhh, give me a break. I earned my 240 on the USMLE, and because of talks like this, I will continue to encourage fellow DOs to take it or else risk the occasional scrutiny that comes along. In qwerty's defense, he later said pretty much the same thing in that he has recognized the exceptional DO's that he has come across, but still.

Anyways, despite his harsh/blunt/brash message, his concerns are valid.

Originally Posted by a1qwerty55

The real disgrace is that fact that we are ignoring that which is blatantly obvious. The quality of our HPSP grads is not what it was and we are turning a blind eye to it. Some of this (not all) is a DO phenomenon.

It isn't just the combat op-tempo that brought the services to this place. The big slide started well before 9/11 and Iraq. It really started when the military embraced civilian managed care for its dependents and retirees, creating first CHAMPUS and its successor Tricare. With those came a broad contraction of the military mission of operating teaching hospitals with well-supported residency programs that once had no need to farm residents out to civilian institutions to meet ACGME requirements. Instead of GMO duty being a brief interlude (they used to be shorter assignments, once) to what was usually a longer service in the military that included residency training in a military teaching hospital and follow-on assignment as a military attending, GMO duty became the de facto center of the military medicine service experience. Fewer training opportunities robbed HPSP candidates not only of anticipated military training, it also diminished the quality of the training experience they had as interns, making military residencies even less desirable than civilian programs which by comparison did not suffer declines in patient volumes and case experience. For many HPSP accessions, internship and GMO duties became the sole extent of their military medical experience, and neither did much to recommend staying in the service as opposed to leaving for better civilian training opportunities. Now those doctors are well distributed in their communities and in teaching centers, and their experience and opinions cannot be counted on as endorsers and supporters of military service at desirable and competitive medical schools.

When I interned at Portsmouth, I had internship colleagues from Harvard, Columbia, UCSF, UCLA, Penn, Duke, Georgetown, and other competitive schools. There were graduates of osteopathic schools, strong interns from Michigan State and other schools, but their numbers were not disproportionate. The only school disproportionately represented was USUHS. HPSP acceptance was meaningfully competitive.

The decline in applicant quality has been attributed to war. That is wrong. The reason fewer high-quality applicants are entering is because of the rightfully understood lack of commitment to quality GME wrought by the services fascination with managed care.

This is not some problem visited on the services by those who commit the U.S. to war--quality did not fall during other wars--and if anything, the value of the scholarship should have appreciated as medical school tuitions have risen, but paradoxically that is not the case. This is the direct result of the services own actions, the sour fruit of their neglect, abuse and deceit.

Originally Posted by narcusprince

I will add to this. RVU only allows the top 85% of graduates to take boards in the appropriate time and the bottom 15% are told to take boards later.

RVU's class of 2014 won't have any late board takers. Maybe the administration got sick of hearing about it on SDN.

To get back to the root question as a RVU'er and HPSP. I joined HPSP because I was in the Marine Corps and knew I wanted to serve again as a Doctor. There are quite a few people who thought of joining HPSP from RVU for monetary reasons but about 10 of us that were prior service definitely tried to stem the flow of them because we didn't want them in our services. I am sure they were some that only did it for the monetary aspect still but our SAMOPS club has been strong and people really seem to be excited about the prospect of serving.

RVU also has latched onto this and started a Military Track program to help teach mil topics one of the Deans of the school is a former Air Force Doctor and another is Former Army Special Forces Doctor. Also it is worth mentioning that the military had a big part in DO's getting nationally licensed and so there is a tradition of Osteopathic Physicians serving in the military.

As for DO vs MD Some people suck on both sides shouldn't be doctors and are going to be doctors in civilian or military any way. If I recall correctly that is called the 10%. Hopefully we all will be great doctors but it's not likely and unfortunately there is little incentive to actually make the rocks disappear in medicine but until we have a tricorder for them to use we are going to be stuck with them. I've seen turds turn into great Marines because they have the right discipline and motivation instilled in them. If you can't find the right carrot find the right stick.

Well good luck to all those students as well as military medical students at RVU. If you can pass your boards and perform at the same level as your colleagues more power to you. Your fine by my book.