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Discussion in 'Osteopathic' started by fozzy40, Oct 12, 2011.

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  1. SpecterGT260

    SpecterGT260 Catdoucheus

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    I'm trying to look into it now. I was always under the impression that a foreign doctor needs to re-take residency here in the US regardless in order to get licensed. So these changes do not affect them anyways. I wasnt aware that you could complete a foreign residency and then a domestic fellowship in the past. According to FSMB there are some eligibility issues in terms of post graduate training - what I cannot find is if they recognize foreign PG training......
  2. donkeykong1

    donkeykong1

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    honestly, i think the whole thing is ridiculous re: the aoa. the strength of some of the ROAD AOA residencies is definitely up to par with the ACGME ones. for years now, graduates coming out of aoa residencies have gone into fellowships under the acgme with no real issues. like its not out of the ordinary for one to do AOA rads and go onto a fellowship at UCSF etc...
  3. donkeykong1

    donkeykong1

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    it depends what country the fmg is from
  4. SpecterGT260

    SpecterGT260 Catdoucheus

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    http://www.theworld.org/2011/04/foreign-trained-doctors-kept-out-of-practice-in-us/

    http://www.ama-assn.org/amednews/2011/07/25/prl20725.htm

    I guess what I am saying is, if the above is true, that if they all MUST complete a US residency, and they all CANNOT enter AOA residencies, that these changes do not affect them at all and only AOA trained physicians stand to be affected since they were the ONLY ones (from what I gather from the above) that could take a non ACGME residency and still apply for fellowhsips to begin with. I'm not saying i'm right, this is just in line with everything Ive always heard about it.
  5. donkeykong1

    donkeykong1

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    it does happen though. As long as they are ECFMG certified, an IMG/FMG can complete a fellowship in the United States without doing a residency here but they will not be board eligible. I worked for an MD/Phd from the ukraine who did a fellowship here but a residency back in his home country. The primary purpose being for research reasons since they'll never be board certified unless they complete a residency in the states.
  6. FormerCorpsman

    FormerCorpsman

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    I disagree with your conclusion on the matter. I feel a capitulation by the AOA to allow MDs into the osteopathic residency programs will essentially dissolve the osteopathic profession as a whole. This will only give credence to the AMA's mission of coalescing power in the medical market, and affording them the leverage to force medical prices even higher. It is imperative that the AOA maintain its stance to provide some sort of competition to the MD establishment, for without this competition, a monopolistic power will be solidified in the AMA.

    The AOA should withdraw from using the ACGME programs and establish more residency programs, or bolster the quality of those in existence. For students who want to pursue ACGME programs, they should endeavor to enter an allopathic school, instead of applying to osteopathic schools. The allowance of the AMA to come in and begin to regulate AOA programs will efface the legitimacy of the AOA, and osteopathic physicians will only be osteopaths in name only. You should look at this issue in the lens of economics, for if you spend sometime and analyze the situation, you will see that the only entity to benefit from an AMA usurpation of power over the osteopathic physicians is the allopathic establishment and not the country and, especially, not the patients. If the AMA does obtain control, then the facade of deception will crumble, elucidating the exact intentions of the special interests of the AMA. Then, perhaps, you will see that they were never really concerned with medicine. Instead you will see it has everything to do with money and power.
    Last edited: Jun 10, 2012
  7. Siggy

    Siggy

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    You think that the AOA is concerned about the country or patients, and that's why the AOA is fighting the AMA?
  8. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Through the lens of economics... hmmmm.... and you suggest coming up with 1000s of more residency seats on the DO side. Any clue how much that costs? I spoke with a GME Director who is just starting up a residency program and it costs 100,000 in direct costs and 100,000 in indirect per resident per year. So, roughly 200,000 per resident per year. Im sure the taxpayers would love to see that bill just so that we can keep the whole fake DO philosophy alive.
  9. aProgDirector

    aProgDirector Pastafarians Unite! Moderator SDN Advisor

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    This is a long thread, and I fear that the new ACGME rule has been misinterpreted as the thread has progressed.

    Osteopathic physicians will still be able to do ACGME residencies. Nothing has changed in that regard at all. The match will be all-in this coming year, which means that many osteopathic physicians will not be able to pre-match -- however that's completely unrelated to the ACGME and was a decision driven by the NRMP.

    This decision by the ACGME has been pursued (theoretically) because of IMG's. IMG's must complete 1-3 years of residency/fellowship training to get a license in most states. What currently happens is that IMG's who do their core training in another country can come to the US to do only a fellowship. Their fellowship training counts towards licensure, so after 1-3 years they can get a license to practice medicine, and off they go. They can't take the ABMS boards, since they have to be boarded in the core field. So, they can't say they are an "ABIM Certified Cardiologist". But nothing stops them from calling themselves a "Cardiologist".

    I am surprised that the ABMS didn't step in to "fix" this. The ACGME did so because fellows supervise residents, and they can't "guarantee the quality of their prior training" -- which is not completely unreasonable.

    The effect on DO's is simply that those residents that complete an AOA residency will no longer be able to complete an ACGME fellowship afterwards. You would be able to complete an AOA fellowship. Any osteopathic physician who completes an ACGME residency would be able to complete an ACGME fellowship or an AOA fellowship (unless the AOA create a similar rule).

    So, the overall impact is pretty small.

    We could debate whether there should be more AOA residency spots, but honestly that discussion has nothing to do with this new rule. Of note, the AOA can't create residency spots, nor have they put any limit or cap on them that I know of. Any hospital can create a residency at any time. Residencies are paid by Medicare. In general, new residencies are funded with new dollars, established residencies which are increased in size usually get no new funding (but that is a complicated issue and depends on many factors).
  10. FormerCorpsman

    FormerCorpsman

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    Let me clarify. I am not stating that the AOA is concerned with patients or the country, for these are my concerns. I would hope that the AOA would burden themselves with these matters, but this may or may not be the case. I believe in a truly free-market system that provides competition.

    The immediate cost in the short run is substantial; however, an AMA take over would cost the citizens a lot more than erecting new Osteopathic residency programs. Last century's history has shown that the AMA sought to curtail the scope of medicine, as well as the number of physicians, in the U.S. to create an environment conducive to elevate healthcare costs and physicians salaries. Hence, the sad disposition of special interest cabals is that once they obtain power and leverage, they will always endeavor to use it to increase their profits at the expense of everyone else. Noting that many residency programs are established under medicare funding, of which I am opposed, hospitals should reign in the amount of salary each resident procures.

    As to the philosophy of osteopathy, it seems more reasonable and logical to espouse a doctrine that promotes longevity through the amicable means of nature, coupled with a holistic investigation as to the cause and effect of various ailments. Concerning the practices of MDs, their approach of disseminating pills for every symptom is foolish and chains people to be dependent on these immediate fixes, which in the long run do more harm than good. But to each his own, I guess.
  11. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Spoken like a true, ignorant premed. Your flowery words do nothing for your argument when your argument is fundamentally flawed.
  12. FormerCorpsman

    FormerCorpsman

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    I only speak from the experience (over 30,000 hours in a clinical setting and 7 months of combat medicine in the field) of which I procured during my time as a Navy Corpsman. In this capacity, I worked with several allopathic physicians during sick call hours on various Marine Corps bases; this was their methodology and approach to medicine.
    Last edited: Jun 10, 2012
  13. littleasian

    littleasian

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    here's a simple solution: if you're a DO, just apply for ACGME residencies. problem solved. you already knew (or should have known) when you applied that it was going to be tougher to obtain residencies/fellowships in the face of increasing class sizes/schools with minimal increases in residency positions.

    the AOA doesn't allow allopathic students to apply for AOA residencies, yet cries foul when ACGMe limits fellowship access to ACGME residents? this proposal sounds absolutely fair. they're already being nice and letting DO's apply for ACGME programs. i wouldn't be surprised if they don't take this further in the future by limiting all ACGME residencies to allopathic students only.

    can't have your cake and eat it too.

    and before anyone cries foul and accuses me of being a MD snob, i'll be graduating with my DO degree in 10 months.
  14. FormerCorpsman

    FormerCorpsman

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    I agree with your sentiments on the matter. However, to be an absolutely principled individual, those who applied under the banner of osteopathy should stick to their programs.
  15. Dharma

    Dharma

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    The free-market system (which isn't so free due to government setting prices and what-not) is that of physicians, MD or DO... that's MD vs MD, MD vs DO, DO vs DO.

    Really? How did you arrive at this conclusion? Any numbers to back this up?

    Slippery slopes and conspiracy theories...

    Yes, during the mid to late 90s there was a lot of speculation of a surplus of physicians on the horizon with fears of medicine going the way of law. I'm not sure I would attribute that to any conspiracy theory though. As far as healthcare costs and physician salaries, I'm not even sure that it was the workings of the AMA behind any changes we have seen either. If anything there a lot of physicians (MD/DO) out there working harder than ever but making less paper with more paperwork, many of whom who complain that the AMA has done very little or nothing for their cause. Overhead costs and cost of living continually go up while reimbursements basically stay the same. If anyone has gotten rich, it's been the insurance companies.

    A LOT of hospitals have holes in their hulls... leaking money like mad while the ship sinks. Seriously, do you really think that hospitals flipping 100% or even most of the bill is realistically possible?

    I appreciate a touch of idealism now and then for a bit of inspiration, but how can you be so sure of this philosophy without any decent exposure to it yet? Don't get me wrong, I am interested in what osteopathic medicine claims to offer, but I'm not 100% convinced either.

    How much exposure have you had to clinical medicine? You speak of MDs as if they are only drug dispensing pill mill wannabee-tycoons hanging the shingle in rundown south Florida strip malls next to to-be-defunct video rental stores. (Is that Jay and Silent Bob over there?) Guess what? Most DOs also write scripts regularly because some drugs actually work! :eek: Once you start taking some physiology classes, you'll start to see (and hopefully gain some appreciation for the fact) that pharmaceuticals play a necessary role. Are there physicians who just go straight to the pad and move on without much thought, except "NEXT!"? Yep, including a bunch of 5-fingered DOs.

    A "holistic" approach (and I almost hate that word) does not necessarily entail the absence of medication; IMO it just refers to seeing the bigger picture- putting together the pieces of the puzzle to hopefully arrive at some understanding, being observant, and taking the whole patient- symptoms, story, emotions and all- into account while also utilizing the best that modern medicine has to offer. Ok, some maybe I'm being a bit idealistic now too, but this sounds more like something any good doctor would do. Not sure if the new-age tag of "holistic" is needed. Oh well. Point being, this is not an osteopathic thing... it's medicine thing.

    While EVERY physician would love to get to the root of every pathology they encounter, it's quite likely that they won't and in order to help their patients have some peace of mind and actually feel better, symptoms need to be quelled, and a lot of the time, this will be in the form of medication. (Yeah, maybe it will OMT as well, or in lieu of). Their well-being is what matters and the means to accomplish this will vary according the circumstances at hand.

    DO or MD, good docs will do this, and good teachers will instruct tomorrow's competent docs about how to go about doing this well. Future physicians need solid training in programs that can be trusted to be up to certain educational and training standards. (PERIOD). The rest is just political BS, including the agendas of any of the overseeing bodies mentioned earlier.

    Like it or not, if it weren't for the ACGME, DO's would not be where they are today. There are a lot of solid DO's out there, representing your future degree well, many of whom wouldn't be in the position they are in today without the training they received in ACGME programs.

    To sum it up, my point is that it really doesn't have to be this us against them mentality. It should be about good education and competent medicine. (<---- idealism!)
  16. FormerCorpsman

    FormerCorpsman

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    In terms of the later half of your prose, I am in agreement of putting the pieces of the puzzle together. Concerning exposure to the realm of osteopathy, I gained my first exposure while in Idaho. I met a man who seemed to understand every aspected of the body biochemically and had an MD partner, who constantly touted his osteopathic partner's ability to sift and discern the underlying causes to most of his patients ailments. This exposure to an osteopathic physicians has driven me to pursue it with great fervor. I am not against using medicine in the short term, but I do not see the benefit of giving pharmaceutical drugs over a long period of time, for the effects have decimated most of my family members.

    To what you stated earlier about a slippery slope and conspiracy theories, I have seen people employ the term "conspiracy theory" in an effort to drive people away from the copious amount of material on various matters. If you will look at earlier post I have place on this thread, you will see some links taking you to articles that have substantial amounts of footnotes to back up a lot of what I am saying. Also, you can look at a JAMA article in 1988, where the AMA was court ordered to admit in their journal that they were caught in a conspiracy to subvert osteopathic, chiropractic, and naturopathic professionals.

    http://jama.jamanetwork.com/article.aspx?volume=259&issue=1&page=81
  17. SpecterGT260

    SpecterGT260 Catdoucheus

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    So with this.... I'm still confused how this is more directed at FMG since non board certified means basically no practice anyways.
  18. Dharma

    Dharma

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    I respect that. I appreciate your coolheaded response as well.

    Anhow, what speciality did this DO work in? Sounds like an interesting experience to say the least.

    And I'll check out the links you mentioned as well, although I'll be reading them with my BS-meter plugged in. :)
  19. FormerCorpsman

    FormerCorpsman

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    The osteopathic physician I shadowed was an internal medicine doctor, who turned down a Cardiology fellowship at Cleveland Clinic. His partner told me about all this, for I did not solicit the information. His partner stated that the osteopathic physician truly espoused every aspect of the osteopathic philosophy and admitted to me that this man was probably the best physician he had ever met. I concurred after shadowing him for +200 hrs, he was by far the best I had ever seen. His patients adored him with the utmost approbation. This man made me fall in love with medicine again.

    I hope you will research the information I am asking you to read, for in it lies pieces to the puzzle of the big picture, if you will. However, every individual is entitled to their respective opinions, and I do my best to respect others out of duty to my ethics and moral principles. Thank you for your candor.
  20. donkeykong1

    donkeykong1

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    they can still be licensed to practice just not board certified.
  21. SpecterGT260

    SpecterGT260 Catdoucheus

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    I suppose. That is scant practice to begin with but yes, technically true. Either way I think this has larger implications for DO than FMG regardless of the initial intent.
  22. johnnydrama

    johnnydrama I'm no Superman

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    I think different specialties handled things differently. FMGs could get board certified in the US for radiology if they could get through 4 years of fellowships.

    This might change that and force them to get into an ACGME residency first.
  23. desijigga

    desijigga Newbie

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    I understand the rule they are implementing is suppose to be targeted mostly at IMGs, but there are numerous Fellowships that need AOA residency graduates to fill all their spots. Just looking at Non competitive fellowships in IM (i.e. Nephrology, ID, Endo, Pulm/cc) have a 20% or something quota to take non ABIM certified residents. They need DO residents to fill all their spots, I think this rule will hurt both the AOA and ACGME programs..

    I guess we can gripe all we want, but simple fact is ACGME does not consider AOA residencies up to par with their standards.
  24. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Yes an N=1 argument is always a valid approach to an argument.
  25. donkeykong1

    donkeykong1

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    if this were true though, then why were AOA residency grads able to successfully complete ACGME fellowships in the past?
  26. johnnydrama

    johnnydrama I'm no Superman

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    Fellows are cheap labor for hospitals.

    There are many more fellowship spots than there are ACGME graduates looking for fellowships.
  27. SpecterGT260

    SpecterGT260 Catdoucheus

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    I don't follow your logic....
  28. donkeykong1

    donkeykong1

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    if it were the case that aoa residencies are subpar, they would churn out low quality grads, which would mean 1. they would fail to qualify to get an acgme fellowship 2. the ones that did manage to get a fellowship spot might have difficulty finishing it i.e need more time for training etc...
  29. donkeykong1

    donkeykong1

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    is there a site where i can see the number of spots filled/unfilled for all the acgme fellowships. just curious
  30. johnnydrama

    johnnydrama I'm no Superman

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    The NRMP has stats for that too. That only covers fellowships that participate in the match though.

    Many aren't even accredited by the ACGME, so you'll never find a truly complete list.
  31. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Im at the AMA meeting right now and apparently there is going to be an update to thise ACGME nonsense. Will post what I find out. Hopefully, it is something substantial not "we are working on it."
  32. donkeykong1

    donkeykong1

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    :thumbup:

    for a quick summary, here is where we stand right now with the proposal:

    http://www.acgme.org/acWebsite/reviewComment/Common_Impact.pdf
  33. johnnydrama

    johnnydrama I'm no Superman

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  34. frankyazz

    frankyazz LECOM '14

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  35. Dharma

    Dharma

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  36. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    No idea. Ill post something when I hear an update. Anyone else in chicago?
  37. donkeykong1

    donkeykong1

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    yep the original, just to refresh people's memory of the situation.
  38. Dharma

    Dharma

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    Cool. Just wanted to be sure. Thanks DK.
  39. frankyazz

    frankyazz LECOM '14

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    Oh okay.. that's what I thought.. Didn't see anything different so I was confused.
  40. DocEspana

    DocEspana The walking man

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    holy crap really?

    I wont be there until saturday morning because my rotation wont let me off, so im pretty much only able to make the physicians HoD. Will you still be around then (saturday morning)? Could have a creepy SDN run in.
  41. GVL3020

    GVL3020

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    So they didn't change anything when it was rewritten ? If I complete an AOA residency will I be unable to do ACGME fellowship ?
  42. johnnydrama

    johnnydrama I'm no Superman

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    As written, yes.
  43. ensuii

    ensuii PGY1

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    Currently, you are able to do an AOA residency and then do an ACGME fellowship although it's generally considered that if the endgoal is to the ACGME fellowship you should do an ACGME residency.

    The provision aims to make it such that AOA residency grads would no longer qualify to attend ACGME fellowship programs.

    The fight right now is attempting to not allow the provision to pass.
  44. Dharma

    Dharma

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    The link posted above is not the rewrite; it provides the proposal as it was stated when first released sometime last year. I don't think there has been any official statement made regarding this week's meetings thus far.
  45. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Hmmm only thing at the AMA conference that was announced is that the AMA is against tje ACGME changes. Sorry i have no more info.
  46. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Yup, I will be here through saturday late afternoon. My flight back isn't until like 8. Doing the delegate thing.
  47. Wolverines83

    Wolverines83 ASA Member

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    lol...I got a knot in my stomach when I saw there was a new post. I was like "oh snap here it is." and then I read your response.

    Talk about anticlimactic.

    Oh well, guess it doesn't hurt that the AMA is against it, right?
  48. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    Hah sorry man, I went to the osteopathic caucus and that was all they were able to tell us. Would love to see a real announcement at some point. Ahh well. C'est la vie.
  49. donkeykong1

    donkeykong1

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    So lets say worst-case scenario this dumb proposal does pass. then what happens to all those unfilled fellowship spots that DOs with AOA residency training and IMGs with prior training used to fill. Wouldn't it make sense for there to be cuts to funding first before passing this restriction?
  50. johnnydrama

    johnnydrama I'm no Superman

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    Funding cuts are already underway.

    I don't believe many (if any) fellowship programs receive full Medicare funding anyway.

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