What can be done to stop irresponsible new DO school proliferation?

[LostAllHope]

Not every rotation needs to be at the NIH and not every attending needs to be on the cusp of curing cancer (or somatic dysfunction) but to argue against the need for elevated standards blows my mind. For most DO students, they don't get a chance to see what a real teaching institution is like until fourth year; by then, most of our minds are made up and we are focusing on our speciality and fluff electives rather than the fundamentals. IMHO, the best reason to address any "anti-DO" bias is by addressing some of the root cause issues.

I completely agree with this statement. At the end of my 3rd year, I did not know how to write SOAP notes or how to properly present a patient because 1) I was never given the opportunity to and 2) these old physicians do not even do these things properly themselves so I had no example to learn from. I feared for the worst as I started my 4th year away rotations at teaching hospitals but luckily I wasn't ******ed and was able to adapt quickly before being discovered. Like I said to one poster via PM, my 2 blocks of IM was done outpatient, one with a private nephrologist and the other with a general IM outpatient. I never saw ACS, PE, acute CHF, AKI, AMS, alcohol withdrawal, DVT, ARDS, etc....just some of the very basics of medicine. If it wasn't for my 4th year rotations, my residency program would have been surprised to have such a clueless intern.

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[meliora27]

I completely agree with this statement. At the end of my 3rd year, I did not know how to write SOAP notes or how to properly present a patient because 1) I was never given the opportunity to and 2) these old physicians do not even do these things properly themselves so I had no example to learn from. I feared for the worst as I started my 4th year away rotations at teaching hospitals but luckily I wasn't ******ed and was able to adapt quickly before being discovered. Like I said to one poster via PM, my 2 blocks of IM was done outpatient, one with a private nephrologist and the other with a general IM outpatient. I never saw ACS, PE, acute CHF, AKI, AMS, alcohol withdrawal, DVT, ARDS, etc....just some of the very basics of medicine. If it wasn't for my 4th year rotations, my residency program would have been surprised to have such a clueless intern.

Your third year experience was totally unacceptable. Did you ever try talking with your school about this?

 

[IslandStyle808]

Yes. If you want a good rotation at a teaching facility, usually there is a fee associated it with the rotation, ie. $1000/rotation. My school has declined paying for these superior rotations because the higher ups believe that the rotations that they can find us are adequate for learning. My school just goes around begging local doctors to take us in. I've had preceptors complain to me as a student that they don't like taking students from our school and the paperwork (ie. rotation evaluations and credentially) involved because they get nothing out of it yet we take up their time. They just take us in because they feel bad for us---kinda sucks to feel like orphans. Meanwhile, a Caribbean school has a contract with our local teaching hospital.

That is the screwed up part of DO education. They can put the student with any doctor no matter where the location and call it a rotation. However, for Caribbean students their core rotations have to be green book certified. Meaning that the rotations have to be done at a hospital with GME. Otherwise, PDs won't even look at them.

 

[IslandStyle808]

It does make sense however what @kp11 was saying to your statement. If kp11 is correct about that, then the reason DO programs open with such large sizes is because they need to break even with their funds for opening the medical school in the first place.

Yeah that definitely make sense. I just wonder what the minimum number would be in order for a DO school to be "in the positive." I am doubting it is 150. If you look at KYCOM, they had an initial student body of around 75 and did not increase class sizes until a couple of decades later. Yet they are still doing fine. Plus some of these are in public universities and funds generated from research could be used to help the school. So the class sizes still leave me a bit skeptical.

 

[cbrons]

Yeah if you're really serious about this PM me because I am def serious about getting this together.

Are you even in med school yet?

 

[Jwalker]

I completely agree with this statement. At the end of my 3rd year, I did not know how to write SOAP notes or how to properly present a patient because 1) I was never given the opportunity to and 2) these old physicians do not even do these things properly themselves so I had no example to learn from. I feared for the worst as I started my 4th year away rotations at teaching hospitals but luckily I wasn't ******ed and was able to adapt quickly before being discovered. Like I said to one poster via PM, my 2 blocks of IM was done outpatient, one with a private nephrologist and the other with a general IM outpatient. I never saw ACS, PE, acute CHF, AKI, AMS, alcohol withdrawal, DVT, ARDS, etc....just some of the very basics of medicine. If it wasn't for my 4th year rotations, my residency program would have been surprised to have such a clueless intern.

Sounds like a school specific problem. What kind of incoming 4th year doesn't know how to write a soap note? First years can do that.

 

[Mad Jack]

They would shut down all but probably 5 schools haha

Nah. Looking at the standards, there's a good number of schools that could survive with some changes and cutbacks in their class sizes. Possibly half of DO schools could make it in the LCME.

 

[Mad Jack]

After all the hue and cry over:
A- Physician shortages
B -Patient load
C - Lack of patient contact time
D - Physician burnout
E - "Lesser" healthcare providers invading physicians' turf by performing functions previously exclusively in the MD/DO's domain.

Go over to KevinMD and the like if you don't know what I'm talking about.

Effort is actually being expended to solve some of these issues by building out new infrastructure to meet demand. It's starting to sound like if you're not crying you're not happy.

Quality control is a self-leveling thing.

Try to keep in mind that there are 7+ billion people on this planet. Do you really think stifling new medical school expansion is in the best interests of our species?

Most of us could care less about 7 billion people kicking around in this world. We want a quality medical education. All the access in the world doesn't do you any good if the person treating you did their 2 years of rotations at some outpatient clinic in rural Nebraska and finished some subpar residency in middle of nowhere North Dakota.

 

[AlteredScale]

Are you even in med school yet?

About 3 months away. Is that ok?

 

[cbrons]

About 3 months away. Is that ok?

no your opinion is actually irrelevant. Not sure how you plan on filing a petition to the AOA when you aren't even a DO student yet. Lol.

 

[AlteredScale]

no your opinion is actually irrelevant. Not sure how you plan on filing a petition to the AOA when you aren't even a DO student yet. Lol.

Well obviously I'm not going to file it right now then.

 

[cbrons]

Yes. If you want a good rotation at a teaching facility, usually there is a fee associated it with the rotation, ie. $1000/rotation. My school has declined paying for these superior rotations because the higher ups believe that the rotations that they can find us are adequate for learning. My school just goes around begging local doctors to take us in. I've had preceptors complain to me as a student that they don't like taking students from our school and the paperwork (ie. rotation evaluations and credentially) involved because they get nothing out of it yet we take up their time. They just take us in because they feel bad for us---kinda sucks to feel like orphans. Meanwhile, a Caribbean school has a contract with our local teaching hospital.

LOL are you kidding me? Please tell me you are either joking or you go to school in Zimbabwe or something.

If this is happening at an american medical school, your administration is really lowest of the low. There is literally no way this should be tolerated.

So let me again get this straight:

You pay a rip-off fee of $50k+ or whatever highway robbery the scum charge you for tuition
+
You have to pay $1,000 for each ROTATION you do ALONG WITH the scam tuition fee?

L
O
L

The criminality of that is so blatant you have to laugh to keep from crying. Up to me? Your administration would be thrown in prison.

 

[Thought Crime Spree]

Your third year experience was totally unacceptable. Did you ever try talking with your school about this?

I had many months at places not unlike those described by other posters in this thread. When talking with 4th years from other schools while out on auditions and interviews conversation quite often turned to comparing bull$%^& 3rd year clerkships we had suffered through. These experiences seem to be the norm in DO clinical education. I think a list of places (endorsed by 4th years who have actually gone through it) that DON'T farm 3rd years off to craptastic preceptorships and 8 hour days in community hospital cafeterias would be more valuable than exposing those that do. I imagine that list will be quite short.

 

[kenjixshadow]

Well obviously I'm not going to file it right now then.

Or some of us become members of COCA and start changing the policy. However, this means we will have to continue working with those individuals. Nvm, it seems like a bad idea lol. Are we going to file this after graduation?


To @cbrons, you must have missed these threads.
http://forums.studentdoctor.net/threads/rotations-suck-not-learn-anything.986592/

& classic one, nurse (RN) as preceptor for general surgery
http://forums.studentdoctor.net/threads/a-nurse-is-my-preceptor-on-surgery-rotation.872852/

 

[Thought Crime Spree]

I took it the other way, when people kept saying, "The school doesn't pay for rotations."

Have you guys actually shelled out cash for rotations, beyond tuition?

I payed fees for away rotations but that seems to be standard. I rotated with several preceptors 4th year who were not payed for taking me in as a student. They just took me out of the goodness in their hearts I guess. I think that the previous poster was saying that his school doesn't actually pay preceptors for 3rd year rotations, they go out and find docs who are willing to volunteer their time. Contrast this with rotations at a big hospital with quality rotations that wants to be compensated for educating students.

 

[Thought Crime Spree]

Crazy. No, I never payed money for away rotations, nor did anyone from my school that I'm aware of. How much does that cost?

It was $50 - $150, payed fees for all 4 aways I did. Some places charge a lot more. University of Colorado Denver is like 4K for a DO to rotate. Some people pay it apparently...

 

[LostAllHope]

I think that the previous poster was saying that his school doesn't actually pay preceptors for 3rd year rotations, they go out and find docs who are willing to volunteer their time. Contrast this with rotations at a big hospital with quality rotations that wants to be compensated for educating students.

That's exactly what I am saying. Our school WILL find us rotations, only they are subpar. If we decide that we want a better rotation, it would be up to us to set it up. More importantly, my school will not cover any fees associated with the rotation UNLESS we can prove that the rotation being offered is subpar by their standards which is a silly standard. To reiterate, for psych, it was totally acceptable to shadow a psychologist or licensed clinical social worker. For IM, outpatient only was acceptable. I know the DO apologist will argue that medical students should take their education into their own hands and find the best rotations that they can, but to blame the student and not the school is just the easy answer to a much deeper and bigger problem with DO programs.

In summary, the school pockets $45k per student in tuition every year, and the school finds low-quality rotations with "good Samaritan physicians" or non-physicians that will take us in for a month WITHOUT payment. Again, I ask, "Where is my tuition dollar going? What am I getting out of this deal besides paying for a medical degree?"

 

[IslandStyle808]

Crazy. No, I never payed money for away rotations, nor did anyone from my school that I'm aware of. How much does that cost?

It was $50 - $150, payed fees for all 4 aways I did. Some places charge a lot more. University of Colorado Denver is like 4K for a DO to rotate. Some people pay it apparently...

I remember an osteopathic student mentioning this in the past. Osteopathic students have to pay a fee to rotate in an allopathic institution. I have no idea who is charging the fee and why there is one. But 4K is just ridiculous.

 

[DocWinter]

I'm not opposed to school expansion, and no, just because a school is new or newer doesn't mean it is crap. HOWEVER, I am opposed to what is becoming mass production of DOs, and mainly because of residency slots.

Is there any proof, or reasonable belief, that there will be enough residency spots available, or created, to hold the new influx of students? Are those spots stable? From my understanding, the ACGME/AOA merger will allow better students to have more opportunity for prime residency slots, be they DO or MD, and that will probably weaken the IMG footprint here in the US< as they are typically the weaker candidates . However, I'm still not convinced the residency situation will be sufficient to hold the new numbers.
You may have better luck going through SOMA to the AOA, although I'd be glad to sign a petition on this.

 

[petyr_baelish]

Figures. Someone with a cat avatar is concerned about string research.

SDN is slowly turning into reddit.
This, I like this.

 

[futuredoc331]

I'm just fascinated by how much a bunch of 21 year old pre-meds and a handful of med students know about the profession and its governing body.

 

[DocWinter]

I'm just fascinated by how much a bunch of 21 year old pre-meds and a handful of med students know about the profession and its governing body.

Do you have something useful to add to the conversation? That sounds like some demeaning sarcasm.

 

[psych72]

I completely agree with this statement. At the end of my 3rd year, I did not know how to write SOAP notes or how to properly present a patient because 1) I was never given the opportunity to and 2) these old physicians do not even do these things properly themselves so I had no example to learn from. I feared for the worst as I started my 4th year away rotations at teaching hospitals but luckily I wasn't ******ed and was able to adapt quickly before being discovered. Like I said to one poster via PM, my 2 blocks of IM was done outpatient, one with a private nephrologist and the other with a general IM outpatient. I never saw ACS, PE, acute CHF, AKI, AMS, alcohol withdrawal, DVT, ARDS, etc....just some of the very basics of medicine. If it wasn't for my 4th year rotations, my residency program would have been surprised to have such a clueless intern.

Luckily, you had the good sense to do away rotations. I did my away rotations in Psychiatry as thats what I'm going into, but I don't know what's going to happen during my medicine months, I'll be pretty clueless as an intern.

 

[jqueb29]

I'm just fascinated by how much a bunch of 21 year old pre-meds and a handful of med students know about the profession and its governing body.

Pre-meds and medical students are the smartest sub-population in the world. Thus, it should not be surprising that we are knowledgable about this stuff at a young age.

 

[AlteredScale]

I would be enthralled to know if there has been a single DO program set on probation in the last 5 years.

The LCME isn't afraid to be upfront with their schools (Baylor was placed on probation last year) and COCA should do the same.

 

[hallowmann]

I would be enthralled to know if there has been a single DO program set on probation in the last 5 years.

The LCME isn't afraid to be upfront with their schools (Baylor was placed on probation last year) and COCA should do the same.

This may be true now, but prior to 5-7 yrs ago it was a once in a blue moon kind of occurrence that the LCME would put a med school on probation. Now they seemed to have upped their game a bit, and that started with probations being dolled out repeatedly for the last few years (especially 2010-2013).

It's great to choose random characteristics to exemplify areas that need improvement, but simply the act of putting programs on probation is not really a good metric, especially since up until a few years ago COCA requirements were generally pretty lax.

Again, this needs to be a more directed analysis. Discuss the aspects of education that particularly require improvement. Demonstrate that those aspects result in poorer training, or at very least the impression of poorer training by many in the field, then outline requirements that if implemented would solve that problem. I would be very surprised if an organized group of students presented a reasonable analysis with the clear goal of improving DO medical education, and COCA ignored it. As I've stated multiple times, they've actually made some major improvements lately, and if there ever was a time to make big meaningful changes, this is it.

 

[psych72]

I would be enthralled to know if there has been a single DO program set on probation in the last 5 years.

The LCME isn't afraid to be upfront with their schools (Baylor was placed on probation last year) and COCA should do the same.

I'm willing to bet that the ceo's of some of these institutions offer all expense paid trips to coca inspectors when they come for visits you know just to make a "friendly" gesture

 

[NurWollen]

I'm willing to bet that the ceo's of some of these institutions offer all expense paid trips to coca inspectors when they come for visits you know just to make a "friendly" gesture

I always try to maintain a healthy cynicism, and if you could show me some evidence that this is the case, I would be greatly concerned. But to just imagine all the shady things that COCA could be doing and assume that they are doing it is nothing but slander. You can't just make up accusations because they could in theory happen. Again, if you've heard this is the case from somewhere or have evidence or have seen it first hand, please share.

 

[psych72]

I always try to maintain a healthy cynicism, and if you could show me some evidence that this is the case, I would be greatly concerned. But to just imagine all the shady things that COCA could be doing and assume that they are doing it is nothing but slander. You can't just make up accusations because they could in theory happen. Again, if you've heard this is the case from somewhere or have evidence or have seen it first hand, please share.

I dont have evidence, I should have re-phrased that, I was being cynical with the absurd tuition our school charges, this is all theoretical though.

Also, I should have re-phrased it as being, tours of the city of where the school is located, etc.

 

[NurWollen]

I dont have evidence, I should have re-phrased that, I was being cynical with the absurd tuition our school charges, this is all theoretical though.

Also, I should have re-phrased it as being, tours of the city of where the school is located, etc.

True. I mean it's not like they keep COCA reps locked in their hotel rooms. And they probably don't take them to the Olive Garden for dinner either. It's powerful people doing business. You do bring up a good point though. There has to be a line somewhere and I imagine that line isn't necessarily the most well defined line. That's probably true of all accreditation bodies for all sorts of different schools though.

 

[meliora27]

COCA makes site visits to the various COM's. If/when the reps are on your campus, you will know. Go seek them out. Talk with them!

 

[MrChance2]

I don't understand why it would affect anyone personally if new med schools open. It will make residency competitive for future grads which I have a moral issue with as I think 50% of premeds think they will be top 10% but likely the people that don't match wouldn't have gotten in and this doesn't affect you unless you repeat a year. If a student gets into a new school off the wait list then he can always reject the offer and apply to PA if he wants things to be like they would be without new schools.

I don't understand the research thing either. Most grads from top 10-25 schools end up taking private practice jobs in rich suburbs and likely never see a lab bench after medical school or residency. Unfortunately that pays better than research jobs...that needs to be fixed before we start pumping out tons of highly trained researchers that opt not to use their skills and make an extra $100k a year instead.

It does create a 2 tiered system....that patients don't really care about. As a practicing physician how big is the gap in interpretation of a clinical research article on uptodate for someone who has research experience during medical school vs someone who who just attends a few conferences and trys to stay current?

I think there has always been somewhat of a tiered system, partially because the folks in South Dakota don't want to drive 8 hours to The mayo clinic for their Primary care appointments. If they need robotic surgery with a procedure that has been around 6 months then they make the drive. If their primary care doc knows enough to tell them they need to make the drive based on continuing Ed then I don't see who gets hurt, other than in emergent and rare situations but it would cost an INSANE amount to put a Johns Hopkins in range of every ambulance call.

 

[HotLunch96]

I always try to maintain a healthy cynicism, and if you could show me some evidence that this is the case, I would be greatly concerned. But to just imagine all the shady things that COCA could be doing and assume that they are doing it is nothing but slander. You can't just make up accusations because they could in theory happen. Again, if you've heard this is the case from somewhere or have evidence or have seen it first hand, please share.

Libel is a "written defamation". Slander is spoken.

 

[NurWollen]

Libel is a "written defamation". Slander is spoken.

Touche

 

[hallowmann]

Touche

Clearly an important point. If it helps any, when I read your comment I interpreted it as people imagining slanderous things and then saying them.

 

[JGimpel]

Stop applying to the new DO schools/residencies and route your complaints, petitions and rotten tomatoes toward the Secretary of Education and/or AG office and you may get better responses.

http://www2.ed.gov/about/contacts/gen/index.html?src=ft#fraud

I've had great results with many disputes by emailing the state Attorney General's office then following up with a phone call. No reason you can't use the national office to make your complaints known.

http://www.naag.org/naag/committees...ent-education-and-training-fund-committee.php

Don't stop until you have talked with another human being a few times.

If you applied to and/or are in a DO medical school or residency that is less than 5 years old, you're part of the problem. Improve your app and do yourself and everyone a favor by reapplying to established programs next time.

There you have it, a couple emails and a couple phone calls that will work if enough people commit to doing them.

 

[JGimpel]

I remember an osteopathic student mentioning this in the past. Osteopathic students have to pay a fee to rotate in an allopathic institution. I have no idea who is charging the fee and why there is one. But 4K is just ridiculous.

For the costs that the student has to pay for some of their med school rotations, check the AAMC's own link:

https://www.aamc.org/students/medstudents/vsas/

They actually separate the fees you have to pay by whether you're an MD or DO student. No attempt made to hide the bias.

Yale is interesting in that they charge the MD students $150 for a rotation, while the DO students pay nothing!

 

[InterstellarStudent]

For the costs that the student has to pay for some of their med school rotations, check the AAMC's own link:

https://www.aamc.org/students/medstudents/vsas/

They actually separate the fees you have to pay by whether you're an MD or DO student. No attempt made to hide the bias.

Yale is interesting in that they charge the MD students $150 for a rotation, while the DO students pay nothing!

Yale doesn't allow DO students to rotate there according to your link.

 

[IslandStyle808]

Yale doesn't allow DO students to rotate there according to your link.

Interestingly they charge a tuition fee for international students. So does this mean they take international students for elective rotations or something else?

 

[JGimpel]

For the costs that the student has to pay for some of their med school rotations, check the AAMC's own link:

https://www.aamc.org/students/medstudents/vsas/

They actually separate the fees you have to pay by whether you're an MD or DO student. No attempt made to hide the bias.

My error, now fix'd!