The 1910 Initiative

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DO Anes

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I presented the "1910 Initiative" today at the AACOM meeting, discussing the irresponsible growth of DO schools and the danger the for-profit school poses to the profession. My basic points:

1. Schools are increasing class size irresponsibly. Allopathic classes of 300 are unheard of. DO schools as becoming 2 year institutions, followed by apprenticeships.
2. COCA standards are broken. COCA explicitly permits for-profit schools, which are illegal in some states (e.g. Kansas), prohibited by the LCME and do nothing to advance the body of knowledge through research and innovation.
3. Osteopathic GME is broken - only 2000 of 3000 possible slots filled this year. Program directors are woefully inexperienced and would not meet ACGME requirements.
4. Osteopathic CME is broken. By requiring only DO speakers, the AOA greatly hinders the ability to obtain CME.
In response to this, we propose the "1910 Initiative", which calls for:

-A new "Flexner Report", examining the quality of osteopathic education by unbiased, educational professionals.
-A review of COCA standards and examination of board memberships and conflicts of interest.
-A moratorium on all for-profit schools and any school not associated with a traditional university. No more free-standing schools.

If we do not police this profession, someone will do it for us and our patients will suffer. In a time when there are 47 million Americans without health insurance, when we rank 43rd in infant mortality and when medical costs are the leading cause of personal bankruptcy, there is no justification for a for-profit medical school. If we are serious about access, cost and quality, any excess revenue from a school should be rolled back into the school, used to open clinics and hospitals or used to reduce tuition, not to line the pockets of investors.

The talk was incredibly well received and nearly everyone in the room came to me afterward and thanked me for saying what most in osteopathic education are thinking, but are afraid to say. Hopefully our leaders will wake up - with your help. Even if COCA cannot be changed, there is nothing to prevent our leaders from publicly stating:
-I DISAPPROVE!
DOCTORS NOT DOLLARS

George Mychaskiw II, DO, FAAP
[email protected]





n
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DO Anes said:
I presented the "1910 Initiative" today at the AACOM meeting, discussing the irresponsible growth of DO schools and the danger the for-profit school poses to the profession. My basic points:
n
Click to expand...

Its cool that you did that. Hmmm. Interesting stuff, and I'm not liking what all this is saying about the profession I am entering; and not just the for-profit thing. Not sure what to think. I'm feeling pre-sullied. All of the improvements you suggest should have already been in place from the beginning, given the stated philosophy.

BTW, What is the average number of seats at MD schools?
 
toothless rufus said:
Its cool that you did that. Hmmm. Interesting stuff, and I'm not liking what all this is saying about the profession I am entering; and not just the for-profit thing. Not sure what to think. I'm feeling sullied. All of the improvements you suggest should have already been in place from the beginning, given the stated philosophy.

BTW, What is the average number of seats at MD schools?
Click to expand...

I think it varies anywhere from ~35-40 per class at Mayo to Wayne State which has ~300. I think most will have around ~150-170 per class.
 
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HarveyCushing said:
I think it varies anywhere from ~35-40 per class at Mayo to Wayne State which has ~300. I think most will have around ~150-170 per class.
Click to expand...

Thanks! Wow, 35-40! That's a small class! I think 150 oughta top it out. Seems like gigantic class sizes might affect education on some level; I don't know. It will at least make it seem a little more impersonal, maybe? Guess I'll find out in my class of 250! :p
 
toothless rufus said:
Thanks! Wow, 35-40! That's a small class! I think 150 oughta top it out. Seems like gigantic class sizes might affect education on some level; I don't know. It will at least make it seem a little more impersonal, maybe? Guess I'll find out in my class of 250! :p
Click to expand...

Yeah I agree. My school also has 250. I wish they had a smaller class size, but from current students they have said that you won't really notice the size of the class.
 
actually having a large class can be somewhat beneficial since you have several personalities from which to choose your circle of friends. i thought my class of 180 was too big but 250....wowza. at least its helping the shortage. as for the Rocky Vista, the whole premise is ridiculous. its great that you guys are fighting this. we def need more docs but "for-profit" education is not a sacrfice that should be made
 
DO Anes said:
I presented the "1910 Initiative" today at the AACOM meeting, discussing the irresponsible growth of DO schools and the danger the for-profit school poses to the profession. My basic points:

1. Schools are increasing class size irresponsibly. Allopathic classes of 300 are unheard of. DO schools as becoming 2 year institutions, followed by apprenticeships.
2. COCA standards are broken. COCA explicitly permits for-profit schools, which are illegal in some states (e.g. Kansas), prohibited by the LCME and do nothing to advance the body of knowledge through research and innovation.
3. Osteopathic GME is broken - only 2000 of 3000 possible slots filled this year. Program directors are woefully inexperienced and would not meet ACGME requirements.
4. Osteopathic CME is broken. By requiring only DO speakers, the AOA greatly hinders the ability to obtain CME.
In response to this, we propose the "1910 Initiative", which calls for:

-A new "Flexner Report", examining the quality of osteopathic education by unbiased, educational professionals.
-A review of COCA standards and examination of board memberships and conflicts of interest.
-A moratorium on all for-profit schools and any school not associated with a traditional university. No more free-standing schools.

If we do not police this profession, someone will do it for us and our patients will suffer. In a time when there are 47 million Americans without health insurance, when we rank 43rd in infant mortality and when medical costs are the leading cause of personal bankruptcy, there is no justification for a for-profit medical school. If we are serious about access, cost and quality, any excess revenue from a school should be rolled back into the school, used to open clinics and hospitals or used to reduce tuition, not to line the pockets of investors.

The talk was incredibly well received and nearly everyone in the room came to me afterward and thanked me for saying what most in osteopathic education are thinking, but are afraid to say. Hopefully our leaders will wake up - with your help. Even if COCA cannot be changed, there is nothing to prevent our leaders from publicly stating:
-I DISAPPROVE!
DOCTORS NOT DOLLARS

George Mychaskiw II, DO, FAAP
[email protected]

n
Click to expand...

Agree completely. Where do I sign? Thank you for your efforts to better our profession. I would be interested to hear if any of the current regime in power in the AOA made any remarks to you about your ideas? Dr. Ajluni, Dr. Opipari (who seems so upset about your article in the JAOA last year), etc... I know you've had a lot of support from the field, it seems most of the resistance (as usual) is from the AOA.

Maybe we can get this done. Again, thank you for leading the way!



Vizsla said:
actually having a large class can be somewhat beneficial since you have several personalities from which to choose your circle of friends. i thought my class of 180 was too big but 250....wowza. at least its helping the shortage. as for the Rocky Vista, the whole premise is ridiculous. its great that you guys are fighting this. we def need more docs but "for-profit" education is not a sacrfice that should be made
Click to expand...

I graduated in a class of 128 - increased during 4th year from 123 by OPP fellows who joined our class. This is one of the few D.O. public schools.

I realize the Osteopathic profession feels the need to expand, and I respect and admire that. However, it must be done responsibly. 300-400 class sizes and schools popping up all over the place are not the way to do it.

Someone posted on another thread - it may have been the "Help save the profession" thread that DO Anes started earlier this week - that new schools should have large endowments and meet other requirements before they can be considered for accreditation. Also agree COCA should disallow for-profit schools and should require schools to be affiliated with a university. And please GOD no more branch campuses - how many Touro campuses are there going to be?

jd
 
Well said DO Anes, however, i'm afraid that there's too much money involved for those for-profit schools to sit back and stop trying... it's a shame because I agree with you completely, but unfortunetly this appears to be the case. Money talks in our country.
 
I agree with most of your points.

I take issue with one... that all DO schools be affiliated with universities. PCOM is a free-standing DO school and widely regarded as one of the soundest DO programs, yet you would categorize PCOM as a failed institution?

Same goes for NYCOM, CCOM ("Midwestern University" isn't really a major university), Western-COMP...etc
 
MaximusD said:
I agree with most of your points.

I take issue with one... that all DO schools be affiliated with universities. PCOM is a free-standing DO school and widely regarded as one of the soundest DO programs, yet you would categorize PCOM as a failed institution?

Same goes for NYCOM, CCOM ("Midwestern University" isn't really a major university), Western-COMP...etc
Click to expand...

I agree with MaximusD on this point. There are free-standing institutions that are not affiliated with, or are part of a major university in the allopathic realm as well- institutions which produce competent and capable physicians. Off the top of my head are NYMC in Valhalla, NY and Meharry Medical College in Nashville, TN. That being said, I agree with most of the points made on the 1910 intitiative.
 
MaximusD said:
I agree with most of your points.

I take issue with one... that all DO schools be affiliated with universities. PCOM is a free-standing DO school and widely regarded as one of the soundest DO programs, yet you would categorize PCOM as a failed institution?

Same goes for NYCOM, CCOM ("Midwestern University" isn't really a major university), Western-COMP...etc
Click to expand...

Well, only 3 of the current DO schools are University affiliated. The other 20 seem to be doing okay. But I ageree that it might be better to be university affiliated, especially if that institution has it's own hospitals. It might put an end to traveling evey 6 months/1yr for clinicals. Although most of those places already have medical schools. Overall, it would allow DO schools to have the support and resources of a big institution.
 
Are FMGs allowed to match in unused DO residnecy slots or do they just go unfilled every year?
 
What he said is no new free-standing schools. Clearly PCOM and CCOM are two of the oldest osteopathic schools and nobody would suggest their closure.
 
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MacGyver said:
Are FMGs allowed to match in unused DO residnecy slots or do they just go unfilled every year?
Click to expand...

Possible if the program is dually AOA-ACGME certified. No if it's only AOA certified.
 
Interesting information, glad somebody finally said something, it is about time. These were many of my concerns and I am glad that fortunately I was able to transfer to an MD school where I don't have to worry about things like this. I still have many friends at DO schools and I honeslty hope that the AOA can pull their heads out and start doing things that are good for the profession, and not just for themselves. The old boys club has got to end!
 
GreenShirt said:
Well, only 3 of the current DO schools are University affiliated.
Click to expand...

What do you consider the three?

-MSU?
-Ohio University?
-Oklahoma State?
-University of New England?
-Lincoln Memorial University?
-Nova Southeastern University?

It could be easily argued that there are more than 3 schools affiliated with a university entity.
 
This is some more detail about the talk at COCA that I sent to the Michigan Society to fill them in:

My colleagues:
I presented this issue at AACOM yesterday. It was a very well attended session and I was stunned at the response. I discussed the issues at length and following the session I was mobbed by people saying basically, "Thank you for speaking out and saying what we have all been wanting to say!" The audience was composed of professional educators from the various schools (except Rocky Vista). Robert Juhasz from AOA attended and gave the AOA party line about accreditation, etc. I responded that, in an era when 47 million Americans have no health insurance, when we rank 43rd in infant mortality, when the leading cause of personal bankruptcy are medical bills and when 16% of the GDP is devoted to healthcare, the operation of a for-profit medical school is indefensible. If this profession is serious about access, cost and quality, there is no justification for excess revenue from a medical school to go into the pockets of a Florida investor. The other AOA response was, "even though the LCME prohibits for-profit MD schools, it would not stand up in court as a restraint of trade." My question then was, "so why didn't the Rocky Vista group open an MD school instead?" You know why, the AMA and MD's would fight it tooth and nail and try the case in the court of public opinion. We, on the other hand, approve the school and members of the Colorado Osteopathic Society have been placed on its board of directors. Conflicts of interest are just the tip of this unethical iceberg.
It may very well be true that, based on COCA standards, the school must be accredited. There is nothing, however, to prevent us as physicians and the leadership of the AOA from publicly stating their disapproval. Will the House of Delegates show this leadership as well? The resolution says nothing about restricting the school, it merely says that we disapprove of the use of medical education as a profit machine for investors.
I DISAPPROVE!
DOCTORS NOT DOLLARS.
I hope you can help in this. Ohio struck out after push back from the AOA hierarchy. Please help me be proud of this profession.
Fraternally,
George
 
I did mean no NEW free standing schools. Virginia, Harrowgate and others are doing the right thing by affiliation with traditional universities. CCOM and the older free standing schools are from a different era of education and university affiliation. No one questions their high quality. The "Rocky Vista University College of Osteopathic Medicine" is just word play designed to fool the unaware.
 
DO Anes said:
This is some more detail about the talk at COCA that I sent to the Michigan Society to fill them in:

My colleagues:
I presented this issue at AACOM yesterday. It was a very well attended session and I was stunned at the response. I discussed the issues at length and following the session I was mobbed by people saying basically, "Thank you for speaking out and saying what we have all been wanting to say!" The audience was composed of professional educators from the various schools (except Rocky Vista). Robert Juhasz from AOA attended and gave the AOA party line about accreditation, etc. I responded that, in an era when 47 million Americans have no health insurance, when we rank 43rd in infant mortality, when the leading cause of personal bankruptcy are medical bills and when 16% of the GDP is devoted to healthcare, the operation of a for-profit medical school is indefensible. If this profession is serious about access, cost and quality, there is no justification for excess revenue from a medical school to go into the pockets of a Florida investor. The other AOA response was, "even though the LCME prohibits for-profit MD schools, it would not stand up in court as a restraint of trade." My question then was, "so why didn't the Rocky Vista group open an MD school instead?" You know why, the AMA and MD's would fight it tooth and nail and try the case in the court of public opinion. We, on the other hand, approve the school and members of the Colorado Osteopathic Society have been placed on its board of directors. Conflicts of interest are just the tip of this unethical iceberg.
It may very well be true that, based on COCA standards, the school must be accredited. There is nothing, however, to prevent us as physicians and the leadership of the AOA from publicly stating their disapproval. Will the House of Delegates show this leadership as well? The resolution says nothing about restricting the school, it merely says that we disapprove of the use of medical education as a profit machine for investors.
I DISAPPROVE!
DOCTORS NOT DOLLARS.
I hope you can help in this. Ohio struck out after push back from the AOA hierarchy. Please help me be proud of this profession.
Fraternally,
George
Click to expand...



I agree 100%. I wish that I had some authority in stating the same sentiments and that the AOA/COCA would take us seriously. This is a huge issue and could possibly effect the direction that osteopathic medicine takes in the future. I wish that Rocky Vista would fail miserably, but I know that being the second med-school in CO will allow them to fill each class. I wish the AOA/COCA could change their mind and stop this before it goes to far. But as we know, that is highly unlikely.
 
Do you think the new school in Mesa (a branch from KCOM) which has a class of only 100 students and is a part of a private University...same campus as a PA, Dentistry, and Physical Therapy is headed in the right direction?
 
Interesting.


I was just speaking with an MD yesterday who told me that he would like to see more DOs at the larger CME courses and conferences, but they dont attend.

Why?

Because the AOA wont give these DOs credit for those events because there arent enough DOs teaching or presenting.

Give me a break. :rolleyes:

The AOA wants us to have the highest quality education possible...as long as they control the program we train in. As soon as we want to step outside the mold...go to an ACGME program or an ACGME sponsored CME course or conference, the AOA looks at us like we're traitors.

Im going to do what is best for my career, but Im not totally convinced the AOA wants the same.

They want my dues. They want my attendance at their events. Hell, they even want me to donate money and promote osteopathy.

What are they going to do for me?

Refuse to give me CME credit because the guy teaching the course isnt a DO.

Thank you AOA...thats how you gain my loyalty. :thumbdown:
 
DO Anes said:
The talk was incredibly well received and nearly everyone in the room came to me afterward and thanked me for saying what most in osteopathic education are thinking, but are afraid to say. Hopefully our leaders will wake up - with your help. Even if COCA cannot be changed, there is nothing to prevent our leaders from publicly stating:


George Mychaskiw II, DO, FAAP
[email protected]
Click to expand...


Dr Mychaskiw,

I agree with you almost completely, and I'm sure you will find just as many on SDN who agree as you did at the confrence. But for those who have no idea how to help push & promote your Initiative through AACOM and perhaps something similar through the AOA, perhaps you could tell them who they can call and how they can make their voice heard. And what further steps can be taken to help further improve the Osteopathic world.

We need some sort of grassroots movement to help advocate for change and to spread the word that the status quo is not working


Jayne D.O.
 
JayneCobb said:
But for those who have no idea how to help push & promote your Initiative through AACOM and perhaps something similar through the AOA, perhaps you could tell them who they can call and how they can make their voice heard. And what further steps can be taken to help further improve the Osteopathic world.

We need some sort of grassroots movement to help advocate for change and to spread the word that the status quo is not working
Click to expand...

:thumbup: As a lowly med-student, I would like to know what I need to do to get involved and have my voice heard.
 
Uncontrolled proliferation of new medical schools is not the best way to promote osteopathic profession. I think what we need to do is to start creating more osteopathic hospitals and let our action speak for our profession.
 
Doc2007 said:
Uncontrolled proliferation of new medical schools is not the best way to promote osteopathic profession. I think what we need to do is to start creating more osteopathic hospitals and let our action speak for our profession.
Click to expand...

Creating hospitals is no small feet, and probably fiscally irresponsible given the massive hospital closings this country has seen in the last 10 years. But we could do much more to create stronger opti's and to strengthening our residencies.

I view the AOA's mandates on many things as truly counterproductive to bettering our profession. As JP has already pointed out, the lunacy with the CME credits. But beyond that, the licensing and recognizing of specialists who go through ACGME programs. We shouldn't segregate and forsake them. we should keep them in the fold and allow them to help better our ranks, bring in new ideas, and otherwise push us to better ourselves. As small as a group as we Osteopathic physicians are, we could easily become intellectually inbred and so dilute our knowledge base that we will eventually marginalize ourselves without any help from the AMA.
 
What about forcing all schools to be accredited by the LCME. Yeah there are some bad LCME schools but not like Osteopathic schools.
 
Mixmaster said:
What about forcing all schools to be accredited by the LCME. Yeah there are some bad LCME schools but not like Osteopathic schools.
Click to expand...

what is an example of a bad LCME school?
 
MaximusD said:
I agree with most of your points.

I take issue with one... that all DO schools be affiliated with universities. PCOM is a free-standing DO school and widely regarded as one of the soundest DO programs, yet you would categorize PCOM as a failed institution?

Same goes for NYCOM, CCOM ("Midwestern University" isn't really a major university), Western-COMP...etc
Click to expand...
NYCOM is part of NYIT, which is a university.
 
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