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A good read for the rest of you as well!!!!

Discussion in 'Medical Students - DO' started by libbuser, May 27, 2001.

  1. libbuser

    libbuser Member

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    If your confused: this was a reply to someone in the forum "UHS vs. KCOM". I think this applies to many other people as well.

    You discuss in your posts about how osteopathic hospitals are sub-par in comparision to clinical training received at "university" based Allopathic Hospitals. You inaccurately state that osteopathic training is not good simply based on the fact that they don't have major University based training hospitals of their own.

    Fact #1: Most osteopathic residency training sites aren't "university" based, rather "community based".
    Fact #2: Likewise, most allopathic residency training sites AREN'T "university" based, rather "community based".

    So, what is your point??? Most allopathic programs aren't university based either??? If you wanted to go to a big, major, more prestigous (in your view, "better") "university based hospital", then you should have gotten into one of those medical schools from the beginning.

    Your right, they are different programs, and offer many advantages (but also disadvantages in my view). Your perception should be that "University" training is better than "Community" hospital training. That is a fair argument, and is both debatable and a big decision to make. You state many of them: having contact with more clinical faculty/residents etc, broader experiences and exposure, better didactics, exposure to newer treatments/technology (hardly could a community based system put together a strong didactic program). But, for each one of the advantages at a university program, I could state just as many disadvantages or advantages by going to a community hospital: less competition for procedures (1st assist in surgery), less traffic as to spend more time with mentors/patients, more exposure to primary care opportunities, etc, etc.

    That decision is entirely a personal choice and view, depending on what "type" of physician you want to become, or what "type" of person you are, what environement you learn best in. But, it is entirely unacceptable to simply state that osteopathic clinical training sucks because they aren't University based.

    You should be honest then, Osteopathic Medicine isn't in line with your goals and dreams. But, the osteopathic establishment doesn't boast anything they don't offer. They boast primary care primarily, holisitic opportunities to become the BEST primary care physician you can become. And they deliver on that promise!!

    It does not negate osteopathic medicine because we don't boast huge 500+ bed teaching hospitals as opportunites for training. Osteopathic medicine, in line with its philosophy and teaching, strongly desires to produce community based, primary care physicians. Or, specialist' that will go out and practice community medicine, with a primary care appreciation. That is our primary goal, #1. Further, many programs want to produce rural, primary care physicians. Your not going to be seeing many opportunities with major university-based hospitals with that kind of perspective. That is the osteopathic tradition.

    I am sick and tired of osteopathic students getting into the profession, and then wanting to go to BIG, "Major Medical Centers" to do training. Well, folks, osteopathic medicine never promised that, and never will. That is not the goal of osteopathic medicine!!!!!! Rather, you should have worked harder at getting into a "university based medical school from the beginning" if that is what you wanted.

    But, don't sit here and be unhappy because the osteopathic profession doesn't offer that to you. The osteopathic profession doesn't have to, because it is not in our interest.

    You should have done research on that prior to matriculating then if you didn't like the opportunities available. MOST osteopathic students are happy with their training, it fits their personality, goals, futures, and dreams.

    Peace!
     
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  3. Kent Ray

    Kent Ray Member

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    libbuser,
    I am not sure but, the post you are refering to was more than likely produced by my hands. I have one question for you. Are you a resident yet? If not I forgive your ignorance but if you are, well you are entitiled to your own oppinion.
    First of all I am well versed in how post graduate Osteopathic and Alopathic medicine works. Private community Osteopathic hospitals are horrible places to recieve your education. This, in my opionion is universal. I don't know of any Osteopathic community hospitals who have dedicated faculty. How many do research? How many of the attendings are up on the very latest medical knowledge? These attendings dont have time to teach, they are in the office all day and have 30min rounds. Tell me how much will you learn?
    So lets do some comparisons of different programs. Lets take two Osteopathic programs and two Allopathic programs. By the way I am going to the University of Iowa, thank God!

    Bi county community hospital. This is a small hospital in Warren, Michigan. We have decent morning and noon lectures. No teaching rounds on any service. I have been on every service in the hospital including surgery, Ob/Gyn, ER, Neuro surg, IM, ICU, ... The only rotation worth your time was ICU. This rotation was not even that great. It was a 10 bed ICU but evidence based medicine was not practiced. I did not see one person monitored with A Swan the entire month. On medicine you round on all your patients in the morining set in the morning then set in the library half the day until your attending is done in the office. After you spend as little time as possible rounding. If you get one 10min teaching session a week you are lucky. Lets look at call nights. Bi county is a 200 bed hospital full most of the time. You have two interns covering 100 patients each. Most of the time you will have from 5 to 10 admits a night. There have been many nights where I was handling several people with AMI or PE, or shock on the floor while being called every 10 min for other stuff and admissions. Their are no caps on admissions and no follow up on the admissions you did. Realistically you are their to make the attendings life more relaxed.
    Mt Clemens General. Slightly larger and nicer hospital than bi county. Programs are the same as far as education.
    Henry Ford. 901 bed allopathic hospital. I have also done over 12 mo of rotations here. During medicine rotations you are assigned to a floor not an attending. Most of the time three interns and one resident are covering 12-15 patients. Morning and noon lectures are given by research leaders and I have to say they are much more informative than lectures given at bicounty. Each day you round on your patients in the morning. The attending will round around 0900. These are teaching rounds and last about 2hrs. You are allowed to second guess your attending, matter of fact you are encouraged to as long as you can back your argument up with researched material. Mandated by the allopathic internal medicine board each resident and intern must receive 4.5 hrs of non rounding teaching every week. This means that every monday-thursday at 2:00 we have 1-1.5 hrs of teaching consisting of one attending, two residents and six interns. Here we present a patient in a group and go over the H&P. We then go to the bedside and perform a proper physical exam. Lastly we talk about proper treatment and current lit. supporting this treatment. Henry Ford has one of the best call scheduals of any hosptial I have been to. The internal medicine residents only have two services where the have to stay overnight, general medicine floor, and all ICU rotations. The rest of the rotations such as nephrology, infectious dz, cardiology all have night float that will take over at 10pm the nights you are on call. No intern is allowed more than five admissions in one day. If a resident is supervising three interns, that resident is only allowed to supervise upto 12 admissions. Almost all the procedures, more than twenty central lines this year, I have done at Henry Ford.
    University of Iowa. Same as Henry Ford but more vigorous call schedual and more didactics.
    What I am saying to you is the old way of teaching in the Osteopathic community is almost laughable, a detriment to the residents, and I would say harmful to the patients (I can explain in another post).
    When I accepted admission to DMU, they promised me an education. I took that at face value and told myself that it would be just as good as allopathic education. Well they delivered in the first two years but failed in the last two.
    As far as post grad Osteopathic education, all I can say is I am out!
    I understand your strong feelings toward this type of post. Let me tell you that if you don't feel the same way when you are done then you are in the minority.
    I agree that small community hospitals would be a good place for maybe FP only if they were provided with clinical faculty that had the time to teach. How can you have a surgery program that has no more than 30 operations a month. How about ER with absolutely no teaching what so ever. Or neurosurgery with one old man who has not read anything for twenty years. Think about it, I think it is time to change things.
     
  4. Popoy

    Popoy SDN Super Moderator

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    Kent Ray, strikes again!!!.... :D

    I've followed your postings in this forum for a long time now, or at least, you're old postings before I became a member. Others have welcomed it and others do not. I'm glad you're in UofI and hope things go well for you in the future.

    Thanks for the informative comparison and warning, as always. I'll keep these things in mind as I will be attending DMU next year.... We'll see if we share the same opinion about things come my 3rd and 4th year.

    Much appreciated, Popoy :cool:
     
  5. libbuser

    libbuser Member

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    Hey Kent,

    Thanks for your reply. I agree with you to an extent. There are some big differences between a larger, university based hospital system vs. a community based hospital system. I think your glorification of large hospital programs is open for interpretation. It is all relative to your stated goals and future. That environment does not necessarily produce "better" physicians, or the physicians in which the osteopathic community is trying to create.

    The fact is, most American hospitals out there are "community based hospitals". Only around the major cities are the "larger", and yes more prestigious "academically" based hospitals. In the US, MOST MD's and DO's alike are actually practicing out of community based hospital systems. Osteopathic medicine's philosophy and values have always been in line with physicians practicing community based medicine. There is no shame in a profession striving to produce primarily primary care docs, with the intention that most of us will practice in community health centers. That is the primary goal of osteopathic medicine. That is no secret. You should have known that prior to matriculation. In fact, most of us osteopathic physicians are going into Family Practice. But, if you don't want primary care medicine, yes, you will have to find alternative choices for residency. And, you have no restriction on you. Go for it! But, don't turn around and tell the rest of us that community based suck, and that they are doing terrible work. These hospitals are actually very crucial for the american public health. We can't have all centers operating like Henry Ford in Detroit.

    Of course, at a larger hospital, academic center (whatever you want to call it), they are going to have better organization, better research, exposure to the newest treatments, better didactics. That is what they are there for. How could a community based hospital compete with that?? There is no way!! There should really be no comparison. Most hospitals in the US couldn't provide those experiences for students. The point is, though, that most of us won't be practicing in those centers for the rest of our lives anyways. We will be at community hospitals, doing very important community medicine, which is the aspect of medicine that needs MORE PHYSICIANS. All of the newly proposed osteopathic medical schools are located primarily in areas that need MORE osteopathic physicians practicing primary care. Period.

    Osteopathic medicine is thus unique in that way. That is appealing to most of us, that is why we have choosen osteopathic medicine. But, there is always those few that go into osteopathic medicine thinking they are going to have all the same opportunities as our allopathic counterparts have. NOT TRUE!! That is not to say you can't go that route. You have that choice as a DO, arguably you have more choices as any MD out there. Seriously!! If you as a DO want to practice in a larger, suburban hospital setting, go for it. There are absolutely NO restrictions on you. I agree with you, community based hospitals are just note equipped to give the training necessary to practice that type of medicine. But, that is a different type of medicine, not BETTER THOUGH. Osteopathic medical schools curriculums aren't concerned with training physicians in the larger, academic institutions. Allopathic programs are handling that just fine. If you wanted that route, you should have went that route then!!!!

    The practice of medicine is different there. So you can't compare necessarily your experiences between hospital "types". It is all relevent to what your future goals are. You have control over that. But, osteopathic medicine, regardless, is better equipped to fill this country with BETTER primary care physicians. That is our goal and and mission.

    You don't produce community based physicians by sending them predominantly to large, academic centers. Just as much as you don't produce future research and academic physicians to smaller community based hospitals. Pick your choice as a DO. But, please recognize that our wonderful allopathic programs and the FEW DO, and IMG grads filling those programs are enough. But, it is no skin of those that DON'T want to practice in those facilities.
     
  6. Popoy

    Popoy SDN Super Moderator

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    libbuser,

    This has been a great issue with Kent Ray for a long period now. He provoked the students of DMU to write issues on curriculum, dean, rotations, etc. Kent, if you're reading this, which you probably will be, see the current Innominator (DMU's newsletter) and you'll see that there is a bit of heated debates about the issues you've put for before about DMU.... Something is being done about it....

    libbuser, nice backing on your arguments and I'm more like yourself than Kent there.

    Kent's experience is that of one person and like everything else in this forum, should be taken with a grain of salt.

    libbuser, these past few posting of yours has been truly helpful, informative, and a wonderful perspective on the pursuit in the osteopathic profession. Thanks for the insight.... Popoy :cool:
     
  7. Hippocrates

    Hippocrates Member

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    To libbuser

    What makes you an advocate of the Ostepathic profession? It sounds like you want to impose your beliefs on the rest of the Osteopathic professionals. With all respect, I don't like that.

    Samir
    CCOM 2005
     
  8. libbuser

    libbuser Member

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    My gosh. I would hope that we all would be advocates of osteopathic medicine!!! Your not?!!??!!

    I am not imposing my views on anyone! I am defending osteopathic medicine for what it is, and what it is not!! Yes, I am an advocate of osteopathic medicine, why aren't you???

    Not sure where you are coming from with your comment??
     
  9. Popoy

    Popoy SDN Super Moderator

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    I have to go with libbuser on this one....

    As a future osteopathic physician, I see myself as an advocate for the growth of the profession.... As libbuser has stated... I'm also not sure were you're comments are coming from Samir?!

    If you read libbuser's postings, there is no imposing of beliefs or ideas in the post.... This is where Kent's previous postings in other trends have also been misunderstood. The point of the post was to inform and make aware of what is happening in their own experiences, NOT imposing of ideas.

    The postings thus far have been professional in manner, I think. I personally like reading long postings such as Kent Rays and libbuser because such things have been thought out, at least I hope so. No matter whether or not these issues are what I believe in or not, I think it should be presented for others to see. TO know what others have gone through in order for others to be wary about what they might experience throughout their education.

    libbuser, I can see is an advocate of osteopathic medicine. I think everyone has different levels of advocacy for osteopathic medicine. As you have stated before, "you don't like it." Then, how much of an advocate are you of osteopathic medicine? Just wonderin' because you are "CCOM 2005." You must have experience something positive that made you pursue osteopathic medicine.

    I mean this post not to attack you, Samir, but to find out what exactly in the post did you think was an imposition of an idea....

    Later peeps.... :cool:
     
  10. mj

    mj Senior Member

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    Actually, Popoy, Lib's original post wasn't in reference to Kent and DMU at all, but rather to the UHS issue that can be found Here:

    Lib claims in those post that it must only be UHS where students are unhappy with their clinicals. Interesting that Kent has the SAME issue from a different school. How are things at Nova these days, I wonder? I recall seeing the SAME issues voiced about those clinicals by various students...

    Lib wants us to believe that the unhappiness of the students who present this side of the coin is all self induced -- they chose the wrong program for what they want to do.

    My questions for Lib would be what about the other 30% or so DO students who won't go into primary care? Do DO schools not have any responsibility for their training because it "doesn't fit with the osteopathic philosophy"?

    What about the primary care physicians-to-be who just want to be taught well? The main complaint of those who are complaining seems to be that they AREN'T BEING TAUGHT.

    Not that the hospitals are too small
    Not that they want to be in more prestigious places
    Not that they want to see rare medical procedures
    Not that they want to be the worlds greatest neurosurgeon
    Not that they want to be more like the MDs -- which are the issues that Lib seems to want to debate.

    But that they want to be the best PHYSCIANS they can be and that osteopathic clinical education is failing to meet that BASIC need.

    Lib said "You don't produce community based physicians by sending them predominantly to large, academic centers." And I don't think anyone -- those who are calling for reform included -- would disagree.

    But Popoy, you don't create the best of breed community based physician by sending them to a community based program and NOT TEACHING them, NOT giving them access to clinical faculty with TIME and MOTIVATION to teach, NOT making them feel supported by their institution...

    I have no doubt that osteo ed. has a lot of bright spots. Again, I don't think any of the "disgruntled" would disagree. What I don't understand is why Lib thinks that makes it OK not to improve in the obvious area where it needs work.

    Does the clinical education at most DO schools prepare someone well enough to be a FP at a community hospital? It sounds like they probably do OK most the time. Is that what "your profession" is striving for Lib -- mediocrity?

    Where is the drive for excellence?

    mj
     
  11. Popoy

    Popoy SDN Super Moderator

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    Thanks mj....
     
  12. prolixless

    prolixless Senior Member

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    mj,
    you and other's recognize the general deficiencies in osteopathic clinical education and I think it's important to be realistic about what's going on rather than to live in denial. But I think you guys are dancing around the crux of libbuser's point. The point is that these deficiencies in clinical education are not unique to osteopathic education. They are very prevalent in the allopathic education too. So it doesn't make sense to try and neatly make this a DO training versus MD training issue. It makes more sense to make this a community hospital versus university hospital issue.

    Now, if you and others want to defend that even allopathic training at community hospitals is better than osteopathic training at community hospitals, then you will actually be confronting the crux of libbuser's argument.
     
  13. "Is that what "your profession" is striving for Lib -- mediocrity?"

    "But that they want to be the best PHYSCIANS they can be and that osteopathic clinical education is failing to meet that BASIC need."

    MJ:

    Are you just looking to create more problems again? :) Your question is diguised as a comment that osteopathic medicine is mediocre.

    I agree with proxiless, this is a community based programs vs. academic based programs issue. Why are you trying to make it out to be a M.D. vs. D.O. issue?

    There are several allopathic programs that are community based too. In fact, there are probably more allopathic programs that are community based rather than based at a large university hospital.

    Besides, it is your residency that teaches you what you need to learn for your specialty. I am very familiar with the medical schools in Ca and the hospitals they rotate through. I have rotated through several types of hospitals myself. The training at a large academic center isn't necessarily better for a medical student. Often at these really large academic centers, the medical student is lost in the shuffle. They also get very little hands-on experience. I think you need a good blend of both. Also, if your school doesn't have the type of experience that you want, you do electives. That's what electives are for. Many of the students from my school wound up getting residencies in Academic Centers. That appeared to be the case for CCOM and AZCOM too. Obviously, these large allopathic centers didn't have problems with our training. I'm not sure why a pre-med would know all these things that a residency director doesn't

    Bear in mind that a few poster from SDN does not represent the whole D.O. community. You should know better than that. It is often the ones that do have problems that take the time to voice their concerns. The ones who are happy usually have very little to say and just go about their business. I could make the argument that since there are maybe at most ten people in the whole community complaining, that everything must be going well. There are people who complain at every level and at every school.

    Do not make generalizations about all schools based upon a few posters on SDN. Unless you have personally surveyed the rotations of every single D.O. school, I think you should limit your comments to what you have experienced (which is nothing yet).

    My opinion is that you know very little about what medical education is like yet you seem to make the broadest generalizations.
     
  14. UHS03

    UHS03 Senior Member

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    I do not think the crux of the argument is academic vs. community hospitals. There are many community hospitals which offer great experiences to students. "Large" hospital does not mean university hospital..it just means a large hospital. The fact of the matter is that out of all the hospitals osteopathic students can go to for their required rotations, far too many of them are tiny community hospitals that are surrounded by much larger and better equipped hospitals. Which do you think the patients and tough cases go to? I agree that a good education can be had at both university and community hospitals, but there is so much variety between community hospitals that you never know what you're gonna get (like a box of chocolates.) Now, if the 150 bed hospital was out in the middle of no where, and therefore had a very large patient population to itself, then I would argue that you will get to see a wide variety of pathology and a lot of hands-on experience. What I don't understand is why I would want to go to a 150 bed hospital in the middle of a metropolitan area, when almost all the interesting cases are going elsewhere.
     
  15. Sorry, it's late over here. I meant Community vs. University.
     
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  17. In my class, a few of the students used to complain too. This rotation isn't as good as Stanford's, we need more of this, etc. By the fourth year, you realize that you did learn all you needed to know. All those students shined at Stanford, UCSF, etc. during their fourth year and matched there too.
     
  18. libbuser

    libbuser Member

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    The point is that these deficiencies in clinical education are not unique to osteopathic education. They are very prevalent in the allopathic education too. So it doesn't make sense to try and neatly make this a DO training versus MD training issue. It makes more sense to make this a community hospital versus university hospital issue.

    THANK YOU PROLIXLESS!!!

    That is exactly my position. I agree with all of you that medical education is facing some serious issues. I am not for mediocrity and get frustrated with the same educational issues as you. But, prolixless is right, this debate quickly went to an osteopathic vs allopathic issue. If you think for a minute that allopathic medicine has a "better" system, then you really haven't looked at allopathic medicine as a whole. They have the same issues, the same problems. We aren't unique.

    I think training at community based hospitals will continue to be vital for osteopathic training, specifically years III & IV. Yes, the pathology will be more diverse, the didactics more organized and prestigous, the entire system somewhat more organized at a larger hospital. They have the staff, the resources to put together a better package. That is one of the benefits of a larger hospital, yes. But, there are honest disadvantages. There are bright spots in community hospital training as well, and disadvantages if your honest.

    Read Dr. Iserson's "Getting into a Residency", an expert who discusses some of those issues.

    In Detroit, Riverview Osteopathic, Riverside Osteopathic, Garden City Osteopathic, Botsford Osteopathic, & Genesys Regional are all "community" hospitals that are thriving. Ask the students there once what they think of there "community" hospital experience. There are many others, including Ohio, Arizona, Colorado, Utah. The AOA will be announcing soon the addition of many new residency programs.

    To think that the osteopathic profession is striving for mediocrity as a whole is ridiculous!! I find that osteopathic physicians in general are wonderful teachers. We love our profession, and want to share it with others.

    Face it and be honest. The osteopathic profession is PRIMARILY striving to produce solid, PRIMARY CARE PHYSICIANS. That is not debatable. I know of many students that want to be orthopedic surgeons, cardiovascular surgeons, etc. Anyways, they are much more critical of their base hospital rotations, simply because they are spending most of there time in "primary care". They are obviously biased, because they have no interest in primary care, thus the "community" hospital in there view sucks. It is not fair to generalize like that.

    I don't think we should be trying to advance osteopathic medicine into other specialities. We have found our niche in training in my view, quality primary care physicians. It is not in our best interest to be keeping the other "30%" that choose other specialities happy. After med school, there are there are plenty of programs out there (yes, few of them osteopathic) to keep you happy. To think that the osteopathic profession could stimulate and be successful in creating more of those programs is ridiculous. We couldn't support that!! Gee whiz, our medical schools are filled with students in which over 70% of us WANT primary care.

    Community hospitals are integral to the osteopathic profession. That is where MOST allopathic and osteopathic physicians practice. Be for real, there are really only a handful of major hospitals out there, mostly all located in major metropolitan areas. So, as a DO, you have many choices for your residency to attend one of those fine institutions.

    I guess to sum up my point: if you are a medical student (doesn't matter if your osteo or allo) that trained predominantly at a "community" hospital as a MSIII and IV, you WILL NOT in most circumstances be unprepared for your residency at a "larger" hospital. Irregardless of your experiences in medical school, you WILL BE JUST AS SUCCESSFUL. Besides, that is why outside clinical rotations exist. As osteopathic students, most of us have anywhere between 5-6 outside rotations, of our choice. Goto to those centers then!! You will be more than prepared for your future residency if that is the "type" of hospital you want to work at!!

    But, it doesn't negate the osteopathic educational profession because our medical schools don't have "formal" rotations at like institutions. Besides, if you really look around and be honest, the osteopathic profession does have several MAJOR medical centers that are osteopathic.

    Again, I am for making our training all the more better at "community" hospitals. They have great potential. That is where most of us will be practicing. My comments are specifically for those that have posted previously making statements that osteopathic physicians are clueless on how to train physicians, and that "community hospitals are horrible places to train physicians." I couldn't disagree more. :D
     
  19. mj

    mj Senior Member

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    LT,

    I want to make an MD vs. DO thing and use broad sweeping generalizations? Oh good gosh Leo.

    The ONLY thing I have said thoughout the discussion is that Lib should be more willing to embrace the issues noted with osteo ed as opportunities for improvement instead of trying to explain everything away...well it may be broke but that was in the plan :rolleyes:

    Do allo programs have the same problems? I never said they didn't but quite frankly IT DOESN'T MATTER. Some probably do. I would hope that rather than sweep those under the rug people would work to change them too.

    The fact is, the issues listed are real. And were voiced by osteo students and THAT is what makes it an OSTEO problem in this discussion.

    I'm so tired of anytime anyone says anything negative here, especially in the osteo forum, THEY have the problem. Did you have a great experience LT -- I know you did and that's fantastic. But there are a lot of people who haven't. And NO they don't all post on this board either and that's not my main source of information. (I can't even believe you said that to me. Shame on you)And, no, they don't just want to complain about it, most of them I've met are actually interested in CHANGING it.

    You have every right to debate what those changes should be. But you have NO right to invalidiate or mimimize their experience as inconsequential because they were "the wrong type" of person or they are "complainers". If the issues and examples are valid ones, we should ALL be interested in making changes because that will make better doctors. Why we can't accept them on face value and help come up with solutions is beyond me. Instead we say, Freedom is a psycho and Kent is just angry and Adrianshoe is Adrianshoe and we just ignore UHS03 because he isn't angry enough yet and I'm just a premed so I don't know what I'm talking about...

    Lib still doesn't get it, and I've grown weary of trying to explain it, but I think that is unfortunate. Lib obviously is commited. It's too bad he/she wants so badly to believe that the world is perfect that he/she can't see that the crux of the issue -- I wasn't taught, I felt alone, I KNOW it could have been a better experience -- at it's root. It's not about MD/DO/Community/Large...it's about some people had a bad time.

    Finally, LT, you don't know me. You don't know anything about me or my experiences with medical education. Please try to keep your misinformed personal judgements and attacks to yourself and try to stay focussed on the issue. That's the only way these discussions are productive.

    mj
     
  20. Popoy

    Popoy SDN Super Moderator

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    mj, I just wanted to clarify that my postings regarding a comment on Kent about DMU and libbuser were completely separate things. I was merely making an analogy how things can get out of hand because some folks are taking things too personally as what had happened in Kent's old postings on topics of residency/rotations.... You must be exhausted posting in two different trends.... (UHS vs KCOM and this one)

    The postings are all a very good read.... When things like this come up, it easily becomes an MD/DO thing as always.... either people misread something, misinterpreted something, or just plained old something...

    Agree to disagree.....

    There are things lacking in both institutions and things are being done about it.... Slow, but there is something being done.... I'm sure schools administration/faculties are not just sitting idly in their behinds waiting for a miracle to happen....

    libbuser, thanks for the book recommendation, I'll be looking forward to reading the book....

    mj, libbuser, Leo, etc.... YOU all are very passionate people doing their best to get each other's issues across.... I'm sure you're all not alone in this endeavor.

    I'll probably see most of you someday advocating your views.... Hey, I say go on!!! There's one thing certain in this life and that's CHANGE....

    Anyway, I'm not sure whether or not I'm making any sense, but my new neighbor is moving in and making a lot of rumbling sounds... Kinda sleepy still....

    Later peeps.... Let's continue to keep things in a professional manner. :cool:
     
  21. Kent Ray

    Kent Ray Member

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    Well I am glad to see so many people on this thread. I would like to address some things Libbuser had to say. First of all we need people like you who will defend Osteopathic education, but please keep your mind open. Lets first talk a little about community based hospitals. You are right when you say that these places CAN be a good place to learn. Their are major differences, for instance on how Osteopathic and Allopathic internal medicine programs are regulated. Of course one by the AOA and one by ACGME. Let me tell you frankly that the AOA has no intrest in shutting programs down even if they are horrible. They need more positions not less. I know that in each setting, Osteopathic and Allopathic, that their are hospitals that are sub par. But let us look at percentages. Let us take OPTIs for example. If we were to ask the AOA to give us a number of teaching physicians for each OPTI this would look very high and you would tend to be impressed. Now lets be realistic, the truth is that almost zero get paid. In other words these people are not clinical faculty but volenteers. Lets take a look at one allopathic community hospital program. Lutheran General in the Chicago area. Probably around 400 beds. Well this is a private hospital but the medicine program is not bad. They have teaching rounds, and afternoon teaching sessions. What is bad about the program is that every patient belongs to a private physician so their are too many people trying to manage care. Also their is no research.
    Libbuser, the 70% that go into primary care is not realy a true number. Of that seventy percent many, many go on to specialize.
    I cannot believe that anyone would not want to surround themselves by the best and brightest. Why should we settle on community programs that have no real educational adgenda. If these programs were filled with motivation and outstanding teaching and didactics I might feel better. The truth is that we are educating physicians in a 1950-1960s style when the physicians had time to teach. Times have changed but the AOA has blinders on. Even educating primary care physicians (esp, IM, Peds, and even FP) in these places is hard to understand.
    We all know that Osteopathic physicians are more likely to be FP and that is just fine with me. Tell me, would you want your FP to more or less versed in current treatments and other therapies. Would you want your FP to come from a residency where he/she was given the opportunity to learn or would you want them to come from a programs that just went through the motions. Please fogive my spelling!
     
  22. prolixless

    prolixless Senior Member

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    Once again, let's get back to the real issue at hand. Is allopathic training at community hospitals better than osteopathic training at community hospitals? If your answer is no, then the complaints on this board ought not to be directed toward osteopathic clinical education, per se, but toward community hospital based training (And, incidentally, that would make statements like "I wasn't taught, I felt alone, I KNOW it could have been a better experience" a function of community based training programs and not a function of osteopathic clinical education). On the other hand if your answer the question is yes, only then do I think you can claim that osteopathic clinical education is deficient (Statements like "I wasn't taught, I felt alone, I KNOW it could have been a better experience" are then a function of osteopathic clinical education and not a function of community hospital based training). Maybe allopathic training at coummunity hospitals is better because they have more paid faculty, or these hospitals tend to receive more funding, or whatever--I don't know what the evidence might be.

    Also, Leotiger made a point that went ignroed and should be addressed. He said that many (all?) osteopathic schools give their students options to rotate at large academic hospitals (I'm assuming these options occur either after or among their core rotations at community based hospitals).

    This point leads to another question that asks to answer the issue at hand: for those allopathic training programs that are primarlly community hospital based, do they give their students greater and more accessible opportunities to do rotations at large academic hospitals? If the answer is no, then osteopathic clinical training is fairing just as well as these allopathic clinical training programs that are community hospital based. But if the answer is yes, then osteopathic clinical training is too inefficient and/or restrictive, and is therefore deficient.
     
  23. UHS03

    UHS03 Senior Member

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    libbuser- 3 years ago when I was getting ready to apply for medical school I remember noticing that EVERY single school I read about had something in their mission about striving to produce primary care physicians. You think this is some big, noble goal of osteopaths alone? You think US News means anything at all? You look at statistics and think 70% of DO's go into primary care...get real! How many of those go into cardiology, gastroenterology, ID, etc. etc.? The answer is that you have no clue, and neither do I. To say that osteopathic schools produce primary care physicians, so we shouldn't go to any lengths to appease those students who actually want to specialize is definitly among the most ridiculous statements I've ever heard on this board. It discredits you and shows you for what you are, an AOA puppet who has bought into all the propaganda. It's clear tht you will only respect those students who do what you think DO's should do, and this closed-mindedness of yours makes you a perfect candidate to maybe run for a position with the AOA someday. You two were made for eachother. :mad:
     
  24. libbuser

    libbuser Member

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    UHS03,

    I will not say much to your antics. Your very personal attacks I think speak for themselves. Read Kents responses to me, very professional, very respectful, 2 DO's that are interested in the profession, trying to make it better, and we can respectfully discuss the issues.

    You, on the otherhand, respond differently. Anger and rage. There is a big difference between challenging someone on the issues, and just being downright nasty.
     
  25. UHS03

    UHS03 Senior Member

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    When I challenged you on the issues I got no response...funny that you only respond to me when I get aggressive (something I usually try not to do.) Fact is, I find your willingness to disregard the training of osteopathic students who wish to pursue specialty training insulting. Your idea that osteopaths should be primary care physicians first and foremost scares me as I don't want people to think of DO's as only "good primary care docs", I want people to think of DO's as good physicians period. When you talked about specialty training for DO's, you hit a nerve with me..and I responded to that. I think you are being a little sensitive as I wasn't half as insulting as you pretend I was.
     
  26. libbuser

    libbuser Member

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    "Your idea that osteopaths should be primary care physicians first and foremost scares me "

    You can't be more wrong with that statement!!

    Osteopathic Medicine has always, and will always ascertain that whatever speciality you practice, you are ALWAYS A PRIMARY CARE PHYSICIAN FIRST, AND FOREMOST!!! Why do you think that the osteopathic profession still requires that ALL PHYSICIANS take a year of their training to do a PRIMARY CARE INTERNSHIP, regardless of your speciality intentions??

    Besides, I never insulted students that are osteopaths that have decided they want speciality training. I have stated in numerous posts that osteopathic students have wonderful opportunities to pursue those interests. Even at a "community" hospital setting in years III & IV, you have over 5 months of electives to pursue that. I simply stated that students shouldn't be looking to the osteopathic profession as it stands currently to provide them with the BEST opportunities in speciality training. Those opportunities are far in between for you. But, that doesn't take away from osteopathic medicine in the least.

    But, that shouldn't pave the road for students to bash, and defame the osteopathic tradition, as you have stated on numerous occassions. There is plenty of support and flexibility in the osteopathic curriculum to provide for that. I site one example, in that the AOA has loosened its restrictions on students wanting to pursue those carriers.

    Nevertheless, osteopathic medicine will continue to be BETTER suited to train primary care physicians. The majority of osteopathic medical schools are ACTIVELY seeking and reqruiting primary care docs. When the majority of the graduates from osteopathic schools WANT to become specifically Family Practice docs, that does change the tone of the entire profession. Thus, the curriculum, clinical rotation experiences are all going to be set-up to enhance that primary care perspective. It is just that the osteopathic establishment further believes that if you want to become a specialist, that you are better served in the future by spending your 1st 5 years as a training physician learning primary care medicine!! The is the philosophy, not propaganda from the AOA, the truth.

    Can it be made better, absolutely!! I am highly critical of my own program. We need more students like myself and yourself to want to become involved. But, becoming involved and making change isn't by going on the internet and telling the entire world that the AOA and that the system is badly in trouble. You paint such a bleak picture, it is hard to even have somewhere to build on!!

    Do you see any positives whatsever in the osteopathic profession??? Are we doing anything correct?? Do you really think we are producing crappy, unqualified physicians??

    I don't think that I, or you, are really missing or losing CRITICAL experiences & skills that will jeapordize any of your future career goals (except my own weakness') as a physician. I doubt that you will ever find a hospital that could keep every student happy. Size doesn't matter. Many large hospitals provide excellent rotations and residency in IM, but their neuro rotations suck!! There are very few hospitals out there that provide quality across the board. Every hospital has its strengths and weaknesses.

    Besides, as med student in years III & IV you should be primarily concerned with diagnosing and treating the BREAD AND BUTTER OF MEDICINE. UTI's, MI's, PNEUMO, DIABETES, STROKES, etc. I think that most osteopathic clinical hospitals provide more than enough exposure to become competent in those areas. Lets not get ahead of ourselves! That is the bottom line.
     
  27. UHS03

    UHS03 Senior Member

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    with all due respect, I think you are confusing what osteopathic medicine is with what the AOA thinks it should be. In my opinion, the requirement to do an osteopathic internship weakens our training as it effectively takes away a year of focused specialty training, with the exception of a few "fast track" internships that are available. If I want to do surgery with an AOA residency, I only get 4 years of surgery training while my allopathic colleagues get 5. I think the osteopathic internship is a big reason many students choose to pursue allopathic residency training. A DO specialist is no more of a primary care physician than his MD counterpart.

    It is an insult to say that the osteopathic community does not have a responsibility to provide the BEST available training for all DO's, regardless of area of specialization.
     
  28. libbuser

    libbuser Member

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    The osteopathic profession is run by the AOA. They do make all rules, regulations, and recommendations. So, if you think it is so horrible that you have to do an osteopathic internship, why did you go osteopathic?? Did you just find that out.

    Most physicians, both older allopathic (the allopaths only dropped that in the last 10 years) and younger osteopathic surgeons have mostly been grateful for the internship they did. The AOA highly values that experience, that IS OSTEOPATHIC MEDICINE!!

    The principle is that you'll be a better physician, thinking as a primary care physician. You can think that principle is hogwash, but that is the reason for it.

    Again, you CHOSE to go into an organization that places primary care medicine above ALL ELSE. That was no secret!


    "It is an insult to say that the osteopathic community does not have a responsibility to provide the BEST available training for all DO's, regardless of area of specialization."

    Do you really think the osteopathic profession can do that?? We don't need anymore specialist in this country!!! We need primary care docs. Why should an organization such as the AOA HAVE TO PROVIDE YOU WITH WHAT YOU WANT, JUST BECAUSE YOU GOT INTO AN OSTEOPATHIC SCHOOL. There are limitations to osteopathic medicine. I can't cry foul on the AOA because they don't have a residency in whatever speciality I want! There are other programs and schools out there better suited for that. This country can only support so many surgery, cardiology, derm, hem/onc programs. Those programs have been established. They are located at large referral centers.

    How do you possibly propose that the AOA increase more orthopedic surgery programs?? Come on, lets give some ideas, instead of just ripping on arguements. What are you thoughts on how the AOA could increase those programs your talking about. How would you finance them? How would you get large hospitals to take on such a project, considering hospitals across the country are in dire need for money?? They can't even pay the nurses and staff.

    Again, the AOA owes you nothing at this point, because I know it never promised that to you!! They can't promise things they don't have.

    It is kind of like going on vacation, with you knowing well ahead of time that the hotel doesn't have a pool, then getting there and complaing to the management that you got jipped and screwed because they don't have a pool for you. You keep complaining that the osteopathic profession owes that to you to provide every opportunity available.

    Seriously, do you really think that is possible and feasible??
     
  29. UHS03

    UHS03 Senior Member

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    You're right the osteopathic community doesn't owe me anything. I am not crying foul, and I am not someone who entered into the profession with my eyes closed. I am not an administrator, so I don't know how to go about implimenting more residency programs, but the AOA will be the first to admit that it needs to do just that. My future as a physician will be just fine, what I take issue with is this defeatist attitude that the AOA can't do this or can't do that. It all comes down to what I said in the other thread, too many osteopathic students are willing to settle for, and justify, mediocrity. It is obvious that your post is just an attempt to convince others to settle for what the AOA offers them, which is funny since the AOA itself admits they are falling short of their responsibility to provide adequate training opportunities (specialty ot otherwise)for graduating osteopathic physicians.
     
  30. Brennan

    Brennan Senior Member

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    Wow..you all are just firing back and forth at one another........
    Hey i am an incoming student that is interested in these subjects.....These are idea's and suggestions that need to be brought up to the AOA and all the organizations so that they can be addressed (if they havent already).....if these issues are to succeed, than many schools and students governments will have to work together......Im an incoming like I said..WVSOM class 2005....im new and need to learn alot....and i would like your help......Tell me your years in school? than i can have an understanding of where we all stand with each other.......
    Also. i must say that ----these are just my opinions, based on readings and research.
    a) The 1 year internship is a good idea, it follows the mission statement and should not be changed.
    b) If you want to specialize, than please do...it would not hurt to have specialists that are DO's, who in turn could train others.
    c) Why compare DO's and MD's....we all use todays microbiologists, chemists, biochemists, genetisists, physisists, and engineers to experiment and develope methods, medicine, and equipment for us to use......they are not specifically toys for just one type of physician...all the big kids need to share the technology..
    d) MD's and DO's should remain seperate entities that exchange idea's and practices, so as to have more than one perspective.....and to better serve the public by not becoming a monopoly.
    e) DO's and MD's should work out a program where there are easier ways to trade/exchange residency programs, to better serve the needs of all students. Some DO's will want to specialize and will need instruction from MD's, and some MD's will want to learn OMM to further their knowledge and scope for community based (family) medicine.
    This is just my ideology thus far and it may change as i learn more..i dont think egos, attitudes, or pride should have any effect on either side helping the other to better help society. what are your varied opinions?
     
  31. libbuser

    libbuser Member

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    Again, this debate has again shifted. This hopefully will be my last posting.

    Many of you have previously stated that the usage of "osteopathic" community hospitals is unacceptable. You have raised real issues and challenges with being trained in those environments. I have stated over and over again that I do believe that we can always improve those sites. But, it does nothing to compare them to the experiences you would receive in a larger, more technically advanced facility. There is no debating that. I have actually done a thesis paper on those issues. Training medical students, interns, and residents is actually one of the only proven ways to increase the number of students practicing in these instituions. Whether you like it or not, you joined a profession that is taking these IMPORTANT HEALTHCARE ISSUES HEAD-ON!! They aren't striving for mediocrity by any means.

    This is where I am coming from:
    As a student at KCOM, when I was a 1st year, we were required to participate in a 2-week preceptorship clinical. The intent of the program was to introduce to ALL KCOM students the idea of primary care medicine, specifically practiced in rural areas. The school went out of their way to put us with physicians that only practiced in "community" hospitals. Some probably could pass for nursing homes! None of us were in large cities, just small, rural Missouri. I, too, like yourselves came to medical school with the perception that small community hospitals sucked! I dreamed of training and practicing at some huge facility, with all the latest technology and treatments. Well, those perceptions all changed when I went on the preceptorship. Yes, I was only a 1st year, and had no clue what what the physician was doing or myself for that matter. But, regardless, it did change my perception on "community" physicians and the centers they worked in. That in only 2 weeks! They do wonderful and important work, and finding myself going down that road, thankfully because I was exposed to that side of medicine. And I will argue, that is a very sincere intention of many osteopathic medical schools.

    Most of these physicians are wonderful practioners, providing highly skilled and much needed care to their patient populations. No, they don't have access to the latest treatment, technology, didactic lectures to keep them polished. They don't have a neurologist to grab in the hall to talk to and consult. They may have to wait a couple days to stabalize the pt before sending them for the cath. Yep, it makes life and the practice of medicine much more challenging. But, these are the physicians in the highest demand in this country. I argue, that the osteopathic profession has always, and will continue to specifically strive to create more of these "community" physicians. In addition, there are several allopathic programs that specifically state they are striving to produce primary care physicians. Look into where they send students for rotations!! It is a proven program. The government as well has joined, willing to pay for tuition for docs to practice in these facilities. There are stats that show that residents and post-grad docs going to community hospitals, usually end of staying in similar settings. That is good for medicine!! These docs aren't striving for less than a standard education. There is a reason why osteopathic med schools seek "community" based hospitals. Just, please bear with me.

    These "community" hospitals we keep bashing are integral to this nations healthcare system. Pick any state, and look at the cities between the larger, urbanized areas. Between them are thousands and thousands of community hospitals that serve their communities. They aren't necessarily rural by any means either. Community hospitals provide care to critical masses of people. The problem is, these are the areas that need more primary care physicians.

    These are some facts from my Medical Sociology Text:
    "There are almost 43 million people living in almost 2,000 areas (mostly rural and inner-city) designated as primary care health manpower shortage areas"

    "The number of practicing physicians per 100,000 residents is more than twice as high in urban as in rural areas. One-quarter of the US population--1/3 of the elderly--live in rural areas but only 12% of active physicians practice there (and many of these are nearing retirement)".

    That is who our "community" hospitals and physicians are primarily serving.

    And I commend the osteopathic profession and our osteopathic medical schools for taking this issue head-on. I commend schools like KCOM and other that are identifying students with the characteristics that show that they may be open to these considerations. I am not here to say that practicing and training in community hospitals is comparable to the larger, academic hospitals. These "types" of hospitals serve 2 very differently purposes. Both, are very important to American healthcare. Why should should we be ashamed of them, embarrassed by them?

    The problem is how can we get students attracted to practicing in "community" hospital settings, the biggest neglected area in medicine today. That is a huge and important issue facing American healthcare.

    And I will share with you some of the research that I did specifically on this issue.
    (1) To create more primary care physicians who themselves desire to practice in these "community" hospitals, foremost, you have to identify students that show those characteristics. Every osteopathic medical school places that #1. Our medical schools seek to fill as many of the seats available with primary care physicians. When you go to an osteopathic institution, the entire system is focused around that dimension.

    (2) How do you get medical students and residents interested in practicing in community settings? I am not just talking about rural areas. Even in larger, urbanized settings, those community hospitals that are dwarfed by the towering 500+ next door, are just as important. So how do get people there to establish a practice? Well, after indentifying those characteristics in applicants, you send them there to experience it firsthand!! The programs in larger hospital settings are AWESOME. In my thesis paper, that is a huge problem in this country. Students like the professionalism, the technology, better pay, intensive training, etc, etc, etc at these larger hospitals. It doesn't work by 1st sending students to AWESOME experiences. They tend to specialize more, and establish themselves in those communities. You don't increase community physicians by sending them into hospital environments like your proposing, they WILL NEVER LEAVE. And the glut of community physicians will continue to drop.

    We need more community based physicians!! Look at those stats above, that is pretty dismal. So, one of the PROVEN methods of doing this is by plugging students into those environments from the beginning. It is not like pulling teeth either. Most osteopathic students entering the profession recognize this. Students, residents, & physicians in these environments aren't sitting around bummed that they don't have the same opportunities as their counterparts do down the street. It just depends on what your goals are. And, for most of us, those goals line up with our current reality.

    And there is nothing wrong with the osteopathic profession intentionally trying to produce these types of physicians. That segment makes up the majority of the osteopathic profession. That is osteopathic medicine. That is why we are affliated with so many community healthcare systems. Those are for most us, our future places of practice. If the majority of the future grads at osteopathic med schools aren't going to be practicing in large, urbanized hospitals, in which we have been comparing; why would there be such a significant push by the AOA to create more sites in these areas?? What is the motivation then, if their mission is to produce primary care physicians in community settings???

    (3) Many of you have challenged back and said, "well don't osteopathic students deserve the best." It all depends on what your idea of success is!! As a KCOM student, I remember going to hospital sites to see where I might match. I heard the rave over this and that hospital. I checked it out, etc. At one of the hospitals, I couldn't believe my eyes. It was incredible. State of art, huge gorgeous lobby, 300+ beds, every speciality you could imagine, beautiful library, impecable diadactics, associations with U of M in Ann Arbor, all around just awesome. But, to be honest, and talking with the students there, when it comes down to it, they aren't really receiving CRITICAL INFORMATION that I am not receiving at what you would think would be my pooh-dunk 120+ hospital. Yes, they are receiving better diadactics, interesting bedside teaching, but really, there are ways around that in education. I may have my nose more in Cecil's, or other learning techniques. There are advantages and disadvantages. It is all up to us as medical students to make the most of our environments. Further, I have done alot of looking into hospital sites, and can you really say that the majority of osteopathic sites are crappy, and substandard. Sure, there are bad apples, but as a whole your willing to state that osteopathic medicine in subpar???

    I have discovered only about 1 thing for sure in osteopathic medicine. That the majority of osteopathic students filling the seats and rotations, are for the most part desiring to become excellent primary care physicians. As a collective group, the bylaws, regulations, philosophy, opportunities are all going to be weighted in our favor. That is the way it is going to be. The AOA, with its stand on primary care being "primary", can't provide all things to all people. We aren't structured like that, yet. Maybe in the future, but that is a long way away.

    The stuggle is, the harder we work and strive to provide as many broad, speciality opportunities, we loose that primary care focus. We really can't be both. Besides, we already know in this country we don't need anymore specialist'. The government is not going to sponsor anymore programs, and that is an important point. So, for the AOA to think they can increase that type of broad training, they are fighting a battle I don't think they could ever win!! We need to keep our emphasis in training students with a primary care focus. Do you really think it is possible to keep our primary care focus, and provide exceptional speciality training?? I am not sure on that!!

    So, if your a prospective students applying to medical school, you will have to accept that. If you want to become a surgeon, your going to have to do a internship. Then, depending on geography, go outside osteopathic medicine and seek your own path. That is just the way it is, like it said, if you think that is unacceptable, how do you think we really could change that?? I don't think we can! Please respect the fact the AOA can't provide all of those opportunities. We now have great relationships with allopathic programs, and larger urbanized facilities. Those doors are wide open for you, and I don't think the AOA honestly is depriving you of any significant hardship for achieving that route. Don't ever let anyone fool you that the AOA is screwing you.

    As Dr. Kenneth V. Iserson puts it:
    "The institution(s) at which a residency program is located often determine the volume of pts tht you will personally see, the responsibility that you will have for these patients, and the procedures that you will perform. Hospitals in large urban settings tend to offer more pts and more responsibility to the resident physician. They are often understaffed with attendings and have an overabundance of pts. At the other end of the spectrum, are those community hospital programs with an abundance of attendings and a dearth of pts. NEITHER SITUATION IS IDEAL!"

    As well:

    "sometimes major deficiences, such as the lack of major trauma in a Surgery program, are corrected by using "away" rotations. These are designed to supply the necessary training that the home instituion lacks. These short stints are often at institutions particularly known for their expertise in the deficient areas."

    Lastly:
    "The actual volume of pts to which you will be exposed, either as the primary provider or as a consultant, is of paramount importance to the quality of your training. However, this information is often misleading. That is, while it is important to guarantee that there will be enough pts, it is also necessary to find out if there are enough residents. Both extremes can be harmful to your training"

    If the ratio of residents to pts is too high (too few pts), you may not be exposed to enough medical activity to get the training you desire. But if the ratio of residents to pts is too low (too few residents), you will be robbed of valuable reading, thinking, and discussion time. You will use this time attempting to care for an ever-multipyling pt load.


    In conclusion, lets be honest, you are not off any worse than any of your other colleagues. Lets make changes for the better. But, as I argued previously, "community" hospitals are important to creating more physicians wanting to practice in those areas. Yes, you will give up some of the tools you might have somewhere else. But, are you really worse off? That depends on your attitude and your goals. But, lets not get on the AOA bashing wagon, and tear down osteopathic medicine. We are doing important work, and our schools do provide a quality education!! Peace. ;)
     
  32. mj

    mj Senior Member

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    Lib, Lib, Lib...you're saying the same thing over and over...and you still aren't getting the argument.

    I'm in a good mood today though, so I'll try one more time.

    Let's try this approach: please respond to this quote by UHS03:

    "One community hospital is so different from another..you just can't compare a Pontiac or Botsford to a place like Mesa General. What is sad is that most DO schools are affiliated with more Mesa General's than Botsford's."

    You see, many of the complaints aren't about community hospitals AT ALL. In fact a lot of people like you PREFER the community setting. What they have issue with is the QUALITY of community hospital they are being sent to.

    Do they all suck? Of course not. Do enough of them suck that you can say osteopathy has a problem with their clinical rotations? Maybe. Do you need to fix the ones that are broke regardless? ABSOLUTELY.

    mj
     
  33. prolixless

    prolixless Senior Member

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    I actually think we're finally moving forward in this argument. Everyone now agrees (I think) that it's not the clinical training at predominantly community hospitals that makes for disgruntled med students, but it's the clinical training at those community hospitals with POOR teaching. If I can read between the lines, I think what's being said is that too much of osteopathic clinical education takes place at thr community hospitals with poor teaching, whereas allopathic clinical education WITH A COMMUNITY HOSPITAL BASED MODEL doesn't have this problem as much or hardly at all. In other words, most of these allopathic clinical programs tend to take place at those community hospitals with good teaching.

    If that's the case, we need more evidence. I need to know whether allopathic students, who did much of their clinical training at community based hospitals, tend to have more positive learning experiences compared to the osteopathic students. Kent ray was the first to actually offer some solid evidence. I think he mentioned something about paid salary for those teaching physicians of ACGME programs in community hospitals, and also something about the AOA refusing to shut down those community hospital programs with horrible teaching (while ACGME programs were less hesitant to do so).
     
  34. Kent Ray

    Kent Ray Member

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    I want to say a few more things. Libbuser, again it is great to hear your enthusiasm. What I will say to you is to hold fast to your arguments if you can prove them. Let me say that I can provide more evidence for my arguments than you can for yours.
    Do you think that the AOA promotes OMM? Well Cogment, one of the largest and most organized Osteopathic training communities provides almost no training in OMM. In fact, I have been in Michigan for three years now and have only recieved three lectures in OMM. I have never once recieved manual intruction. I have never seen anyone use this in many of the hospitals and matter of fact I have never seen an OMM table in any of the hospitals here. The AOA requires that we do an Osteopathic exam on all our patients H&P. If you do not do this you will be repremanded. Well I refuse to do this exam and have won! Don't get me wrong, I would like to participate in some study that would hopefully prove the benifits of OMM but this is not even thought about. Why should I do this if no lectures are given about omm and no one will teach.
    Let me tell you another story. The FP program was closed at a hospital in the Cogmet consortium. In this program the director is a very nice guy but in my opionion should not be a physician. In his clinic the residents, interns and students see all his patients. He doesn't go over your treatment or teach in any way. He usually will only see the people that want OMM (he only knows the Kirksville crunch). His theory on treating Hypertension is taking the patients age minus the systolic blood pressure and if it is l00 or less they are fine.
    Now, this program was closed. Why do you think? Well the only reason was that they were not getting enough applicants. What I am trying to say is that the AOA has no intensions in providing good clinical training weather it is community based or not. This is not only the AOA's fault but the fault of many of the schools including Kirksville. They should be held responsibe for creating residencies where the end point is a physician who is compitent.
    Libbuser, I am telling you what you are saying is immaginary, or "Dreamy". I can tell you will all honesty that if you have a resident that finishes his training at Bi-County, Riverside, Riverview, Genesys, or Bostford in internal medicine and compare them with residents form Henry Ford or UofI, well...
    It is ok to have an emphasis on primary care. Its ok to have some of your training in community hospitals. What is not ok is to allow your residents to be trained with people like I discribed above. If you think this is the exception and not the rule than, my friend you need to get out their and experience both side like I have.
     
  35. libbuser

    libbuser Member

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    I think Kent just set us back again. MJ, and everyone else, you keep telling me I don't "get it". Well, I am not reacting to you, I am reacting to this:

    "Libbuser, I am telling you what you are saying is immaginary, or "Dreamy". I can tell you will all honesty that if you have a resident that finishes his training at Bi-County, Riverside, Riverview, Genesys, or Bostford in internal medicine and compare them with residents form Henry Ford or UofI, well... "

    So now we know how you really feel.......
    I don't think you'll find too many people that would be willing to agree with that statement. That is just a flat out bogus statement. If you lined up 10 physicians from Genesys and 10 physicians from HF, there is no way your going to tell the difference. Give me break. Does anyone out here really believe Kent! When you make statements like that, there is nothing to debate. Insulting indeed. It also shows that you really aren't interested in making the profession better.

    You in one breath say we need better teachers and mentors, how could you possibly be a role-model and mentor with your obvious attitude towards osteopathic clinical sites. Leaders and motivators don't make significant change by walking around making such harsh and extreme statements.

    You have all these ideas, how could we possibly make every institution a rubber stamp with all the qualities of Henry Ford??

    Do you know who Dr. Anderson is at Riverview hospital?? I wonder if you'd be willing to tell him that his IM program at Riverview is inferior to Henry Ford? He is an incredible teacher and motivator, highly respected around the nation for his compassion and teaching skills. Kent, it is disgusting that you would make such insulting remarks against such a wonderful man! You obviously don't know anything about Riverview or the legendary Dr. Anderson. Disgusting and shamful indeed.

    How do you propose to increase the # of practioners practicing in primary care shortage areas??

    Have you read the osteopathic oath lately?? Why don't you read the last paragraph. You show no deciency, respect, or compassion toward this profession.

    You may think I am "dreamy", but I do know one thing, you don't make change with attitudes like yours. There is no chance in making our education better with the attitudes like yours floating around!

    Besides, Kent, I'd be real careful with the words you choose. You sound like a person that is burning bridges. You'll be looking for a job shortly, and I don't know many healthcare systems, insurance companies, or physician groups that are going to be laying out the red carpet with an attitude like yours.
     
  36. Kent Ray

    Kent Ray Member

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    Libbuser,
    Yes you are right! I have a very harsh attitude. I would love to make a bet with you, that I will never give up on the Osteopathic profession. I don't share your ideas, but what does that matter. I don't know who Dr. Anderson is but I can tell you that his program cannot compare with Henry Ford. If you leave his address I will write him a letter. Don't worry I wont be so brash with your hero. By the way, can you send me a copy of his latest research material.
    I will say outright that Osteopathic clinical training is hands down inferior to allopathic on average. We have a long way to go but nothing is being done. Matter of fact we are moving in the wrong direction.
    You keep harping about increasing the number of physicians in underserved areas. To tell you the truth I don't realy care about this situation and I am not going to be a primary care provider!
    Let me tell you something else. My class never took the Osteopathic Oath!!! I think that the AOA, hospital administrators, and deans should be held to an oath of improving our education. Maybe they could keep telling impressionable people like yourself half truths about how great post graduate Osteopathic education is.
    You reply to my messages like this is the first time I have ever done anything like this. I have written more letters to more people than I can count. I don't care about your "bridges", I care about the future of Osteopathy. I will continue to step on toes, I will continue to write letters that people think are insulting, I will continue to be annoyed with uninformed people. You can agree or disagree, I don't care but if you are going to present an argument please be able to back it up. If you require more evidence from me over my ideas please say so.
    I would encourage everyone to take what I say and what others say with a grain of salt. You have to experience life for yourself and form your own opionions. What I would say is that you should always believe in what you say and don't waiver unless someone else can prove you wrong. Try to always consider someone elses point of view.
    So, Libbuser, take this tread and email it to the president of the AOA, to the Dean of DMU where I gratuated, to where every you want! I would be happy to defend my comments. Maybe you should identify your self as I have plainly done so people can know who you are. By the way if you want more some evidence of my "insults" visit www.ioma.org Here you will find my very same argument with one of our so called clinical deans. Please reply with something more challanging than name calling. Thanks
     
  37. libbuser

    libbuser Member

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    "You keep harping about increasing the number of physicians in underserved areas. To tell you the truth I don't realy care about this situation and I am not going to be a primary care provider!"

    #1, the AOA & osteopathic medical schools think this is very important! Kent, maybe it is time to admit that your goals as a physician (whatever they might be) are not this professions priority. What are your future goals??

    Kent, I think that is great your not going to be a primary care provider. You obviously want to be a specialist, and I assume you want to do research. Hey, that is great! But, I wonder why you think that the osteopathic profession is any less because it doesn't offer those opportunities for you. Dr. Anderson at Riverview doesn't do or doesn't want to do research. Further, the residents in training there don't care about research.

    So, now we are on to something.

    Take 2 aspiring IM physicians. One IM resident wants to practice medicine in a huge hospital that is employing the latest techniques, cutting edge technology, exposure to research etc. That sounds like your type of program. Yes, Henry Ford and U of I are superior to say Riverview in grooming those type of physicians.

    IM physician #2. Their dream is to practice medicine in the community. No research, would rather let the guys like yourself do the research, write the journal articles, when we get stumped refer our pts on to the University hospital for further work-up. We want to wake up in the morning and see people with Thyroid problems, Pneumo, Depression, UTI blah blah blah.

    2 different physicians with 2 different ideas on how they want to practice medicine. Both important in advancing healthcare. Kent, we need both types of physicians.

    But, you seem to think that what is best for the #2 physician is going to a program that has on-going research, like the programs your describing.

    Your statements make me wonder if you think that any physician NOT doing research and at the cutting edge of technology is subpar??
     
  38. Kent Ray

    Kent Ray Member

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    Libbuser,
    It must seem that I have no life. I sit here for several hours while I am studying replying to your statements.
    I do not think that a primary care physicians are inferior to specialists. Matter of fact I have great respect four our primary care physicians.
    Do you think that residents from HF cannot diagnose pneumonia, hypothroidism, or depression. Come on, give me a break. Even as a primary care provider, I would not want my training to take place at riverview, bicounty, genesys,.... If you don't want to do research that is fine. I believe that most (with the exception of Texas, Ohio, and a few other Osteopathic schools) Osteopathic schools are functioning on the level of community colleges. As a whole the Osteopathic community is not doing its part in establishing new research. What do you think we should do? As it is now we are borrowing from the allopathic community. How proud should we be?
     
  39. libbuser

    libbuser Member

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    Osteopathic schools are functioning on the level of community colleges

    Funny, the same US NEWS & World Report that ranks your beloved U of I as #9, also ranks 3 osteopathic colleges.

    How do you account for the fact that the director of the USMLE visited KCOM this Spring to learn more about our curriculum, so that they could implement our concepts into their future "oral" board portion?

    Doesn't sound like other professionals think we are operating like "community" colleges. Kent, how can anyone take you serious when you make such ridiculous claims. Your just playing with me for amusement. Your right, we are both wasting our time with each other. You are either playing me like a fiddle, or you truly are one arrogant future doc. I will no longer respond to your antics.
     
  40. Kent Ray

    Kent Ray Member

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    Libbuser,
    I promise that I am not "playing you". I am trying to get across a point. If you don't reply than that is fine with me. I do feel that many of our schools operate in a vo-tech like model. Why is this so hard to understand. We have schools like DMU, Kirksville, KC, NOVA all producing too many students and not providing them with postgradute eduation. Tell me what postgraduate programs has Kirksville produced. I will tell you that Des Moine is only associated with two hospitals in Iowa. Hardly enough to provide residency positions to two hundred graduates per year!
    By the way I read about the trouble Kirksville is haveing with the dean and the president. It appears that when the faculty speaks out they get fired!
    By the way if you knew me you would never say that I was arrogant. Your comments are taken lightly, it is hard to swallow what I am getting at. It is even harder for a person like yourself who has not yet experienced internship in both allopathic and Osteopathic instituions to know the truth.
    I wish you luck and I am sorry if I have insulted you in anyway. Keep on fighting for your ideas!
     

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