Anyone here against expanding GME?

[Mjolner]

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How did this somehow evolve into an argument of DO vs MD?

What. Are you new to SDN?

 

[Psai]

.

 

[TaroBubbleTea]

Just insecure, defensive dos trying to justify their worth to themselves

Let's get back on topic and discuss ways to curb midlevel encroachment.

Edit: Oops, wrong thread!

 

[TBV]

They're always trying to measure up. It's cool if I had an inferiority complex I'd be all up in their forum clamoring for approval and attention too.

"Guys look at me! I'm better than you! I take an extra class!"

 

[Krupke]

@Mjolner maybe what I meant by my statement wasn't clear. I have no problem with DOs competing for the same residencies as MDs (and I would say that a DO who scores higher than me on step 1 knows more preclinical medicine than me). I'm more concerned about there being no deterant for flooding the market with new physicians. New DO schools are allowing more people who were below average on the MCAT to enter med school. The problem with law schools is that too many people are able to get their JD and that destroyed their market. Having getting into med school be the rate limiting step ensured that people going hundreds of thousands of dollars into debt would have jobs at the end. What I was saying wasnt a dig at DOs; it was a dig at the fact that expanding DO schools are letting too many people enter the med field.

I'm glad we can all agree that opening more sub-standard medical schools is terrible. I hate that COCA and the DO leadership allows this also.[/QUOTE]
http://www.bozemandailychronicle.co...cle_bb325702-b8f9-5f09-bdc7-193bd22b210e.html

Have DO students complained to COCA? The quality of students at many DO schools have been increasing, but opening all these random schools that have very low standards is going to keep that stigma alive. These schools only care about making money and couldn't care less if they are devaluing the degree

 

[Vaseline]

They're always trying to measure up. It's cool if I had an inferiority complex I'd be all up in their forum clamoring for approval and attention too.

"Guys look at me! I'm just as good! I work really hard!"

older docs need to stop selling out. they are permitting it. ex: i worked at clinic last year with two MD partners. they decided they wanted to bring on a new partner. instead of hiring an MD partner, they realized they could hire two PAs for about price of one MD, but see much more patients with the two PAs. and of course they skim a considerable amount of the $$ generated by the two PAs. they went with the two PA option. sigh.

 

[TBV]

older docs need to stop selling out. they are permitting it. ex: i worked at clinic last year with two MD partners. they decided they wanted to bring on a new partner. instead of hiring an MD partner, they realized they could hire two PAs for about price of one MD, but see much more patients with the two PAs. and of course they skim a considerable amount of the $$ generated by the two PAs. they went with the two PA option. sigh.

I don't blame them. At the end of the day they are running a business and their job is secure. They owe me no favors in holding a job for me and if it were me I'd try to make as much money as I could as well.

 

[IlDestriero]

I don't blame them. At the end of the day they are running a business and their job is secure. They owe me no favors in holding a job for me and if it were me I'd try to make as much money as I could as well.

Exactly. Medicine is a business.

 

[Vaseline]

I don't blame them. At the end of the day they are running a business and their job is secure. They owe me no favors in holding a job for me and if it were me I'd try to make as much money as I could as well.

it's called respecting your profession and not letting it erode because you want to make more $$$. these two docs were already netting around 400K prior to their decision to hire PAs

 

[TBV]

it's called respecting your profession and not letting it erode because you want to make more $$$. these two docs were already netting around 400K prior to their decision to hire PAs

Respecting your profession or not it's a good business decision. You start stringing together a few bad ones and soon you'll be out of the business. I'd like to see you open your own practice and see how easy it is to respect your profession when the bill comes.

 

[Stagg737]

Just insecure, defensive dos trying to justify their worth to themselves

They're always trying to measure up. It's cool if I had an inferiority complex I'd be all up in their forum clamoring for approval and attention too.

"Guys look at me! I'm better than you! I take an extra class!"

Has nothing to do with insecurity, especially when the remarks come from ignorant individuals who have never exposed themselves to what they're bashing other than through a random forum online. It has to do with ignorance, closed-mindedness, and lack of respect towards one's peers. Most DOs have no problems admitting the average student at their school wouldn't measure up to the average grad from an elite MD school, or even some mid or low tiers. But talking crap about any of your peers and disrespecting them for no reason is just childish.


Anyway, back on topic. I do think the expansion of GME is pretty unnecessary at this point. More schools, both MD and DO, are opening to fill residency positions which don't need to be filled and instead of churning out more docs from residency. Tbh, I can think of a few med schools (both MD and DO) which I would never attend and more than one that I don't think should remain open due to poor performance.

Instead of expanding education, I would rather the higher-ups focus on figuring out how to incentivize more to practice in the less desirable locations. Both within cities and on a national scale. Other than monetary incentives, I'm not really sure how to realistically do this without drastically changing the healthcare system. Even then, I don't think it would effectively address the problem, as most large countries have problems with access to care.

 

[Danglebells]

I am against expanding GME.

Here is why: as a taxpaying citizen it doesn't need to be expanded. There are X number of US graduates, and X+ number of residency positions.

As a medical student applying for residency, I sure as hell wish there were more positions available to me. And if I were applying for plastics I would definitely wish there were more spots, but thats not how a society works. Especially when there are tons of unfilled rural primary care residencies unfilled.

Honestly the cheapest and easiest way to increase the number of rural PCPs is to NOT increase GME. When supply meets demand, and people are given the choice to match rural FM or not match at all, those positions will be filled.

Once we start filling the positions that we already have, then we can expand. And expand appropriately, by not adding more freaking city based orthopods.

By increasing the number of GME slots, we have to spend medicare dollars on fixing a problem that doesn't really exist right now, and its a problem that only affects GME applicants,

(which is a smaller number of people in the US than the number of people who support the voluntary human extinction movement)

 

[Wordead]

Has nothing to do with insecurity, especially when the remarks come from ignorant individuals who have never exposed themselves to what they're bashing other than through a random forum online. It has to do with ignorance, closed-mindedness, and lack of respect towards one's peers. Most DOs have no problems admitting the average student at their school wouldn't measure up to the average grad from an elite MD school, or even some mid or low tiers. But talking crap about any of your peers and disrespecting them for no reason is just childish.


Anyway, back on topic. I do think the expansion of GME is pretty unnecessary at this point. More schools, both MD and DO, are opening to fill residency positions which don't need to be filled and instead of churning out more docs from residency. Tbh, I can think of a few med schools (both MD and DO) which I would never attend and more than one that I don't think should remain open due to poor performance.

Instead of expanding education, I would rather the higher-ups focus on figuring out how to incentivize more to practice in the less desirable locations. Both within cities and on a national scale. Other than monetary incentives, I'm not really sure how to realistically do this without drastically changing the healthcare system. Even then, I don't think it would effectively address the problem, as most large countries have problems with access to care.

....it sounds like just insecurity, really. It's the same arguments the carib grads make.

 

[jw3600]

Just insecure, defensive dos trying to justify their worth to themselves

You realize there is a difference between feeling insecure (which I don't, don't want to speak for others) and not being on board with shunting of all DOs into primary care against their will even though some vastly out perform a subset of allopathic students. This really isn't that hard of a concept.... Are you purposely being obtuse?

 

[Vaseline]

Respecting your profession or not it's a good business decision. You start stringing together a few bad ones and soon you'll be out of the business. I'd like to see you open your own practice and see how easy it is to respect your profession when the bill comes.

greed is what it is.

well, with the current trend of healthcare, private practice won't exist when i am an MD. so, ha.

 

[Psai]

Let's get back on topic and discuss ways to curb midlevel encroachment.

Edit: Oops, wrong thread!

Look at your username, your avatar and your tag and do a little reevaluation

 

[W19]

Anyway, back on topic. I do think the expansion of GME is pretty unnecessary at this point. More schools, both MD and DO, are opening to fill residency positions which don't need to be filled and instead of churning out more docs from residency. Tbh, I can think of a few med schools (both MD and DO) which I would never attend and more than one that I don't think should remain open due to poor performance.

Can you name some of these schools, especially the MD ones? From I have seen, LCME seems to have tighter control over MD than COCA has over DO. I go to a low tier MD school and some of the problems regarding rotation I have read about even mid-tier DO would not go unnoticed by LCME... People don't even have to lift a finger when it comes to rotation at my school... The school does everything for us!

It's not terribly difficult to implement the 1st 2-year of med school. You can put 500 students in a big amphitheater and teach them basic science...The last 2-year might be more challenging however... When you have a class of 200+ students (which most DO schools have) and you don't have your own big medical center, it is going to be difficult to fit these students into rotations where they can learn something... I can't even imagine setting up my own 3rd year rotations!🙁

 

[Mjolner]

Can you name some of these schools, especially the MD ones? From I have seen, LCME seems to have tighter control over MD than COCA has over DO. I go to a low tier MD school and some of the problems regarding rotation I have read about even mid-tier DO would not go unnoticed by LCME... People don't even have to lift a finger when it comes to rotation at my school... The school does everything for us!

It's not terribly difficult to implement the 1st 2-year of med school. You can put 500 students in a big amphitheater and teach them basic science...The last 2-year might be more challenging however... When you have a class of 200+ students (which most DO schools have) and you don't have your own big medical center, it is going to be difficult to fit these students into rotations where they can learn something... I can't even imagine setting up my own 3rd year rotations!🙁

I love that I get to set up my third year rotations. We pick sites off a list. And we can pick sites where we can "audition" before audition rotations. Or we can see if we like the hospital/program/town before going and wasting an audition.

Sure it has some downsides, but I like it. I don't want to be a dermorthoneurosurgeon so I'm not too worried that it'll somehow bite me. If that were my thing, I would have gone to my state MD even tho I hated it during interview.

 

[MD2BE92]

Can we close this thread mods?

Tired of getting alerts and it is so far derailed at this point AMTRAK couldn't clean this **** up

 

[Mjolner]

Can we close this thread mods?

Tired of getting alerts and it is so far derailed at this point AMTRAK couldn't clean this **** up

 

[TBV]

Can we close this thread mods?

Tired of getting alerts and it is so far derailed at this point AMTRAK couldn't clean this **** up

Let me blow your mind... unwatch thread button.

 

[TaroBubbleTea]

Look at your username, your avatar and your tag and do a little reevaluation

Someone's a bit salty.

Look, I meant no harm. I merely thought there was no need to make this like the hundreds of threads already existing comparing MD vs DO. Lighten up.

 

[Stagg737]

....it sounds like just insecurity, really. It's the same arguments the carib grads make.

How so? I'm not saying all DOs are equal to all MDs. I'm just saying I think it's bs to label one's peers as inferior or undeserving just because of where they went to school.

You realize there is a difference between feeling insecure (which I don't, don't want to speak for others) and not being on board with shunting of all DOs into primary care against their will even though some vastly out perform a subset of allopathic students. This really isn't that hard of a concept.... Are you purposely being obtuse?

Have you seen Psai's posts?

Can you name some of these schools, especially the MD ones? From I have seen, LCME seems to have tighter control over MD than COCA has over DO. I go to a low tier MD school and some of the problems regarding rotation I have read about even mid-tier DO would not go unnoticed by LCME... People don't even have to lift a finger when it comes to rotation at my school... The school does everything for us!

It's not terribly difficult to implement the 1st 2-year of med school. You can put 500 students in a big amphitheater and teach them basic science...The last 2-year might be more challenging however... When you have a class of 200+ students (which most DO schools have) and you don't have your own big medical center, it is going to be difficult to fit these students into rotations where they can learn something... I can't even imagine setting up my own 3rd year rotations!🙁

I'm not going to outright slam med schools, but I'll pm you the schools that I know people at and have spoken to that make me feel like those schools shouldn't exist. As for setting up third year rotations, it depends what you're shooting for. We set up our own rotations if you're at certain sites so it could be a good or bad thing. If you want to go IM or into a specialty that will mainly be at the hospital, then people here try to go to sites where they'll work with a team of residents. We also have rotations available where you just follow a preceptor at whatever sites they work at instead of just being in a team. A lot of people going into surgery like to get at least 1 or 2 of those rotations in because they get a lot more exposure than standing in the back of the room as a team. Some students even end up being first assist on most of the surgeries they see, so they end up with a lot more hands on experience going into residency. There are plenty of negatives too, but it really just depends on how well you plan your rotations and if you know what you're trying to get out of them.

 

[username456789]

I'm not going to outright slam med schools, but I'll pm you the schools that I know people at and have spoken to that make me feel like those schools shouldn't exist. As for setting up third year rotations, it depends what you're shooting for. We set up our own rotations if you're at certain sites so it could be a good or bad thing. If you want to go IM or into a specialty that will mainly be at the hospital, then people here try to go to sites where they'll work with a team of residents. We also have rotations available where you just follow a preceptor at whatever sites they work at instead of just being in a team. A lot of people going into surgery like to get at least 1 or 2 of those rotations in because they get a lot more exposure than standing in the back of the room as a team. Some students even end up being first assist on most of the surgeries they see, so they end up with a lot more hands on experience going into residency. There are plenty of negatives too, but it really just depends on how well you plan your rotations and if you know what you're trying to get out of them.

As several people have pointed out, one of the main things you should be learning in medical school is how to function as a resident on part of a team. That is what you will be doing for 3-7+ years, and no amount of "first assist" in a direct preceptorship is going to prepare you for this. The weakest residents I've worked with as an intern were the ones who attended schools where this was commonplace. They also happened to be DO grads.

Being able to first assist in surgery as a medical student is kind of like "early clinical exposure" as a first year student. It means pretty much nothing, but sounds good if you have no idea what you're talking about. It's a sort of cool experience, but does not help prepare you the way you should be preparing. Your goal (among others) should be to understand the daily flow and decision making/tasks involved with patient care in a hospital, but more immediately you should be learning how to function as an effective and efficient intern/resident.

Hands on experience doesn't mean much if you don't know why you're doing what you're doing with those hands.

 

[Psai]

As several people have pointed out, one of the main things you should be learning in medical school is how to function as a resident on part of a team. That is what you will be doing for 3-7+ years, and no amount of "first assist" in a direct preceptorship is going to prepare you for this. The weakest residents I've worked with as an intern were the ones who attended schools where this was commonplace. They also happened to be DO grads.

Being able to first assist in surgery as a medical student is kind of like "early clinical exposure" as a first year student. It means pretty much nothing, but sounds good if you have no idea what you're talking about. It's a sort of cool experience, but does not help prepare you the way you should be preparing. Your goal (among others) should be to understand the daily flow and decision making/tasks involved with patient care in a hospital, but more immediately you should be learning how to function as an effective and efficient intern/resident.

Hands on experience doesn't mean much if you don't know why you're doing what you're doing with those hands.

Agree, the worst rotation I had was the one where they stuck me in the OR all day. The idea was to get a lot of surgical exposure and to get to know the attendings who grade you. But I think that it would have been much more valuable to learn how to run the floor and see new consults rather than retracting all day. It was cool to use the bovie, cut skin, suture but being yelled at for not being able to manipulate the camera properly on your first try when you're in a quadport and your resident is right on top of you is not what I consider to be a good time.

 

[Stagg737]

As several people have pointed out, one of the main things you should be learning in medical school is how to function as a resident on part of a team. That is what you will be doing for 3-7+ years, and no amount of "first assist" in a direct preceptorship is going to prepare you for this. The weakest residents I've worked with as an intern were the ones who attended schools where this was commonplace. They also happened to be DO grads.

Being able to first assist in surgery as a medical student is kind of like "early clinical exposure" as a first year student. It means pretty much nothing, but sounds good if you have no idea what you're talking about. It's a sort of cool experience, but does not help prepare you the way you should be preparing. Your goal (among others) should be to understand the daily flow and decision making/tasks involved with patient care in a hospital, but more immediately you should be learning how to function as an effective and efficient intern/resident.

Hands on experience doesn't mean much if you don't know why you're doing what you're doing with those hands.

Interesting comparison. So other than doing well on shelves, what would you say the most important thing to learn during 3rd and 4th year is? Just how to function within part of a team? How much does the clinical education itself actually matter? l only ask since pretty much every resident I talked to said they learned more in the first few weeks of residency than their entire 2 clinical years.

@Psai , if one is going to be surgical resident, wouldn't they want to get as much OR exposure as possible? I understand wanting to learn more about running the floor if you're shooting for IM, but for surgery I'd think it wouldn't be as much of a priority. Not sure what field you're going for, but if there were one or two things you wish you had learned better or gotten more experience with during rotations, what would that be? Not trying to be difficult, just trying to figure out what I can do next year to make the most out of it.

 

[FiveOClock]

We set up our own rotations

You can't seriously make a statement like this and still expect anyone to think you're equal to an MD. I'm not saying you're going to be a bad doctor, but I am saying that your experience is not equivalent in intellectual rigor to a typical MD cirrculum.

 

[Stagg737]

You can't seriously make a statement like this and still expect anyone to think you're equal to an MD. I'm not saying you're going to be a bad doctor, but I am saying that your experience is not equivalent in intellectual rigor to a typical MD cirrculum.

Maybe I should rephrase that. Our school standardizes it's rotations at hospitals with residency programs and physicians with experience training students and we select where we want to do rotations. We actually frequently rotate at programs with MD students and even at several medical school hospitals. So we don't really set the rotations up ourselves (other than audition rotations, obviously).

If a student works with a preceptor instead of a hospital, they still have to do didactics and present grand rounds (which we've been doing since first year). Is it exactly the same as doing it with a group of residents? No, but we're still held to similar standards and have to understand how to do it. Also, seeing as I don't go to an MD school, I'm not sure how rigorous it is, but I somehow doubt it's much more difficult than what we're doing during the first two years. As for clinical years, I obviously can't speak to that yet. However, given our match lists over the past few years I'm not overly concerned.

Are there any reasons why you think that such a curriculum would be "less rigorous" than an "MD curriculum" other than just assumptions? Genuinely curious.

 

[JoeyB]

Does this post make me look stupid?

 

[Straight_Four_Porsche]

I'm against having it give spots to FMGs who do not plan on staying in the US after residency. Because at that point, you're putting government/tax money towards training physicians who will not even serve the US beyond the immediate future, and that isn't what the program is about.

Other than that, I'm all for expanding it, provided there is a demand, especially for primary care fields.

Maybe my attempt to get the this thread back on track is futile, but...

 

[jw3600]

I'm against having it give spots to FMGs who do not plan on staying in the US after residency. Because at that point, you're putting government/tax money towards training physicians who will not even serve the US beyond the immediate future, and that isn't what the program is about.

Other than that, I'm all for expanding it, provided there is a demand, especially for primary care fields.

Maybe my attempt to get the this thread back on track is futile, but...

Maybe your attempt to get it back on track would be better if you made a rational argument. FMGs come to train and then practice here because it's vastly better being a physician here then most other counties. That's why full fledged attendings from other counties literally do a 5 year surgical residency in the states to get licensed here. Great work, Abraham Lincoln.

 

[Straight_Four_Porsche]

Maybe your attempt to get it back on track would be better if you made a rational argument. FMGs come to train and then practice here because it's vastly better being a physician here then most other counties. That's why full fledged attendings from other counties literally do a 5 year surgical residency in the states to get licensed here. Great work, Abraham Lincoln.

Not sure where the hostility is coming from, but okay...

FMGs who come here to train and then practice here are perfectly fine. I am specifically referring to FMGs who come here, train in residency, and then go back to their home countries. At that point, they are receiving monies out of the Medicare GME fund, which is taxpayer funded. Why are we funding spots for people who will not practice here?

You could make the argument that it's some sort of moral duty for the program to pay to educate physicians to serve other countries, but that can become a slippery slope, especially here where tax dollars are being doled out.

I cannot find information regarding how many FMGs return to their home countries after residency though, so it may be minimal. Then again, it may not be...

 

[MD2BE92]

Between DO and MD programs hopefully we will see a shutting out of FMG for placements our own students should be filling as programs expand.

We don't need to water down the field anymore by expanding GME, read the rest of this thread of you want an explanation of how this will affect jobs/talent/brain drain from the field

 

[Donald Juan]

Not sure where the hostility is coming from, but okay...

FMGs who come here to train and then practice here are perfectly fine. I am specifically referring to FMGs who come here, train in residency, and then go back to their home countries. At that point, they are receiving monies out of the Medicare GME fund, which is taxpayer funded. Why are we funding spots for people who will not practice here?

You could make the argument that it's some sort of moral duty for the program to pay to educate physicians to serve other countries, but that can become a slippery slope, especially here where tax dollars are being doled out.

I cannot find information regarding how many FMGs return to their home countries after residency though, so it may be minimal. Then again, it may not be...

FMGs don't come here to train to return to their country. Our residencies are notoriously difficult to get into for FMGs, much more rigorous than many countries (even with work hour restrictions), potentially wouldn't license you to practice in another country or wouldn't prepare you for that countries health system, and US physicians make more than almost all other physicians in the world. You clearly are very unfamiliar with the process, that's why you experienced "hostility" from a previous poster.

 

[jw3600]

FMGs don't come here to train to return to their country. Our residencies are notoriously difficult to get into for FMGs, much more rigorous than many countries (even with work hour restrictions), potentially wouldn't license you to practice in another country or wouldn't prepare you for that countries health system, and US physicians make more than almost all other physicians in the world. You clearly are very unfamiliar with the process, that's why you experienced "hostility" from a previous poster.

No no DJ. I probably offended him with my micro aggression for explaining why his comment (that he was so gracious to "help the thread get back on track with") was factually inaccurate.

I appreciate the use of the quotation marks as well.

 

[Wordead]

Maybe I should rephrase that. Our school standardizes it's rotations at hospitals with residency programs and physicians with experience training students and we select where we want to do rotations. We actually frequently rotate at programs with MD students and even at several medical school hospitals. So we don't really set the rotations up ourselves (other than audition rotations, obviously).

If a student works with a preceptor instead of a hospital, they still have to do didactics and present grand rounds (which we've been doing since first year). Is it exactly the same as doing it with a group of residents? No, but we're still held to similar standards and have to understand how to do it. Also, seeing as I don't go to an MD school, I'm not sure how rigorous it is, but I somehow doubt it's much more difficult than what we're doing during the first two years. As for clinical years, I obviously can't speak to that yet. However, given our match lists over the past few years I'm not overly concerned.

Are there any reasons why you think that such a curriculum would be "less rigorous" than an "MD curriculum" other than just assumptions? Genuinely curious.

How on earth do you do grand rounds and didactics with just a preceptor?

 

[dozitgetchahi]

FMGs don't come here to train to return to their country. Our residencies are notoriously difficult to get into for FMGs, much more rigorous than many countries (even with work hour restrictions), potentially wouldn't license you to practice in another country or wouldn't prepare you for that countries health system, and US physicians make more than almost all other physicians in the world. You clearly are very unfamiliar with the process, that's why you experienced "hostility" from a previous poster.

There are plenty of FMGs that return to their home countries following a US residency. There are a couple planning to do this in my residency class alone. Saying that nobody does this is totally false.

 

[Straight_Four_Porsche]

.

 

[Straight_Four_Porsche]

FMGs don't come here to train to return to their country. Our residencies are notoriously difficult to get into for FMGs, much more rigorous than many countries (even with work hour restrictions), potentially wouldn't license you to practice in another country or wouldn't prepare you for that countries health system, and US physicians make more than almost all other physicians in the world. You clearly are very unfamiliar with the process, that's why you experienced "hostility" from a previous poster.

As the above poster said, I had assumed this was at least somewhat common...

 

[MD2BE92]

As the above poster said, I had assumed this was at least somewhat common...

WHY on earth should we finance this then? There are no circumstances which, all things considered, benefit our country or taxpayer dollars to finance some FMGs residency. Either taking a spot here away from US trained doc (MD or DO) or taking our money elsewhere eventually.

Does anyone other than me see how dumb this ideology is?

 

[Mjolner]

WHY on earth should we finance this then? There are no circumstances which, all things consider, benefit our country or taxpayer dollars to finance some FMGs residency. Either taking a spot here away from US trained doc or taking out money elsewhere eventually.

Does anyone other than me see how dumb this ideology is?

My understanding is that this was the rationale behind the combined match--to squeeze out FMG and IMG. Whether or not that will happen or if the DOs will just get horribly screwed remains to be seen. I personally don't think it will be that bad right away. Although, if you're enrolling in a DO school in the next couple of years and hoping to do Derm, Ortho, NSG, etc I'd prepare for disappointment.

 

[Stagg737]

How on earth do you do grand rounds and didactics with just a preceptor?

We start doing grand rounds as first years to our class and the faculty and are expected to perform at least at the level of 4th year students. They actually broadcast the presentations online as well so anyone can watch. At one point our dean actually stopped a group mid-sentence in the presentation and basically told them it was crap (I won't say exactly what was said, but it was embarrassing and announced in front of the entire class). Idk if the presentations are actually up to standards of first year residents, but we've had several resident directors/teachers come sit in on them and most thought they were listening to 4th year students, so I'd say the standards are at least moderately rigorous.

I don't know a lot about the didactics yet, as I'm a M2. From what I understand if you're rotating with a preceptor, you're also required to attend didactics at the school or another location that does have didactics with other students rotating with preceptors. I don't know the exact logistics of this, but from what I understand both grand rounds and didactics are a requirement for us regardless of how you're rotating.

 

[IlDestriero]

The above is a real problem with many newer, DO and offshore schools. Their structure is very different and shunting the students off to diverse preceptors and non academic locations gives a very variable experience and doesn't serve you well to prepare you for internship and residency.

 

[W19]

COCA needs to up their accreditation standards IMO... I remember seeing a thread in SDN about some MD school in PR whose accreditation was completely revoked (not probation) because their main hospital filed for bankruptcy. These are the things COCA need to do in order to keep DO schools in check... DO schools are popping up everywhere lately. NYIT just opened a branch in Arkansas and will have 160+ students in their 2016 inaugural class... State schools like FIU/FAU/UCF with resources opened up with 60-70 students in their inaugural class... How come every DO school can start with so many students when they have no big medical center(s), and then increase their class size to 250+ in 2 to 4 years?

 

[Mjolner]

COCA needs to up their accreditation standards IMO... I remember seeing a thread in SDN about some MD school in PR whose accreditation was completely revoked (not probation) because their main hospital filed for bankruptcy. These are the things COCA need to do in order to keep DO schools in check... DO schools are popping up everywhere lately. NYIT just opened a branch in Arkansas and will have 160+ students in their 2016 inaugural class... State schools like FIU/FAU/UCF with resources opened up with 60-70 students in their inaugural class... How come every DO school can start with so many students when they have no big medical center(s), and then increase their class size to 250+ in 2 to 4 years?

Because COCA like money more than making quality physicians.

 

[Wordead]

We start doing grand rounds as first years to our class and the faculty and are expected to perform at least at the level of 4th year students. They actually broadcast the presentations online as well so anyone can watch. At one point our dean actually stopped a group mid-sentence in the presentation and basically told them it was crap (I won't say exactly what was said, but it was embarrassing and announced in front of the entire class). Idk if the presentations are actually up to standards of first year residents, but we've had several resident directors/teachers come sit in on them and most thought they were listening to 4th year students, so I'd say the standards are at least moderately rigorous.

I don't know a lot about the didactics yet, as I'm a M2. From what I understand if you're rotating with a preceptor, you're also required to attend didactics at the school or another location that does have didactics with other students rotating with preceptors. I don't know the exact logistics of this, but from what I understand both grand rounds and didactics are a requirement for us regardless of how you're rotating.

Oh. Grand rounds as a preclinical student is pretty much completely pointless, especially when you're giving it to classmates. Whats the point of giving a talk on say, bariatric surgery, when there is no bariatric surgeon in the room to give feedback or correct outdated information? What you're describing is just preclinical students presenting a topic to other students.

The didactics make sense and are the same.

 

[Mad Jack]

I agree and don't know why it's not done. Hard nosers on here always respond with the snide "might as well call yourself an NP then" but if we can shorten the amount of schooling needed (AND NOTE, not the actual residency or fellowship training time) but the undergrad and preclinical time, I think it should be done. Frankly, medical school curriculum can be started after high school assuming students have a solid foundation in biology, chemistry, and physics which many do. All that's needed is to maybe have a 1-2 year period after high school where students can simply take (or many can retake) their BCPMs. You can still take a couple electives in this time. There's really no need for a major of study if your plan is to apply to medical school. I'm not saying you eliminate majors for pre-mess but you should be able to apply without one so long as you've completed your BCPM and some electives like economics, philosophy, psychology, further math, etc. I think the real time wasters are upper level biology we take. They're pretty much the same thing we take during medical school anyways. Then after the 1-2 year period, students take the MCAT and apply once they've gotten their scores back. That could potentially shorten the process by 2 years.

You could even go more extreme by teaching the BCPM in 11th-12th years which is where most of us gunners realistically mastered them and start medical school right after high school. I know this can be done because I have friends who left high school early or took off right after high school to pursue their medical education abroad and have since come back with 250+ step scores. In addition, I know a couple smart doctors who pushed their kids to get into medical school early (18-19 y/o) and they're managing the curriculum well enough.

Anyways, there's always going to be the issue of maturity but frankly there's no hard evidence to support one way or the other so we are basically stuck in this status quo which inconveniently sticks because it lets universities eat more of our tuition money.

Premeds aren't required to take upper level bio, they do that to themselves.

 

[Mad Jack]

See, that's not entirely true. Every hospital I've worked at, including med school and residency, the CRNAs took call the same as the physicians with reasonably similar hours.

Also, no where did I say I liked this trend. I don't really trust CRNAs, but patients really don't get a say in it if we like our surgeon and go where he/she operates.

They were hourly employees where I worked, 9-5ers for the most part unless they wanted the overtime (which the hospital was reluctant to give, as there were plenty of residents around). I lived in a supervision state though, so CRNAs were barred from being paid salary and could effectively take call since they'd need an anesthesiologist there anyway.

 

[Mad Jack]

Ok, I think I get you.

In what country have you ever heard of an attending level physician ever making less that 6 figures?

You're right. Our salaries are very much dependent on supply..

And the lower wages will be because of increased competition. I get it we all got to eat, but it's pretty hard to make claims about other people's "selflessness" as you call it when you want to keep your salary up not by being better than the competition but rather by preventing the competition.

Your entitlement is showing..

there's actually only about ten countries in the world where specialists make over 100k and fewer still where generalists do. We could very quickly be headed down that path.

 

[MD2BE92]

there's actually only about ten countries in the world where specialists make over 100k and fewer still where generalists do. We could very quickly be headed down that path.

Yeah...you're right lets reimburse our specialists to the tune of mexico or greece (whose economy is failing) and have surgical specialists botching surgeries left and right.
God help us if we de-incentivize a crucial field like medicine, for the more difficult work. Ludicrous.

Edit: Sorry I mis-read thought it sounded like you were advocating for a decrease in reimbursements.
However, it is still really concerning with this trend. I WOULD NEVER go to mexico to have a surgery done. Period.