Dismiss Notice
Hey Texans—join us for a DFW meetup! Click here to learn more.

Are newer COM focused on making $, too much?

Discussion in 'Medical Students - DO' started by SouthEast2BDO, Dec 11, 2008.

  1. SouthEast2BDO

    Joined:
    Dec 10, 2008
    Messages:
    1
    Likes Received:
    0
    Status:
    Medical Student
    I'm now in the 4th year at my school. I would not say that I am unhappy but I am concerned. I go to a newer school in the South East (name left out b/c I don't feel it's important) and this fall meeting lots of students from newer COM and other Osteopathic schools-- we had the same thoughts and feelings. Our schools are primarily about money. They are using the Dr Shortage to make some cash.

    They are concerned with getting the tuition size up and getting as much money in as possible. There is little doubt, in what I've seen, that quality of education has taken a distant 2nd or 3rd seat. Those I have talked w/ also are concerned w/ the lack of graduate programs. We were definitely miss led in this area. The programs sold to us 4 years ago (told would be in place in a couple years) are no where insight. The programs that are established are small programs and are not attractive, and yes are primary care. Now that we are looking at residency we are pushed to go to Michigan, PA or OH. Nothing wrong w/ those places but that's not what a lot of us were sold 4 years ago. We all know it takes time but these things are obviously not the number one task at hand.

    Another thorn that many of us feel is the primary care push. One individual said that he would love to see his dean get up and first state, "I make X amount of money but would like you to go and make a lot less starting at X in this small town". We basically feel it is wrong to push people w/ $200,000 of debt into the lowest paying specialties. Sure they use to work in these specialties, but they never will again give up their big salaries and go back to being a working Dr. Also, I thought I knew what I wanted to do before medical school, but now after some experience I know. I would at least like a school that supports the specialty where I am happy.

    Lastly, do you think that your school is overly tolerant w/ students. I'm all for giving students a chance but I think there should be a line and those that cross it should be dismissed. This was a topic at lunch on an away rotation. Honestly, it had not really crossed my mind, but since then I have wondered why our schools are so tolerant of terrible behavior. Maybe the tuition money is more important than their reputation?

    I'm sure some of you agree and others disagree, great!
    My point of this is how do we get our schools to become better. I would rather have a smaller school w/ much better academics and residency options, than a big one that turns out fair Dr's w/ no where to go. When I mentioned this politely to the school leadership; it was a very cold response. If you have ideas or thoughts please voice them. Any and all input is greatly appreciated.
     
  2. Note: SDN Members do not see this ad.

  3. Bacchus

    Administrator Moderator Physician 10+ Year Member

    Joined:
    Apr 27, 2007
    Messages:
    20,559
    Likes Received:
    1,857
    Status:
    Attending Physician
    Money fuels everything. Is your education compromised? There are plenty of schools that charge tuition higher than most COM's. Is it a scandal when an OOSer pays 2X tuition? Yes. But that's why you don't apply to these schools. They'll still get their class filled but it isn't your money. Most COMs are private, as you know, so in order to have financial security they must bring in money. At most private institutions this is done by tuition.

    Four years is not a long enough time to build up a program and its reputation in order to take it to the magnitude of "the place to rotate." If you don't like the program, match elsewhere. Enjoy a change of scenery.


    As you acknowledge, these people worked in those fields. They "paid their dues" and progressed through their careers. Match into what you want. You have autonomy over yourself. You aren't in a contractual agreement to practice primary care nor are you in a locational agreement to move to PA, MI, or OH. Osteopathic medicine is not going to get away from primary care, so I expect this push to continue well into the future, especially with the preventative care craze and the projected shortage.


    I'm not at my school yet, however I do agree there is a lot of tolerance for students. However, a school's lifeline is its reputation. Building that reputation up over the years is hard to do. Not one school is so overly tolerant that its producing bad physicians. You're always going to have bad eggs, it just happens. However, if the problem is extreme, I do have faith that the school will take proper action. Lets not forget either that we are investments and the school is paying more to train us than we are paying them to do this job. It may be financial, but no one throws money away.
     
  4. scpod

    Physician Moderator Emeritus 10+ Year Member

    Joined:
    Oct 13, 2005
    Messages:
    3,241
    Likes Received:
    120
    Status:
    Attending Physician
    I'm not sure how many times you really have to say this for people to understand, but the tuition for DO schools is no higher than it is for MD schools. If you sikmply averaged the tuition it would seem to be, but this is because of the status as private schools. Please check the costs for MD private schools and the tuition for out-of-staters at MD schools for comparison:

    http://services.aamc.org/tsfreports/report.cfm?select_control=PRI&year_of_study=2008

    http://services.aamc.org/tsfreports/report.cfm?select_control=PUB&year_of_study=2008

    Private schools are always higher because they have to use tuition to make up for what the state gives them, etc. Its not an Osteopathic problem; it's a medical school everywhere problem. Besides, you know what the tuition is going into it and you have the option of applying to schools that cost less. Bitching about it later is silly.

    The lack of GME programs has long been a problem, but it is seriously being worked on. The number of residencies has increased over the years, albeit not as quickly as enrollment. One of the worst problems was very recently resolved when the government agreed to give start-up loans to new hospitals want new residencies. The remaining problem is the requirement that a director be certified by an AOA board to begin a specialty program, and there aren't enough of them to do that. That means a Cardiologist trained at Johns Hopkins couldn't start one. Talk to your AOA representative about changing that rule and you'll open tons of things.

    There are FPs making well over $300,000 a year in smaller places because they do lots of procedures. I'm just finishing up with a FP doc who makes 3 to 5 grand a day when he's not even in the office because of the number of things going on-- bladder scans, stresses, x-rays, etc. If you really want to make money you can, even in primary care. You just have to have a good business sense.... and most doctors don't. That's one thing they don't teach in medical school, and that's too bad.

    Keep in mind, though, that tradirtionally DOs have been primary care docs. They learned their craft from other primary care docs and that's what they wanted to do. A whole lot of DO students still want to do that. However, many of them have chosen to go into top specialties and are doing so, even at allopathic institutions. In order to ge those nerosurgery-type specialties you have to be at the very top of your class-- regardless of your status as a DO or MD. If you are at the top of your cless at any school, you will have much to choose from.

    Lastly, you asked about tolerance of terrible behavior....haha! Not at my school. You wear the wrong thing and you get sent home. It's not a universal phenomenon, though :)
     
  5. 4Doc4

    2+ Year Member

    Joined:
    Oct 30, 2008
    Messages:
    70
    Likes Received:
    0
    Status:
    Medical Student
    Great post scpod. This points to the obvious sentiment that every story has two sides. Roaming through a lot of the threads on sdn lately there seems to be a lot of negativity bogging down negativity. The fact remains a strong emphasis on an American capitalist ideology - i.e. any individual who puts their energy and effort to be the best they can be and works harder than 90% of people can accomplish anything they want. Regardless of the initials behind your name people notice successful people.
     
  6. andexterouss

    5+ Year Member

    Joined:
    Feb 12, 2005
    Messages:
    354
    Likes Received:
    1
    You are right that private schools are expensive but the problem is that DO schools rarely provide adequate financial aid while private MD schools are amassed with financial aid.My friends at Albert Einstein and NYU pay close to half their tuition even though the full tuition is 40k+ because they were able to apply for scholarships and other financial programs being offer by the schools.Other MD schools have similar programs.

    That line is often too repeat that it's almost becoming a cliche.Radiologists and cardiologists are basically CEOs.They each seem to own or have stake in a CT, MRI and an outpatient body scanner operator! The truth is, some specialties can lend themselves to following a business model while others especially in PC can't . If every FP doc starts running lots of unnecessary tests and procedures to bring in the buck, the cost of healthcare will skyrocket and Medicare will step in with an axe and not a scalpel. Radiologists recently got a good cut(and other penalties) in their pay for basically running the same scheme .
     
  7. 4Doc4

    2+ Year Member

    Joined:
    Oct 30, 2008
    Messages:
    70
    Likes Received:
    0
    Status:
    Medical Student
     
  8. andexterouss

    5+ Year Member

    Joined:
    Feb 12, 2005
    Messages:
    354
    Likes Received:
    1
     
  9. Bacchus

    Administrator Moderator Physician 10+ Year Member

    Joined:
    Apr 27, 2007
    Messages:
    20,559
    Likes Received:
    1,857
    Status:
    Attending Physician
     
  10. scpod

    Physician Moderator Emeritus 10+ Year Member

    Joined:
    Oct 13, 2005
    Messages:
    3,241
    Likes Received:
    120
    Status:
    Attending Physician
    Who's talking about "unnecessary" tests? When you've spent enough time in a medical office you realize that the tests you run are pretty much what Medicare or private insurance will already pay for. The difference is.... do you send them out to someone else, or do you perform them in your own office? If you've been trained in doing punch biopsies, do you send them out or do them in your office? Does your patient have to go to a cardiologist for his or her stress test, or can you do it on your own with your own trained staff? Send them across the street for an ultrasound, or hire a tech and do it in your office?

    Like it or not, medicine is a BUSINESS, and if you don't treat it like it is, then you may fail at it. Remember what you learn in medical school-- should you study harder, or study smarter? The same thing goes for a medical practice-- practice harder, or practice smarter?
     
  11. andexterouss

    5+ Year Member

    Joined:
    Feb 12, 2005
    Messages:
    354
    Likes Received:
    1
     
  12. Bacchus

    Administrator Moderator Physician 10+ Year Member

    Joined:
    Apr 27, 2007
    Messages:
    20,559
    Likes Received:
    1,857
    Status:
    Attending Physician
    Is it feasible for a DO school to build a hospital? Possibly, but not the wisest financial decision.

    There are more MDs than DOs, thus a lot of those schools have more alumni and alumni networking, more money.

    The MD schools are usually attached to universities and thus have a larger endowment. I don't see the unaffiliated schools starting an UG any time soon.

    The burden isn't going away.
     
  13. Lamborghini1315

    Lamborghini1315 Sleep deprived
    7+ Year Member

    Joined:
    Jun 7, 2006
    Messages:
    918
    Likes Received:
    1
    Status:
    MD/PhD Student
     
  14. MossPoh

    MossPoh Textures intrigue me
    7+ Year Member

    Joined:
    Apr 24, 2006
    Messages:
    7,992
    Likes Received:
    40
    Status:
    Medical Student
     
  15. andexterouss

    5+ Year Member

    Joined:
    Feb 12, 2005
    Messages:
    354
    Likes Received:
    1
    My point that there is potential for widespread abuse if FPs start performing in-house testing and procedures. Since there is an incentive to make money, lots of unnecessary tests will be performed leading to skyrocket cost in healthcare. Radiologists had the same privilege which they abused and were punished with pay cuts and banned from self-referrals.
     
  16. andexterouss

    5+ Year Member

    Joined:
    Feb 12, 2005
    Messages:
    354
    Likes Received:
    1
    Why not? Under good management, hospitals can a big generator of revenue. Research funds can also be attracted.

    True. But lets take PCOM for example. PCOM is what?100 years old?Of the thousands of students it has graduated over these many years, how many of its wealthy graduates have setup a trust fund to provide a full ride scholarship to a student from their alma mater? The tuition, last I heard ,is less than 40k . A few of its orthopods, anesthesiologists,plastic surgeons, radiologists,cardiologists etc can gather together ,chip in a thousand bucks here and there ,get a tax write-off and send 5 students with a full ride scholarship. I doubt that's going to happen.

    If the OP and his classmates are any indication, few DOs upon graduation give back to their respective schools. Lots of these students come in with hope, ideals and zeal only to be disillusioned and bitter by the time they hit 3rd/4th year.They never come back to contribute to the system.
    The sad part is that we need these students to work and change the system. If all we do is b*tch, nothing will change and more for-profit schools will keep opening and limited residency slots will continue.
     
    #15 andexterouss, Dec 11, 2008
    Last edited: Dec 11, 2008
  17. Bacchus

    Administrator Moderator Physician 10+ Year Member

    Joined:
    Apr 27, 2007
    Messages:
    20,559
    Likes Received:
    1,857
    Status:
    Attending Physician
    PCOM had a hospital that it sold because of financial issues. You'd they know what they're doing after a hundred years. As healthcare matures (or continues to die) it will become increasingly difficult to manage hospitals.

    I agree however that alumni could throw a few bucks into the ring. But, medicine in general causes these people to become so pissed off at the system that they say a big FU.
     
  18. Red Beard

    7+ Year Member

    Joined:
    Apr 25, 2006
    Messages:
    561
    Likes Received:
    17
    Status:
    Attending Physician
    I haven't read this whole thread in detail, so forgive me if this was already said:

    I've noticed over the last few years this uninformed assertion that DO schools are all 'in it for the profit' keeps coming up. It should be pointed out that there is only one for-profit school, RVU. The high cost of tuition relative to MD schools has been discussed as well, AMSA has published a very informative overview of tuition breakdown for state and private allopathic schools as well as commenting on osteopathic schools... http://www.amsa.org/student/tuition_FAQ.cfm

    My concern is that this statement about osteopathic schools being 'in it for profit' keeps getting thrown out there and everyone gets their panties in a bunch, a lot of what is said is unfounded. Google stores this crap, and for the indefinite future this is out there for the even less informed to latch on to, unfairly tainting our reputation.

    I absolutely agree that high tuition is a significant problem and needs to be addressed. However, repeatingly posting "All DO schools are evil, money making degree mills" only hurts us. I ask that people figure out what they are basing there assertions on before spouting off on the topic.


    /end mini-rant
     
  19. Dissected

    Dissected All bleeding stops eventually
    7+ Year Member

    Joined:
    Jul 16, 2008
    Messages:
    2,667
    Likes Received:
    37
    Status:
    Resident [Any Field]
    There is a disconnect here for me...In order to maintain non-profit status (RVU excluded, take it to the other threads :p) the cash flow is invested back into the school. This means that all of the incoming funds are retained by the organization for its future provision of programs and services. If the money is not invested back into the program, they could lose non-profit status. Making more money for a non-profit = more money towards their programs. Med-school programs = education...

    Anyone?
     
  20. JayneCobb

    JayneCobb big damn hero....
    Moderator Emeritus 5+ Year Member

    Joined:
    Oct 17, 2006
    Messages:
    1,443
    Likes Received:
    3
    Status:
    Fellow [Any Field]
    What I don't understand is how people give the schools a pass since all the schools are raising rates at unbeleiveable rates. Tution has (adjusted for inflation) risen 439% from 1982 to 2007, and this is down right criminal in my mind.

    I had a family member who graduated from the same medical school I went to almost 20 years before I did and he graduated with $10,000 in debt, I graduated with $200,000 in debt. Something doesn't add up in the rate of inflation of tutition.
     
  21. Dissected

    Dissected All bleeding stops eventually
    7+ Year Member

    Joined:
    Jul 16, 2008
    Messages:
    2,667
    Likes Received:
    37
    Status:
    Resident [Any Field]
    As I stated, where do you suppose this money is going? They are not allowed to gross income that can be used like most businesses...the surplus has to be poured back into the school. I think that the cost to maintain a medical institution demands this amount of money, where else would it go?? Even with the rising tuition prices schools have had financial issues. Its not like they are building enormous golden statues of AT Still or trying to run giant teaching hospitals. I think it is easy to underestimate the cost of running an institution without government aid. Why do you think USC and other private undergrads have comprable tuitions???
     
  22. HarveyCushing

    7+ Year Member

    Joined:
    Mar 12, 2005
    Messages:
    1,377
    Likes Received:
    3
    I know that the president of my university gets paid +1 million a year. I'm sure quite a bit of the increase in tuition goes towards the salaries of the higher up admins since their income has to increase a good bit to account for the wonderful things they do every year.
     
  23. Dissected

    Dissected All bleeding stops eventually
    7+ Year Member

    Joined:
    Jul 16, 2008
    Messages:
    2,667
    Likes Received:
    37
    Status:
    Resident [Any Field]
    :annoyed: lame. I got excited when AIG's CEO agreed to a $1 salary next year. Its not like he ever has to work another day in his life.
     
  24. GoBuckeyes913

    GoBuckeyes913 Intoxicating
    7+ Year Member

    Joined:
    Jan 23, 2007
    Messages:
    365
    Likes Received:
    10
    Status:
    Attending Physician
    The one thing I cannot overlook in this discussion is why some DO schools feel the need to have branch campuses.

    LECOM has 3. Three. Is that really necessary? PCOM GA, really? Do you see Pitt setting up franchises all over PA? Absolutely not. I'm not speaking negatively about these branches of schools whatesoever, just about the idea.


    Personally, it really bothers me that this is happening, and I feel that it not only decreases the worth of the school, but it reinforces the notion that DO schools are for-profit institutions.

    Ugh:rolleyes:
     
  25. HarveyCushing

    7+ Year Member

    Joined:
    Mar 12, 2005
    Messages:
    1,377
    Likes Received:
    3
    I believe UPitt has built a medical center somewhere in the Middle East (Dubai, UAE, Kuwait?) as well as Italy. Also, I believe Duke (Singapore), Cornell (Quatar) and Harvard (Dubai) have/will open up medical school branches overseas. Not saying this is the same as opening up branches in the US, however it is the same theory and purpose; to extend the reach of the university and make more $$$$.
     
  26. DannMann99

    10+ Year Member

    Joined:
    Aug 14, 2007
    Messages:
    423
    Likes Received:
    1
    Status:
    Attending Physician
    Well if its any consolation. I know PCOMs rationale for starting a branch campus in GA was that it is forecasted to be one of the states hit the hardest by the physician shortage. So they figure increasing med students down there will increase physicians.
     
  27. Dissected

    Dissected All bleeding stops eventually
    7+ Year Member

    Joined:
    Jul 16, 2008
    Messages:
    2,667
    Likes Received:
    37
    Status:
    Resident [Any Field]
    But...they're not.....

    I don't think anyone assumes they are, they CANT be with their tax status or the strict guidelines they have to spend all surplus funds.
     
    #26 Dissected, Dec 12, 2008
    Last edited: Dec 13, 2008
  28. HarveyCushing

    7+ Year Member

    Joined:
    Mar 12, 2005
    Messages:
    1,377
    Likes Received:
    3
    Still kinda weird to have a "Philadelphia" College of Osteopathic Medicine in the middle of Georgia. At least change the name to fit into the area rather than be a sore thumb. Its like doing a rotation in Atlanta and your attending asking where you are a student and you say PCOM-GA and he asks how long you are staying in the area and you have to explain to him that you actually live there and that is where the school is located. :eek:
     
  29. JayneCobb

    JayneCobb big damn hero....
    Moderator Emeritus 5+ Year Member

    Joined:
    Oct 17, 2006
    Messages:
    1,443
    Likes Received:
    3
    Status:
    Fellow [Any Field]
    427% in 20 years, this has far outpassed inflation & cost of living increases, and no one has yet to try and reasonably explain this outside of hypotheticals. I'm sure technology is expensive, and buildings are expensive, but 427% increase expensive? I'd like to see a detailed break down and justification of these costs. If it's justified, then it's justified, but the shere increase in it boggles at least my mind.

    The few universitise I could find that posted their budgets online, had the Admin costs accounting for about 5% of total costs, but the budgets were so lumped together, it was hard to see what they were actually spending it on.
     
  30. Dissected

    Dissected All bleeding stops eventually
    7+ Year Member

    Joined:
    Jul 16, 2008
    Messages:
    2,667
    Likes Received:
    37
    Status:
    Resident [Any Field]
    Yea its a lot..but if you think about it, schools have grown, which means more faculty have to be hired. Add that to dramatically inreased average salaries over the past 20 years and that is a HUGE expense. Its hard to swallow paying employees an arm and a leg, but the alternative is losing qualified/tenured faculty members. Thats my theory.
     
  31. JayneCobb

    JayneCobb big damn hero....
    Moderator Emeritus 5+ Year Member

    Joined:
    Oct 17, 2006
    Messages:
    1,443
    Likes Received:
    3
    Status:
    Fellow [Any Field]
    The 427% is after standard cost of living inflation, so I do not see how staff salaries can account for this level of increase. Sure classes are larger, so they hire more staff, but shouldn't that be fairly proportional to the tution already there? Unless they're adding far more staff than they had previously, so they need to justify the additional staff if that accounts for all the cost increases. So in my mind, this does not explain the reasoning.
     
  32. Red Beard

    7+ Year Member

    Joined:
    Apr 25, 2006
    Messages:
    561
    Likes Received:
    17
    Status:
    Attending Physician
    I am not sure where the 427% figure came from, but I know that is not exclusive to osteopathic medical schools. There has been a similar magnitude of tuition inflation across all colleges and professional schools, public and private, over the last two decades.
     
  33. dozitgetchahi

    7+ Year Member

    Joined:
    Oct 20, 2008
    Messages:
    1,583
    Likes Received:
    606
    Status:
    Fellow [Any Field]
    Believe it or not, much of this has to do with the widespread availability of cheap government-sponsored and/or private student credit. Think about it: back before the big-time Stafford/PLUS/etc loans came on line in the early 80s, schools at every level really had to compete on price because plenty of people simply did not have any hope of being able to finance huge tuition bills (or pay them outright, for that matter). Unfortunately, one unintended consequence of the arrival of huge, government-sponsored student loans was the fact that schools realized they could suddenly start charging a lot more than they had before because the new government credit was so easy for almost everyone to get.

    Since that point in time, of course, tuition has skyrocketed at most private institutions and substantially increased at many public ones. There was a time where the maximum Stafford loan amount might have actually been enough to get you through a decent state school, etc...now it's barely enough to get one through a community college.
     
  34. JayneCobb

    JayneCobb big damn hero....
    Moderator Emeritus 5+ Year Member

    Joined:
    Oct 17, 2006
    Messages:
    1,443
    Likes Received:
    3
    Status:
    Fellow [Any Field]
    The 427% is for al colleges, not just post-graduate. The levels of increase are similar if not the same.

    This makes some sense, in a sick twisted way, but sad to say this makes sense. So it's time to have these colleges justify their mandatory costs and staffing.
     
  35. theKirk

    2+ Year Member

    Joined:
    Apr 25, 2007
    Messages:
    58
    Likes Received:
    0
    Status:
    Medical Student
    to the Original Poster:

    I see this is your very first post. Welcome. ;)

    Yes, you got sold a load of crap. But I'm not one of the money conspiracy theorists. They aren't so much about the money. They were admittedly put in the southeast b/c that was where the HUGE primary care doctor shortage was to hit.
    So, while they are not actively trying to enforce folks to go to primary care, they are simply NOT actively helping folks specialize. So, they are indirectly serving what they were put here for.

    Secondly, it's a new school. We all should have thought this out more thorougly and it was not some hidden secret. It was in front of us the whole time. They put a new DO school in the south. Period. They didn't put new DO residencies in the south. Duh.
    I'm smacking myself in the head for not putting 2 and 2 together.

    Moreover, we all should have also realized that a new school is an experiment. And consequently, the first ~4 classes are going to be just that. Experiments. We are a barometer. The eggs that are gonna break making this omelet.

    To answer the question "how do we make things better?" Only time and successful classes will make it better. They are willing and somewhat expected to take the first few drafts in the loss column. And we will go down in school history as a decent test run.

    I'm not mad about it. It is common sense. And we should have expected these issues. I'm simply impressed how resourceful and assertive our class has been. I just hate that others might look at us later and say We succeeded DESPITE our administration, not because of it.
     
  36. DOinMS

    2+ Year Member

    Joined:
    Jan 15, 2007
    Messages:
    85
    Likes Received:
    0
    Status:
    Medical Student
    Finally - someone had the guts to tell the truth about the issue.
     
  37. nascardoc

    nascardoc Daddy to 2 kiddos
    7+ Year Member

    Joined:
    Oct 30, 2006
    Messages:
    1,237
    Likes Received:
    0
    Status:
    Resident [Any Field]
    I think one of the issues regarding tuition differences, in terms of hospitals making money for MD schools, etc., is that a lot of DO schools are in rural America. They do this to fill in a need in these parts of they country and having a hospital in these regions, while great for the people in the area, is not going to make millions and millions of dollars for the school. The funds just aren't in those parts in the country, nor are the huge amount of people in the areas. It's a lot different for a hospital to go up in Chicago, LA, Memphis, versus Kirksville, Harrogate (TN), or Pikesville (KY). So you will never see hospitals as a major revenue source for osteopathic schools.
     

Share This Page