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"Although there are a lot of variables in a person's decisions and reasons, there are forces at play beyond anyone's control that will greatly affect your life. The economy, increasing patient load, decreasing resources and various "reform" plans are going to put an heretofore unseen stress on the US health care system. Additionally, new changes in the ACGME regarding internship and fellowship will increase the crush on their residencies. The Carib and IMG grads are basically done for at this point, but the DO's are not far behind. Over expansion of class sizes and schools with no regard to GME, lower accreditation standards and the AOA's continued territorial ostracism of ACGME grads are all combining into a perfect storm that will shake this profession to its core. I expect a progression: first, CMS stops funding AOA residencies; second, the USDE mandates that any school graduating physicians, MD or DO, be accredited by the LCME, rather than COCA. Finally, grads of LCME-accredited DO schools who completed ACGME residencies are converted to MD, while the others are limited to manipulation only, like British DO's. No amount of wishing or "proud to be a DO" chest thumping will change this. It is sad, as I do love the profession, but the storm is coming, sad or not. This may not have been the case 10 years ago, but in 2012, MD>DO>>>>>>>>IMG>>>>>>>>>>>>>>>>>>>>>>>Carib IMG."

His account is "DO Anes". Very disparaging to DO and for-profit institutions. How did he come to be the dean of a for profit DO institution?
 

Mad Jack

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"Although there are a lot of variables in a person's decisions and reasons, there are forces at play beyond anyone's control that will greatly affect your life. The economy, increasing patient load, decreasing resources and various "reform" plans are going to put an heretofore unseen stress on the US health care system. Additionally, new changes in the ACGME regarding internship and fellowship will increase the crush on their residencies. The Carib and IMG grads are basically done for at this point, but the DO's are not far behind. Over expansion of class sizes and schools with no regard to GME, lower accreditation standards and the AOA's continued territorial ostracism of ACGME grads are all combining into a perfect storm that will shake this profession to its core. I expect a progression: first, CMS stops funding AOA residencies; second, the USDE mandates that any school graduating physicians, MD or DO, be accredited by the LCME, rather than COCA. Finally, grads of LCME-accredited DO schools who completed ACGME residencies are converted to MD, while the others are limited to manipulation only, like British DO's. No amount of wishing or "proud to be a DO" chest thumping will change this. It is sad, as I do love the profession, but the storm is coming, sad or not. This may not have been the case 10 years ago, but in 2012, MD>DO>>>>>>>>IMG>>>>>>>>>>>>>>>>>>>>>>>Carib IMG."

His account is "DO Anes". Very disparaging to DO and for-profit institutions. How did he come to be the dean of a for profit DO institution?
It's pretty damn overblown, and an old statement that we know doesn't hold water.
 
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harkas

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^Agreed. Are you saying this person is Dean Mychaskiw? How do you know it's him btw?
 
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IsWhat

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It's pretty damn overblown, and an old statement that we know doesn't hold water.
His first point was spot on - the AOA basically no longer exists beyond 2020. What makes you believe his other points aren't a possibility? The MD world already tried the brute force method to get rid of DOs in California and lost, so I don't think things will happen as forcefully as this dean expects. More likely DOs will quietly be absorbed just like the GME deal went down.
 

Mad Jack

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His first point was spot on - the AOA basically no longer exists beyond 2020. What makes you believe his other points aren't a possibility? The MD world already tried the brute force method to get rid of DOs in California and lost, so I don't think things will happen as forcefully as this dean expects. More likely DOs will quietly be absorbed just like the GME deal went down.
The idea that DOs will be relegated to manipulation despite already completing GME and being in practice is absurd though. The LCME quite frankly doesn't want to deal with taking over DO schools- the merger of GME was silently pushed at the behest of CMS, who was sick of dealing with two entirely different GME accreditation systems. Most people didn't really keep up on the behind-the-scenes workings of things, so that went unnoticed, but if you talk to people that were directly involved in the process, this wasn't some ACGME brute-force move for a merger. The AOA could very well have kept their own system, they just would have been barred from fellowships after an AOA residency, so that is one you can blame on the AOA, not the ACGME. They wanted to protect the interests of members farther on in the process at the expense of future DO graduates.

They won't push for a merger of the COCA and LCME though, as what happened in California was widely viewed as violating antitrust law, and would likely not stand up to a challenge in court today. The same would go for the exclusion of DOs from the match, as IMGs and those with equivalent medical education have already successfully fought antitrust battles and won. Voluntary absorption is still an option, and if it's voluntary, well, then hell, why not. Let's heal the great schism in medicine once and for all.
 
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IsWhat

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The idea that DOs will be relegated to manipulation despite already completing GME and being in practice is absurd though. The LCME quite frankly doesn't want to deal with taking over DO schools- the merger of GME was silently pushed at the behest of CMS, who was sick of dealing with two entirely different GME accreditation systems. Most people didn't really keep up on the behind-the-scenes workings of things, so that went unnoticed, but if you talk to people that were directly involved in the process, this wasn't some ACGME brute-force move for a merger. The AOA could very well have kept their own system, they just would have been barred from fellowships after an AOA residency, so that is one you can blame on the AOA, not the ACGME. They wanted to protect the interests of members farther on in the process at the expense of future DO graduates.

They won't push for a merger of the COCA and LCME though, as what happened in California was widely viewed as violating antitrust law, and would likely not stand up to a challenge in court today. The same would go for the exclusion of DOs from the match, as IMGs and those with equivalent medical education have already successfully fought antitrust battles and won. Voluntary absorption is still an option, and if it's voluntary, well, then hell, why not. Let's heal the great schism in medicine once and for all.
This is what I am saying, the powers that be are obviously using a more tactful method to get what they want (as opposed to the more brute force methods which failed in the past).

I also don't agree that the LCME doesn't want full control over undergraduate medical education. The LCME and ACGME have been in bed with each other since the beginning, and being able to put quality control and class size restrictions on DO schools ensures LCME MD graduates don't start losing GME spots due to the massive increase in DO students.
 

Goro

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There are quality control measures already in place (unlike the Law). If schools start producing more grads than residency spots, and said grads can't find jobs, then schools will be forced to either cut their class sizes (I'm talking to you, VCOM, Touro and LECOM) or even close branch campuses.

Agree that a lot in the OP sounds like "the sky is falling!" mindset that first appeared when the merger went through.
 

Fat Lil Chubster

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There are quality control measures already in place (unlike the Law). If schools start producing more grads than residency spots, and said grads can't find jobs, then schools will be forced to either cut their class sizes (I'm talking to you, VCOM, Touro and LECOM) or even close branch campuses.

Agree that a lot in the OP sounds like "the sky is falling!" mindset that first appeared when the merger went through.
The rate limiting step is graduate medical education.
 
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Fat Lil Chubster

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"Although there are a lot of variables in a person's decisions and reasons, there are forces at play beyond anyone's control that will greatly affect your life. The economy, increasing patient load, decreasing resources and various "reform" plans are going to put an heretofore unseen stress on the US health care system. Additionally, new changes in the ACGME regarding internship and fellowship will increase the crush on their residencies. The Carib and IMG grads are basically done for at this point, but the DO's are not far behind. Over expansion of class sizes and schools with no regard to GME, lower accreditation standards and the AOA's continued territorial ostracism of ACGME grads are all combining into a perfect storm that will shake this profession to its core. I expect a progression: first, CMS stops funding AOA residencies; second, the USDE mandates that any school graduating physicians, MD or DO, be accredited by the LCME, rather than COCA. Finally, grads of LCME-accredited DO schools who completed ACGME residencies are converted to MD, while the others are limited to manipulation only, like British DO's. No amount of wishing or "proud to be a DO" chest thumping will change this. It is sad, as I do love the profession, but the storm is coming, sad or not. This may not have been the case 10 years ago, but in 2012, MD>DO>>>>>>>>IMG>>>>>>>>>>>>>>>>>>>>>>>Carib IMG."

His account is "DO Anes". Very disparaging to DO and for-profit institutions. How did he come to be the dean of a for profit DO institution?
This sounds like those morons who predict when the world is going to end. This scenario portrays things going bad, and no one bothers to step in to fix anything. We all just stand and watch things crumb helplessly, not going to happen.
 

dsdmurray

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"Although there are a lot of variables in a person's decisions and reasons, there are forces at play beyond anyone's control that will greatly affect your life. The economy, increasing patient load, decreasing resources and various "reform" plans are going to put an heretofore unseen stress on the US health care system. Additionally, new changes in the ACGME regarding internship and fellowship will increase the crush on their residencies. The Carib and IMG grads are basically done for at this point, but the DO's are not far behind. Over expansion of class sizes and schools with no regard to GME, lower accreditation standards and the AOA's continued territorial ostracism of ACGME grads are all combining into a perfect storm that will shake this profession to its core. I expect a progression: first, CMS stops funding AOA residencies; second, the USDE mandates that any school graduating physicians, MD or DO, be accredited by the LCME, rather than COCA. Finally, grads of LCME-accredited DO schools who completed ACGME residencies are converted to MD, while the others are limited to manipulation only, like British DO's. No amount of wishing or "proud to be a DO" chest thumping will change this. It is sad, as I do love the profession, but the storm is coming, sad or not. This may not have been the case 10 years ago, but in 2012, MD>DO>>>>>>>>IMG>>>>>>>>>>>>>>>>>>>>>>>Carib IMG."

His account is "DO Anes". Very disparaging to DO and for-profit institutions. How did he come to be the dean of a for profit DO institution?
I don't mean to drag up an old post, but do you have a source for this quote? It's a pretty heavy thing to say without evidence.
 

MyGrainAura

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There are quality control measures already in place (unlike the Law). If schools start producing more grads than residency spots, and said grads can't find jobs, then schools will be forced to either cut their class sizes (I'm talking to you, VCOM, Touro and LECOM) or even close branch campuses.
What quality control measures are in place to force schools to close or reduce class sizes? If there comes a day when every residency program is filled to 100% capacity and you still have hundreds of grads who don't match, then you could blame all the schools collectively but it'd be hard to force a small handful of them to take corrective action and let the other ones go unscathed.

While there are valid criticisms of schools with large enrollments like LECOM and VCOM, it would be difficult for a state board of education to make a conclusive determination that a particular school needs to close or reduce class size because it is "flooding the system" with too many graduates.
 

Goro

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What quality control measures are in place to force schools to close or reduce class sizes? If there comes a day when every residency program is filled to 100% capacity and you still have hundreds of grads who don't match, then you could blame all the schools collectively but it'd be hard to force a small handful of them to take corrective action and let the other ones go unscathed.

While there are valid criticisms of schools with large enrollments like LECOM and VCOM, it would be difficult for a state board of education to make a conclusive determination that a particular school needs to close or reduce class size because it is "flooding the system" with too many graduates.
Those school that can't find jobs for its graduates will be sanctioned.

Pharmacy and law schools are already decreasing their class sizes.
 

Osminog

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Yeah, that's messed up.

See bold:

Dear Mr. Crosby:

I am writing to you to urge the AOA to take immediate action in the interest of the profession. As a practicing osteopathic physician for over 20 years and a former AOA health policy fellow, it is clear to me that osteopathic medicine in the Untied States is in serious jeopardy and, unless we act now, it will not survive the upcoming challenges to the American health care system.

The recent initiative by Ms. Pletz at KCUMB is a poignant illustration of how close we are to a precipice that, if crossed, may end my profession. Although the issuance of a combined DO/MD degree at a single institution would set a dangerous precedent, the issues identified by Ms. Pletz are nevertheless real and should not be discounted.

COCA and the AOA, through its silence, have allowed irresponsible growth of osteopathic medical education without adequate clinical training at either the undergraduate or postgraduate levels. While allopathic schools hesitate to increase class sizes by 10% over 5 year periods, some osteopathic colleges have increased enrollment by more than 50% over one year in areas where there is a paucity of existing clerkship opportunities. Osteopathic colleges have opened numerous branch campuses, at high levels of enrollment, while barely graduating inaugural classes from the home schools. COCA accredited the first for-profit medical school in the United States in nearly a century without well-publicized and open debate and without a clearly defined rationale for the economic model. Putting aside Rocky Vista University, there is no credible for-profit medical school in the industrialized world. The vast majority of osteopathic graduates enter ACGME residency training, but there is no organized mechanism for them to return to the profession as program directors, DME’s and deans, thus perpetuating the vicious cycle of ever decreasing OGME opportunities. Category 1 osteopathic CME is so restrictive in design that is a constant source of difficulty and frequently cited as yet another reason for our graduates to leave the organized profession. Concurrently, the AAMC has called for a 30% increase in allopathic class sizes, clerkship opportunities are limited or bought and paid-for by third-world for-profits and CMS has not increased funding for residency training beyond 1997 levels. Ore economy is in its worst condition since the Great Depression and political health care reform proposals continue to limit reimbursement, decrease services and limit technology and innovation as the number of ill and elderly climb to record levels. We are fixated on primary care to the exclusion of specialties, while nurses, technician and other allied health professionals deliver the same care without well-demonstrated differences in morbidity and mortality.

Quite simply, Mr. Crosby, this profession is at crisis point. If we do not act to address these threats, then surely the US Department of Education will. Patient lives are at stake and it will only take one osteopathic Libby Zion to bring down the house of cards. I am well aware the COCA is an independent body, not controlled by the AOA, however, as you said yourself, the AOA can testify and set forth its opinion to COCA and the leadership of the AOA can use their bully pulpit to advocate for the necessary measures to protect the profession and the patients for whom we care. Surely the testimony of the AOA president and Board of Deans carries more weight than the testimony of a lone ACGME trained anesthesiologist. It should also be noted that the AOA appoints the members of COCA, so the organizations are separate, but related.

The following steps should be taken immediately:
1. A moratorium on any new osteopathic schools, branch campuses or expansion of class sizes.
2. A review of COCA standards and comparative study of LCME equivalents.
3. A prohibition of for-profit schools, including existing schools.
4. A review of all osteopathic undergraduate and graduate clinical education for standard and quality of teaching.
5. A rationalization (decrease) of class sizes in accordance with #4, above.
6. An accommodation in COCA standards, so that osteopathic physicians certified by the ACGME can serve as AOA residency program directors, DME’s and deans.
7. Acceptance of AMA CME as equivalent to AOA.
8. Development of endowment funding to increase OGME opportunities.
9. A prohibition of joint DO/MD degrees.

Mr. Crosby, I urge you and the AOA to act on this with all deliberate speed. Our profession has distinguished itself since the days of Andrew Taylor Still as offering patients a better philosophy and practice of health care. The benefit we offer to our patients has facilitated the acceptance and growth of our profession against overwhelming odds. The disappearance of osteopathic medicine would be a tragedy. Please, stand for what is ethical, stand for what is right, stand for our patients and stand for our uniquely American practice of care. If we do not police the profession, surely someone else will.

Fraternally yours,

George Mychaskiw II, DO, FAAP, FACOP
Professor and Chair, Department of Anesthesiology
Drexel University College of Medicine
 
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Those school that can't find jobs for its graduates will be sanctioned.

Pharmacy and law schools are already decreasing their class sizes.
LECOM grads do pretty well on boards and getting residency spots.

Any sort of national directive on reducing class sizes would certainly hone in on LECOM since it's the biggest school in the country --- but they could make a case that they produce quality graduates and the poorer-performing schools should be sanctioned instead, even though their enrollments are smaller.
 

Goro

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LECOM grads do pretty well on boards and getting residency spots.

Any sort of national directive on reducing class sizes would certainly hone in on LECOM since it's the biggest school in the country --- but they could make a case that they produce quality graduates and the poorer-performing schools should be sanctioned instead, even though their enrollments are smaller.
We're saying the same thing...schools that have graduates that can't find jobs will be the ones sanctioned. It won't be an across the board thing.
 

Cath Up

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So this AOA author that decried for profit medical education is now a dean of a for profit medical school?



Dangers of For-Profit Education: More Than Just Words | The Journal of the American Osteopathic Association

“There is no reason why, were business to decline, the RVUCOM campus could not be converted overnight into another office park in the rapidly growing Denver metroplex. “




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Based on the information presented, correct.
 
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Cath Up

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So this AOA author that decried for profit medical education is now a dean of a for profit medical school?



Dangers of For-Profit Education: More Than Just Words | The Journal of the American Osteopathic Association

“There is no reason why, were business to decline, the RVUCOM campus could not be converted overnight into another office park in the rapidly growing Denver metroplex. “




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Quote from your article:

"Other for-profit medical education ventures have been attempted in the United States in recent years. In 1999, Ross University School of Medicine, a for-profit allopathic institution on the Caribbean island of Dominica, planned to open a branch campus near Casper, Wyo, under the same clarion calls sounded by RVUCOM—meeting the needs of underserved rural communities in the Rocky Mountain West."

That is exactly what BCOM does in NM. He must be making a lot of money to pull a 180 like this.
 
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