DO vs Carib vs reapplying MD

[AzizImSorry]

Why can't we just make a "my parents don't approve of my choice to be a DO" support group somewhere on this forum and move on? OP seems to value their parents' view more than their desire to be a doctor by whatever means necessary... should probably only talk to people of a similar mindset and see how they made their decisions. All of the facts have been presented 123943502x in this thread. At what point do we call this an exercise in futility?

At the very least, OP please re-title the thread "Having a hard time dealing with parents' expectations: DO vs Carib vs. reapplying MD"

Not trying to be a dick, just making it seem like less of click bait

---

Members don't see this ad.

 

[Mansamusa]

Why can't we just make a "my parents don't approve of my choice to be a DO" support group somewhere on this forum and move on? OP seems to value their parents' view more than their desire to be a doctor by whatever means necessary... should probably only talk to people of a similar mindset and see how they made their decisions. All of the facts have been presented 123943502x in this thread. At what point do we call this an exercise in futility?

At the very least, OP please re-title the thread "Having a hard time dealing with parents' expectations: DO vs Carib vs. reapplying MD"

Not trying to be a dick, just making it seem like less of click bait

Well, OP started out anti-DO himself and now seems to be coming around to the understanding that DO school is his best option. This thread has been productive, imo

 

[Med Ed]

My bad. I was referring to the US teaching hospitals selling their sites to Caribbean students for their clinical years. It didn't make much sense.

Couldn't the smaller hospitals benefit from the prestiges/resources/status involved in training only US students and being an affiliate for the US medical school? So the financial status of the hospitals would be protected.

A lot of these facilities are not teaching hospitals, per se, they are practice-oriented hospitals that do some teaching on the side. Over the years they have seen costs increase and revenue streams shrink or divert elsewhere (e.g. ambulatory surgery centers). This is one of the drivers of consolidation.

Having GME programs allows a hospital to negotiate higher payment rates. Having medical students drifting around the wards? Not so much. If anything they slow people down and cause loss of productivity. "Prestige" and "status" doesn't count for much when your primary goal is keeping the lights on.

I have mentioned Hofstra-LIJ and OUWB as two new schools that were founded on a solid model. LIJ and William Beaumont are both very large health systems, and both see the benefits of developing medical student "pipelines" into their GME programs, and ultimately into their clinician ranks. They can afford to play the long game and win.

 

[Med Ed]

Why aren't the attendings for those students teachers? Don't they supervise and teach the students?

Let's say you are a private practice doc who can see X patients in Y hours. Now your hospital is telling you that you will have to take students, which will cause you to see fewer patients over a longer period of time. You did not ask for this, and if you had wanted to be an academic physician then you would have taken a job in an academic health center.

Some people rise to the challenge and find it enjoyable, others get resentful and may even go so far as to quit. I have seen it happen.

 

[AzizImSorry]

Well, OP started out anti-DO himself and now seems to be coming around to the understanding that DO school is his best option. This thread has been productive, imo

Respectfully disagree

 

[swiftjab]

Let's say you are a private practice doc who can see X patients in Y hours. Now your hospital is telling you that you will have to take students, which will cause you to see fewer patients over a longer period of time. You did not ask for this, and if you had wanted to be an academic physician then you would have taken a job in an academic health center.

Some people rise to the challenge and find it enjoyable, others get resentful and may even go so far as to quit. I have seen it happen.

Well, that's stupid. Working at a full-time job, I often have to train my co-workers as well. I also didn't ask for it and it's certainly not on the job description. I can say that if I had wanted to be a teacher I would have taken a job at a school. But I suck it up and do it well anyway. This happens in every career field, and if those doctors can't handle their responsibilities then maybe it's for the best that they quit.

 

[AzizImSorry]

Well, that's stupid. Working at a full-time job, I often have to train my co-workers as well. I also didn't ask for it and it's certainly not on the job description. I can say that if I had wanted to be a teacher I would have taken a job at a school. But I suck it up and do it well anyway. This happens in every career field, and if those doctors can't handle their responsibilities then maybe it's for the best that they quit.

That's not a very good analogy. Does your full-time job require you to have a certain amount of work-product/time? Is that work-product directly influencing somebody's health and well-being? I don't know what your job is, but I would think the stakes are very different. I would bet that everyone who had your position before you had to train their coworkers as well. It's an accepted norm, even if it's not explicitly stated in your contract. Physicians at non-academic hospitals want to be clinicians, not teachers. And some of them may be brilliant clinicians but terrible teachers - both the patients and the students suffer when you make someone like that teach as well.

 

[Med Ed]

Well, that's stupid. Working at a full-time job, I often have to train my co-workers as well. I also didn't ask for it and it's certainly not on the job description. I can say that if I had wanted to be a teacher I would have taken a job at a school. But I suck it up and do it well anyway. This happens in every career field, and if those doctors can't handle their responsibilities then maybe it's for the best that they quit.

Philosophically I don't disagree with you, but these aren't coworkers. The term coworker implies some longevity to the arrangement, but this is really just an endless menagerie of students who will hang around for a month or so and then disappear, never to be heard from again.

 

[Lawpy]

Let's say you are a private practice doc who can see X patients in Y hours. Now your hospital is telling you that you will have to take students, which will cause you to see fewer patients over a longer period of time. You did not ask for this, and if you had wanted to be an academic physician then you would have taken a job in an academic health center.

Some people rise to the challenge and find it enjoyable, others get resentful and may even go so far as to quit. I have seen it happen.

Philosophically I don't disagree with you, but these aren't coworkers. The term coworker implies some longevity to the arrangement, but this is really just an endless menagerie of students who will hang around for a month or so and then disappear, never to be heard from again.

That's why i feel that hospitals selling spots to Caribbean schools are doing a severe disservice to the medical profession. Why exploit and penalize physicians who aren't interested in teaching by making them take in Caribbean students?

If the students are US MD/DO students, that's better because the education/training pathway is definite in nearly all situations. For Caribbean students, it is simply a waste of resources.

 

[Mansamusa]

That's why i feel that hospitals selling spots to Caribbean schools are doing a severe disservice to the medical profession. Why exploit and penalize physicians who aren't interested in teaching by making them take in Caribbean students?

If the students are US MD/DO students, that's better because the education/training pathway is definite in nearly all situations. For Caribbean students, it is simply a waste of resources.

But hospitals administrators are worried about their bottom line and not the medical profession.

So if Carib schools pay $400/wk for each student rotating in a hospital, a hospital that takes 30 students will get (400*30*4) almost $50,000/month. That is enough to hire or retain 2 more doctors. http://thehappyhospitalist.blogspot.com/2010/08/how-much-money-do-doctors-make-for.html Most doctors bring in $1-2 million in revenue to their hospitals. (or you can hire a bunch of NPs and PAs who can mitigate the resource waste from the students while bringing in revenue)

It's a waste of resources in a moral sense that we should be working towards strengthening the profession so that patients have the best care in the future, but medicine has too much business involved which causes admins to care more about profit than anything else

 

[Med Ed]

That's why i feel that hospitals selling spots to Caribbean schools are doing a severe disservice to the medical profession. Why exploit and penalize physicians who aren't interested in teaching by making them take in Caribbean students?

If the students are US MD/DO students, that's better because the education/training pathway is definite in nearly all situations. For Caribbean students, it is simply a waste of resources.

About the best article I have seen on this subject can be found here (at Politico, of all places). We aren't talking chump change (emphasis added):

New York State has thousands of international students training at its hospitals.

In 2008, the city’s Health and Hospitals Corporation signed a ten-year contract worth up to $100 million from St. George’s University in Grenada. The deal gave St. George exclusive rights among international schools to HHC facilities, though about half of HHC’s clinical clerkship spots remain for U.S. students. So far, the perennially cash-strapped HHC has received $37 million from St. George’s. (The HHC board member who proposed the contract, Dr. Daniel Ricciardi, was also on St. George’s faculty. He resigned from HHC after the deal became public.)

The same year, American University of the Caribbean (AUC) on St. Maarten reached a 10-year, $19 million deal with Nassau University Medical Center.

 

[swiftjab]

That's not a very good analogy. Does your full-time job require you to have a certain amount of work-product/time? Is that work-product directly influencing somebody's health and well-being? I don't know what your job is, but I would think the stakes are very different. I would bet that everyone who had your position before you had to train their coworkers as well. It's an accepted norm, even if it's not explicitly stated in your contract. Physicians at non-academic hospitals want to be clinicians, not teachers. And some of them may be brilliant clinicians but terrible teachers - both the patients and the students suffer when you make someone like that teach as well.

I'm a premed on my gap year so naturally I work in the healthcare industry, pharmaceutical, to be exact. As quality control, I am directly influencing somebody's health and well-being so I wouldn't think the stakes are very different, otherwise I wouldn't have taken the job. Honestly, I may not be a great teacher ( I just don't have that much experience teaching), but I try my best to get better at it for the sake of my coworkers and the patients because what we do matter. I would like to see the physicians that are unenthusiastic about teaching also step up their game because what they do also matter.

Philosophically I don't disagree with you, but these aren't coworkers. The term coworker implies some longevity to the arrangement, but this is really just an endless menagerie of students who will hang around for a month or so and then disappear, never to be heard from again.

Ok maybe teaching coworkers is a bad example, then how about teaching high school/college summer interns? Medicine isn't the only field with interns lol.

 

[ddc150]

Why not apply to UQ Ochsner in Australia ? They boasted a 2016 match rate of 93% and a 75% top 3 choice match rate. Pretty darn good if you ask me for an IMG school.


Sent from my iPhone using SDN mobile

 

[AzizImSorry]

I'm a premed on my gap year so naturally I work in the healthcare industry, pharmaceutical, to be exact. As quality control, I am directly influencing somebody's health and well-being so I wouldn't think the stakes are very different, otherwise I wouldn't have taken the job. Honestly, I may not be a great teacher ( I just don't have that much experience teaching), but I try my best to get better at it for the sake of my coworkers and the patients because what we do matter. I would like to see the physicians that are unenthusiastic about teaching also step up their game because what they do also matter.



Ok maybe teaching coworkers is a bad example, then how about teaching high school/college summer interns? Medicine isn't the only field with interns lol.

I don't see how the stakes are similar, or how quality control is directly influencing others. Of course quality control is important for drugs and affects the end user, but not directly or in a similar way. Doctors have incredible autonomy; training a physician is so much more than giving them requisite info to do the job and sending them on their way. You're training someone to be able to make decisions with that info, effectively and efficiently, that will have a direct impact on every patient they see in their (possibly) 40 year careers.

I agree that people should try to make an effort to improve, if only for the sake of others; but at what point is it detrimental to everyone involved if you have a bad teacher trying to teach a student when they're much more productive in practice? Even if only from a utilitarian view, doctors who actively choose to be clinicians in non-academic settings do so for a reason.

This may be taking this too far, but what if we asked MD/DOs who work only in research to start seeing patients because of the physician shortage we're facing? Do you think that would be a reasonable appropriation?

 

[Lexdiamondz]

I'm a premed on my gap year so naturally I work in the healthcare industry, pharmaceutical, to be exact. As quality control, I am directly influencing somebody's health and well-being so I wouldn't think the stakes are very different, otherwise I wouldn't have taken the job. Honestly, I may not be a great teacher ( I just don't have that much experience teaching), but I try my best to get better at it for the sake of my coworkers and the patients because what we do matter. I would like to see the physicians that are unenthusiastic about teaching also step up their game because what they do also matter.



Ok maybe teaching coworkers is a bad example, then how about teaching high school/college summer interns? Medicine isn't the only field with interns lol.

Aaaand this is exactly why you don't get it.

You teaching your co-workers, or a company teaching its interns is ultimately beneficial for the company because it raises productivity in the long run. Using time out of your day to teach medical students in a community setting decreases productivity because those same medical students aren't going to eventually contribute to the hospital's operations, and if an attending is already a bad teacher than that just makes everything worse because even the instruction isn't being delivered efficiently and effectively, wasting everyone's time.

People often choose to go into community practice specifically because they don't want to teach. So why on earth would it be a good idea to send students into a setting where their instructors would rather them not be there?

 

[Weirdy]

Dude just stfu. His family is rich. Should he prostrate himself in front of the self important worms of pre-allo and apologize for that?

If you mention how poor you are in this thread then theres a good chance you are a troll or just trying to stir the pot for no reason.

Sent from my SM-N910P using SDN mobile

Not a troll.

But I get why I shouldn't mention how poor I am.

Point taken.

 

[Lawpy]

But hospitals administrators are worried about their bottom line and not the medical profession.

So if Carib schools pay $400/wk for each student rotating in a hospital, a hospital that takes 30 students will get (400*30*4) almost $50,000/month. That is enough to hire or retain 2 more doctors. http://thehappyhospitalist.blogspot.com/2010/08/how-much-money-do-doctors-make-for.html Most doctors bring in $1-2 million in revenue to their hospitals. (or you can hire a bunch of NPs and PAs who can mitigate the resource waste from the students while bringing in revenue)

It's a waste of resources in a moral sense that we should be working towards strengthening the profession so that patients have the best care in the future, but medicine has too much business involved which causes admins to care more about profit than anything else

Read more: http://www.politico.com/states/new-...ition-for-rotation-space-000000#ixzz4AjUz8gyP
Follow us: @politico on Twitter | Politico on Facebook

About the best article I have seen on this subject can be found here (at Politico, of all places). We aren't talking chump change (emphasis added):

New York State has thousands of international students training at its hospitals.

In 2008, the city’s Health and Hospitals Corporation signed a ten-year contract worth up to $100 million from St. George’s University in Grenada. The deal gave St. George exclusive rights among international schools to HHC facilities, though about half of HHC’s clinical clerkship spots remain for U.S. students. So far, the perennially cash-strapped HHC has received $37 million from St. George’s. (The HHC board member who proposed the contract, Dr. Daniel Ricciardi, was also on St. George’s faculty. He resigned from HHC after the deal became public.)

The same year, American University of the Caribbean (AUC) on St. Maarten reached a 10-year, $19 million deal with Nassau University Medical Center.

Hm interesting reads. But more broadly, is the following Caribbean Cycle Theory accurate?

1. Caribbean schools are formed to avoid dealing with stringent ACGME/LCME accreditation regulations while making a lot of money on student debt.
2. Demand for Caribbean schools is very large and inelastic, because for reasons mentioned by @Goro @gonnif et al., applicants are ill-informed, desperate, emotional etc. and will do anything and everything to become a doctor. This won't change anytime soon no matter how much information is thrown at them. Oh and Caribbean MD is somehow better than a US DO degree (so prestige + bragging rights).
3. Caribbean schools exploit the applicant demand even more by giving applicants nice perks like no MCAT, no ECs etc. as well as an opportunity to study medicine in a tropical environment with warm beaches. Caribbean schools also boast of high match rates and ability to send students to the US for their clinical rotations.
4. Applicants embrace the Caribbean ruse and happily invest hundreds of thousands of dollars to pursue medical education, which gives Caribbean schools millions of dollars in annual revenues. The cost for preclinical education is trivial: it's just lecture slides and some poorly supported medical labs. So as @Med Ed pointed out, the profit margins are very high in preclinical years.
5. However, sending Caribbean students to US is problematic because clinical sites at hospitals are limited. Sending all students to the US is impractical and unfeasible since the marginal cost is too high and the profit margins will drop to zero or even negative.
6. Caribbean schools respond to this by significantly increasing attrition rate: fail out more than half the class and delete them from the school records so that the final match rates will look nice and tidy. Caribbean students that fail are stuck with debt and their medical career is done. The Caribbean schools in turn don't care.
7. For the remaining students, Caribbean schools notice that the clinical sites in the US are stratified (i.e. some hospitals are failing, some are excellent). The Caribbean schools bribe the failing clinical sites with a lot of money per student over few months.
8. Realizing that the opportunity to pursue US clinical education is super important for landing a US residency, Caribbean students become hypercompetitive and fight for grades at poor clinical sites.
9. In turn, the administration at failing clinical sites decides to punish the physicians who want nothing to do with academics and teaching by assigning them a student and teaching responsibilities with little to no benefits.
10. Physicians respond by going academic, being furious and punishing the students for wasting their time, or quitting altogether, making the clinical education for Caribbean students significantly more random and hypercompetitive.
11. The Caribbean students that have survived the clinical rotations apply for the match, only to end up successfully matching at good specialties with good programs (very rare), matching at malignant/poorly run programs, having to SOAP their way through into poor programs, or ending up not matching (significant majority) and having to reapply again.
12. Caribbean schools focus on the rare successful matches and use them as advertising tactics to persuade applicants to apply to the Caribbean, thereby restarting the cycle.

 

[deleted451730]

Please do not apply Caribbean. Go the US DO route instead. Or go the Caribbean route and make your parents wonder at the end why all you have is a $250k piece of paper without any residency prospects. They might despise your choice even more at that point.

 

[Kisangani]

It's been a while since I've last logged onto this site. Several users PMed me requesting that I update this thread with what I decided to do. I luckily ended up getting an offer of admission from the sole domestic MD program that I interviewed/waitlisted at about two and half weeks before the start of classes. I took this admission offer and have just finished my first year there. Prior to getting off the waitlist (in June when I started this thread), I did end up declining my DO offer of admission, and, had I not gotten off the waitlist, I would have matriculated to SGU.

 

[Matthew9Thirtyfive]

It's been a while since I've last logged onto this site. Several users PMed me requesting that I update this thread with what I decided to do. I luckily ended up getting an offer of admission from the sole domestic MD program that I interviewed/waitlisted at about two and half weeks before the start of classes. I took this admission offer and have just finished my first year there. Prior to getting off the waitlist (in June when I started this thread), I did end up declining my DO offer of admission, and, had I not gotten off the waitlist, I would have matriculated to SGU.

Wow. Then you are one lucky duck. I hope you said a prayer after that acceptance came in, because it saved you a huge load of trouble.

 

[ThoracicGuy]

It's been a while since I've last logged onto this site. Several users PMed me requesting that I update this thread with what I decided to do. I luckily ended up getting an offer of admission from the sole domestic MD program that I interviewed/waitlisted at about two and half weeks before the start of classes. I took this admission offer and have just finished my first year there. Prior to getting off the waitlist (in June when I started this thread), I did end up declining my DO offer of admission, and, had I not gotten off the waitlist, I would have matriculated to SGU.

While you ended up with a good result, I wouldn't recommend turning down the DO acceptance in favor of SGU to future readers. You could have had the DO acceptance and then gotten the MD acceptance and told the DO school that you won't be attending at that point.

Good luck in school.