Emphasis on primary care

[thedelicatessen]

I've been reading about how osteopathic physicians are more likely than allopathic physicians to practice rural primary care, which I think is great. I have some theories about why this might be, but are there specific aspects of the osteopathic curriculum that promote primary care and/or the rural practice? Thanks.

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[GreenShirt]

If you're looking at the rural aspect, I think it's largely due to historical/political reasons. There has always been a shortage of primary care physicians in undeserved areas. DO have traditionally filled this niche. Historically, this saved DOs from being eradicated in many states because state legislatures were reluctant to revoke the practice rights of the physicians that were filling the gap left by MDs.

If you're looking at the primary care aspect by itself, the above argument factors in as well, but it's more attributed to the basic philosophy which emphasizes the promotion of health in patients. This is facilitated by the on-going doctor-patient relationship found in primary care.

 

[Jack Daniel]

Interesting question. I know that many curricula promote family medicine, and FM is a popular residency choice for DOs. Perhaps rural primary care offers the greatest scope in a FM career?

 

[Pansit]

Definitely due to the more "B" type students in DO schools instead of "A" type students who are concerned with getting that Neurosurgery residency from day one of med school. So in general, students at DO schools are less prestige driven and do not shy away from the more "looked down" specialties like family practice in rural areas...

 

[Jack Daniel]

Also, since many DO programs are community based, instead of urban research centers, maybe many new DO physicians continue practicing in the same environment they're trained in.

 

[Toohotinvegas33]

I think the exposure of rural medicine that some schools require is a major factor. I think some students are scared of being out in a small town where you cant get labs back right away or cant just send them to the specialist down the street. But once they do some rotations and see the rewards of being a rural Doc many will go into it.

 

[ceftazidime]

At NSU-COM we have 3 months of rural medicine, 2 months of FM, and 2 months of Peds. In my opinion, this leads to more primary care physicians because it either:
a) allows students to gain an appreciation for these fields of medicine
b) prevents them from doing electives in more specialized fields, thus preventing them from getting more specialized residencies.

I get the feeling that it's the latter. If you understand how the residency application process works and why the timing of your electives during 4th year is so important, you will see how these extra months in primary care can really hinder you from getting into radiology or dermatology. I'm all in support of promoting primary care, but to place obstacles in a student's ability to get into a competitive specialty is messed up.

 

[toothless rufus]

...but to place obstacles in a student's ability to get into a competitive specialty is messed up.

If that is true...that's really not cool. In fact, that would be quite uncool on so many levels! I cannot imagine sane adults deciding to do something like that to coerce students into primary care. A school should most passionately want their students to be able to pursue whatever they want in medicine. You should get out of a school what you want as a career and a medical education on your own terms, as you are paying for it, and oh, that lil thing called free will. It is not nice if a school were to try to railroad people into a lifelong career in something they might not be interested in. I cannot fathom that reasonable folk dedicated to education would want anything but the ultimate happiness of their students in whatever field they wish to enter!

But yeah, sure is a lot of rural and primary care time though! How does the 4th year timing thing work? How much time is there for electives? Like four months, I think? There must be a way to manage things so there is a happy ending, I'm quite certain. Maybe they aren't aware that it can be an impediment? I can't imagine the thinking is like this: Well, doctors are desperately needed in X,Y,Z underserved blah blah blah. Hey! Lets MAKE them go into these fields! Well just kinda goof the specialty elective timing up! MWAAAHAAAHAH! Heck, they'll still be doctors, and hopefully make in the 6 figures anyway, right? And since they're doctors they should WANT to do what is best for their patients. And what is best is underserved rural primary care!! So everyone is happy all around! Yaaay!

Why on EARTH would anyone want to do that to someone?

That would be cruel.

 

[InductionAgent]

If that is true...that's really not cool. In fact, that would be quite uncool on so many levels! I cannot imagine sane adults deciding to do something like that to coerce students into primary care.

As a WVSOM student, we had to do a lot of primary care rotations & in rural areas, but I ended up matching into anesthesiology.

Our first rotation was required to be family medicine in a rural area. I did mine at a community hospital (with OP clinics). I had a great preceptor who wanted me to get a broad exposure to all the specialties and start thinking about what I wanted to do, so I spent some time in the ER, with a psychiatrist, endocrinologist, internist, and in surgery. While I was hanging out in the OR, I started talking with the anesthesiologist, who let me do some intubations. That's when I first became really interested in anesthesiology. So it all worked out.

But in any case, we also had to do rotations in psych, OB/Gyn, and surgery during our third year, as well as IM and peds. I split a month of elective between dermatology and forensic path. So the only major specialty I didn't get exposed to was radiology (and ophtho), which I already knew didn't interest me. I did a rotation in anesthesiology June of my 4th year, which sealed the deal.

Students who are interested in a specialty generally find a way to get more exposure to it and match in it if they're motivated; the ones matching into primary care want to do primary care. Not to mention that peds and IM lead to all sorts of subspecialties. No one's being coerced.

 

[RockfordWF]

I've been reading about how osteopathic physicians are more likely than allopathic physicians to practice rural primary care, which I think is great. I have some theories about why this might be, but are there specific aspects of the osteopathic curriculum that promote primary care and/or the rural practice? Thanks.

More rotations in primary care and rural practice.

 

[Faraaz23]

Yes, there are definitely things in the curriculum that gear us towards it. Here at NSU, we have 5 or 6 hours of "rural medicine" lecture in the middle of one of our systems. Also, as someone mentioned, we have 3 months of required rural rotations 4th year (although one month you can set up anywhere in the world). You shadow a doctor regularly your first two years here that is primary care. Also, its the subtle things I pick up whenever we have visiting-docs come and lecture us, they often say things like "it goes a lot more into detail than this, but this is all you guys will have to know as primary care doctors." This leads me to believe that they are being told to not go into anything more than an PCP has to know it. There is absolutely nothing wrong with going into primary care, but I think we are definitely being pushed towards it whether we realize it or not.

 

[TexasTriathlete]

A lot of DO programs claim this, and there certainly is a shortage of primary care physicians in many areas. However, I think a lot of DO schools these days are happy to see their students do well on both board exams and go onto a highly-competitive ACGME residencies. It shows potential applicants that opportunities as a DO are not limited to primary care, which will attract high-quality applicants.

 

[toothless rufus]

"it goes a lot more into detail than this, but this is all you guys will have to know as primary care doctors." This leads me to believe that they are being told to not go into anything more than an PCP has to know it. There is absolutely nothing wrong with going into primary care, but I think we are definitely being pushed towards it whether we realize it or not.

Yeah, there is nothing wrong with choosing primary care. But statements like the above quoted seem to imply sinister underlying machinations that should not be. I also have no problem if a school wants to run their program that way; but please, be upfront about it, so people can go elsewhere if their interests do not align. Maybe they can be reasoned with, and convinced to play nice and fair!! Heck! Who doesn't want to play nice and fair! Yaaaaaay!!! Problems solved.