Good Editorial Exchange in JAOA

[drusso]

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Evaluating the Rationale of the Osteopathic Internship

Adam B. Smith, MSIV
West Virginia School of Osteopathic Medicine Lewisburg, West Virginia

To the Editor:

As a fourth-year student at the West Virginia School of Osteopathic Medicine, Lewisburg, I had to choose between pursuing an American Osteopathic Association (AOA)–approved or an Accreditation Council for Graduate Medical Education (ACGME)–accredited residency program. Interestingly, my decision to pursue an ACGME-sponsored position has been met with some resistance. Therefore, I would like to explain the reasoning behind my choice, as well as examine some of the conventional views that have governed osteopathic medical education.

In a recent meeting with our institution's dean of students, I was asked whether I was going to complete an osteopathic internship. I replied that I was not and was informed that as an osteopathic physician who had not completed an AOA-approved osteopathic internship, I would not be eligible for licensure in West Virginia, Florida, Pennsylvania, Oklahoma, and Michigan. I asked whether there were any incentives—as opposed to penalties—in seeking an AOA-approved internship. None was offered.

As readers might imagine, the dean's urging to consider spending another year of general rotations to satisfy an arguably outdated piece of legislation was a confusing proposition. My question to him was this: Why would an organization, namely the AOA, as well as the entire osteopathic medical profession, that has worked so hard to establish equal practice rights for osteopathic physicians throughout the United States and beyond, remain committed to a self-imposed policy that limits those very rights of practice?

As concerns the underserved populations of the aforementioned states (rural and otherwise), one must ask why the osteopathic medical profession wishes to enforce legislation that prevents osteopathic physicians from helping those who need it most? With respect to those who initially drafted the policy, the logic is difficult to understand in today's medical climate. Paradoxically, it is to the credit of the AOA that osteopathic physicians are now able to pursue nearly any specialty they choose.

Given that most transitional yearlong programs are an extension of the clerkship experience, I wanted to know what was so unique about the osteopathic internship that required such a mandate. Most students interested in subspecialty training must complete between 1 and 3 years of general internal medicine, making an extra year of required rotations through the areas of pediatrics, obstetrics, and surgery unnecessary. This is not required for those interested in pursuing areas other than primary care.

I explained to the dean that I would consider adding an extra year to my training if the osteopathic internship provided something extra in terms of education, such as a solid foundation in osteopathic manipulative medicine (OMM). At this point, most AOA residency programs do not.

In some areas of the United States, osteopathic physicians have traditionally been a cornerstone in primary care, and many osteopathic medical schools are still oriented toward this goal.

The subject of OMM raises other questions. Why, for instance, does the osteopathic medical profession insist on maintaining exclusive rights to such a valuable mode of therapy? Maintaining exclusive rights to OMM only seems to further contradict the stated goal of equal practice rights within the medical profession. Consider a scenario in which an osteopathic physician had developed penicillin. Could he or she have withheld such valuable treatment in good conscience?

It is worthwhile to consider that what was appropriate a century ago may not be appropriate today. It is difficult to understand, given the current medical climate, why the AOA continues to support legislation that discriminates against the osteopathic physicians they represent. Without clear educational advantage, a mandated osteopathic internship as it exists today promises only to limit the scope of practice for osteopathic physicians. Such an internship will further promote what is largely an artificial distinction between osteopathic training programs and those of our allopathic colleagues.



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Response
Michael I. Opipari, DO, Chairman
I am sensitive to the challenges students face in selecting between osteopathic and allopathic programs. Such challenges may involve distinct opportunities related to specialty choices or geographic choices. I am not sensitive, however, to choices made that are based purely on logic that implies that the internship year is a waste of time. Let me explain.


You selected the osteopathic medical profession. This means that you made a choice to commit to the philosophy, responsibility, and requirements of the osteopathic medical profession, as established by the American Osteopathic Association (AOA). The internship is one of those requirements.

I also meet your rationale with resistance. Your rationale (not your choice) ignores that the osteopathic medical profession, which you chose to grant your degree and to educate you to become a physician, provides an approved training system. This system has been in place for more than 70 years and existed when you entered the profession. More importantly, your chosen profession values the internship year.

You ask whether there are incentives associated with the internship. You also question the program's uniqueness, given the requirements of the AOA, as well as the requirements for licensure eligibility in five states. I will give you some incentives:

A year of bridging and transitioning from classroom to clinical decision-making. Although minimal classroom activity occurs in third- and fourth-year clerkships, independent decision-making in patient care does not occur until the internship year.

A year of clinical growth and maturation to create a more balanced, professional, and self-assured physician. This is recognized and appreciated in later years.

A year of added clinical exposure and experience, providing increased medical knowledge and enhancing future residency training.

A year that provides a final opportunity to integrate the multiple specialties of the rotating internship into a total patient care package. There is significant value in having exposure to specialties other than your chosen residency.



I wish to address the issue of your feelings regarding AOA's support of licensure requirements based on the internship. Licensure laws are the exclusive province of each state, not of the AOA. Some states have separate licensing boards, and others have combined boards. The AOA has no control over state policy, as evidenced by only five states having such a law. The AOA educational leadership supports the internship based on the rationale of quality education and not for political or other purposes.

The internship does not represent an extra year of training within the osteopathic system. In comparison with allopathic residencies, each of the specialties are equal in duration, with the exception of one, even including the internship. The reason the internship is included in the residency duration is because of the valued significance of that year.

Finally, osteopathic manipulative treatment (OMT) is not the only significant or distinctive characteristic of osteopathic medicine. Although vital, OMT is a skill that is based on a profound philosophy of biomechanics, science, and a total approach to the patient. Without this philosophic and scientific basis, as taught and integrated into osteopathic medical education, the mechanical skill of OMT alone offers little. The cultural beliefs of the osteopathic medical philosophy and science form the basis of OMT techniques and skills. Delivery of osteopathic medicine is governed by those beliefs and applications, which we have been taught and which are integrated in all osteopathic medical care, whether the manual skill is used or not.

The Council on Postdoctoral Training and all educational leadership of the AOA have a rational and educational basis for continuing to promote and require the osteopathic internship. It is not based on the licensure requirements of five states in which the AOA has no decision or authority. We are also sensitive, however, to the continuing perception of many students who choose not to participate annually in increasing numbers. As perception becomes reality, and reality drives the emergence of change, we must remain open to that change as demanded by need. But please understand the underlying rationale for the requirement, and be willing to accept this as a loss in your education and training.

Council on Postdoctoral Training American Osteopathic Association

 

[drusso]

Osteopathic Medical Training: Developing the Seasoned Osteopathic Physician

Robert C. Clark, DO, MS
Touro University College of Osteopathic Medicine College of Health Sciences Vallejo, California

To the Editor:

I reviewed the letter by Adam B. Smith, DO, and the response by Michael I. Opipari, DO with interest.

The first thing that struck me about Dr Smith's letter was his signature: "Adam B. Smith, MSIV" (now Adam B. Smith, DO). At my suggestion, the American Academy of Osteopathy has embraced the concept of brand identity and, consequently, adopted a signature designation of OMS (osteopathic medical student) with whatever Roman numeral appropriate for that student's year.

Our students are not medical students; they are osteopathic medical students. In the name of unity within the osteopathic medical community, I encourage the American Osteopathic Association (AOA) to adopt a similar concept of branding.

As the heads of most successful corporations of the world will tell you, brand identity is something to be preserved and protected with great vigor. Regardless of how good one's product or service is, without brand identity, no one will have an immediate awareness of either. This may translate into a lack of customer loyalty.

During my years in osteopathic medical school, education was a 2.5-year academic year curriculum with a 1.5-year clinical curriculum followed by a 1-year rotating internship. Most of those who graduated from internships went into practice; only a few who were going into specialties proceeded into residencies. Over time, as we all know, that has changed, and most osteopathic medical schools now have a 2-and-2 program with typically 3 years of graduate experience.

It strikes me that the clinical astuteness seen in today's graduates on completion of their residencies seems to be much the same as when we completed our internships. Over time, I have seen a change in osteopathic medical students' perspectives from "What do I have to know to be a good physician" to "How little do I have to know to pass the next test?" This is no way applicable to a particular student, but only as a generality that I see occurring with greater frequency.

I realize that many osteopathic medical school students wrestle with the dilemma of whether to choose an osteopathic internship and graduate training program versus an allopathic graduate training program. In some cases, the choice is made for them; for example, those in a US military branch are likely to adhere to the military pathway because they have made a choice that takes them in a particular direction. Other osteopathic medical students may have a particular practice location in mind or a particular mentor they wish to follow.

Several of my friends faced the same dilemma, and most chose the osteopathic medical pathway because their choice to join the osteopathic medical profession was their first priority. They believed in the profession and wished to abide by and practice its principles. Some reported that their osteopathic training programs were exceptionally osteopathic in orientation, and others reported otherwise. A few friends who took the allopathic medical pathway have found that in some cases, there is no "osteopathic thinking" involved. The result was that these students felt like the proverbial fish out of water. Other friends discovered that their newfound allopathic medical colleagues embraced them because they had the potential to offer something different and more. So there is great diversity and disparity between training programs within both the osteopathic medical and the allopathic medical professions.

Dr Opipari provided several examples in response to the question, "What are the incentives?" In my third and fourth years of osteopathic medical school, I was given well-defined responsibility with virtually no authority. I had numerous duties, took dozens of histories and physical examinations (H&P), and wrote the orders I was told to write. I was carefully guided as I managed the care of a few patients. During my internship, I oversaw osteopathic medical students. As my skills improved and my clinical acumen increased, physicians who had trained me allowed me to begin to actively manage the care of patients while they observed my ability. Any time I needed guidance, those teachers stepped in to keep me on track. I was given great latitude.

Perhaps today's osteopathic medical students do not need to do as many H&Ps and (in their third and fourth year) have far more opportunity for independent clinical practice without a safety net than that of my cohort. I frankly doubt it.

Dr Opipari works around the question but never asks it point-blank. Therefore, I will: "Did Dr Smith choose the osteopathic medical profession because he researched the profession and wished to become a member? Or did he join the osteopathic medical profession after his first choice, allopathic medicine, did not consider him worthy; and therefore, osteopathic medical school was his second choice?" If the former is the case, then I am inclined to be sympathetic to his protestations. If the latter is the case, then I suggest he be grateful to those who viewed him as a person capable and worthy of becoming a physician and embrace the profession that was willing to extend its hand of membership so that he could pursue his career goal.

The issue of osteopathic manipulative medicine (OMM) is one that is near and dear to my heart, as I am a specialist in that area. I do not believe for 1 second that the osteopathic medical profession insists on maintaining exclusive rights. I can tell you from personal experience and the experiences of past teachers that the reason we have had to work diligently to maintain osteopathic manipulative treatment (OMT) as the centerpiece of our profession is that our counterparts in the allopathic medical profession, for the most part, do not care to learn OMT. Those new to OMM who are sincerely interested in learning these practices are welcomed by osteopathic physicians and teachers with open arms and ultimately become more osteopathic in their thinking and their self-image than many in the osteopathic medical profession.

It is sad that there are many in the osteopathic medical profession who feel disdain for OMT when it is the mode of therapy that makes us unique. To paraphrase Norman Gevitz, PhD, "If somebody cannot see or feel the difference between two practitioners, then there is none."1

Osteopathic manipulative treatment is the most significant characteristic of osteopathic medical practice. It is visible and palpable. We can talk to a great degree about differences in philosophy and thinking between osteopathic medicine and allopathic medicine, but patients do not see it or feel it to the extent that they see and feel OMT.

If Dr Smith were to refer to the charter of the American School of Osteopathy (now the Kirksville College of Osteopathic Medicine of A. T. Still University of Health Sciences, Kirksville, Mo, he would find that osteopathy as defined by A. T. Still, MD, DO, was designed to improve the practice of medicine, obstetrics, and surgery. The reason Still created a profession that is separate from allopathic medicine is that the allopathic medical profession, of which he was a member, refused to accept and share his ideas. Therefore, Still had to begin a new medical profession. People came to Still to learn the new therapy and, by building a strong foundation, helped to bring the osteopathic medical profession to where it is today. Therefore, I believe there is nothing wrong with the rotating internship; it provides a good real world experience of the spectrum of patients' problems that a new physician may encounter.

Here is a consideration for the student who is convinced that he knows the particular specialty career path he wants to take: I have noticed that people having a broad educational background beyond their narrow interest area can often solve complex problems more effectively than their counterparts with comparable training who do not have a broad-based perspective.

Therefore, my suggestion to students who are contemplating such training questions is to take the rotating internship, if possible. If you cannot, do the best you can to receive the broadest experience possible. The more your training covers a spectrum of possibilities, the better physician you will ultimately become. Every practicing physician has had to make compromises to circumstances that were bigger than he or she could handle. Laws are made by political bodies, not by professional organizations. If you do not like the law, contact a representative of your profession's political body to change it. And last, when you joined the osteopathic medical profession, you asked to become a member. I am reminded of a long-standing military officer who once said that the best officers who took command gave their initial order of "All existing orders stand." Then, only after some time of truly observing the installation and its operations, were changes made, if any.

To all osteopathic medical students and to this student in particular, I would say: You do not have the experience of being in a command role, of being in a practice role, of being in the osteopathic medical profession long enough to demand that changes be made. Give it time. If you still feel the way you do now in another 2 to 5 years, then lobby your delegates to the AOA and other organizations affiliated with this profession to bring about the changes you believe need to be made. But, until you have lived it for a while, back off. Focus instead on advancing your knowledge and skills to that of those who have preceded you.

References
1. Gevitz N. `Visible and recognized': Osteopathic invisibility syndrome and the two percent solution. J Am Osteopath Assoc. 1997;97:168 -170.[Medline]

 

[drusso]

Response

Adam B. Smith, DO, Resident physician


I read with interest the letter submitted by Robert C. Clark, DO, MS, in response to my previous letter to the editor, and it has only reinforced my belief that I would not be where I am today had I allowed myself to be constrained by such outdated dogma.

The issues I raised represent not only my personal interests, but those of my colleagues as well. They are the issues of an emerging osteopathic medical profession. My primary concern is the question of having a new generation of physicians trained in this century dealing with academic and professional challenges that are distinctly different from those of yesterday. Nowhere in my essay did I demand a particular change. I simply asked questions and provided arguments for my point of view. The responses I have received thus far, however, including that of Michael I. Opipari, DO (J Am Osteopath Assoc. 2004;104:231) have been defensive, unenlightened editorials that have provided little evidence in support of the status quo they defend. They have not addressed the questions I raised, nor have they attempted to do so.

These responses have not addressed the lack of incorporation of osteopathic manipulative medicine (OMM) into osteopathic internship or residency programs. Further, the responders made little effort to explain why the American Osteopathic Association (AOA), which has worked successfully to expand practice rights for US-trained osteopathic physicians throughout the provinces of Canada, appears to have no interest in lobbying the few remaining US state agencies to change their requirements for osteopathic internship. It stands to reason that our goal as a profession should be to ensure equal practice rights for osteopathic physicians, regardless of their choice of internship.

The questions I raise have everything to do with maximizing opportunities available to osteopathic medical students and osteopathic physicians alike. Medical school students coming after us deserve more than smoke and mirrors. If answering such questions is too much to ask, then I suggest that Dr Clark grind his axe elsewhere so that those interested in addressing the issues relevant to osteopathic medicine in the 21st century can do so in a productive manner.

Regarding Dr Opipari's June response to my letter evaluating the rationale of the osteopathic internship, I was surprised to find so many questions left unanswered. He did mention some incentives for the internship. For example, he noted that that internship year serves as a bridge from classroom to clinical decision-making, it must be said that though true, it is a feature that is not unique to the osteopathic internship. Dr Opipari further presents the osteopathic internship as providing a year of clinical growth and maturation. Again true, but again he neglected to say that this feature is the basis for every internship program everywhere. Dr Opipari further describes the osteopathic internship as a year of added clinical experience that does not represent an extra year of training within the osteopathic medical system. Why then are osteopathic residency programs offering a greater number of so-called specialty-track programs, whereby the first year of their residency is counted as an osteopathic medical internship, and, according to the American Osteopathic Web site, may reduce the total number of years of postdoctoral training?

Let us put our money where our mouths are and explain how the two systems of medical training are different, how the curricula vary between traditional osteopathic medical and allopathic medical rotating internships, and why students should accept a particular point of view. This will, by the way, require more than opinion.

Interestingly, Dr Clark states that osteopathic manipulative treatment (OMT) is the most significant and distinctive characteristic of osteopathic practice, while Dr Opipari, Chairman of the Council on Postdoctoral Training for the AOA, states clearly in his June response that OMT is not the distinguishing characteristic. The profession is riddled with these inconsistencies, which I find concerning. Such inconsistencies point toward the real problem, which is not a student questioning the system in good faith but a rift in the governing philosophy of our profession.

I am familiar with the charter of the American School of Osteopathy, as well as the work of George W. Northup, DO, Osteopathic Medicine: An American Reformation,1 which I would recommend to all who read this letter. Dr Northup reminds us, as Dr Clark has, that Dr Still's original intention was not to create a separate and distinct form of healthcare, but as the title reads, to reform the healthcare system. It was in response to the close-minded establishment of his day that he founded the osteopathic medical profession. For that reason, I believe he would have encouraged us to share our ideas to improve the landscape of osteopathic medicine, and, in doing so improve the landscape of medicine as a whole.

We need not be separatists, nor promote artificial distinctions. To my mind, we are the Apple Computer in an International Business Machines Corporation world. Our challenge, similarly, is to define ourselves. But to do that, we must first answer hard questions about who we are and what we want. Our challenge as we move forward is that of integration, not isolation.

Perhaps it would help if Dr Clark knew that I have worked as a creative director in the development of brand management strategies for companies such as Harley-Davidson and Eastman Kodak before beginning medical school, and I am not just some impatient youth hurling epithets at the establishment. Perception is certainly a key issue in the successful evolution of the osteopathic medical profession. Therefore, I can tell you, from experience both as a professional and as a student, that it is not beneficial to the perception of the osteopathic medical profession for our students to be penalized for pursuing the residency program of their choice.

Regardless of my stand on these issues, I am proud of the choice I have made. I have yet to experience disdain for OMM or for the osteopathic medical profession of which I am a member. Where would I be now if I had allowed my postdoctoral training opportunities to be limited by the mandate of the osteopathic internship? Certainly not at Yale University, New Haven, Conn, where I am confident that I will receive an excellent, broad-based education in primary care internal medicine.

My suggestion to students who are contemplating the question of osteopathic versus allopathic residency is this: Do not limit yourselves or your options. Choose the program that is right for you. You have invested many dollars and countless hours in your education. You deserve every opportunity available to you as an osteopathic physician. Furthermore, do not be afraid to ask the questions that need to be answered if we are to further improve the quality of our product and the equity of the osteopathic medical profession.

Yale Primary Care Internal Medicine Program
Yale–New Haven Hospital New Haven, Connecticut

References
1. Northup GW. Osteopathic Medicine: An American Reformation. Chicago, Ill: American Osteopathic Association;1979.

 

[medic170]

Is it not true that, in the magic 5 states, the internship requirement can usually be waived fairly easily by DO's who are in allopathic residencies?

I am also curious about how people on SDN feel about the internship year and the 5 states that require it (I live and go to school in MI, one of the 5). Do you think it should be eliminated? Should I be writing my State Legislature?

 

[EMTLizzy]

I am also curious about how people on SDN feel about the internship year and the 5 states that require it (I live and go to school in MI, one of the 5). Do you think it should be eliminated? Should I be writing my State Legislature?

The first time I heard about the internship was when I met with a DO anasteseologist who told me to do it no matter what I went into. He didn't mention the 5 states, but said that by doing the rotating internship for 1 year I am a head and shoulders above the rest when looking for my final residency.

I don't, however, think it should be required in just the 5 states. Why isn't it required in the other 45? Did they drop the requirement, or did they never have it? If just 5 states have decided they require students to do the internship, this is a form of discrimination against DO students.

Dr. Smith raises many valid points. He did fail to mention the lack of residency spots open, though. I wish this would be addressed by one of the powers that be. It seems to be an issue they dance around quite well.

That being said, I'm going to start a campaign....Dr. Smith for AOA president. We may be frustrated with the AOA leadership right now, but it looks like things will change as a new generations of physicians graduates.

 

[Idiopathic]

I don't, however, think it should be required in just the 5 states. Why isn't it required in the other 45? Did they drop the requirement, or did they never have it? If just 5 states have decided they require students to do the internship, this is a form of discrimination against DO students.

No, but it is a way for the 5 DO hospitals in those states to get cheap labor and keep DO's in the fold. I believe the actual requirement is state-specific and that the legislature decides what is required for state licensure. They are lobbied to by the AOA on this matter, but certainly on no others regarding osteopathic education.

Also, does anyone know if the only public, state-supported DO schools are in these states? So many are private, but it seems as though all these states have public schools. Just a thought.

 

[Boomer]

No, but it is a way for the 5 DO hospitals in those states to get cheap labor and keep DO's in the fold. I believe the actual requirement is state-specific and that the legislature decides what is required for state licensure. They are lobbied to by the AOA on this matter, but certainly on no others regarding osteopathic education.

Also, does anyone know if the only public, state-supported DO schools are in these states? So many are private, but it seems as though all these states have public schools. Just a thought.

TCOM is public, TX doesn't require it.

PCOM and LECOM are private, PA does.

NSU is sorta private, FL does.

It's really ridiculous. I've heard several arguments from the "old guard" and basically, they're all full o'****e.

 

[Boomer]

Here's my reply to Oppiari's response the first time this was discussed on here:




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What an asinine response from the AOA (quelle surprise ).

1. The internship IS NOT required for licensure in 45/50 states (that's 90% for those math minded folks in the audience).

2. The AOA DOES NOT provide enough training programs to accomodate all of the graduates of DO schools (while at the same time, opening new schools and campuses--great thinking there, guys).

3. We've already had a a transition from classroom to clinical decision making--it's called 3rd and 4th year. You get the same growth and confidence in an ACGME PGY-I year. Implying that these added rotations (as scut monkeys) makes you a better physician is to imply that MDs are worse because they don't have these added rotations in their post-grad training.

4. The 5 states (one of which, I am a legal resident, as well as an incoming intern in an allopathic residency) are STUPID AS HELL for this requirement. Especially OK (where the attorneys are about to cause a mass exodous of physicians), WV (where surgeons recently walked out of the state), and FL--three states that are constantly bitching about not having enough doctors.

5. Time spent training in specialties other than your own detract from your residency training. I'm doing Internal Medicine--how does wasting a month holding a retractor and tying sutures make me a better internist?

6. I don't even have the energy to rebutt this one--but scientific basis of OMM? Are you f'n kidding me?? I have no real qualms about using OMM--it seems to relieve some pain and discomfort in some people. I've seen people get benefit from it--but SCIENTIFIC??? Not even close....

 

[macman]

Adam Smith presents some spirited arguments and I am a little disappointed with the quality of responses from the AOA leadership. Having recently completed the new million dollar (or was it a thousand?) COMLEX PE exam I am even more suspicious as to whether the AOA ship will make it back to port and listen to the students/residents. From my perspective-the AOA's #1 priority should be solid OMM research with as much integration into the specialties as possible.

A side note on the PE: (without violating their confidentiality policy) it was not clear what you have to do to 'pass', but as far as I could tell, any 2nd year DO student at a school which trains you to interact with standardized pts. should pass this thing. I think its great they test some OMT with this exam, but why not make the whole test OMM? Then both DO schools and students might be more involved in this area. If you cannot do a H&P then is the end of fourth year the time to discover this? On the whole-I hope this exam will be improved so that fourth year students are not wasting their time.

I have chosen not to do the AOA match and its not b/c I could not find a good AOA internship that I liked. I actually found three that would have been great. However, I'm applying to a very competitive specialty this year and a few programs I like offer the internship as part of the package. So if I do a AOA internship I'm blocked from those!

One point made in response to Dr. Smith was to become involved in order to create change-that is fair. Its up to us who are angry with the system to put in some time and become future AOA leaders.

Terry

 

[deeq]

macman,
i, and i'm sure many others, agree with you that if we want to see change then we do need to become more involved. but, i also did not participate in the aoa match because i could not locate any programs with enough patient volume or cutting edge technology to suit my needs (i'm matching soon for ob/gyn but want to subspecialize). and frankly i find it quite frustrating and exhausting this whole battle between what i call the old school elite and us, the younger generation who would like to see maybe some form of integration for omm.
anyway, just my 2 cents!
i'm on my merry way to snowy philly for i am taking that damned exam tomorrow. i have a pulse so i should pass....right?!

 

[bikerboy]

I actually submitted a letter to the editor of the JAOA in response to all this. In case it doesnt ever get published, here is just a snipit:

Dr. Clark, in his response to Dr. Smith, made a reasonable suggestion when he suggested students and residents who have concerns gain more experience and competence before proposing changes. The challenge I see with this advice is those with concerns might just become exasperated or apathetic and find satisfaction in ACGME programs and stop participating in the DO discussions altogether. With the majority of DOs currently accepting ACGME residencies, is it not plausible that only the “unconcerned” DOs remaining in the system are left to assume positions of influence in the DO world? I doubt this self-selected minority would have any reason to examine a system that has worked for them, and surrounded only by fellow osteopathic patriots, feel no compelling reason to change anything.

 

[deeq]

Dr. Clark, in his response to Dr. Smith, made a reasonable suggestion when he suggested students and residents who have concerns gain more experience and competence before proposing changes. The challenge I see with this advice is those with concerns might just become exasperated or apathetic and find satisfaction in ACGME programs and stop participating in the DO discussions altogether. With the majority of DOs currently accepting ACGME residencies, is it not plausible that only the “unconcerned” DOs remaining in the system are left to assume positions of influence in the DO world? I doubt this self-selected minority would have any reason to examine a system that has worked for them, and surrounded only by fellow osteopathic patriots, feel no compelling reason to change anything.

exactly. as per my earlier post: i'm exasperated almost to apathy. i hope your letter gets published, because we need more voices 'heard' in print. thanks

 

[dkwyler94]

exactly. as per my earlier post: i'm exasperated almost to apathy. i hope your letter gets published, because we need more voices 'heard' in print. thanks

Totally agree. I have become so tired of both the OMM dogma taught more as a religion than a science and the AOA's failure to respond to students that I pretty well have given up on the AOA and DO profession. I am going to do an ACGME residency and fellowship. Plan to do academic medicine and will only be permitted to teach at an ACGME program. I simply feel that the DO profession has nothing to offer me. They have no direction, and are simply trying to develop themselves by opening schools and increases the numbers without training us in residency or even adequatly in our third and fourth years. They have let me an my colleagues down.
David Wyler, MSIV

 

[JohnDO]

I actually submitted a letter to the editor of the JAOA in response to all this. In case it doesnt ever get published, here is just a snipit:

Dr. Clark, in his response to Dr. Smith, made a reasonable suggestion when he suggested students and residents who have concerns gain more experience and competence before proposing changes. The challenge I see with this advice is those with concerns might just become exasperated or apathetic and find satisfaction in ACGME programs and stop participating in the DO discussions altogether. With the majority of DOs currently accepting ACGME residencies, is it not plausible that only the “unconcerned” DOs remaining in the system are left to assume positions of influence in the DO world? I doubt this self-selected minority would have any reason to examine a system that has worked for them, and surrounded only by fellow osteopathic patriots, feel no compelling reason to change anything.

Beautiful. Someone needed to point out that the osteopathic leadership has effectively shut out those with a different point of view by not allowing osteopathic physicians who are not AOA board certified to participate. Thus, they are unlikely to hear dissent from "within the ranks", because the system ensures that only those who feel the system is adequate will have a voice. For this reason, I believe that the first step in moving the osteopathic profession forward is to allow osteopathic physicians who are ACGME certified to participate in leadership.

Be sure and let us know if your letter gets published. Thanks for taking the initiative to write. I know I will be writing letters when I get a few years of school under my belt. For now, I resort to ranting on an internet forum 🙂