Osteopathic Education needs?

[siulrc]

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We all agree that no matter if you are a DO or MD both are physicians. But still there is one aspect of the osteopahtic education that is lagging behind its counterpart allopathic education. Most of the osteopahtic colleges do not have their own teaching (hospitals) facilities for their students to go through their clinical years. Contrasting with most of the allopathic schools that do have their own, This creates a disanvantage for osteopathic medical students bcz institutions relies on part-time faculty or non-paid faculty. With the exception of UMDNJ-SOM and MSU-SOM where most of the faculty is a full time members the rest of the schools relies on part time. This affect negatively the education imparted bcz most of this instructors are not committed to teaching. Again, I said most not all of them. Students are forced to depend on themself for a vast part of their clinical education. The same thing happens in osteopathic hospitals interships and residencies.

I think that the AOA should have the initiative of encouraging the schools to put in their future agendas the acquiring of teaching facilities own by the school where the most faculty is a full time paid faculty of the school. In the mean time we as osteopathic students will suffer the adverse consecuences is this situation plus we'll still be lagging behind our allopathic counterpart in terms of clinical medical education.

What is you opinion about this matter?
Keep posting

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siul

 

[sph]

Just curious, are you an osteopathic student? Have you already gone through your clinical years? I'm just wondering if your info on poor clinical exposure is based on firsthand experience.

 

[sph]

I do agree with you by the way that it would be beneficial for osteopathic students to have their own teaching facilities in conjuction with the option to rotate through allopathic facilities....just in case they decide to apply to an allopathic residency along with an osteopathic residency.

 

[siulrc]

sph:
I will be a M1 starting in the fall at PCOM. My info I gathered from interviewing medical students plus from differents forums where M3,M4 and residents have expressed the same frustations. One of this forum is the bulletin board from the AOA site. Plus, this is a obvious situation for someone that have done a indepth research in osteopathic education. Even the AOA have acknowledge this and that's why they are trying to come up with every cumsortium possible to improve the osteopathic clinica education. But i think that they should focus in looking for long term solutions instead of short term like this partnerships. The long term solution is for the schools to start planning on owning their own universities hospitals and teaching facilities.

Keep posting

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siul

 

[RollTide]

Teaching hospitals lose way too much money each year for this to be an intelligent consideration. Osteopathic colleges do not have the research base to pay for these losses the way allopathic colleges do with research grants. Many allopathic schools are already struggling with this problem and some end up selling their hospitals. The tuition at most osteopathic schools is already high, and if it was increased to over $30,000 like some allopathic private schools have done in an effort to pay for teaching hospitals, this would hurt the graduates more than it would help. Osteopathic graduates would be shackled with over $200,000 in debt making it difficult to live a comfortable life. If you guys are really interested in helping, when you graduate and finish your residency, go back and teach at an osteopathic teaching hospital. This is how you could make a difference.

 

[ADRIANSHOE]

Actually this isn't a valid statement JOSH.

1. not all teaching hospitals lose money.
2. Research grants ARE needed, but arguing against teaching hospitals because of a lack of grants is refusing to saddle the horse because the horse is hungry... we need to BOTH feed the horse (generate research) and then saddle it...improve our teaching hospitals and associations...Volunteering isn't the answer...it denies you time and income while working within a badly flawed system....For example, while I was teaching in the public schools and busting my ass to overcome the many disgusting problems you voters allow to occur, it finally dawned on me that I was working for a fundamentally flawed system and no matter what I did, the end product was always going to be subpar...
Instead of VOLUNTEERING for existing programs, people would be better served in setting up NEW and educationally SOUND programs of instruction and not giving anything of value or time to the ethically and educationally flawed systems currently in place....IF WE BUILD IT THEY WILL COME, but becoming a minor cog in a broken gear isn't the answer.
3. PRESSURE is needed and CLOUT is needed to bring about improvement, We need to figure out what the schools will deem to be in their best interests and dangle it in front of them while demanding improvements.
4. We must NEVER reward mediocrity by becoming a part of it.
5. We must never volunteer our services when we have already paid these institutions exorbinant amounts of money and yet they refuse to give the volunteer any loan reimbursement for our volunteer time while they generate income from our efforts...that is just wrong.
Please let me know of any institution in the osteopathic community that gives loan reimbursement to volunteers....also how much money does the university generate from your volunteerism and what is your cut of this income?
If you want to volunteer, do it at a free clinic, but not for an institution making millions of dollars and throwing it away on administration salaries and such.

 

[siulrc]

Roll Tide:
Actually, I disagree with you. One of the problems confronting osteopathic schools is that most of them depend in tuition money to bere the administrative cost of running a medical school. Not having clinical teaching facilities osteopathic schools are missing out a huge amount of money in grants for research. Most of the schools do not have the necessary facilities to conduct broad scientific investigations.

Most of the allopathic that have their own medical centers do not depend on tuition money, their money comes from grants. We are talking about a huge amounts. Plus, this medical centers will bring more money in the form of physician's offices, research institutes and etc.

I am not saying this has to be done now but at least it should be something in every school agenda.

Keep posting.

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siul

 

[reddog]

I think University run hospitals are probably more than likely going to fade out over the next couple of decades. I know that many of Texas MD med schools are selling their hospitals to cut their losses. With gov. cut backs in funding, many of these hospitals can't survive because most of the people that go to university hospitals can't pay. That was always the trade off. Can't pay? Go to the university hospital and they will see you. Oh by the way, the doctors aren't really doctors but "doctors in training"! I honestly think it is better to go to a school that doesn't have a hospital that you have to train in. What if that hospital sucks? Can you opt out and go train in TX or CA for example? No way! At some of the university hospitals there are so many other students there, you only get to observe for most of your rotations(1st hand knowledge, not hersey).I've met 3rd years doing traveling rotations where there are only 2 or 3 other students at the hospital they were at. They were doing all kinds of stuff;deliveries, surgery,VASCECTOMIES! Oucch! Not on my nards!!
I wouldn't get hung up on the hospital thing. Like I said above, even the best med schools in the country are selling their hospitals as soon as they get buyers!

 

[mj]

Well I just don?t think I can take another round of Adrian and Josh going at it over volunteerism vs. paid faculty!

Consider that several studies indicate that for profit hospitals have an overall higher cost than not for profit despite spending less overall for personnel and charity work.
http://www.nejm.org/content/1999/0341/0006/0420.asp?37a984bccd

and
http://www.nejm.org/content/1999/0341/0006/0444.asp?37a984bcfa

The point is Adrian, the mere pursuit of something for money does not mean it will be done efficiently nor does pursuing something for purposes other than making a profit mean efficiencies cannot be generated.

But yes, I agree payment adds accountability and easy in replacement should there be a lack of productivity.

While research supported teaching hospitals potentially will get you closer to your stated aim, please realize that while you're out collecting your pots of money you will need bigger pots because taking on a teaching hospital requires more funding than a non teaching hospital would:

http://econwpa.wustl.edu:8089/eps/hew/papers/9702/9702002.html

Also realize that Medicare reform has brought it?s share of headaches to teaching hospitals, and while I know changes are being lobbied for, to my knowledge the government has not yet approved any changes (although not being at an HMO anymore, I haven?t looked lately, so I could be wrong):

http://www.nejm.org/content/1999/0341/0004/0299.asp

You are moving from one flawed system to another.

Adrian, you have consistently requested models to support a paid faculty approach. I haven?t pulled out my old stuff because I haven?t had time (I?ll see if I can find them), but have you read May 10 JAMA? I think it provides some of the food for thought you are looking for:

http://jama.ama-assn.org/issues/v283n18/related/jed00030.html

The problems you are seeking answers to are greater than just how do you train better physicians, as that training is tied to the greater questions of the rest of the health care delivery system.

Finally, a personal favorite, a commentary by Leon Eisenberg of Harvard writing on many of these issues:

http://archinte.ama-assn.org/issues/v159n19/full/icm90018.html?38144e6f6c#rr18

I'll see if I can find the other articles on organizational models, but please, no more on the volunteer argument! I just can?t take it! lol

mj


[This message has been edited by mj (edited 05-25-2000).]

 

[ADRIANSHOE]

MJ, where are you going with your nonprofit vs profit comment?

also, it should be obvious from my allusions to the education system that i agree regarding the inherent flawed nature of the current health care system.

 

[mj]

Where I'm going: argue until the cows come home that paying people adds accountability and making them work for free is just plain unfair. Do not argue that a volunteer system leads to bad things. Bad organizational structure and bad management leads to bad things. System where money is not the motivator can work efficiently, even more efficiently than systems where the bottom line is a motivator.

You seem to keep wanting to say that if we just fix up this corner of the house, the fact that the rest of the house is a dilabidated, falling down shack is OK.

I was responsible for all the finacial analysis and reporting at HMO that was part of a fully integrated health care system, partially owned by a med school. What I learned during my tenure there is that the issues between medical education and medical care cannot be so neatly sorted out. IMO adding teaching hospitals to the mix buys you more trouble than it fixes.

Simply paying faculty will not make your issues go away. You have to change the mindset, the organizational culture that perpetuates non paid faculty, or you really haven't done anything but give people a paycheck. And that is way harder to do than convince an administration to find money for payroll.

mj

PS Did you read the JAMA article on Emory?
http://jama.ama-assn.org/issues/v283n18/full/jco00034.html

Regardless of what you think of the proposed model, the methodology was very sound.




[This message has been edited by mj (edited 05-25-2000).]

 

[RollTide]

Something else to consider.

Is there a need for a large academic hospital in the areas that current osteopathic colleges are located. Will there be enough patients to train the students who will be educated there?

Kirksville. NO
Pikeville. NO
UNECOM. NO
WVCOM. NO
UHS, NSU, AZCOM . There are already large academic teaching hospitals in the area.
MSU, CCOM, OSU,OUCOM, NYCOM, UMDNJ. There are osteopathic teaching hospitals at these schools right?

I am not sure about the others but I think you get my point. You can not just open up a Burger King accross the street from another Burger King. You MUST consider what the current missions of osteopathic medical colleges are. Most of our schools are providing badly needed PCPs for the rural areas of the U.S. This effects where our schools are located and where osteopathic students are trained.