Please enlighten me

Discussion in 'Clinical Rotations' started by aefdompa, Jan 16, 2000.

  1. aefdompa

    aefdompa Member

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    It seems to me that alot of osteopathic students want allopathic residencies. I don't understand why. I hope to attend NYCOM in 2002 and would like do a family medicine osteopathic residency at either Lutheran or Jamaica Hospital. Both of these hospitals has a D.O as the head of the program for osteopaths and allopaths. Is this desire to obtain allopathic residencies a speciality thing or what?
     
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  3. UHS2002

    UHS2002 Senior Member

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    Some of the reasons osteopathic graduates go into allopathic residency programs:

    - there aren't that many osteopathic programs, so for certain specialties, you have a better numerical chance going through the allopathic match
    - there aren't that many osteopathic programs period. If you are interested in a particular area of the country and a particular specialty, you may not have an osteopathic choice.
    - some people prefer to do their residency at large medical centers, which excludes most of the osteopathic hospitals out there.
    - a few specialties are not avaliable as osteopathic residencies.
    - one may prefer a particular program which just so happen to be allopathic

    By the way, I think that osteopathic programs should be open to allopathic graduates too, as long as any interested applicants were willing to undergo prior training in manipulative medicine, to the same extent and level expected from an osteopathic applicant (since this is the ONE big difference in the two med school programs).
     
  4. young guy np

    young guy np Member

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    what specialties are not available in the osteopathic residencies?

    Young guy np
     
  5. prefontaine

    prefontaine Senior Member

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    Apparently the original poster also wants to do an ACGME residency, since Lutheran and Jamaica are ACGME programs that have gone to the trouble of adding AOA accreditation. Without the DOs, Lutheran and Jamaica would have primarily IMGs from third world countries.
     
  6. aefdompa

    aefdompa Member

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    Not! Lutheran Medical Center is an affiliate of NYCOM located in an urban area in Brooklyn. I want do my residency in a large urban enviroment. Diversity is very important to me and exposure to a variety of medical conditions will help make me an excellent Family Physician. It seems Lutheran is where its at for now anyway. I have no intentions on taking the uslme and I am pleased to see D.O's are medical directors of Osteopaths/allopaths residency programs. Prefontaine, where are you doing your residency/specialty and what med school did you attend? I've read your previous posts and know that you are not happy as a D.O. What a pity.
     
  7. UHS2002

    UHS2002 Senior Member

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    young guy np

    until very recently there were no AOA positions in IM/Peds and a few other combined programs.

    At this time, there is ONE site offering IM/Peds and that is Olympia Fields in Chicago (affiliated with CCOM). They have 2 funded positions. There are 180 ACGME accredited IM/Peds residency programs. So, the choice for a DO graduate under these circumstances becomes obvious: Should I do 1 year of internship and then apply to the only 2 AOA positions, with the knowledge that I will have trouble matching at a ACGME program afterwards if I don't land one of the only 2 AOA approved positions? Or should I try for one of the few hundred ACGME positons without going through the extra AOA internship?!

    By the way, and since I touched on the suject,I think the AOA is shooting itself in the foot with these weird policies. I have absolutely no problem being a DO, I went into an osteopathic school certain that I wanted to go into primary care, so it can't even be said that I am not one of those people who wanted to be very specialized and yet went into a field dominated by primary care. I have no a priori problem with staying within the osteopathic community for the entirety of my training. Yet, because of the limitations imposed by having to do the extra year of internship, I will probably fall totally outside the fold of the osteopathic community in my post graduate education. I cannot take the extra year so that I can compete for 2 positions nationwide and which will put me at a disadvantage when competing for a ACGME position (not to mention: who wants to be an intern twice, plus who wants to do a 5 year residency when the usual length is 4, plus who wants to work one year without funding?! Someone must keep paying those student loans...). Therefore, I don't even plan to apply for these two AOA positions, since I think I would be foolish to bank on them vs. at least a couple of hundred positions at ACGME accredited programs. If the AOA positions started at the PGY1 level, you bet I would apply! But without any guarantees of acceptance there, why should I do 1 year of AOA internship and then be looked upon as a less favorable candidate by an ACGME program because they can't fund my last year since I already did 1 year of internship elsewhere???

    I think the same discourse can be applied to many other specialties? Unless you are going into an area where there are plenty of AOA approved residencies, or you are dead set on practicing in one of the 5 states that require the completion of the AOA internship year, why take the chance?!

    Any of the fourth year students,residents or practicing DOs out there, what do you think? Am I looking at this from the wrong prespective? Any insights are appreciated.
     
  8. aefdompa

    aefdompa Member

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    Thank you for enlightening me. I wasn't aware of the limited number AOA accredited residencies for various specialites. There are quite a few family practice programs in NY and fortunately that is what I am interested in . Sorry for the confusion.
     
  9. spunkydoc

    spunkydoc Senior Member

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    UHS--

    i am with you 100%--i think the AOA is killing the profession--

    however, i think it would be wise to wait as long as possible to see if they actually change the rules..
     
  10. prefontaine

    prefontaine Senior Member

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    aefdompa, my original post is accurate and I am quite familiar with Lutheran's location and Claudia Lyon, the residency director. No need for your pity, I have never stated that I am not happy as a DO, only disappointed in the quality of the osteopathic undergraduate and graduate academics, the AOA and the general hypocrisy of the profession. Since you have yet to experience DO school let alone residency, there is no way that you can comprehend what it will be like. In case you have not noticed, no upper year student or resident has disagreed with my posts, just the pre-osteopathic students and occasional first year students with minimal experience and little idea of what they are talking about.
     
  11. aefdompa

    aefdompa Member

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    Prefontaine,
    No, your original post is inaccurate. There are people who are disappointed with the allopathic and osteopathic profession. I don't know where you went to school or what your expectations were so it's difficult for me to comprehend your apathy. On the other hand you are right, I do have alot to learn about osteopathic medicine. I'm in the process of trying to shadow an Osteopathic Physician. This Dr. seems to be big in the Osteopathic Community. He is a program Director for one of the FP residency programs in NY and he serves as a Preceptor for PCOM Students. I hope it works out. Perhaps, it makes a difference what medical school you attend. Accd to previous post, Nycom and Pcom seems to be the best. I've looked into osteopathic/allopathic for family practice medicine and there are plenty of osteopathic residencies in NY. Most of them are affliates of NYCOM. What do you think of Lutheran? Is it a good program? Are you a family practice resident? I've noticed that in NY many of the Family practice residencies have two progam directors. D.O's for Osteopaths and M.D's for Allopaths. What were some of the simalarites and differences you noticed? Why do you think allopathic family residencies are better than osteopathic? Aside from this, I work for a major HMO in NY and physicians in general are not regarded as highly as one might think. Frankly, the quality of physicians today suck. Alot of doctors today dont give a **** about the patients. It is all about the $$$$$. All the physicians that I am referring to are all M.D's.(I am not bashing all M.D's) I can't believe that some of these people are Physicians. No preauth no surgery. Just because you have a 4.0 and perfect scores on the boards does not mean that you will make a execellent dr. The key is a balance of competency and compassion. Being a physician is a very big responsiblity and many blame their incompetance on hmo's. There will be people who will not respect you if you are a D.O or M.D. There will be people who will look down upon you because you are a family physician not a brain surgery. Thats life. As long as my patients are happy with my care and I can lead a comfortable life then who cares.
     
  12. roger2004

    roger2004 Senior Member

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    Aefdompa,
    well said. It seems you and Prefontaine are more in agreement than one would first think. Maybe you're each just "on a different page" of the same book. As a newcomer to this arena I have found both of your comments to be extremely enlightening and valuable. I am just beginning to grasp some of the inherent problems the present system imposes on many DO students. Not that dealing with problems exists within the "exclusive domaine" of med students. However, being forwarned is be forarmed so to speak. The literature and posts I've read on osteopathic philosophy and practice also suggest this is certainly not a new problem (perhaps new to me as I consider myself a relatively uninformed newcomer). These issues appear to be entrenched in a long, sometimes contentious, and constanly evolving history. It seems from a historical perpective and with an awareness of perceived deficiences in the present system, the osteopathic path does offer students the opportunity to attain their professional goals and perhaps make a difference (not to sound trite - you know, one step at a time and all that!) and NOT by default. I AM concerned by what I've read regarding AOAvsACGME Residency programs and requirements etc, however I feel lucky to be in this position (my "youthful idealism" may be showing!) and am more than willing to deal with these acknowledged difficulties. Thanks for the enlightenment. Any further coments welcome and good luck to you.

    ------------------

    rog
     
  13. Deb

    Deb Senior Member

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    aefdompa

    I take offense to one of your statements "Alot of doctors today don't give a
    **** about the patients. It's all about the $$$$...no preauth, no surgery".
    It's obvious you have alot to learn. Since your experience is limited to your
    work in an HMO (I assume you are not an upper level executive, ie., privy to
    what is REALLY going on.) you are hardly in a position to criticize physicians.

    It's true that physicians have become hostile towards insurers, but it's NOT
    because they don't care about patients. If a doctor is not reimbursed for
    his/her services, they will eventually be unable to care for ANYONE! Many
    insurance companies do not "play fair" and routinely use a number tactics
    designed to delay/forgo payment. You see, every dollar paid to a physician
    is one less dollar paid to executives and shareholders.

    Although I have never worked for an HMO, every physician I have ever worked
    with has had these types of problems with insurers. One in particular tried
    to take insurers at their word...he ended up with ONE MILLION in accounts
    receivable. The VAST majority of physicians care deeply for their patients,
    but they have been forced to take a tougher stance when it comes to
    reimbursement. They're not trying to get rich, they're just trying to stay
    in business!

    Yes, doctors make very nice incomes, but are they getting rich...No. No one
    has any problem with those in other fields earning six figures (I wonder how
    much the executives at your HMO make?), but for some reason, many believe
    physicians (whose education takes 2-3 times longer than ANY other profession)
    make too much money?!?!?!?!?! I can assure you that after you've spent 12+
    years of your life in school and incurred a six figure debt for the privilege,
    you will feel differently! So before you start bashing the very profession
    you are about to enter, please educate yourself as to the realities of medicine.

    Deb
    MS-3
     
  14. aefdompa

    aefdompa Member

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    Deb,
    I know that I have a lot to learn about medicine. However, you have a great deal to learn about managed care. It will play a huge role in your financial health.
     
  15. Michaelis

    Michaelis Junior Member

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    aefdompa:
    Nice try, but not so fast. As a third year, Deb has, I'm sure, at least a cursory knowledge of the relevance--and arrogance--of managed care to/regarding the contemporary practice of medicine. You state that she has "a great deal to learn about managed care," yet you yourself offer no specifics on such. If you're going to adopt a stance of apparent superiority, then at least provide us the evidence to buttress this noblesse oblige attitude. Your turn to "enlighten" us.
     
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  17. spunkydoc

    spunkydoc Senior Member

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    well said deb and michaelis--

    aef, seriously, just get out into the real world of medicine and look at it from our side of the table..there are 2 sides to every story..the rich get richer, but in medicine, docs just keep giving and giving and giving..

    keep in mind that there is trying to practice good medicine and take care of your patients within a very frustrating framework of managed care..all of us already in medicine at whatever level have experienced the ills of managed care..

    if you truly have HMO experience of some sort, then walk into medicine with an open mind and apply your prior experience to improving health care delivery from our end.

    good luck
     
  18. yeahright

    yeahright Junior Member

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    oh yeah, i love the arrogance of premeds who think their idealism and self righteousness can save the whole world all at once.
    aef, you're planning on surgery, right? tell me it's not about the money and prestige. if it wasn't, you wouldn't be "educating" yourself to the dirty business of medicine thru your HMO job, you'd be down at the local homeless shelter or better yet, mental health or addiction center dealing with the people who fall throught the cracks. save the grandstanding for your interveiwers, they'll eat it up. oh, and don't forget that the rest of us were just as smug in our prior successes, only we've since learned when to shutup.
     

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