primary care vs speciality

[sebas]

Hello,

I have heard that Osteopathic medical schools tend to focus mainly on primary care and kind of push and encourage its students towards primary care. I was just wondering if this true for all schools? If not, then which schools have the highest percentage of students who choose to specialize?

Thank you

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[DOctorJay]

I know UMDNJ, PCOM, and NYCOM tend to have higher percentages of students who land specialty residencies. Not sure of other programs, try to find some match lists or percentage numbers from the schools themselves.

-J

 

[DoctorInSpace]

I don't find that NSUCOM pushes primary care all that much.....but that is just my humble opinion. I like that, b/c I never considered primary care at all. My three main interests were research, forensic pathology, and aerospace medicine. And they didn't care when I interviewed, and they don't seem to care now.

 

[bla_3x]

AZCOM does tend to push PC, albeit rather indirectly. You will hear a lot of "As a family practice physician..." and such. Not that it is at all affecting our education, I just think that it is osteopathy's job to make sure DOs are seen to a MUCH greater extent in ALL of the medical specialties. Personally, I think that it IS time to evolve the profession in his regard, and we?d benefit by schools not putting such a focus on PC and letting students get a good, all-around, unbiased, education. Again, I don't think that our education is lacking at all. I just think that our profession can go farther with such a change. IMHO.

 

[Heeed!]

Many of us at NSUCOM try to side-step the family practice propaganda. I'm of a slightly different opinion than DocInSpace: I think we get it crammed down our throats, but I'm a little oversensitive to it, too. Here's why: we get 2 electives during our 3rd and 4th year rotations that are ours to choose. Only 2. Any other elective has to be in primary care. Additionally, we get 3 long months of rural medicine. So, if you want a specialty outside of primary care, you have 2 chances to rotate at whatever sites you want and show face w/ the PDs, get recommendations, etc. I think that is severely limiting our options and forcing us in 1 direction.

 

[drvlad2004]

At NYCOM, we definitely have high number of students who specializes. I don't think that primary care has not been pushed down our throats like other DO schools. The FP department has feebly tried to encourage primary care. Besides upstate NY, primary care just doesn't do well in NY, not even in the inner cities like the South Bronx. Many family practicioners are struggling and are being increasingly disregarded in the NYC/LI area. Personally, I never considered primary care as a career choice. Besides IM, most NYCOMers go into Gas, EM, PM&R, and surgery. The majority of students go into allopathic residencies. The NYCOM students I know that enter osteopathic residencies predominantly go for the specialties, especially EM, rads, ortho, and general surgery.

Also CCOM is another school that has a good # of students who specializes.

 

[sebas]

bump please.

 

[Claymore]

While I think most schools still push primary care, I think more and more students are realizing the reality that they will be in such serious debt when they graduate that primary care may not be the best (financial) option. It is ironic that the schools encourage students to enter the lowest paying specialties, yet keep increasing tuition every year.

I think over the past few years we've seen more DO's around the country gravitate towards such specialties as EM, PM&R, and Anesthesia because of lifestyle issues. And of course there will always be lots of DO's in Medicine, Peds, and Ob/Gyn. I see this trend (away from Family Med, in particular) continuing.

 

[sophiejane]

True, it is a viscious cycle...high tuition-->large debt---> pressure to earn more money.

The fact is, you are going to make a comfortable living no matter what you do. You will be able to pay back your loans in a reasonable amount of time (unless you require expensive cars and a giant house your first year out of residency). If your heart is in primary care, do it. If not, find what you love.

Having said that, I wholeheartedly approve of the DO stance on pushing primary care. We have a long history of it, we are good at it, we have skills that predispose us to be good at, like hands-on OMT skills, more emphasis on interviewing and a generally--yes, I about to say the "H" word--holistic approach to patient care. (Please look up the word in the dictionary before flaming me).

Not only that...there is a general glut of specialists and a lack of PC docs in the US, especially in historically underserved urban and rural areas. (I do know about the declline of CT surgeons and neurosurgeons--but do we really need all these anaesthesiologists and radiologists? I think those folks are in for a rude awakening...the numbers of new docs in those specialties are rising faster than the job openings). Call me a bleeding heart, but I want to be of service...and if there is a need for PC, that's what I'll do.

 

[bla_3x]

It is true in general that there is a lack of PCPs in the rural areas. However, there IS a lack of specialist in the rural areas too I know from experience. My mother was in need of a specialist, and although there was "1" in her town.... he was booked for MONTHS, while the myriad of PCPs in the area have a virtual open door policy. Now, I am not saying that my mom is the rule?. but I really don?t think that she is the exception either. All fields of medicine are needed in these areas.
Osteopathic medicine has done a great job in the areas you spoke of, and there is no reason why it should stop. I just think that the AOA should push the idea of specialty work at a fair level as the PC. If only to make those of us who may go into something else feel a little better (sad sobby moment)We are great at getting people to go work in underserved areas, why not get them to be a GI doc, surgeon, or other specialist in those areas too. With the aging population, there will be an overwhelming need for a variety of specialties.

 

[sophiejane]

Good point about specialists in underserved areas--you are absolutely correct about that. The problem however, is not a lack of specialists (there are zillions of them in cities) but a lack of them who are willing to practice in rural settings. The answer is not for more people to specialize, but for those who do, to encourage them to practice in underserved areas.

The big secret is that rural docs can make a boatload of money. Like you said, their practices are full (including PCs in most communities, from what I have heard), many patients pay cash, overhead is low, and housing costs are low.

I'm thinking of having a rural practice during the week and then having a weekend apartment "getaway" in the city rather than the other way around!
I'll be heading into the city while all the other weekenders are heading out...

 

[VentdependenT]

True, it is a viscious cycle...high tuition-->large debt---> pressure to earn more money.

The fact is, you are going to make a comfortable living no matter what you do. You will be able to pay back your loans in a reasonable amount of time (unless you require expensive cars and a giant house your first year out of residency). If your heart is in primary care, do it. If not, find what you love.

Having said that, I wholeheartedly approve of the DO stance on pushing primary care. We have a long history of it, we are good at it, we have skills that predispose us to be good at, like hands-on OMT skills, more emphasis on interviewing and a generally--yes, I about to say the "H" word--holistic approach to patient care. (Please look up the word in the dictionary before flaming me).

Not only that...there is a general glut of specialists and a lack of PC docs in the US, especially in historically underserved urban and rural areas. (I do know about the declline of CT surgeons and neurosurgeons--but do we really need all these anaesthesiologists and radiologists? I think those folks are in for a rude awakening...the numbers of new docs in those specialties are rising faster than the job openings). Call me a bleeding heart, but I want to be of service...and if there is a need for PC, that's what I'll do.

Wow are you in for a rude awakening. Choose what you want because you like it, not because of some perceived need you state exists. Paying for your education should allow you to do this.

Also, there is no need to slam on other specialties. I worked hard and this degree allowed me, and several other smart osteopaths which I know, to specialize. With the way FP is going I don't think its fair to force students to take 3 rotations in it. 1 is plenty. A broad based approach is much more beneficial. More IM, Surg, and definitely electives are a good start. Primary care does not equal FP.

Meanwhile I'll be in the OR, PACU,or ICU. Laterz

 

[sophiejane]

Wow are you in for a rude awakening. Choose what you want because you like it, not because of some perceived need you state exists. Paying for your education should allow you to do this.

Like I said in the first paragraph my previous post, go with where your heart is.

There was no slamming of specialties--I have no problem whatsoever with the specialties themselves. Obviously, we need specialists. I was simply stating what the numbers say, which is that FP and IM docs are declining while the need for them rises, meanwhile we are seeing big jumps in gas and radiology.

I also don't recall equating FP with primary care. (I will likely do Meds-Peds or IM). At TCOM we get a fair amount of FP, but they just reduced from 3 months to 2, and added an elective.

I am glad you are smart. That is great. However, some of the smartest people in MY school go into primary care.

 

[Heeed!]

Sophiejane: I do know about the declline of CT surgeons and neurosurgeons--but do we really need all these anaesthesiologists and radiologists? I think those folks are in for a rude awakening...the numbers of new docs in those specialties are rising faster than the job openings). Call me a bleeding heart, but I want to be of service...

I don't think Vent felt slammed. You are merely implying that specialists are of less service. I remember hearing about a concept in an economics class I had that I think might explain the trend we see in IM, FP, etc. I think it was called supply and demand.

 

[sophiejane]

I don't think Vent felt slammed. You are merely implying that specialists are of less service. I remember hearing about a concept in an economics class I had that I think might explain the trend we see in IM, FP, etc. I think it was called supply and demand.

I didn't mean to imply specialists are of less service. However, I do think we can all agree that well-heeled suburbanites are not a loss for radiologists, but that many in rural areas are in need of FPs, Peds, OBGYN, Internists, and geriatricians--all "primary care" specialties.

In light of the way things are right now with healthcare in our country, I feel that I personally could be of more service where there is a true need for physicians--that's all I meant.

I am pretty sure that supply and demand does not apply here--it's just not that simple. Otherwise, we'd have enough docs for everyone--even in rural areas.

New docs are making decisions about their futures based largely on lifestyle more than ever before (this was in a recent journal article--I will try to find it and post it) and this is totally understandable since we ALL work our butts off for our degree, we are ALL smart, and we are ALL in major debt when we finish. (even us primary care folks ).

All I was trying to say is that I think that DO schools still provide a real service in graduating so many docs who do primary care, and many who do it in underserved areas.

 

[Molly Maquire]

There is actually a severe shortage of Radiologists and Anes. relative to the demand. That is why the salaries in these fields are currently so high.

 

[Heeed!]

Thanx for getting my back Mollie. I knew that economics knowledge of mine would come in handy someday.

 

[sophiejane]

I should do my research before opening my mouth.

http://www.aamc.org/students/cim/pub_anesthesiology.htm

Now, let me see about those radiologists...

I still stand by my crusade for underserved areas, however! How 'bout some of those new anaesthsiologists come on out to the sticks?!

 

[sophiejane]

well, things are looking a little better for rads...

http://www.rsna.org/publications/rsnanews/apr04/shortage-1.html

I guess we should all be glad to know there is still a physician shortage in general.

Now if we can just do something about the uninsured and ease up the backlogs in the ERs....but that's for another discussion...

 

[bla_3x]

I still stand by my crusade for underserved areas, however! How 'bout some of those new anaesthsiologists come on out to the sticks?!

Now, how about getting all those future rural specialist to be D.O.s too