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Residencies in U.S. all meds or combo w/alternative (integrative)?

Discussion in 'Clinical Rotations' started by Magic70, Dec 13, 2005.

  1. Magic70

    Magic70 Junior Member
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    I'm in the process of finishing up pre-requisites and I am currently finding out as much about residencies and fellowships. My areas of interest lie in OMM, physical medicine/rehabilitation, accupuncture, oriental and alternative medicine. From what I gathered, in order to specialize in OMM, rehabilitation, or sports medicine, the resident must first complete 3 years of either family practice or internal medicine, and then go on to specialize in OMM, Sports Medicine, rehab, etc (I'm assuming that each speciality would be considered a fellowship). Is that correct? Does there exist a residency that is purely, OMM, or rehab without doing the first 3 years of residency in internal medicine or family practice? I have no problem doing a residency for 3 years in internal medicine or family practice, however, I do have a problem with prescribing unnecessary pharmaceutical drugs. Are there internal medicine or family practice residencies that are more alternative/holistic/integrative in nature? I don't believe in prescription drugs in family practice, internal medicine, rehab, etc. (I believe they serve their purpose in the ER and with surgery, this is just my belief and I will not debate this issue, I'm just trying to get some questions answered). From the information I have gathered, with internal med. and family practice residencies, you practice medicine the way the attending practices. So if the attending prescribes drugs all day, that's what you will be doing. That's why I need to know if there are any residency opportunites out there that are alternative in nature with no prescription drug use incorporated? I highly doubt that these would exist in any type of hospital setting. Can an internal med. or family practice residency exist in a community health based practice? Essentially, I don't want to ever write a single script during residency or in practice. Also, does anyone know of any residencies that incorporate accupuncture? If no one knows the answers to these questions, does anyone know of anyone that does and that can help me? Please Help. Thank you
     
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  3. nabeya

    nabeya Senior Member
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    Being a chiropracter sounds perfect for you. You can pretty much guarantee yourself that you'll never touch a prescription pad if you go that route. That way you won't ever have to worry about writing a script. And you can do acupuncture too. :)
     
  4. quideam

    quideam Too tired to complain
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    I guess you could try naturopathy? Although their scope of practice is very, very limited. If you don't want to prescribe medications at all, then I really don't think that regular medical education in the US is what you're looking for. I've heard of "chinese medicine" schools and things like that, where you can become a certified acupuncturist. Maybe you should look into that?
     
  5. size_tens

    size_tens Senior Member
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    You could go to a traditional medical school and do a residency in physical medicine & rehabilitation. I'm not too familiar with the specialty but it might be worth investigating if you are interested in that kind of work.
     
  6. njbmd

    njbmd Guest
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    Hi there,
    It is unlikely that you will go through any residency in the United States without writing a prescription.

    njbmd :)
     
  7. Magic70

    Magic70 Junior Member
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    Hi... Thanks for the help
     
  8. bowlofcherries

    bowlofcherries Junior Member
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    I think it is wonderful that you have these interests and wish you best of luck in your pursuits, regardless of which path you choose. I share many of your interests and am currently an MSIII. My plan is to get clasically trained, and ultimately end up in mind-body research.
    I would encourage you to explore the benefits and sacrifices of a medical education. For myslef I knew that I can only get credibility as a medical researcher if I was trained in the scientific method and with an MD title. (Of course, a PhD would have been similar, but I enjoy clinical work, hence the MD). That is the Achilles heal of many CAM/IM publications - the line between science and pholosophy is often blurred because the people who carry out the bulk of the alternative research are not scientifically trained or so at odds with the established scientific community that they at times overlook basic research design axioms.
    Of course, chances are you would like to do clinical work primarily. I agree that we are overmedicating people and that the drugs we have are to a great extent a product of pharmaceutical advertising and sales. However no matter what field you end up in, even as a Naturopath, you will deal with patients who also see an MD and you will be a better doctor if you know about their meds, how they work, what side effects they have, and how they are compatible or not with the herbs/other alternative treatments you will be using. I believe that an MD education will provide you with that knowledge.
    As to the disadvantages... you might find that you have many philosophical differences with your med school classmates and even more so with the atendings you encounter. You will have to write scripts as a resident. About script writing, I was a sceptic too... but after being on the wards for a while, I have seen first hand the benefits and comfort that some of these meds bring to people and I can no longer be so extreme in my views. I am taking care of many inner city poor people with poorly managed diabetes, uncontrolled HTN... how do you not treat these people with drugs? Of course, Ideally through lifestyle modification you can wean them off the drugs, but what do you do in the meantime and what if they are not open to lifestyle changes?
    Finally, I do not know of any IM residencies yet... but there is a great fellowship at the NIH in IM research for MDs, which I highly recommend. Also, there is the American Academy of Medical Acupuncture - a professional organization for MDs/DOs, which provides training and certification. The classes are held in hospitals and physicians can get CME credits for this.
    Hope this helps!
     
  9. OSUdoc08

    OSUdoc08 Membership Revoked
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    Go to a DO school and specialize in OMM.
     
  10. raspberry swirl

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    i didn't read the OPs entire post because it seemed really long to me, but yeah, if i were you, i'd go to a DO school and do an OMM (manipulative medicine) residency. you'll have to do a year of internship (in which you'd have to prescribe) but that seems like the best bet to me. or you could do a pmr residency (as an MD or a DO). but seriously, as the previous posts have mentioned, if you do MD or DO you'll have to prescribe. its really niave to think that you wont. if you're really hell bent on no prescriptions, i would advise not getting a medical degree, and getting a degree(s) (certification(s)?) in acupuncture, chinese medicine, etc.

    as dangerous as many prescription drugs are, many of them are sheer miracles. i wouldn't throw out the idea of a prescription pad yet. as much a fan of manipulative medicine that i am, i haven't seen it revive a cardiac arrest yet.
     
  11. Adcadet

    Adcadet Long way from Gate 27
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    I obviously speak without much authority since I don't know you, so take what I say with a grain of salt. I also speak in regards to the MD degree, but I suspect much of what I say applies very well to DO schools as well.

    If I were you I would seriously reconsider spending 4 years, $150,000 (or whatever), and tons of effort to get a degree (MD) who's major treatment modality you seem to fundamentally disagree with. Furthermore, your disbelief in prescription drugs suggests that you may have a problem (emotionally, intellectually, philisophically) with the scientific underpinnings of clinical medicine, which is an art based on a science if practiced properly. I wonder if you will be able and willing to learn and understand the basic science behind the pharmacology you'll need to know.

    OK, and then there's the residency part. How will your attendings trust you to manage patients if you seem so reluctant to prescribe medications? Say in your intern year you have a patient going for surgery. Do you skip the beta blocker, despite the boatloads of evidence that it prevents perioperative MIs (I'm assuming you got through medical school and understand that beta blockade is generally regarded as appropriate for your patient)? If so, your attending may very well think you're being negligent, and you may have just killed your patient. In a primary care rotation, do you suggest an herbal remedy that is unproven in favor of an inhaled corticosteroid for a patient with poorly-controlled asthma? Again, you may have just killed your patient.

    My point is that it's great to question the use of prescriptions (all therapies, really), and to be skeptical. And it's great if you want to use alternative medicines and OMM and do some clinical research into their proper use. But an irrational approach and refusal to follow the standard of care will likely jeopardize your patients' lives and your ability to pursue training. I suspect you need to think long and hard if pursuing an MD is the best route for you to take.
     
  12. fang

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    There have been a couple of great posts here already-- here are my 2 cents:

    I'm guessing you're an undergrad finishing up pre-med training. How is it that you think you're qualified to understand the potential benefits and dangers of presciption drugs enough to dismiss them entirely? That's extremely presumptive. Yes, medications are at times over-prescribed, and often harm people in some ways while helping them in others. Until you know more I wouldn't judge the entire spectrum of pharmacology based on an impression.
     
  13. sophiejane

    sophiejane Exhausted
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    Have you considered getting an ND instead of an MD or DO? NDs (naturopathic doctors) have the same basic training as MDs and DOs in biochem, anatomy, and physiology. Their pharm classes are obviously different and are geared toward herbs, homeopathy, etc. (but I think they get some traditional pharm too). They get accupuncture and training in alternative modalities as part of their training. Sounds like that's just what you are interested in.

    The OMM will be harder to get without being a DO, but not impossible. You will not be able to get boarded in OMM or PM&R without completing an intern year, and you can't complete an intern year without prescribing and/or writing orders for medications.

    I agree with some of the other posters: it doesn't seem like a good use of your time and money to go through allopathic or osteopathic training, in which a great deal of your time will be spent learning prescription drugs and how to use them.
     

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