Welcome to the new era of MEGA D.O Schools™

[2021Doctor]

I have only my faith that AOA/COCA are smarter than the ABA. And the Pharmacy people seem to be cracking down on their oversupply problem as well.


Don't count on them to help, obviously.

Please explain this. I do not see any headlines about pharmacy schools cutting back on class sizes or closing.
According to the American Association of Colleges of Pharmacy (AACP), the number of pharmacy graduates was 13,838 in 2014, up 84.8% from 7488 in 2003. The AACP also projects that number will grow to 15,632 by 2017.
Will the Pharmacy Bubble Really Burst?

---

Members don't see this ad.

 

[Goro]

Please explain this. I do not see any headlines about pharmacy schools cutting back on class sizes or closing.
According to the American Association of Colleges of Pharmacy (AACP), the number of pharmacy graduates was 13,838 in 2014, up 84.8% from 7488 in 2003. The AACP also projects that number will grow to 15,632 by 2017.
Will the Pharmacy Bubble Really Burst?

A collaborator of mine who is faculty at a Pharm school told me that several Pharm schools have cut their class sizes, including hers. So the data in your info might not be recent enough.

 

[Aslanim]

Please explain this. I do not see any headlines about pharmacy schools cutting back on class sizes or closing.
According to the American Association of Colleges of Pharmacy (AACP), the number of pharmacy graduates was 13,838 in 2014, up 84.8% from 7488 in 2003. The AACP also projects that number will grow to 15,632 by 2017.
Will the Pharmacy Bubble Really Burst?

I haven't seen anything about pharmacy schools closing either. However, I have seen schools continue to open up. For example, this year William Carey University (WCU) opened a pharmacy school in Mississippi.
William Carey opens pharmacy school: 'Maybe we can end the shortage'
Last year in 2017 there were 3 new pharmacy schools that opened. (University of Texas Elpaso, Medical College of Wisconsin, and SUNY Binghamton.)
2016 saw 4 new pharmacy schools open (Ketchum in California, Larkin in Miami, Fred Wilson in North Carolina, and yes an Idaho State branch in ALASKA!)

 

[BorntobeDO?]

Agree with DO2015CA. I think the fail would not appear on your transcript at most schools if you remediate.
Having bad stuff written about you in your MSPE is a big red flag.
Blows my mind how many students go out on their residency interviews without ever having read their MSPE. I think every student should review their MSPE.

The sad thing is when a school doesnt show a failure in a transcript but then highlights remediated courses in an mspe. Your advice is spot on as usual. Everyone should read thier MSPE.

 

[puahate]

It kinda sucks how in this generation everything is getting worse. DO school expansion, midlevel encroachment, increasing administration stronghold on how physicians should practice, decrease trust in physicians.

The glory days are gone. It's only getting progressively worse on all sides. I dont see anyone trying to reverse it.

 

[BlueBleck]

The question is why did they allow all these schools to open then make comlex harder to pass this year? It brings in more money yeah (more takers and Failers) but placement rate is gonna TANK when you have a bunch of barely got in DO applicants getting tazerfaced by COMLEX


Let’s just be honest most people who got into DO school by the skin of their teeth don’t just blast med school away. Some do but it’s not the normal. Do we really think the otherwisewoulsbe future carib gone DO kids are gonna swim?

It’s not fair to them to let them in.

It seems well accepted that comlex is an easier exam than step. Step seems to be an accepted minimum bar. Not sure I'm really seeing the issue with COMLEX standards being raised right now.

I additionally don't see why we wouldn't accept borderline remedial kids who would probably go IMG instead. It's ed debt either way, except in the carib, they're pretty much guaranteed to have none of their typical social support.

Another thing: how sure are we that admissions standards line up with medical school success? The mcat is only moderately predictive of step performance at r~.5. And I recall reading that an mcat of something low like 27 (or was it 24?) was sufficient to pass step. In either case, URM in MD world is about there, yet academic attrition is, in absolute terms, low for URMs (https://www.aamc.org/download/102346/data/aibvol7no2.pdf). It's roughly 7% or 66 kids for blacks versus 1% or 100 kids for whites. If the argument is that we're doing remedial kids more bad than good by accepting them, then would you agree that we're doing URM a disservice by accepting them via affirmative action? Or in other words, do you agree with the mismatch theory (at the med school level)? Or in more mathematical terms, are those attrition rates unacceptable and should be addressed by cutting URMs and other similarly remedial students throughout the entire system?

they kind of look fine to me if i can be honest. Like I get that 1% would be better for all students. But there's a romance that I subscribe to where I'd rather give passionate but borderline students a chance and allow them to grow into the shoes that I want them to fill, than to not give them a chance at all in the name of protecting them. Beyond 10% is where I would personally find it to be obviously acceptable paternalism. But I can accept different lines.

 

[libertyyne]

It seems well accepted that comlex is an easier exam than step. Step seems to be an accepted minimum bar. Not sure I'm really seeing the issue with COMLEX standards being raised right now.

I additionally don't see why we wouldn't accept borderline remedial kids who would probably go IMG instead. It's ed debt either way, except in the carib, they're pretty much guaranteed to have none of their typical social support.

Another thing: how sure are we that admissions standards line up with medical school success? The mcat is only moderately predictive of step performance at r~.5. And I recall reading that an mcat of something low like 27 (or was it 24?) was sufficient to pass step. In either case, URM in MD world is about there, yet academic attrition is, in absolute terms, low for URMs (https://www.aamc.org/download/102346/data/aibvol7no2.pdf). It's roughly 7% or 66 kids for blacks versus 1% or 100 kids for whites. If the argument is that we're doing remedial kids more bad than good by accepting them, then would you agree that we're doing URM a disservice by accepting them via affirmative action? Or in other words, do you agree with the mismatch theory (at the med school level)? Or in more mathematical terms, are those attrition rates unacceptable and should be addressed by cutting URMs and other similarly remedial students throughout the entire system?

they kind of look fine to me if i can be honest. Like I get that 1% would be better for all students. But there's a romance that I subscribe to where I'd rather give passionate but borderline students a chance and allow them to grow into the shoes that I want them to fill, than to not give them a chance at all in the name of protecting them. Beyond 10% is where I would personally find it to be obviously acceptable paternalism. But I can accept different lines.

When I read that chart I see only 60%of aa kids passing medical school in 4 years and 80%in 5. That means up to 40% have board or class failures requiring repeating of a year. The 5 year threshold is what is used for attrition. 1/5 vs 1/20 is a larger.

I don't think we are doing urms a disservice. I think they are needed, but admitting orms at that threshold seems not necessary. Having reasonable threshold and standards is something important. The students that fail years or have red flags are going to get harder to match. Why not have them work out the issues at the beginning by having higher standards by having them retake mcat or do post bac work.

 

[Mad Jack]

Before this happens, DOs will fill all the FM and IM slots and be competing with IMGs for these. Don't forget to blame the AOA for their miserable leadership and allowing the merger to go forward.

With the numbers we have, the merger would have barely made a difference.

 

[Moose A Moose]

With a few days separating us from 2019, (Happy New Year folks!), it is important to keep in mind that 2019 will continue to usher in the trend of MEGA D.O schools™. A MEGA school™ is hereby defined as a program that enrolls more than 400 medical students a year. In 2019, 2 Southern institutions NOVA and LMU-DCOM will join the ranks of MEGA D.O Schools™.
Thus starting summer 2019, the list of MEGA schools™ will become:
1- KCUCOM (453 students first year enrollment)
2- LECOM (589 students first year enrollment + projected 120 for LECOM Elmira = an impressive 709 first year students in 2020)
3- LMU-DCOM (projected 254 +162 = 416 students first year enrollment)
4- NSU-KPCOM (projected 256 + 162 = 418 students first year enrollment)
5- NYITCOM (435 students first year enrollment)
6- PCOM (418 students first year enrollment, possible 120 expansion of GA-PCOM = 538 first year students)
7- Tuoro NY (407 students first year enrollment)
Welcome to the new era of MEGA D.O Schools™!

Sources:
https://www.aacom.org/docs/default-...14d6e069d49ff00008852d2.pdf?sfvrsn=54422197_6
https://osteopathic.org/wp-content/...-list-of-colleges-of-osteopathic-medicine.pdf

What are you talking about? How are you skewing these numbers?

 

[AnatomyGrey12]

Close, but what will also happen is ACGME will trim AOA residencies out and not let DO world expand. That's why it would be so stupid to go into an AOA (especially new) residency. It's all a power move by the ACGME

Lol every post you make is #fakenews...... any resident that begins an AOA residency before 2020 will be allowed to finish and obtain board certification, regardless of whether or not that program gets ACGME accreditation. Additionally, ACGME will not trim AOA programs that get accreditation because they want those spots. They absolutely will let residencies expand at DO schools, if they meet the requirements, because it isn't the DO world expanding, it's theirs.

 

[Aslanim]

What are you talking about? How are you skewing these numbers?

All my numbers (except the ones where I say projected) are from the first source I posted.
https://www.aacom.org/docs/default-...14d6e069d49ff00008852d2.pdf?sfvrsn=54422197_6
If you open the link and look at the second column "First year enrollment" and go to the 11th row for example, you will see the main KCUCOM branch has 283 first year students. The 12th row with KCUCOM in italics shows 173 students in the Joplin branch of the same program. Thus KCUCOM has 283 + 173 = 456 first year students.
Then do the same for Tuoro NY - LECOM - NYITCOM - and PCOM.
For NSU and LMU (where I said projected because the increase will happen in summer 2019) I'm assuming an extra 162 students enrolled first year . (Which is what COCA has us accustomed to for new programs recently.)

 

[studentdoct4281]

Lol every post you make is #fakenews...... any resident that begins an AOA residency before 2020 will be allowed to finish and obtain board certification, regardless of whether or not that program gets ACGME accreditation. Additionally, ACGME will not trim AOA programs that get accreditation because they want those spots. They absolutely will let residencies expand at DO schools, if they meet the requirements, because it isn't the DO world expanding, it's theirs.

Not fake news at all. And good luck getting a job post-residency from a non-acgme accredited certification especially the do non friendly side. just pointing out the better options for do side of things in case they don't realize

 

[AnatomyGrey12]

Not fake news at all. And good luck getting a job post-residency from a non-acgme accredited certification especially the do non friendly side. just pointing out the better options for do side of things in case they don't realize

Those residents will find jobs just like the graduates of those programs always have....

 

[deleted407021]

What are you talking about? How are you skewing these numbers?

They’re adding up all the enrollment for all branches of each school and pretending that’s meaningful or supports Falling Sky Thread Late 2018 and the mega school thing they made up.

Heads up OP, MCG has like 230+ students a year. Drexel 260+. University of Illinois 300+.

Chill.

Sources: the Internet

 

[DrMcLovin]

Not fake news at all. And good luck getting a job post-residency from a non-acgme accredited certification especially the do non friendly side. just pointing out the better options for do side of things in case they don't realize

Lol what? Can you explain how the majority of DO orthopedic surgeons found jobs?

 

[DarkHorizon]

Not fake news at all. And good luck getting a job post-residency from a non-acgme accredited certification especially the do non friendly side. just pointing out the better options for do side of things in case they don't realize

What’s the basis of this statement? Can you explain why me and my colleagues have plethora of job offers with AOA board eligibility (not certified yet)?

 

[Ho0v-man]

What’s the basis of this statement? Can you explain why me and my colleagues have plethora of job offers with AOA board eligibility (not certified yet)?

Obviously bc the ones offering those jobs don’t read well-informed posts on SDN like that one. Clearly, you just got lucky.

 

[libertyyne]

They’re adding up all the enrollment for all branches of each school and pretending that’s meaningful or supports Falling Sky Thread Late 2018 and the mega school thing they made up.

Heads up OP, MCG has like 230+ students a year. Drexel 260+. University of Illinois 300+.

Chill.

Sources: the Internet

Mcg alone has 2.5 times the research funding compared to all DO schools combined, so yes they may have large classes but these schools continue to provide clinical and research opportunities that the average megaDO doesn't.

 

[whitenoise8]

With a few days separating us from 2019, (Happy New Year folks!), it is important to keep in mind that 2019 will continue to usher in the trend of MEGA D.O schools™. A MEGA school™ is hereby defined as a program that enrolls more than 400 medical students a year. In 2019, 2 Southern institutions NOVA and LMU-DCOM will join the ranks of MEGA D.O Schools™.
Thus starting summer 2019, the list of MEGA schools™ will become:
1- KCUCOM (453 students first year enrollment)
2- LECOM (589 students first year enrollment + projected 120 for LECOM Elmira = an impressive 709 first year students in 2020)
3- LMU-DCOM (projected 254 +162 = 416 students first year enrollment)
4- NSU-KPCOM (projected 256 + 162 = 418 students first year enrollment)
5- NYITCOM (435 students first year enrollment)
6- PCOM (418 students first year enrollment, possible 120 expansion of GA-PCOM = 538 first year students)
7- Tuoro NY (407 students first year enrollment)
Welcome to the new era of MEGA D.O Schools™!

Sources:
https://www.aacom.org/docs/default-...14d6e069d49ff00008852d2.pdf?sfvrsn=54422197_6
https://osteopathic.org/wp-content/...-list-of-colleges-of-osteopathic-medicine.pdf

Just a minor correction. Touro NY does not have 407 first year students. It has 135 for each of its two campuses, for a total of 270.

Perhaps the number you came to is including students in the Master's program, which has roughly 70 students at each campus.

 

[_Rod_of_Asclepius_]

 

[2021Doctor]

Just a minor correction. Touro NY does not have 407 first year students. It has 135 for each of its two campuses, for a total of 270.

Perhaps the number you came to is including students in the Master's program, which has roughly 70 students at each campus.

Your post is not correct according to the table in the OP

 

[BlueBleck]

admitting orms at that threshold seems not necessary

So you're saying that URMs themselves are better off being admitted than not. Can I ask why that does not hold true for ORMs? Do URM and ORM debt terms differ?

Again, because your point came from the angle of, "protecting the students from themselves." Why wouldn't we protect URMs from themselves? They're arguably more in need of protection. I get the societal reason. But we're talking about protecting students.

Why not have them work out the issues at the beginning by having higher standards by having them retake mcat or do post bac work.

More money, time and effort for what I'm not sure are validated selection criteria that I see being possibly very highly classist. It's true that we would get more qualified candidates on average. But we'd also screen out a lot of students who wouldn't be able to dedicate themselves to such efforts for financial constraints. My concern is that retaking the MCAT or doing more postbac work could easily end up correlating more with family SES than actual aptitude.

Why I'm asking these questions is because I think we're really restricting ourselves by only looking at med school admissions criteria. What I think we both find very disturbing is how dangerous the drop out of med school is. You're saying that to limit that risk, we should limit those who are allowed to expose themselves to that risk. But the way you're doing it violates some of our fundamental values on opportunity (evidenced a bit by your being uncomfortable doing away with affirm action) as well as possibly leading us to increasingly stringent but also perverse admissions criteria. I don't think we need to constrain ourselves to that. I think a better solution is to cushion the drop. Making med school credits transferrable to midlevel programs, for instance, is a great cushion. A PA with med school debt is in trouble, but isn't destitute like a current non-placed grad is.

 

[Moose A Moose]

They’re adding up all the enrollment for all branches of each school and pretending that’s meaningful or supports Falling Sky Thread Late 2018 and the mega school thing they made up.

Heads up OP, MCG has like 230+ students a year. Drexel 260+. University of Illinois 300+.

Chill.

Sources: the Internet

He’d make the headline folks at CNN and Fox News proud.

 

[_Rod_of_Asclepius_]

It kinda sucks how in this generation everything is getting worse. DO school expansion, midlevel encroachment, increasing administration stronghold on how physicians should practice, decrease trust in physicians.

The glory days are gone. It's only getting progressively worse on all sides. I dont see anyone trying to reverse it.

Agreed. Best advice I can recommend is to get yourself in the best possible spot to be the doctor you want to be and focus on YOU.

 

[libertyyne]

So you're saying that URMs themselves are better off being admitted than not. Can I ask why that does not hold true for ORMs? Do URM and ORM debt terms differ?

Again, because your point came from the angle of, "protecting the students from themselves." Why wouldn't we protect URMs from themselves? They're arguably more in need of protection. I get the societal reason. But we're talking about protecting students.



More money, time and effort for what I'm not sure are validated selection criteria that I see being possibly very highly classist. It's true that we would get more qualified candidates on average. But we'd also screen out a lot of students who wouldn't be able to dedicate themselves to such efforts for financial constraints. My concern is that retaking the MCAT or doing more postbac work could easily end up correlating more with family SES than actual aptitude.

Why I'm asking these questions is because I think we're really restricting ourselves by only looking at med school admissions criteria. What I think we both find very disturbing is how dangerous the drop out of med school is. You're saying that to limit that risk, we should limit those who are allowed to expose themselves to that risk. But the way you're doing it violates some of our fundamental values on opportunity (evidenced a bit by your being uncomfortable doing away with affirm action) as well as possibly leading us to increasingly stringent but also perverse admissions criteria. I don't think we need to constrain ourselves to that. I think a better solution is to cushion the drop. Making med school credits transferrable to midlevel programs, for instance, is a great cushion. A PA with med school debt is in trouble, but isn't destitute like a current non-placed grad is.

There is a need for UIM physicians, there is a societal benefit. admitting ORMs with lower stats serves no societal purpose. You can construct it as classist , but there is a bit about both protecting society's investment and the student, considering the societal cost to train a physician . MD schools have managed to maintain higher standards even with expansion. Your SES argument might make a slight bit of sense if MD schools did not already incorporate that into the selection criteria. There is also a smaller pool of applicants from lower SES, because if your family situation is precarious you are working and do not have the luxury to go to medical school. By your logic we should just do away with gpa and mcat and let anyone join, how does selection occur in such circumstances? volunteer hours? scientific productivity? What you are proposing is in opposition to our values of opportunity by taking away gpa and mcat from the equation.considering one is straight up an aptitude test and the other a measure of hard work.

This topic seems to be out of the scope of this thread. If you want to continue perhaps you should make a thread based on that.

 

[deleted407021]

Mcg alone has 2.5 times the research funding compared to all DO schools combined, so yes they may have large classes but these schools continue to provide clinical and research opportunities that the average megaDO doesn't.

Are we just appropriating “megaDO” as SDN cannon now?

 

[Aslanim]

Just a minor correction. Touro NY does not have 407 first year students. It has 135 for each of its two campuses, for a total of 270.

Perhaps the number you came to is including students in the Master's program, which has roughly 70 students at each campus.

Thank you for bringing this to my attention whitenoise8. Although the COCA document (link in first post) seemed to indicate 407 students, I believe you are correct in that Touro-NY only has 270 first year students. Their website states 135 students per campus as you said.
Demographics
I have edited the original post to remove Touro-NY from the list of MEGA Schools™.

 

[Aslanim]

I thought COCA might attempt to draw a line in the sand about the sale of Rocky Vista to the company (Medforth) that owns the Carribean Medical School St. George University.
Oops. I was wrong.

Rocky Vista University College of Osteopathic Medicine (Parker, Colorado) – granted substantive change request for a change in ownership, pending a satisfactory focused site visit.
https://osteopathic.org/2018/09/24/accreditation-decisions-for-colleges-of-osteopathic-medicine-9/

The link you posted also suggests that both ACOM and ATSU (Arizona) will be increasing their class sizes.

• Alabama College of Osteopathic Medicine (Dothan, Alabama) – conditionally granted substantive change request for a planned class increase, pending a satisfactory focused site visit.
• A.T. Still University, School of Osteopathic Medicine (Mesa, Arizona) – conditionally granted substantive change request for a planned class increase, subject to receipt of additional information to be submitted to the COCA Executive Committee.

I was wondering if current medical students at either school have heard about this from school administration/through the grapevine.
Link:
https://osteopathic.org/2018/09/24/accreditation-decisions-for-colleges-of-osteopathic-medicine-9/

 

[hallowmann]

Thank you for bringing this to my attention whitenoise8. Although the COCA document (link in first post) seemed to indicate 407 students, I believe you are correct in that Touro-NY only has 270 first year students. Their website states 135 students per campus as you said.
Demographics
I have edited the original post to remove Touro-NY from the list of MEGA Schools™.

While you're correcting stuff, it should be noted that you combined some separate campuses (independent branches as opposed to just satellites) for some schools and not for others. This may be because of how its listed on that AACOM document,which is misleading.

For example: You added the LECOM PA campuses to the Bradenton campus numbers, but the Erie/Seton Hill/Elmira campuses are main/satellites where the Bradenton campus is an independent campus owned by LECOM Health. For AZCOM and CCOM, they are both separate branches owned by MWU. Same goes for ATSU-KCOM and ATSU-SOMA. As for the Touros, Touro-CA, Touro-NY (Middletown being a satellite), and Touro-NV, from what I remember are all separate branches, despite being owned by the same entity (along with the NYMC MD school).

The document is misleading and the numbers you've calculated as a result are also misleading. I still think LECOM is ontop, but the number will be closer to 500 not 700.

 

[BlueBleck]

There is also a smaller pool of applicants from lower SES, because if your family situation is precarious you are working and do not have the luxury to go to medical school.

So because society can reap benefit from URMs, they are allowed to wade into riskier pools and we aren't allowed to protect them from themselves. in other words, URMs don't deserve protection because we, society, can profit from them.

by your logic we should just do away with gpa and mcat and let anyone join, how does selection occur in such circumstances? volunteer hours? scientific productivity? What you are proposing is in opposition to our values of opportunity by taking away gpa and mcat from the equation.considering one is straight up an aptitude test and the other a measure of hard work.

didn't say that. i said retaking the MCAT or post-bac work, such as volunteering or post-bacs are *more* classist than already classist selection criteria. And that they're of dubious predictive worth. Because the students most likely to be able to commit to a second dedicated studying period are more likely to have the means to, especially in the post-bac period where non-rich grads are going to have to find full time employment. I'm not suggesting alternative selection criteria. I'm saying that re-tests and post-bac work is more classist with dubious predictive value. They don't necessarily say more than what they've already said. They're more sensitive for SES than aptitude than the first test take.

This topic seems to be out of the scope of this thread. If you want to continue perhaps you should make a thread based on that.

I'm following your logic to its natural end. I don't see it as out of the scope of this thread. You're saying in no uncertain terms that people with within a likely SE of your scores aren't capable of med school and that they should commit to processes that are highly classist to signal that they're capable of med school. Your purported reason is because you want to protect people from failing out of med school, which we agree is a catastrophe. The real initial discussion was about the catastrophe of failure, for which increasing admissions standards is but one, and very narrow and protectionist, strategy. That you keep wanting to constrain your own discussion to increasing admissions criteria suggests your own bias in this discussion.

That we both can't follow your logic to their natural ends suggests that you don't really even care for your own purported reasons. I suspect it's just a prestige issue. More DOs of lower standards means DO standards will never rise. I'm fine with that. You seem to not be, based on your very narrow desire to raise admissions standards for reasons that you can't sufficiently explain. As an asian american, this is the kind of thing that white people do to us to explain why they should do away with affirmative action. I'm use to this sort of rhetoric and couldn't stop sniffing it from your arguments in heavy doses. If you want admissions standards to be rise, that's fine. I'm not okay with your using, "protecting low performing students," as a cudgel though, and that is my real quibble with you.

 

[Angus Avagadro]

Wuh? The bottom third has nothing to do with classist policies. It has to do with students who are not prepared for the academic rigors of med school. Of course there are many factors, which aren't very relevant once they arrive at med school. Look at the students with red flags for residencies,..... course and board failures. They are the usual suspects, mostly in the bottom third. If you were to look back at their applications, you would not see stellar academics, usually criteria more near our cutoffs. I'm looking into this at our school. Our students are our our product and their success is paramount. Why bring them in and allow them to fail when they are not ready? Some schools with linked post bac programs are cheaper with 1 yr post bac and 4 yrs there than 4 years at some private schools. So cost is not quite as prohibitive as you suggest. As i said in prior posts, DO schools take too many borderline students, especially newer ones.

 

[libertyyne]

So because society can reap benefit from URMs, they are allowed to wade into riskier pools and we aren't allowed to protect them from themselves. in other words, URMs don't deserve protection because we, society, can profit from them.

1. These are the only pools of UiMS. Schools take what they can and take a chance on who they think will perform.
2. UIMs tend to serve underserved populations that resemble them .
3. Undeserved populations are more likely to seek the care they need and entrust their physician if their physician is like them.
4. Schools are not there to protect applicants or matriculants, their mission is to serve the community. They minimize loss of medical students by adhering to the only selection critieria that have moderate correlation to completion of the rigors of medical school. MCAT/GPA.
5. You dont have an alternative , yet somehow the entire medical establishment and all the studies pointing to this fact are inadequate for you. lol.

didn't say that. i said retaking the MCAT or post-bac work, such as volunteering or post-bacs are *more* classist than already classist selection criteria. And that they're of dubious predictive worth. Because the students most likely to be able to commit to a second dedicated studying period are more likely to have the means to, especially in the post-bac period where non-rich grads are going to have to find full time employment. I'm not suggesting alternative selection criteria. I'm saying that re-tests and post-bac work is more classist with dubious predictive value. They don't necessarily say more than what they've already said. They're more sensitive for SES than aptitude than the first test take.

6. You are missing the plot. Grades and MCAT show that you are ready to handle medical school. If you have a 2.0 and 487 you in all liklihood dont know how to study, or dont care to study. Why would i give you a seat if there are 100's of other candidates who display that they are ready for the rigor of medical school and I as a school can minimize risk of not graduating a full class.
7. They are not more classist they are the baseline for evaluation, yet another common thing in our ethos of evaluating people by the work they have done, not by the work they promise they will do.
8. Dont you think getting a BA or BS is also too classist?
9.As mentioned above postbacs can be cheaper than OOS tutition.

I'm following your logic to its natural end. I don't see it as out of the scope of this thread. You're saying in no uncertain terms that people with within a likely SE of your scores aren't capable of med school and that they should commit to processes that are highly classist to signal that they're capable of med school. Your purported reason is because you want to protect people from failing out of med school, which we agree is a catastrophe. The real initial discussion was about the catastrophe of failure, for which increasing admissions standards is but one, and very narrow and protectionist, strategy. That you keep wanting to constrain your own discussion to increasing admissions criteria suggests your own bias in this discussion.

10. Get a grip, Not a single day goes by where DO students on this forum dont complain about not having the same opportunities as MD students.
If you want equal GME outcomes you need to have equal resources, education, and selection criteria.

Currently DO schools have an image problem of being the place where students end up when they dont get into an MD school. By increasing class sizes, opening more schools, and not investing in research, DO schools are going to continue to live up to that stereotype.
If you want to continue the status quo and basically continue to have two tiers of medical education and not have parity in outcomes this is great plan.

11. You can call it protectionist, but I am going to have call people my collegues, I would like medicine to continue to be synonymous with the best and brightest.

That we both can't follow your logic to their natural ends suggests that you don't really even care for your own purported reasons. I suspect it's just a prestige issue. More DOs of lower standards means DO standards will never rise. I'm fine with that. You seem to not be, based on your very narrow desire to raise admissions standards for reasons that you can't sufficiently explain. As an asian american, this is the kind of thing that white people do to us to explain why they should do away with affirmative action. I'm use to this sort of rhetoric and couldn't stop sniffing it from your arguments in heavy doses. If you want admissions standards to be rise, that's fine. I'm not okay with your using, "protecting low performing students," as a cudgel though, and that is my real quibble with you.

12. Nice strawman, I clearly stated that it was to protect the schools mission not just the goals of the applicants. If a person fails out of medical school it is on them, and it is their own money they are wasting just like any other higher education endeavor.

13. lol@ race card. Im not white so thanks?

14. See here is the difference between you and me. I want DO/MDs to be interchangeable. I want the gme outcomes to be the same and I want the success and attrition rates to be the same. I would rather they all be MD. But that also means that the standards are the same in terms of clinical , research and admissions, until that happens there will always be the disparity and bias that gets talked about on this forum.

 

[Kuratz]

At some point the unmatched rate of DOs will hit a critical mass and COCA will call for rapid expansion of residency positions. That is when you'll see MDs get involved passionately and fight hard against the tide because it would effectively mean an inevitable pharmacy or law situation. Practicing docs are not naive and have actively maintained a physician shortage in part to keep salaries high. The current residency bottleneck is the only thing that prevents massive downward pressure on the job market. It is necessary. There will be losers in this, but the exact nature and degree is uncertain. I've always held that DOs can get superb training. However, contrary to the mantra maybe 10 years ago, going to a brand new DO school isn't necessarily a slam dunk way to practicing medicine. Pre-meds who only hold acceptances at the newer DO schools are the most vulnerable to struggling in med school anyway and need to tread with caution knowing the reality. Hardworking and reasonable students should be fine. Bottom quartile students at new DO schools however...
Caveat emptor

 

[2021Doctor]

At some point the unmatched rate of DOs will hit a critical mass and COCA will call for rapid expansion of residency positions. That is when you'll see MDs get involved passionately and fight hard against the tide because it would effectively mean an inevitable pharmacy or law situation. Practicing docs are not naive and have actively maintained a physician shortage in part to keep salaries high. The current residency bottleneck is the only thing that prevents massive downward pressure on the job market. It is necessary. There will be losers in this, but the exact nature and degree is uncertain. I've always held that DOs can get superb training. However, contrary to the mantra maybe 10 years ago, going to a brand new DO school isn't necessarily a slam dunk way to practicing medicine. Pre-meds who only hold acceptances at the newer DO schools are the most vulnerable to struggling in med school anyway and need to tread with caution knowing the reality. Hardworking and reasonable students should be fine. Bottom quartile students at new DO schools however...
Caveat emptor

I think you will never see a mass expansion of GME funding by the federal government. It is a lot cheaper to use more PAs and NPs since they do not need to do a residency program and don't need GME funding. The feds will just push for expanded use of NPs and PAs rather than cough up more GME money.

 

[libertyyne]

I think you will never see a mass expansion of GME funding by the federal government. It is a lot cheaper to use more PAs and NPs since they do not need to do a residency program and don't need GME funding. The feds will just push for expanded use of NPs and PAs rather than cough up more GME money.

I would never say never. I do think the fed will increase funding of GME. It might be massive or it might just be a change in the formula to tie it to population growth. AMA and COCA are already trying to sett it up.

 

[deleted950463]

I would never say never. I do think the fed will increase funding of GME. It might be massive or it might just be a change in the formula to tie it to population growth. AMA and COCA are already trying to sett it up.

And the GME expansion is needed because? We don’t have a physician shortage problem. We have a maldistribution problem.

 

[libertyyne]

And the GME expansion is needed because? We don’t have a physician shortage problem. We have a maldistribution problem.

I agree with you. Ama and coca on the other hand don't think so. Plus at the rate the schools have been expanding it won't be too soon where med students will also get on board.

 

[Goro]

And the GME expansion is needed because? We don’t have a physician shortage problem. We have a maldistribution problem.

One of the things I wonder about is that over the next 10-20 years, Baby Boom doctors will be retiring or dying off in droves.

So will the expansion of med schools keep pace with that? Or will GME be a choke point, leading to an actual doctor shortage? I don't know the answer.

A google search on "avg age of US doctors" gave me the chart below: Close to 50% of the respondents are 56 or older, and some 17% are 66 or older. If this data is accurate, how many of the 950K doctors in the US will we need to replace in 10 years? Food for thought, the avg Caucasian doctor lives to age 73 (at least some 20 years ago), but they mostly retire around age 65.

Keep in mind that we only mint some 28-30000 new medical grads each year.


Whaddya think?

from Physicians age group distribution United States 2018 | Statistic
Mortality rates and causes among U.S. physicians. - PubMed - NCBI

 

[DrStephenStrange]

And the GME expansion is needed because? We don’t have a physician shortage problem. We have a maldistribution problem.

Yes, I agree we do have a maldistribution problem, but if GMEs open where we actually need Doctors (in less desirable areas), don't you think it might solve this problem even a little bit? People from these areas that suffers from this maldistribution might wanna go back to train in their home town after medical school, and end up staying in the area. Instead of going really far away, and end up being forced to stay away because they're all settled by the time they finish, and the cost of having to move again might not be worth it.

Edit: also what @Goro said might be something to consider.

Sent from my SM-G950U using SDN mobile

 

[libertyyne]

Yes, I agree we do have a maldistribution problem, but if GMEs open where we actually need Doctors (in less desirable areas), don't you think it might solve this problem even a little bit? People from these areas that suffers from this maldistribution might wanna go back to train in their home town after medical school, and end up staying in the area. Instead of going really far away, and end up being forced to stay away because they're all settled by the time they finish, and the cost of having to move again might not be worth it.

Edit: also what @Goro said might be something to consider.

Sent from my SM-G950U using SDN mobile

Is there any evidence that supports this? You can't just open up an ent gme in the middle of nowhere. And residents can go back home after training. The problem is that young people don't want to live in shortage areas.

 

[2021Doctor]

I would never say never. I do think the fed will increase funding of GME. It might be massive or it might just be a change in the formula to tie it to population growth. AMA and COCA are already trying to sett it up.

I am sorry but this makes no sense to me. What the AMA and COCA want will not be major factors. Most doctors are not AMA members and COCA has little power over the federal government. I want a new boat, new house, and a new car but nobody is going to give them to me. I have been hearing about the lifting of the GME cap for years.
Let's look at some of the success the AMA, AAMC, and COCA have had in getting the GME cap removed.
Resident Physician Shortage Reduction Act of 2007 - DIED
Resident Physician Shortage Reduction Act of 2007 (2007 - S. 588)
Resident Physician Shortage Reduction Act of 2009 - DIED
Resident Physician Shortage Reduction Act of 2009 (2009 - S. 973)
Resident Physician Shortage Reduction Act of 2011 - DIED
Resident Physician Shortage Reduction Act of 2011 (2011 - S. 1627)
Resident Physician Shortage Reduction Act of 2013 - DIED
Resident Physician Shortage Reduction Act of 2013 (2013 - S. 577)
Resident Physician Shortage Reduction Act of 2015 - DIED
Resident Physician Shortage Reduction Act of 2015 (2015 - S. 1148)
Resident Physician Shortage Reduction Act of 2017 - DIED
Resident Physician Shortage Reduction Act of 2017 (S. 1301)
These bills have spanned both Democrat and Republican Congresses and Democrat and Republican Presidents and uniformly failed.
I ask you "What is the definition of insanity?"

Many would argue the US has a maldistribution but not a shortage of physicians.
Remember what the Obamacare architect Dr. Ezekiel Emmanuel says:
Dr. Emanuel and his colleagues arrived at this conclusion from a simple calculation to estimate the number of physicians required to care for all U.S. residents.
The U.S. currently has more than 900,000 active physicians, including 441,735 primary care physicians, 80,000 pediatricians and 484,384 specialists. Of the total number of primary care physicians, about 12 percent work part time, leaving about 388,000 full-time primary care physicians.
The Agency for Healthcare Research and Quality recommends the average physician provide care to between 1,500 and 2,000 patients per year. A survey from the Medical Group Management Association found that the median physician panel size was 1,906 and the average was 2,184, according to the report. Dr. Emanuel reasoned that if each of the 388,000 full-time primary care physicians cares for an average of 1,500 patients, they could care for about 583 million people. There are 240 million adults currently living in the U.S. Similarly, if each of 49,000 pediatricians cared for 1,500 children, they could provide care for the 73 million U.S. children. By these calculations, there is a surplus, not a shortage, of physicians in the U.S..
Dr. Zeke Emanuel: 'Ominous' physician shortage projections don't add up

The holy grail for fixing the U.S. healthcare system can be found by targeting potentially avoidable conditions, said Ezekiel Emanuel, M.D., special adviser for health policy to the director of the White House Office of Management and Budget.
In the first general session of the Medical Group Management Association's annual conference Sunday evening, Emanuel said a “high touch” approach by physicians that eliminates those avoidable conditions could lead the way toward a healthier population and slower growth in the costs.
By “high touch,” Ezekiel means giving primary-care physicians a greater role in providing care, with nonphysicians, such as nurse practitioners, also doing more. The aim is to increase interactions via in-office visits, phone and e-mail so that patients are cared for more regularly, thereby avoiding costly care in the hospital.
Emanuel sees potential in ‘high touch' approach

 

[libertyyne]

I am sorry but this makes no sense to me. What the AMA and COCA want will not be major factors. Most doctors are not AMA members and COCA has little power over the federal government. I want a new car but nobody is going to give me one. I have been hearing about the lifting of the GME cap for years.
Let's look at some of the success the AMA, AAMC, and COCA have had in getting the GME cap removed.
Resident Physician Shortage Reduction Act of 2007 - DIED
Resident Physician Shortage Reduction Act of 2007 (2007 - S. 588)
Resident Physician Shortage Reduction Act of 2009 - DIED
Resident Physician Shortage Reduction Act of 2009 (2009 - S. 973)
Resident Physician Shortage Reduction Act of 2011 - DIED
Resident Physician Shortage Reduction Act of 2011 (2011 - S. 1627)
Resident Physician Shortage Reduction Act of 2013 - DIED
Resident Physician Shortage Reduction Act of 2013 (2013 - S. 577)
Resident Physician Shortage Reduction Act of 2015 - DIED
Resident Physician Shortage Reduction Act of 2015 (2015 - S. 1148)
Resident Physician Shortage Reduction Act of 2017 - DIED
Resident Physician Shortage Reduction Act of 2017 (S. 1301)

I ask you "What is the definition of insanity?"

Just because a bill has failed in the past does not mean that it will fail in the future. If anything the persistence of the effort should mortify you. There are countless examples of bills that failed in the past getting passed or ressurected in a different form. What you are completely failing to acknowledge is that like it or not AMA is the largest physican group with the sole purpose of lobbying for "physician" interests. The decentralization of most physicians is what leads to the lack of access and lack of having their wishes fulfilled. Whether you like it or not they have more power compared to the average physican. And who do you think lawmakers are going to listen to ? splintered groups of individual physicians or AMA which is the largest physican organization(with the largest number of dollars spent lobbying), COCA and LCME that actually oversee medical schools.
American Medical Assn: Summary | OpenSecrets

You are acting like we live in a world where politics and the federal government is a completely rational entity. Hint, its not. Spend more money, you have more access. Have more access and you can literally write the bills. Once a crisis point comes and congress decides to deal with the issue the AMA is going to have a lot of input.

 

[BorntobeDO?]

Yes, I agree we do have a maldistribution problem, but if GMEs open where we actually need Doctors (in less desirable areas), don't you think it might solve this problem even a little bit? People from these areas that suffers from this maldistribution might wanna go back to train in their home town after medical school, and end up staying in the area. Instead of going really far away, and end up being forced to stay away because they're all settled by the time they finish, and the cost of having to move again might not be worth it.

Edit: also what @Goro said might be something to consider.

Sent from my SM-G950U using SDN mobile

In a tiny town of 5k people, how many of them are going to be school age? Of those who are school age, how many actually have the capability to complete medical school, or even the desire? How many of their friends will immediately move away upon graduating highschool because there is no jobs/work/future in those dying towns?

Its easy to say 'recruit from the rural areas' but in reality, there are many reasons why these places are going down the tube. The population is significantly less educated, the workforce is much older or in retail, the major jobs that their fathers did are gone or reduced (mining, logging, manufacturing, farming, etc). The pool of people who could do medical school are small in the first place given that background, and then if they come back, everyone they know has now left except grandma and grandpa due to the lack of decent jobs. All that is left is retail and drugs. You really think most people will come back to that?

This is why schools promoting 'rural primary care' haven't had a significant impact in actual rural areas. When the local economy is broken, you don't fix it by sticking a doc there. Ironically enough tho, sticking a medical school does seem to help the economy where it is at (till that bubble burst too). But it does nothing for the other little rural town a hour away that doesn't have that government funded benefit.

 

[2021Doctor]

Just because a bill has failed in the past does not mean that it will fail in the future. There are countless examples of bills that failed in the past getting passed or ressurected in a different form. What you are completely failing to acknowledge is that like it or not AMA is the largest physican group with the sole purpose of lobbying for "physician" interests. The decentralization of most physicians is what leads to the lack of access and lack of having their wishes fulfilled. Whether you like it or not they have more power compared to the average physican. And who do you think lawmakers are going to listen to ? splintered groups of individual physicians or AMA which is the largest physican organization, COCA and LCME that actually oversee medical schools.
American Medical Assn: Summary | OpenSecrets

Please give us the reasons why we will get more GME money in the future despite a long history of failure.
Also, the statement in bold is patently false imo. Many doctors see the AMA as being out for its own interests rather than the interests of physicians.
1) Only 17% of physicians are AMA members. The AMA represents only about one-sixth of all doctors
2) The AMAs biggest revenue stream comes from its CPT code monopoly which it wants to preserve.
Doctors Expose AMA’s Secret Pact with Federal Government
3) Why the American Medical Association Had 72 Million Reasons to Shrink Doctors' Pay
Forbes Staff
What Scott is referring to here is the Current Procedural Terminology code set, or CPT, an AMA-owned system that is used by Medicare to set up its fee schedule for various medical procedures and services. This government-granted monopoly is a windfall to the AMA’s D.C. pooh-bahs, who reported$72 million in revenues from “royalties and credentialing products” in 2010. That hefty sum amounted to a quarter of the AMA’s total 2010 revenues; by comparison, the organization received $38 million in members’ dues in 2010.
When the AMA gets twice as much through the government as it gets from its own members, we can hardly be surprised that the AMA today is more a tool of Washington’s interests than those of doctors. This is why the AMA decided to support Obamacare, even after Democrats reneged on their promise to include a permanent “doc fix” in the law that would have prevented doctors’ Medicare fees from sinking to Medicaid levels.
Why the American Medical Association Had 72 Million Reasons to Shrink Doctors' Pay

 

[libertyyne]

The statement in bold is patently false imo. Many doctors see the AMA as being out for its own interests rather than the interests of physicians.
1) Only 17% of physicians are AMA members. The AMA represents only about one-sixth of all doctors
2) The AMAs biggest revenue stream comes from its CPT code monopoly which it wants to preserve.
Doctors Expose AMA’s Secret Pact with Federal Government
3) Why the American Medical Association Had 72 Million Reasons to Shrink Doctors' Pay
Forbes Staff
What Scott is referring to here is the Current Procedural Terminology code set, or CPT, an AMA-owned system that is used by Medicare to set up its fee schedule for various medical procedures and services. This government-granted monopoly is a windfall to the AMA’s D.C. pooh-bahs, who reported$72 million in revenues from “royalties and credentialing products” in 2010. That hefty sum amounted to a quarter of the AMA’s total 2010 revenues; by comparison, the organization received $38 million in members’ dues in 2010.
When the AMA gets twice as much through the government as it gets from its own members, we can hardly be surprised that the AMA today is more a tool of Washington’s interests than those of doctors. This is why the AMA decided to support Obamacare, even after Democrats reneged on their promise to include a permanent “doc fix” in the law that would have prevented doctors’ Medicare fees from sinking to Medicaid levels.
Why the American Medical Association Had 72 Million Reasons to Shrink Doctors' Pay

Im not sure you see that I agree with you. AMA does not have my interests at heart. But do you think capital hill see's that? It sees it as the largest physican group , and a large lobbying arm. It spends 10x more money compared to the next physician group. So yes you would be ignoring them at your own peril. They have been beating the drum of expansion for a decadeand COCA, LCME and even the carrib for-profits have already joined them. It is just a matter of time till this froths up.

 

[deleted950463]

Explain to me, why should the congress expand GME, when the only people that will be serve by that are on the average, worse students that go to DO schools, whereas before the DO expansion would have ended up in the Carribean anyway? Hard to win the hearts and minds when you can make the argument that this only benefit marginal students like myself.

 

[libertyyne]

Explain to me, why should the congress expand GME, when the only people that will be serve by that are on the average, worse students that go to DO schools, whereas before the DO expansion would have ended up in the Carribean anyway? Hard to win the hearts and minds when you can make the argument that this only benefit marginal students like myself.

its because the AMA , LCME, AAMC and COCA people in the industry are telling congress too, writing their bills for them, and spending money lobbying them to expand, all the while stating that it will help alleviate some physician shortage in the minds of those organizations.

 

[2021Doctor]

its because the AMA , LCME, AAMC and COCA people in the industry are telling congress too, writing their bills for them, and spending money lobbying them to expand, all the while stating that it will help alleviate some physician shortage in the minds of those organizations.

How do you propose to get the money for more GME funding, cut Social Security? print it out of thin air? cut medicare payments?

You do realize that both Obama and Trump have had budgets that pushed for GME funding cuts due to worsening US budget deficits.
1) Other healthcare provisions include a permanent fix to Medicare's sustainable growth-rate formula for paying physicians, the reduction of Medicare bad-debt payments to providers, and almost $16.3 billion in cuts to graduate medical education funding.
Obama's 2016 budget cuts Medicare but eliminates sequestration
2) But the plan struck a dissonant chord with providers, in part due to its consolidation of graduate medical education spending in Medicare, Medicaid and the Children's Hospital GME Payment Program to a new mandatory capped grant program.
Funding in the new capped program would be targeted to address medically underserved communities and health professional shortages.
The change would lead to a $48 billion drop in GME funding over 10 years, according to Kenneth Raske, president of the New York Hospital Association
Trump calls for $18 billion cut to HHS funding.

 

[libertyyne]

How do you propose to get the money for more GME funding, cut Social Security? print it out of thin air? cut medicare payments?

You do realize that both Obama and Trump have had budgets that pushed for GME funding cuts due to worsening US budget deficits.
1) Other healthcare provisions include a permanent fix to Medicare's sustainable growth-rate formula for paying physicians, the reduction of Medicare bad-debt payments to providers, and almost $16.3 billion in cuts to graduate medical education funding.
Obama's 2016 budget cuts Medicare but eliminates sequestration
2) But the plan struck a dissonant chord with providers, in part due to its consolidation of graduate medical education spending in Medicare, Medicaid and the Children's Hospital GME Payment Program to a new mandatory capped grant program.
Funding in the new capped program would be targeted to address medically underserved communities and health professional shortages.
The change would lead to a $48 billion drop in GME funding over 10 years, according to Kenneth Raske, president of the New York Hospital Association
Trump calls for $18 billion cut to HHS funding.

Not sure if you keep track of the federal government but they are not renown for being fiscally responsible. All I am saying is that when people stop matching, you are going to hear a lot about gme expansion, and depending on the political and social forces at work at the time it is possible that it will occur. People were equally in disbelief about the ACA, social security or other large bills. GME expansion is tiny cost compared to tax cuts or many other things congress does on a regular basis. You can be in disbelief all you want, But I wouldnt personally put a large bet on the line that it wont happen.

 

[AnatomyGrey12]

Is there any evidence that supports this?

There is evidence that says that a resident is most likely to work within a 200 mile radius of their residency program. Theoretically creating a residency program in town A will lead to more doctors in town A.

You can't just open up an ent gme in the middle of nowhere.

This was going to be my response as well. The reason these rural towns don’t have GME is because you can’t just open up a program in the middle of nowhere. You have to have a site where you see a certain variety of pathology, acuity, etc to have a training program @DrStephenStrange

Also, the statement in bold is patently false

It’s literally not. Most doctors not being AMA members doesn’t change the fact that it is the largest organized group lobbying for physicians.