What is DO Leadership Thinking for 2020?

[jrlob91]

My and the interns ran the show on the days that the IM seniors were away at conference. I literally carried 4 patients and put orders in before and after rounds. It's balls easy picking NS@75 and moxifloxacin for the pneumonia patient with a million comorbid issues, since that's the literal day to day routine at an AOA program. Same experience in family med. I ran the entire encounter and the attending popped their head in to say hi and checked the button to bill my note. I literally only needed the attending to prescribe the benzos and pain killers.

Meanwhile, at the acgme IM rotation, I had my A&Ps torn apart. They pimped on why you'd picked Levophed vs phenylephrine. They pimped on what exactly you'd do for the ICU patient's vent and fluids if X and Y are happening. Every little decision there was challenged and used as an educational experience.

Thanks for the info bro

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[jrlob91]

Nice to see where your priorities lie lol. The ones that'll actually kill patients should be shunned from medicine first, aka anyone that went AOA.

Just gave back my diploma, you win!

 

[CajunMedic]

Don’t you know that everyone at McDonalds has Griddle guidelines memorized

You laugh, the management test I took in my life WAAAY before medicine was just that. Rote memorization of every piece of esoterica you can imagine...

 

[gyngyn]

Please disagree with civility.
If that is not possible, there is also an ignore function.

 

[Skiiiiiing]

Not rhetorical, honest question. The only place I've heard impending doom of COM expansion and GME stagnation is SDN (though anyone who does the numbers can see the writing on the wall). I can understand how leadership sees DO expansion as a way to get the share of the market, but they're hedging their bets on 1. PD's will favor DOs over IMG and 2. Lower level, cheaper labor (NP's, PA's) not filling the gap, thus pressure to expand GME funding. So are they ignorant, willfully blind, or just not talking about adverse outcomes from overexpansion and lack of GME?

The merger itself is not that bad.

The merger combined with mass proliferation of DO schools is indefensible.

 

[Skiiiiiing]

I think inevitably this is what will happen across the board.

MD enrollment not spiking. DO enrollment is. The crunch is going to start killing new DO, I don't know of it gets to quality DO.

 

[Skiiiiiing]

Until it has actual teeth it means nothing

Nah, that important people are talking about it is a good sign. I happen to think it's completely indefensible.

Who can blame them?

Me, for one. Most of the elderly want to leave a legacy of positive and lasting contribution on their way out. Not leave a dumpster fire of 60% match rates in exchange for a pile of money.

 

[W19]

MD enrollment not spiking. DO enrollment is. The crunch is going to start killing new DO, I don't know of it gets to quality DO.

Even if the increased of MD and DO enrollment is about the same in terms of raw #, but the rate of DO enrollment is alarming. COCA needs to put a stop on that, otherwise the DO degree will suffer.

 

[Skiiiiiing]

Even if the increased of MD and DO enrollment is about the same in terms of raw #, but the rate of DO enrollment is alarming. COCA needs to put a stop on that, otherwise the DO degree will suffer.

My point was: given quality of students these new schools are admitting (sub 500 common, sub 495 not rare) and the quality of real education - lectures with non-doctoral faculty and taught by students and no hospital - they are not going to be competition for any MD school I know of.

Does the effect spread to existing DOs and the better DO schools? Probably

 

[Dr.Bruh]

WHO HURT YOU? WHY DID THEY DO THIS TO YOU?

Dudes wife cheated on him with an AOA trained neurosurgeon.

 

[Dr.Jekyll75]

Even if the increased of MD and DO enrollment is about the same in terms of raw #, but the rate of DO enrollment is alarming. COCA needs to put a stop on that, otherwise the DO degree will suffer.

I feel that COCA will eventually get dissolved by the LCME just like the ACGME took out the AOA. This will decrease the number of DO schools and the proliferation. More than likely only the well-established schools will survive leaving maybe 7 of them around ? but who knows when that will happen. These new schools wont last long, this is just one last push for COCA board members to get quick rich and leave

 

[sab3156]

Just read this entire thread. Extremely entertaining.

 

[sab3156]

When AOA president Dr. Baker came to speak at my school someone asked about the issue of the growing number of schools without the residencies to match and he basically said it's out of their control. To paraphrase, he said that's entirely up to COCA and the standards they set. If a school meets whatever their criteria is then they get approved. I fully acknowledge that I know very little about the details of the whole thing and I'm just repeating what was said, but taking him at his word I would say your question should be directed to COCA and not DO leadership.

The dude also came to mine and said that he wants to see all DOs graduating from ACGME residencies/fellowships to forego the ABMS board certification in favor of the AOA board certification, because it's better for the profession or something crazy like that. The guy is on some special drugs. Can't trust a word that guy says. He also twisted some statistics to suit his random one-liners about how all the ACGME programs are excited about more DO applications and "believe in the osteopathic students".

 

[BorntobeDO?]

The dude also came to mine and said that he wants to see all DOs graduating from ACGME residencies/fellowships to forego the ABMS board certification in favor of the AOA board certification, because it's better for the profession or something crazy like that. The guy is on some special drugs. Can't trust a word that guy says. He also twisted some statistics to suit his random one-liners about how all the ACGME programs are excited about more DO applications and "believe in the osteopathic students".

I am sure they believe in us, we are not exactly unicorns. That doesn't mean they want us tho. So I guess he was kind of telling the truth.

 

[sab3156]

FM is the biggest triage job in the world. The rest of the world lets med student jump directly in practicing FM or doing a 1 year internship before becoming fully licensed in FM.

There is a handful of top university programs (Harvard MGH/BWH, Yale, WashU, etc.) that don't even really care about family medicine, and they instead have a primary care focused IM track. I like that approach.

 

[W19]

There is a handful of top university programs (Harvard MGH/BWH, Yale, WashU, etc.) that don't even really care about family medicine, and they instead have a primary care focused IM track. I like that approach.

I was shocked to learn some schools don't even have a FM clerkship in their curriculum. Amazing!

 

[Stagg737]

Sub 220 students should stay in family medicine, as the MDs already do. The loophole that DOs with low usmle had should've been closed a hell of a lot earlier than 2020. A having a bad FM doctor makes no difference. It's just a triage job. Having a bad specialist makes a huge difference. It'll be life vs serious physical harm vs death.

Even my DO hospital doesnt hire DO surgeons. The only one they hired was sent to wound care. The operative ones are all MDs trained in ACGME. And honestly, I'll be picking up the same policy. I wont send any of my patients to an AOA-trained doctor either.

This is literally one of the dumbest things I've ever read on SDN. Almost every sentence is blatantly false other than the bolded which is only half false (actual statement is false as it wasn't a "loophole", but I'll give you the sentiment). Seriously though, when someone applies to any medical school "on a whim" this is the kind of backwards, nonsensical though process I'd expect.

To correct you though. FM isn't just triage, it's the management of chronic health issues and preventing them from occurring. You're thinking of EM in terms of triage. The fact that you don't understand that makes it difficult to take anything you say seriously.

Even US has had NPs and PAs running clinics solo for the past decades without issue.

If you think this is only happening with FMs and not specialties you're in for a very rude awakening when you get to the real world of medicine...

My beef here is with the AOA residency standards. It's a big backdoor into medicine for under-qualified people and you guys are sooooo upset at getting called out for it.

I'm quoting this one because I think it's the most valid thing you've said, even if it's not always true. There are too many AOA which don't provide adequate training to their residents and either just don't teach enough or just treat residents as more staff to move the meat. I can name a half dozen ACGME programs off the top of my head (many of them in NYC!!) which are the same way as well and there are many more I could find with a really simple search, so acting high and mighty like this is only an AOA problem is misinformed as well.

MD enrollment not spiking. DO enrollment is. The crunch is going to start killing new DO, I don't know of it gets to quality DO.

I mean, they're both increasing significantly though. There have been 8 new MD schools that have opened since 2016 and I believe there are 5-7 more that will be opening by 2020. It's not a unilateral issue, but it is likely to hurt those coming from new DO schools more (for many reasons).

Even if the increased of MD and DO enrollment is about the same in terms of raw #, but the rate of DO enrollment is alarming. COCA needs to put a stop on that, otherwise the DO degree will suffer.

To the bolded: Why is the rate of expansion more alarming the the increase in raw numbers??? I've asked it several times now and no one has given me a good answer for this yet and it's tiring hearing people talk about "expansion rate" while completely ignoring raw numbers. At the end of the day, I don't really care if there's a 10% increase or 100% increase in applicants if the total number of applicants in the pool for X number of positions is the same. So ignoring the fact that DO expansion is going to hurt applicants more than it will help, why is the rate so important while raw numbers don't matter especially when that rate will only decline as we move forward?

 

[Meekor]

This is literally one of the dumbest things I've ever read on SDN. Almost every sentence is blatantly false other than the bolded which is only half false (actual statement is false as it wasn't a "loophole", but I'll give you the sentiment). Seriously though, when someone applies to any medical school "on a whim" this is the kind of backwards, nonsensical though process I'd expect.

To correct you though. FM isn't just triage, it's the management of chronic health issues and preventing them from occurring. You're thinking of EM in terms of triage. The fact that you don't understand that makes it difficult to take anything you say seriously.



If you think this is only happening with FMs and not specialties you're in for a very rude awakening when you get to the real world of medicine...



I'm quoting this one because I think it's the most valid thing you've said, even if it's not always true. There are too many AOA which don't provide adequate training to their residents and either just don't teach enough or just treat residents as more staff to move the meat. I can name a half dozen ACGME programs off the top of my head (many of them in NYC!!) which are the same way as well and there are many more I could find with a really simple search, so acting high and mighty like this is only an AOA problem is misinformed as well.



I mean, they're both increasing significantly though. There have been 8 new MD schools that have opened since 2016 and I believe there are 5-7 more that will be opening by 2020. It's not a unilateral issue, but it is likely to hurt those coming from new DO schools more (for many reasons).



To the bolded: Why is the rate of expansion more alarming the the increase in raw numbers??? I've asked it several times now and no one has given me a good answer for this yet and it's tiring hearing people talk about "expansion rate" while completely ignoring raw numbers. At the end of the day, I don't really care if there's a 10% increase or 100% increase in applicants if the total number of applicants in the pool for X number of positions is the same. So ignoring the fact that DO expansion is going to hurt applicants more than it will help, why is the rate so important while raw numbers don't matter especially when that rate will only decline as we move forward?

What I think he’s trying to get at is in terms of oh much quicker DO schools are expanding. Yes MD and DO have added the same number of schools in the last decade, HOWEVER, DO students have increased at a much higher rate in proportion to the total number of MD students increased. This is due to LCME only allowing new MD schools to start at half their expected full class then ramp up to their total approved number. Unlike DO schools where you can get approved for 250 spots and admit 250, as opposed to admitting 100 and giving the school time to develop the proper clinical and GME resources. So yes, there remains more positions than students, but with gap decreasing every year, DO proliferation in its current state will make whatever gap there is currently non existent rather soon. Will ICOM or BCOM be able to create enough GME positions for their graduates? Or the UT or RVU or NYIT ARCOM or the new PCOM campus? Who knows? That is what’s so reckless about the current expansions of the DO med school field

 

[W19]

@Stagg737

If you don't see the difference b/t DO expansion vs MD, I don't know what to tell you. LCME will not allow a school like FAU to have 100+ students if they don't have the proper structure in place while COCA has no issues with a DO school in the middle of nowhere having 250 students... with another 150+ students at a satellite campus.

FYI: FAU is a big state university in south FL surrounded with great infrastructures and a lot major hospitals (400+ beds) within a ~40 miles radius.

 

[Stagg737]

This is due to LCME only allowing new MD schools to start at half their expected full class then ramp up to their total approved number. Unlike DO schools where you can get approved for 250 spots and admit 250, as opposed to admitting 100 and giving the school time to develop the proper clinical and GME resources.

This is a good point, and I didn't realize new MD schools were required to have smaller class sizes initially, but it still doesn't answer my question as to why proportion is more important than raw numbers. To be clear, I'm not for DO (or MD) expansion at the rates it's occurring without doing something additional to ensure GME positions are available. I'm just trying to get someone to give me a reason why we're looking at proportion of expansion instead of the raw numbers, as the latter seems far more important and telling than the former.

@Stagg737

If you don't see the difference b/t DO expansion vs MD, I don't know what to tell you. LCME will not allow a school like FAU to have 100+ students if they don't have the proper structure in place while COCA has no issues with a DO school in the middle of nowhere having 250 students... with another 150+ students at a satellite campus.

FYI: FAU is a big state university in south FL surrounded with great infrastructures and a lot major hospitals (400+ beds) within a ~40 miles radius.

That's not what I'm saying. I'm saying why is the rate (DO schools are increasing at an X% rate) more important than the raw numbers (there will be X new DOs by 20XX)? I don't care about proportion, I care about raw numbers, and no one has given me a decent reason as to why proportion is more relevant than raw numbers, yet that's all people talk about. That's what I'm asking about. I'm also familiar with FAU, but again that's not what I'm talking about.

 

[Meekor]

This is a good point, and I didn't realize new MD schools were required to have smaller class sizes initially, but it still doesn't answer my question as to why proportion is more important than raw numbers. To be clear, I'm not for DO (or MD) expansion at the rates it's occurring without doing something additional to ensure GME positions are available. I'm just trying to get someone to give me a reason why we're looking at proportion of expansion instead of the raw numbers, as the latter seems far more important and telling than the former.




That's not what I'm saying. I'm saying why is the rate (DO schools are increasing at an X% rate) more important than the raw numbers (there will be X new DOs by 20XX)? I don't care about proportion, I care about raw numbers, and no one has given me a decent reason as to why proportion is more relevant than raw numbers, yet that's all people talk about. That's what I'm asking about. I'm also familiar with FAU, but again that's not what I'm talking about.

Because the raw numbers don’t matter in the long run, they only matter in the short run. So yes you are right in the fact that currently the raw numbers show an excess of positions still. HOWEVER, and this is just using hypothetical numbers since I don’t have them off the top of my head, let’s say MD expansion has increased by 10-15% over the last 5 years from 20000/yr to ~22000/yr, with 2-3% increase each year in the last ten years. DO schools let’s say has increased from 5000yr to 8000/yr which is a 60% increase over the same period giving it a growth rate of 12-15% a year. Again this is just to show you why proportions matter, the numbers aren’t correct and don’t reflect the current number of students right now. So back to the matter at hand, if we agree that 1) the % increase does not change for MD or DO 2) there is no upper limit from COCA or LCME in schools or approved spots; we see rather quickly the conundrum. Let’s say this year MD students are at 22000, they would be expected to add 440-660 next year. If we take DO at 8000 for this year, they would be expect to add anywhere from 960-1200 students next year. The final MD count would be ~22500 and the DO would be ~9000, so if this current rate of expansion continues residency spots will crunch much faster for everyone involved. But the rate at which DO is doing it without the proper infrastructure is what’s going to hurt DOstudents.

Again the numbers I used are just round numbers to illustrate a point, they are not the real data. I’m sure someone can do the math again with the actual numbers, but I won’t because i just graduated and am currently on vacation.

 

[DrStephenStrange]

I think what @Stagg737 is trying to say (he can correct me if I interpreted it wrong) in terms of percentage and raw numbers is that percentage only matters if both parties started at the same raw numbers. Saying MD added X% and DO added X% is an unfair comparison because 15% out of "let's say" 20000 is more than "let's say" 50% out of 5000, and in time, if they keep increasing by the same raw number of students both percentages are only going to decrease. In that sense, the raw numbers are more important than the percentages.

Sent from my SM-G950U using SDN mobile

 

[Skiiiiiing]

This is literally one of the dumbest things I've ever read on SDN. Almost every sentence is blatantly false other than the bolded which is only half false (actual statement is false as it wasn't a "loophole", but I'll give you the sentiment). Seriously though, when someone applies to any medical school "on a whim" this is the kind of backwards, nonsensical though process I'd expect.

To correct you though. FM isn't just triage, it's the management of chronic health issues and preventing them from occurring. You're thinking of EM in terms of triage. The fact that you don't understand that makes it difficult to take anything you say seriously.



If you think this is only happening with FMs and not specialties you're in for a very rude awakening when you get to the real world of medicine...



I'm quoting this one because I think it's the most valid thing you've said, even if it's not always true. There are too many AOA which don't provide adequate training to their residents and either just don't teach enough or just treat residents as more staff to move the meat. I can name a half dozen ACGME programs off the top of my head (many of them in NYC!!) which are the same way as well and there are many more I could find with a really simple search, so acting high and mighty like this is only an AOA problem is misinformed as well.



I mean, they're both increasing significantly though. There have been 8 new MD schools that have opened since 2016 and I believe there are 5-7 more that will be opening by 2020. It's not a unilateral issue, but it is likely to hurt those coming from new DO schools more (for many reasons).



To the bolded: Why is the rate of expansion more alarming the the increase in raw numbers??? I've asked it several times now and no one has given me a good answer for this yet and it's tiring hearing people talk about "expansion rate" while completely ignoring raw numbers. At the end of the day, I don't really care if there's a 10% increase or 100% increase in applicants if the total number of applicants in the pool for X number of positions is the same. So ignoring the fact that DO expansion is going to hurt applicants more than it will help, why is the rate so important while raw numbers don't matter especially when that rate will only decline as we move forward?

Any of those MD schools taking large numbers of sub 500? Any of them rely heavily on lectures streamed from other locations? Any have a large share of courses taught by 3rd years and MA levels? Any unaffiliated with a hospital and "give you total freedom to design 3rd and 4th year"?

Most of the new DO schools meet several of the above, one I know of meets all.

 

[Stagg737]

let’s say MD expansion has increased by 10-15% over the last 5 years from 20000/yr to ~22000/yr, with 2-3% increase each year in the last ten years. DO schools let’s say has increased from 5000yr to 8000/yr which is a 60% increase over the same period giving it a growth rate of 12-15% a year. Again this is just to show you why proportions matter, the numbers aren’t correct and don’t reflect the current number of students right now.

See, but the raw numbers do matter in both of those situations. You're saying MDs are adding 2,000 positions while DOs are adding 3,000. I'm asking why aren't we using those numbers instead of percentages which make things seem much more disastrous? Saying there's a 15% growth rate sounds so much worse than a 2% growth rate when in reality the raw numbers aren't that different. That's what I'm getting at.

People are also (falsely) assuming that those rates are going to maintain consistent which I think is due to the use of the percentage. A consistent growth rate in terms of percentage would mean an exponential growth in terms of raw numbers. That may have happened recently due to the sudden surge in schools opening in the past 20 years, but to think that it's going to continue at that rate is just foolish imo. For example, if we started with 1 school and say there's a 100% growth rate every 2 years, then in 10 years there'd be 32 schools, which would be insane even as hyperbole. Idk what the real life numbers would look like (I can run them later if you'd like), but saying such a growth rate will continue is completely ridiculous.

Again, I'm not saying there isn't an issue with DO school expansion. There are many. I'm just looking at this from a logical standpoint and trying to figure out why people are using the percentage to predict trends instead of raw numbers, especially when the percentage historically has so much variation.

Any of those MD schools taking large numbers of sub 500? Any of them rely heavily on lectures streamed from other locations? Any have a large share of courses taught by 3rd years and MA levels? Any unaffiliated with a hospital and "give you total freedom to design 3rd and 4th year"?

Most of the new DO schools meet several of the above, one I know of meets all.

Completely irrelevant to the point I was making, but all are issues with some of the newer schools. Some of these points (significant courses taught by med students and large numbers of matriculants with terrible applications/stats) are ones which shouldn't be allowed. Again, I'm not advocating for expansion at all, I'm just asking why people are using a certain form of data when looking at this expansion when it is so misleading and open to (improper) extrapolation.

 

[hallowmann]

Sub 220 students should stay in family medicine, as the MDs already do. The loophole that DOs with low usmle had should've been closed a hell of a lot earlier than 2020. A having a bad FM doctor makes no difference. It's just a triage job. Having a bad specialist makes a huge difference. It'll be life vs serious physical harm vs death.

Even my DO hospital doesnt hire DO surgeons. The only one they hired was sent to wound care. The operative ones are all MDs trained in ACGME. And honestly, I'll be picking up the same policy. I wont send any of my patients to an AOA-trained doctor either.

You don't know what you're talking about. Like not at all. Like so much so that I don't even know where to begin. I guess I'll just start with the first sentence.

You are incorrect. You will absolutely see MDs with sub-220 Steps in a lot of other fields other than FM. IM has a ton of them actually, let alone many other specialties.

Having a bad FM doc is a huge problem actually, and low numbers of FM docs, and hell PCPs in general, is one of the reasons our healthcare is that much worse than other countries. But by all means believe what you will, agree with the nursing lobby, you know until they argue that they can do whatever unfortunate field you end up in.

My and the interns ran the show on the days that the IM seniors were away at conference. I literally carried 4 patients and put orders in before and after rounds. It's balls easy picking NS@75 and moxifloxacin for the pneumonia patient with a million comorbid issues, since that's the literal day to day routine at an AOA program. Same experience in family med. I ran the entire encounter and the attending popped their head in to say hi and checked the button to bill my note. I literally only needed the attending to prescribe the benzos and pain killers.

Meanwhile, at the acgme IM rotation, I had my A&Ps torn apart. They pimped on why you'd picked Levophed vs phenylephrine. They pimped on what exactly you'd do for the ICU patient's vent and fluids if X and Y are happening. Every little decision there was challenged and used as an educational experience.

Man, you really don't know what you're talking about. You think you were a big boy doctor because you "managed" a PNA patient with moxi and NS? Or that having your A&P's "torn up" with questions like Levophed vs. Phenylephrine was a measure of great doctoring by those residents.

It's ok, you'll grow up when you actually have to manage a patient. But man, that's going to be a rough intern year for you. The only thing worse than someone lazy in medicine is someone who thinks they know everything... by 3rd year med school no less.

I'm getting a kick out of how dumb you are making yourself sound. I've been around a lot more ACGME programs, and in multiple fields too, than you most likely.

Took me a while to even realize he was serious. Dude, I'm in an ACGME university program and I have no idea where this guy gets his ideas.

3.4 gpa, zero ECs, 34 mcat-score in on november, applied in december and got into NYCOM.

I got accepted one of the "hardest" DO schools on a whim after deciding on med school 3 months prior.


AOA grads aint getting hired in NYC or long island. They're all going to rural jobs in NJ and PA 3 hours away from the city. USmle is only a memorization exam upto 230-240, Past that is all about connecting the dots.

I managed patients without any oversight at a AOA IM program that had 97% AOBIM pass rate last year. I doubt your program is any more special. The didactic sessions they held were literally step 2 questions. Only difference was they included doses.

FM is the biggest triage job in the world. The rest of the world lets med student jump directly in practicing FM or doing a 1 year internship before becoming fully licensed in FM.

Even US has had NPs and PAs running clinics solo for the past decades without issue.

Man, every post is just showing less and less knowledge about medicine in general. I again don't even know where to start, so I guess I'll just address the most obvious.

-There are plenty of AOA grads working in NYC and Long island... can't believe I have to even say that. Sure, maybe not new grads that have $300k debt because they don't want to take a $100k pay cut to live in a higher COL place, but to say that they don't work there is just ridiculous.
-FM is nothing like triage. You might be confusing FM with that triage nurse you saw in the ED. Usually I hear ED docs referred to as glorified triage, which is also inaccurate, but at least you can sort of understand why that's said given that the main job is answering "admit" vs. "don't admit" and "how sick are you?".
-No one can become an FM doc with 1 year of residency. You're thinking about a GP, which anyone in any residency program could become. FM docs are actually board certified.
-You aren't actually "licensed in FM". You're licensed in the practice of "medicine and surgery", and most people can get that after getting a medical degree, finishing a licensing exam series, and 1-3yrs of residency depending on your state. You aren't licensed in FM, or IM, or Ortho for that matter. You might be confusing licensing with certification, which requires completing a residency (of at least 3 yrs) and passing of a board certification exam.

You should really learn more about the field of medicine before residency app time.

There is a handful of top university programs (Harvard MGH/BWH, Yale, WashU, etc.) that don't even really care about family medicine, and they instead have a primary care focused IM track. I like that approach.

Its a non-sustainable approach that only works in cities, which about half of America is not. You'd have to have an OB/Gyn, Peds doc and a PC IM doc to do the job of an FM doc in a rural setting. It also means that as a family you're going to have to get someone to go to 3 different appointments to get the same care. Like I said, that can work in cities where there are plenty of OBs and Peds docs, but to expect the one or even handful of Peds docs or OBs to see every single child or woman with OB or Gyn concerns is impractical.

Also, it should probably be pointed out that many other top 20 programs have very strong FM programs or are opening or expanding their FM programs. To name a few, UPenn just took over Lancaster General, one of the top FM programs in the country to improve its presence in FM, UWash places a huge emphasis on FM, OHSU & UPMC have very strong FM programs, UNC-Chapel Hill has a very strong FM program, UCSF and Stanford have been opening up new FM programs and expanding others.

I suspect that a lot of the programs that are shutting down FM programs are doing so for a purely financial reason, because typically FM programs don't directly make hospital systems money. When looking exclusively at their internal expenses/revenue, they're usually always in the red. That said, FM actually makes a lot more money for a system than what is seen solely within the department's internal finances. This happens mainly through cost saving in the ED, preventing bounce backs on inpatient, referrals, etc. Its why places like Kaiser, among others, having actively recruiting FM docs and PCPs in general with some pretty competitive salaries.

This is literally one of the dumbest things I've ever read on SDN. Almost every sentence is blatantly false other than the bolded which is only half false (actual statement is false as it wasn't a "loophole", but I'll give you the sentiment). Seriously though, when someone applies to any medical school "on a whim" this is the kind of backwards, nonsensical though process I'd expect.

To correct you though. FM isn't just triage, it's the management of chronic health issues and preventing them from occurring. You're thinking of EM in terms of triage. The fact that you don't understand that makes it difficult to take anything you say seriously.

If you think this is only happening with FMs and not specialties you're in for a very rude awakening when you get to the real world of medicine...

I'm quoting this one because I think it's the most valid thing you've said, even if it's not always true. There are too many AOA which don't provide adequate training to their residents and either just don't teach enough or just treat residents as more staff to move the meat. I can name a half dozen ACGME programs off the top of my head (many of them in NYC!!) which are the same way as well and there are many more I could find with a really simple search, so acting high and mighty like this is only an AOA problem is misinformed as well.

I mean, they're both increasing significantly though. There have been 8 new MD schools that have opened since 2016 and I believe there are 5-7 more that will be opening by 2020. It's not a unilateral issue, but it is likely to hurt those coming from new DO schools more (for many reasons).

To the bolded: Why is the rate of expansion more alarming the the increase in raw numbers??? I've asked it several times now and no one has given me a good answer for this yet and it's tiring hearing people talk about "expansion rate" while completely ignoring raw numbers. At the end of the day, I don't really care if there's a 10% increase or 100% increase in applicants if the total number of applicants in the pool for X number of positions is the same. So ignoring the fact that DO expansion is going to hurt applicants more than it will help, why is the rate so important while raw numbers don't matter especially when that rate will only decline as we move forward?

He'll wake up eventually. Like you said, there is just too much misinformation in his posts for it not to happen when he becomes a real doctor.

What I think he’s trying to get at is in terms of oh much quicker DO schools are expanding. Yes MD and DO have added the same number of schools in the last decade, HOWEVER, DO students have increased at a much higher rate in proportion to the total number of MD students increased. This is due to LCME only allowing new MD schools to start at half their expected full class then ramp up to their total approved number. Unlike DO schools where you can get approved for 250 spots and admit 250, as opposed to admitting 100 and giving the school time to develop the proper clinical and GME resources. So yes, there remains more positions than students, but with gap decreasing every year, DO proliferation in its current state will make whatever gap there is currently non existent rather soon. Will ICOM or BCOM be able to create enough GME positions for their graduates? Or the UT or RVU or NYIT ARCOM or the new PCOM campus? Who knows? That is what’s so reckless about the current expansions of the DO med school field

Just to clarify, the max new DO schools can open with is 150 (technically 162, 108% times its allotted seats). Its mainly the schools that have been around for a while or opened up new campuses that are hitting that 250+ range (there are also MD schools in that range, but they are more established schools as you've alluded to).

Personally I think COCA's elimination of the minimum GME placement requirement on DO schools is what's going to destroy DO schools. With no requirements on actual outcomes, schools have no incentive to make new GME, become affiliated with more GME programs or even just limit how much they expand by. Its going to be a mess, and COCA has no one to blame but itself.

 

[sab3156]

Its a non-sustainable approach that only works in cities, which about half of America is not. You'd have to have an OB/Gyn, Peds doc and a PC IM doc to do the job of an FM doc in a rural setting. It also means that as a family you're going to have to get someone to go to 3 different appointments to get the same care. Like I said, that can work in cities where there are plenty of OBs and Peds docs, but to expect the one or even handful of Peds docs or OBs to see every single child or woman with OB or Gyn concerns is impractical.

Working fine for those programs. At Harvard MGH/BWH, they have a joint IM-Peds track that seems to get you exactly what a FM program would get you with the exception of obstetrics. How much expertise does an FM doc actually have in ob/gyn? Not much, judging from the curriculum of a few programs I just checked out. Is it really that much different than an IM-Peds track and then doing electives in what you're missing? Doesn't seem to be. Seems that you can just restructure things a bit and all of a sudden you have primary care physicians with more rigorous training than FM.

 

[ThreeCheers]

SDN: FM is a worthless, glorified triage field! Any idiot could become an FM doc without a residency!
Also SDN: Waaah, I can't believe these mid-levels are encroaching on primary care. Don't they realize that MDs/DOs are more qualified for the job due to their extensive training???

 

[sab3156]

SDN: FM is a worthless, glorified triage field! Any idiot could become an FM doc without a residency!
Also SDN: Waaah, I can't believe these mid-levels are encroaching on primary care. Don't they realize that MDs/DOs are more qualified for the job due to their extensive training???

I get the point you're making, but to be fair, those two arguments don't necessarily contradict.

 

[ThreeCheers]

I get the point you're making, but to be fair, those two arguments don't necessarily contradict.

Personally, I take issue with saying that IM is an inherently better residency than FM.

There is admittedly a strong overlap. I did both my core FM rotation and an outpatient IM elective in a (major city) suburban area, and the jobs were basically identical. However, there are unique niches that each field can offer.

You asked how much OB training a FM resident will get, and the answer is "quite a bit" in rural, unopposed FM residencies that offer OB tracts. I know several people that chose or considered the FM --> women's health route because they simply didn't care about things like emergent surgical interventions on ruptured TOAs. FM also has its niche in fields like sports medicine, adolescent medicine, etc. Plus, it provides good training if your goal is outpatient primary care. Meanwhile, IM is the better residency if your goal is inpatient medicine. It is also your only option if your goal is to subspecialize in an organ system.

Basically, FM and IM are two separate fields, and there are good reasons to choose both of them over the other. And I wouldn't trust any worthless M4 to do either job (source: a worthless M4).

EDIT: I also disagree that the two arguments don't contradict. If you imply that every single FM attending and resident can be replaced by people that haven't completed residencies (i.e. mid-levels), then you are leaving A LOT of physicians out of work.

 

[sab3156]

Personally, I take issue with saying that IM is an inherently better residency than FM.

There is admittedly a strong overlap. I did both my core FM rotation and an outpatient IM elective in a (major city) suburban area, and the jobs were basically identical. However, there are unique niches that each field can offer.

You asked how much OB training a FM resident will get, and the answer is "quite a bit" in rural, unopposed FM residencies that offer OB tracts. I know several people that chose or considered the FM --> women's health route because they simply didn't care about things like emergent surgical interventions on ruptured TOAs. FM also has its niche in fields like sports medicine, adolescent medicine, etc. Plus, it provides good training if your goal is outpatient primary care. Meanwhile, IM is the better residency if your goal is inpatient medicine. It is also your only option if your goal is to subspecialize in an organ system.

Basically, FM and IM are two separate fields, and there are good reasons to choose both of them over the other. And I wouldn't trust any worthless M4 to do either job (source: a worthless M4).

EDIT: I also disagree that the two arguments don't contradict. If you imply that every single FM attending and resident can be replaced by people that haven't completed residencies (i.e. mid-levels), then you are leaving A LOT of physicians out of work.

So you don't think an IM-Peds primary care track with ob/gyn electives is more rigorous training than an FM program? You mentioned that rural programs offer quite a bit of ob/gyn training, but I mean on average, or what the typical training is like at most programs.

I just looked at Boston University's FM program which is a very competitive FM program - looks like there are 4 weeks of obstetrics and 4 weeks of outpatient gynecology. Can you really say that an IM-Peds track with some elective training in ob/gyn isn't going to be very similar with some distinct advantages in training?

You said that FM provides good training if your goal is outpatient - but IM primary care tracks have the same goal. So what exactly is the distinction between an IM-Peds with ob/gyn electives and a FM residency? It just seems obvious to me that FM is just an extremely light-weight version of IM, Peds, and Ob/gyn put together. The IM tracks seem to be far more substantial in the training.

 

[ThreeCheers]

So you don't think an IM-Peds primary care track with ob/gyn electives is more rigorous training than an FM program? You mentioned that rural programs offer quite a bit of ob/gyn training, but I mean on average, or what the typical training is like at most programs.

I just looked at Boston University's FM program which is a very competitive FM program - looks like there are 4 weeks of obstetrics and 4 weeks of outpatient gynecology. Can you really say that an IM-Peds track with some elective training in ob/gyn isn't going to be very similar with some distinct advantages in training?

You said that FM provides good training if your goal is outpatient - but IM primary care tracks have the same goal. So what exactly is the distinction between an IM-Peds with ob/gyn electives and a FM residency? It just seems obvious to me that FM is just an extremely light-weight version of IM, Peds, and Ob/gyn put together. The IM tracks seem to be far more substantial in the training.

Boston U is competitive because people want to live in Boston. It doesn't necessarily mean that it is the most "rigorous" tract.

I applied to rural FM with an OB tract as my backup. I can assure you that all of these programs had far more than 8 weeks of OB. And that's just on the lowly AOA side! I'm sure the almighty ACGME provided for even more rigorous OB tracts.

Personally, I think general FM and outpatient/PC IM tracts are interchangeable. I don't see either one as particularly prestigious, or as more "light-weight" or "substantial" in its training than the other. Would you mind sharing what specifically do outpatient IM residencies offer over FM residencies that makes them more "rigorous"? Because it feels like you're just making that assumption based on IM being overall more competitive than FM. And just FYI, "because that's how Harvard does it, dammit!!" isn't a very compelling reason.

 

[sab3156]

Would you mind sharing what specifically do outpatient IM residencies offer over FM residencies that makes them more "rigorous"? Because it feels like you're just making that assumption based on IM being overall more competitive than FM.

At least for the MGH and BWH IM-peds residencies, you would still have some real IM training and real Peds. With some ob/gyn electives along the way, this sort of training seems to be far superior to a typical FM program. I just don't see how you can make an argument that a regular FM program gives you better training than 4 years of: internal medicine, inpatient/outpatient pediatrics, and then electives in ob/gyn... sounds unbelievable, to be honest. FM really is just a light-weight IM/Peds/Obgyn residency, no matter how you look at it... that's pretty much the goal of FM. Complex cases are referred out. The IM-peds track that I'm talking about is a 4 year training program that has outstanding pediatric training and an actual full year of inpatient adult IM.

Seriously, what educational advantage does FM offer? This just sounds like an emotional issue at this point.

Curriculum – Harvard MGH Medicine & Pediatrics

And just FYI, "because that's how Harvard does it, dammit!!" isn't a very compelling reason.

Citation?

 

[hallowmann]

Working fine for those programs. At Harvard MGH/BWH, they have a joint IM-Peds track that seems to get you exactly what a FM program would get you with the exception of obstetrics. How much expertise does an FM doc actually have in ob/gyn? Not much, judging from the curriculum of a few programs I just checked out. Is it really that much different than an IM-Peds track and then doing electives in what you're missing? Doesn't seem to be. Seems that you can just restructure things a bit and all of a sudden you have primary care physicians with more rigorous training than FM.

Not really sure what "working fine" even means in this context. Yeah, its not really going to affect them as a school. The main effect is going to be less people doing primary care, which I would honestly argue isn't doing fine in the current healthcare climate, but to each their own.

IM-Peds is a 4-yr program, FM & IM & Peds individually are each 3yr programs. IM-Peds is also explicitly inpatient focused. Plus there's relatively few spots and program sizes are relatively small in comparison to FM. There's also very few PC IM tracks, and I don't even know how many PC IM-Peds spots there are (if any). There are actually very few people who choose to go that route, especially compared to the FM route.

In terms of what's missing, all of Gyn is basically missing, while OB is certainly a big part of OB/Gyn, its a very specific population, and 90-95% of the time it actually can be done by midwives with an OB backup. There's plenty of Gyn & pre/postnatal care that FMs do everyday in clinic. Looking at a list of rotations in a curriculum isn't going to demonstrate that.

FM also is inherently geared towards outpatient training whereas IM is inherently geared towards inpatient. Even the PC tracks don't necessarily have the same amount of outpatient training as FM programs.

Also, I'm genuinely not sure what you mean by more rigorous training. Residencies are rigorous, and how rigorous they are is based more on the program than anything else. You seem to be making a lot of claims based on pre-conceived notions or on limited personal experience. You have already made up your mind about something that its obvious you don't know much about.

 

[ThreeCheers]

At least for the MGH and BWH IM-peds residencies, you would still have some real IM training and real Peds.

I'm not sure what you mean by "real" IM and peds. A lot of FM programs have their inpatient rotations at affiliated university hospitals. Their clinics aren't much different than what you'll find at an outpatient internist's clinic (except, y'know, kids). Sounds pretty real to me!

Complex cases are referred out.

Wait, I thought we were talking about FM, not EM. Kidding, but again FM programs generally do not refer their cases out any more frequently than an outpatient internist does. And unopposed rural programs might not even have the option of referring certain cases if the proper specialists aren't available.

The IM-peds track that I'm talking about is a 4 year training program that has outstanding pediatric training and an actual full year of inpatient adult IM.

I don't see how extra inpatient training is beneficial if you're ultimate goal is ambulatory medicine. It should be a component, sure, but not the focus. The only thing more rigorous about med/peds vs. FM is its length. I think 3 years is enough training for FM given that it is the same length as IM, peds, and EM residencies.

Honestly, I don't think you understand what the purpose of the med/peds residency is. People don't go into med/peds because they want to do a more "rigorous" version of FM. It is a very niche field that allows people to subspecialize in an organ system, and follow patients with specific congenital conditions throughout their entire lives.

 

[sab3156]

Honestly, I don't think you understand what the purpose of the med/peds residency is. People don't go into med/peds because they want to do a more "rigorous" version of FM. It is a very niche field that allows people to subspecialize in an organ system, and follow patients with specific congenital conditions throughout their entire lives.

We are talking about programs that don't have FM and what they do have that's comparable. You don't think FM is just a light-weight combination of various specialties so that there is vastly improved access to basic healthcare? It's not an attack on the specialty to acknowledge that. But anyway, we've hijacked this thread.