The CA School of Osteopathic Medicine turned into UC-I after the CA Medical Ass'n tried to outlaw all DOs in CA. One has to admire them for their ruthlessness.
Putting aside financial considerations, do you believe there's any value to DO schools remaining DO? Or do you think it would be better to have one medical degree (MD)?
Yes, they allow people who couldn't achieve their dream to become doctors because they didn't have the stats to get into an MD school. I'm very OK with that. My state likes it because a lot of my graduates go to a LOT of underserved areas to practice, by choice.
Do you believe there is anything inherent to their osteopathic nature that is responsible? In other words, if your school was an MD but with the same metrics as it currently does as a DO school, do you think that would change the nature of the graduates?
Even if the input metrics were the same, the outcomes would probably vary, because it would make graduates more competitive for competitive residencies and therefore less likely to enter primary care just because they have more options.
I find it interesting that people consider primary care a career of last resort for students. The guy who was number 1 in my class went into family medicine by choice. My other friend did rural family medicine by choice. He read a book on differential equations while on vacation with our families, placed out of the course by taking the final and getting an A. Earned a masters in bioengineering while working on a generation of an artificial heart. Primary care consists of FM, general IM, OBGYN, and Peds. A.whole bunch of students enter medicine to pursue careers in these areas. Not everyone wants to go scoping for dollars. I understand the options aspect, but many DO students are there by choice and desire a career in these areas.
Extremely less stringent.
You are absolutely right that primary care can be desirable for those who are at the top of the class too. But the statistics show that primary care is often entered by the people in class with the lowest step scores and lower grades (low AOA percentages). This generally indicates primary care is less competitive and therefore less desired in terms of number of applications per spot available.
ngl this makes me begin to doubt the common sentiment that DOs receive the exact same training as MDs + OMM...
No hate to my DO colleagues, but I would go out on a limb and say that if given the choice, most DO students would have gone to an MD school.
It's an unspoken secret, but we don't take it personally.
When that survey is administered at the end of the year, do you think some of the students don't pick the MD option since they may be taking into consideration their grades/MCAT? In other words, if a student had a 3.5/503 in undergrad, would it be possible they not choose the "rather go to MD school" choice in the survey since with their metrics, the MD route wasn't an option? And if the survey asked regardless of metrics, do you think those numbers would shift?
I love how you keep it real even though you work at a DO school. Makes the advice that you give a lot more trustworthy.
Most students don't know this tbh. At my school, sites with more residents are generally talked about as a negative thing when upperclassmen talk about rotations.
I suspect it's a fine balance. Too many residents might mean dilution of clinical and teaching experiences, while too few residents might mean an absence of an institutionalized teaching culture.
With the explosion of newer schools, new rotation sites are hard to find. There just aren't enough uni training slots for every med student in the country. As others have said, a balance of preceptor slots and teaching service slots is preferable. One you get formal didactic lectures and learn how to critically review a publication, the other you get more hands on experience. Both are necessary. Only 1 rotation on teaching service is inadequate imo.
I agree.
I think it comes down to choice. MD students can choose to do a chill community rotation without residents and with an attending that is known to send people home early. Or they can chose to do general surgery in the community for example if they do not need a big name academic LOR, but do want to get 1-on-1 time in the OR as first assist (I know someone who is going into OBGYN who did this). DO students get put at community sites where there is only as much teaching going on as the attending cares for. At least when residents are around, those residents are by definition learning and being taught, so the culture of teaching is more noticeable.
I also believe another hurdle for DO students is the lack of Osteopathic Hospitals. Many have closed over the decades or merged with larger institutions. Many of these DO hospitals had teaching services where students would get didactic experience with residents and hands on experience. It's apparent to me that corporate medicine has put DO students at a greater disadvantage.
There are low-tier MD schools with LOWER matriculant stats than some "upper tier" DO schools but the MD still matches WAY better usually due to having more home programs in competitive specialties, affiliations, MD prestige/bias
It may be a negative thing for motivated students who want to "learn more" but there are also many who are fine paying $60k to get sent home after 3 hours (tons of my friends preferred this). At the end of the day, residencies value working with residents more than having 1-on-1 time with a community doctor because ultimately they want the student to function at the level of an intern as an intern.
I don't necessarily disagree. But to add some texture, residencies want qualified people who will pass the board exam. Sub Internships should be done to ready yourself for residency and patient management skills, EMR, writing notes and orders, etc.. Recently Covid threw wrench into that. My son as a Sports Med fellow had an ortho intern and ms4 last July who were not comfortable interviewing and examining a patient before he saw them because they hadn't done it in the past. Matching a resident is a very personal thing for the program and fit is very important.. When I evaluated potential residents, I looked for work ethic, personality,(do they get along with people), basic knowledge, etc.. It's my job to teach them, so I want someone who doesn't piss people off and who works hard. I, to this day, carry mental scars from 2 residents with glowing letters from great schools. One from UCSF and the other from JHU. Both bright, but were chronically late, abrasive, and felt patient care duties were beneath them. I was constantly barraged by Attendings, Nurses, and co residents complaining about them.
Did you eventually fire them?
Prob not since it’s much easier to just push them through (no hate on @Angus Avagadro, just a flawed system).
This.
See below regarding LCME reqs.
Honestly now that I am a DO resident surrounded almost exclusively by MD's I can very confidently say my clinical education was literally the same as my peers. Although I will fully admit I went to one of the strongest DO schools that is run functionally the same as an MD school.
Actually I'm fairly certain if you read the wording of LCME requirements the LCME minimum requirement is literally the same. 1 Core clinical rotation with residents. MD schools just traditionally are attached to academic hospitals or stronger affiliations with hospitals that have residency programs so they far exceed that minimum requirement. I agree 100% the practice some DO schools engage in with sending students all over the country and requiring THEM to find their own clinical rotations is straight up criminal and those schools should be shut down. I despise many aspects of the DO education pathway, and it stems from the leadership orgs who simply use students as a means to get paid.
Oh, absolutely. A few mutants get through despite our best efforts. It wouldn't be the first time a school would write a supportive LOR for someone so they can leave become someone else's problem. I'm pretty sure the military does the same thing if someone is a problem. Agreed, it's a hardship if you lose a resident for whatever reason. Wreaks havoc on call schedules and morale. You must do something egregious to drop a resident today.
No, despite several faculty in favor of that. @Matthew9Thirtyfive is correct. It's easier to pass them along, avoids messy lawsuits, etc..
Yeah, it’s just easier that way. The military is a little different since you can’t actually kick someone out for being abrasive and being crappy at their job. You can just make it so they are basically never going to promote and unlikely to be allowed to reenlist. If they neglect duties, that’s a different story and you can pretty easily get rid of them.
