Why the hell are DO programs expanding so much?

[MacGyver]

What the hell is the AOA thinking? Do they really think its in theri best interest to see dozens of new schools opening in areas that dont even have doctor shortages?

This is totally foolish thinking. You will depress the wages of both DOs and MDs by pursuing this strategy, and for what?

Is increasing the number of DOs so valuable in terms of public perception that its worth a pay cut due to market saturation?

thats absolutely ridiculous.

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[luckystar]

For once, I sort of agree with MacGyver My concern lies not so much in terms of wage depression, but that there had better be effective quality control if more schools are to be opened, there's already a shortage of "good" DO residency spots, and where all these students are going to do their rotations. All of these new schools that are being opened are private institutions, i.e. big money. This is probably a naive question, but why not try pushing for more public schools?

 

[Goofyone]

Originally posted by MacGyver
What the hell is the AOA thinking? Do they really think its in theri best interest to see dozens of new schools opening in areas that dont even have doctor shortages?

This is totally foolish thinking. You will depress the wages of both DOs and MDs by pursuing this strategy, and for what?

Is increasing the number of DOs so valuable in terms of public perception that its worth a pay cut due to market saturation?

thats absolutely ridiculous.

MacGyver I respect what you're saying. I'm a D.O. student.
Dr. Beehler, the AOA president, came to my school recently to speak to us. He actually expressed his disappointment at the opening of new DO schools. He didn't say outright, but he made it sound like the AOA actually doesn't even have a say in the opening of new schools, but only the accredidation. Of course I could be wrong, that was the impression I got.

Does anybody know for sure, is it the AOA that makes decisions like this or is it AACOMAS (american association of colleges of osteopathic medicine)? Now I'm curious.

Personally, I think the Osteopathic world should focus on a complete restructuring of their GME programs before cranking out more DOs with no place to train. We'd be screwed hard if it weren't for ACGME letting us in, real hard.

On the other hand, MacGyver, I hear a lot of talk about physician surplus, but we can't kick out any more physicians than we have residency spots--and the ACGME programs are still taking plenty of FMGs. I worry more about getting the residency I want then finding a job when I get out.

 

[bigmuny]

Originally posted by Goofyone
MacGyver I respect what you're saying. I'm a D.O. student.
Dr. Beehler, the AOA president, came to my school recently to speak to us. He actually expressed his disappointment at the opening of new DO schools. He didn't say outright, but he made it sound like the AOA actually doesn't even have a say in the opening of new schools, but only the accredidation. Of course I could be wrong, that was the impression I got.

I don't think that is the case at all, and I know that AOA pulls down big accreditation fees from schools(ya gotta pay to play). I think this is reason we are seeing so many branch campuses, because they don't have to go through as lengthy or expensive an accreditation process. I heard Beehler give a speech as well.. I was less than impressed.

Does anybody know for sure, is it the AOA that makes decisions like this or is it AACOMAS (american association of colleges of osteopathic medicine)? Now I'm curious.

AOA is the accreditation body.

Personally, I think the Osteopathic world should focus on a complete restructuring of their GME programs before cranking out more DOs with no place to train. We'd be screwed hard if it weren't for ACGME letting us in, real hard.

Amen, we could really be screwed.

On the other hand, MacGyver, I hear a lot of talk about physician surplus, but we can't kick out any more physicians than we have residency spots--and the ACGME programs are still taking plenty of FMGs. I worry more about getting the residency I want then finding a job when I get out.

 

[hossofadoc]

Hmmmm...let's see there is a shortage of 20,000 primary care docs in the US in a recent report that I read....so we could either open up more schools and educate ourselves or we could go out of the country and get FMG! So, what would you do? DO's are also more prone to go into primary care!

I don't see you getting upset at programs that accept FMG's and aren't these programs basicly saturating the market? Not to mention these are all MD programs!

Also, which schools are opening where there is not a demand for docs?

 

[DireWolf]

Originally posted by hossofadoc
Hmmmm...let's see there is a shortage of 20,000 primary care docs in the US in a recent report that I read....so we could either open up more schools and educate ourselves or we could go out of the country and get FMG! So, what would you do? DO's are also more prone to go into primary care!

I don't see you getting upset at programs that accept FMG's and aren't these programs basicly saturating the market? Not to mention these are all MD programs!

Also, which schools are opening where there is not a demand for docs?

First of all, the trend of D.O.s going into primary care is declining. Second of all, it's a joke that they keep opening up more D.O. schools for the sole purpose of making more money. Once again, more students will be left high and dry come residency time. Instead of adding more D.O. residency spots and improving the dreadful ones that already exist, they stand pat and open more schools. D.O. students should be able to sue these guys. This is another disgrace to our profession. Those who view this as a positive development are naive at best. Wake up people. Educating more students without dramatically increasing and improving training spots is deplorable.

 

[bigmuny]

Originally posted by hossofadoc
Hmmmm...let's see there is a shortage of 20,000 primary care docs in the US in a recent report that I read....so we could either open up more schools and educate ourselves or we could go out of the country and get FMG! So, what would you do? DO's are also more prone to go into primary care!

I don't see you getting upset at programs that accept FMG's and aren't these programs basicly saturating the market? Not to mention these are all MD programs!

Also, which schools are opening where there is not a demand for docs?

It is being predicted that there might be a shortage of of docs in the future. They were saying that there would be too many docs two years ago. there is always a shortage of primary care docs in underserved areas, because few people want to practice in underserved areas. creating more docs won't fix the problem, creating incentives to practice is these places will. just because an fmg does residency in the states, does not mean they can stay in the states when they are done.

 

[Buster Douglas]

Originally posted by bigmuny
...there is always a shortage of primary care docs in underserved areas, because few people want to practice in underserved areas. creating more docs won't fix the problem...

Problem: Shortage of primary care doctors and consistently high number of unfilled primary care residency positions.

Solution: Produce more doctors to fill these positions.

*We don't need more specialists. Thus, there's no need to create more residencies. There's plenty of primary care slots to go around. If that means the competitive residencies get a bit more competitive then so be it. It will force more people into areas of medicine where doctors are needed most. The 'mission' of osteopathic schools is to fill the void not widen the disparity.

 

[MacGyver]

Buster Douglas,

your colleague is right. there is no OVERALL shortage of primary care docs, teh shortage is ONLY in rural areas.

Building new schools wont fix that problem. What it WILL do is increase competition in big cities wehre all the docs are at.

 

[Buster Douglas]

Originally posted by MacGyver
there is no OVERALL shortage of primary care docs, teh shortage is ONLY in rural areas.

Building new schools wont fix that problem. What it WILL do is increase competition in big cities wehre all the docs are at.

MacGyver,

So, what happens when competition in the big cities does increase?
More people are forced out into areas where they are in demand.

I do agree that more incentives would help expediate the process of solving the problem. It already does (i.e. FMGs (citizenship) or NHSC (tuition)). But, I think building more schools does more good for this country than it does bad.

Competition is the American way. The demand will always dictate the supply. You might think otherwise, but have no worries, Mac, you'll still be making 10x more than the average human being... that is... as long this country still calls itself capitalist.

 

[Buck Strong]

I'm more worried about the quality of doctors all these new schools are putting out. I mean, what's too low of a MCAT/GPA...ya gotta draw the line somewhere, right? Plus, who are going to teach at these new schools? You have to defend your territory somewhere. I don't blame some of you for being defensive, if a bunch of MD schools started sprouting up left and right, i'd also be worried about the general state of things, and the devaluing of the degree. Just my two cents.

 

[bigmuny]

the competition in big cities is already increased, hence the reason that docs straight out of residency wanting to practice in large urban centers make less money than those willing to practice in smaller communities. i think we also sometimes confuse underserved with meaning too few docs. there are underserved areas of la and nyc, the problem is not too few docs, it is to few resourcess. be very careful with this notion of saturating the market with new physicians(the ama has been very careful about not letting this happen). this is what has happened in the legal profession where you are no longer gauranteed a job in law anymore because law degrees have become a dime a dozen. one of my buddies is 9mo out of law school and still no job, 90K in debt. can you imagine being 200K in debt after a minimum of seven years hard work, and uncertain about your ability to get a good paying job?

 

[Buck Strong]

Competition is also why I can't get a decent shirt anymore that doesn't fall apart after 5 washes, because everything is made in taiwan or mexico...It's why my domestic car spends more time in the shop than in my driveway. Now, I can always get another shirt, or buy another car, but I wouldn't want my health messed around with in the same manner. I don't want quality docs in cities to be undercut by DO's who were trained in one of these new schools that popped up overnight...who are now willing to take less money because of oversaturation. And being selfish...20 years from now, I don't want to have to look over my shoulder, for fear of having to move and practice in butt-f**k, North Dakota, because supply has exceeded demand, and i'm "forced out into area's where we're in demand"

 

[DD214_DOC]

Originally posted by Buck Strong
Competition is also why I can't get a decent shirt anymore that doesn't fall apart after 5 washes, because everything is made in taiwan or mexico...It's why my domestic car spends more time in the shop than in my driveway. Now, I can always get another shirt, or buy another car, but I wouldn't want my health messed around with in the same manner. I don't want quality docs in cities to be undercut by DO's who were trained in one of these new schools that popped up overnight...who are now willing to take less money because of oversaturation. And being selfish...20 years from now, I don't want to have to look over my shoulder, for fear of having to move and practice in butt-f**k, North Dakota, because supply has exceeded demand, and i'm "forced out into area's where we're in demand"

That's why you don't do it for the money.

 

[Buck Strong]

Originally posted by JKDMed
That's why you don't do it for the money.

I don't see what not wanting to live in North Dakota has anything to do with money. By the way, anyone from North Dakota, no offense...I'm just trying to make a point. I have no problem with our industries finding cheaper labor...I kinda like the fact that our consumer goods are so cheap...my gripe is with quality...eventually, you get what you paid for.

Oh...and don't try to bait me into that whole money mess...I know why I'm doing it, and trust me, money isn't my main motivation, I feel no need to defend my stance on that issue. Peace.

 

[BACMEDIC]

Someone implied that the entrance into the new schools is not has high as other DO schools, saying that MCAT/GPAs are lower. What is this statement based on - frustration or facts?

I've been offered seats at both new and old schools - so what's the difference?

 

[drusso]

A very good article recently came out that addresses these very issues. It is mandatory reading for people who want an informed discussion on this issue:

Acad Med. 2003 Nov;78(11):1144-8.

How private colleges of osteopathic medicine reinvented themselves.

Cummings M.

Statewide Campus System, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan 48824, USA. [email protected]

Starting in the last decade of the 20th century, private colleges of osteopathic medicine (COMs) began to restructure themselves in ways that represent a distinct departure from the past. Their new organizational model de-emphasizes many of the characteristics that distinguish allopathic medical schools today. The new emphasis centers on high enrollment, diversity of health-related programs, formation of universities of health science, expansion, and a retreat from involvement in clinical and postdoctoral education. Such changes reflect an admixture of entrepreneurship, an ability to respond quickly to changing environments, and an insularity that draws them away from traditional forms of clinical and postdoctoral medical education. The private COMs carved out their own niche in medical education and created a new model compatible with their institutional strengths and weaknesses and related to their economic, educational, and human resources. As an evolving educational model, the private COMs have undergone a remarkable transformation in a brief period; they bear watching for future developments and to assess their long-term viability.

 

[Buster Douglas]

Originally posted by Buck Strong
...20 years from now, I don't want to have to look over my shoulder, for fear of having to move and practice in butt-f**k, North Dakota, because supply has exceeded demand, and i'm "forced out into area's where we're in demand"...

...I'm more worried about the quality of doctors all these new schools are putting out. I mean, what's too low of a MCAT/GPA...ya gotta draw the line somewhere, right?...

Buck,

Two things...

FMG's already know the feeling of being shoved into less desired specialties and locations. I know a few that completed residency training in their home countries, came to America, and were forced into choosing and completing another residency from the leftovers. Most of them got stuck with FP, but being that they're the only FP for miles, they still see a nice share of the wealth. Some have moved their practices from the city into the rural areas for the same reason.

Another thing, MCAT and GPA have no correlation with board scores (or the quality of physicians). If that were true, then the schools with the lowest entrance stats would always yield the lowest board scores. For the sake of discussion, there's no doubt that Pikeville has the lowest entrance stats, but it is little known that the school boasts a 96% pass rate. Not only is PCSOM ranked 5th among the 20 osteopathic schools by the boards, in the past 2 years grads have nailed the top score on step II and step III.

 

[bgreet]

Perhaps we need the second coming of Flexner. But really, is it even known yet just what the entrance requirements are for these schools? And just how many are there? I agree that the quality of the DO should be upheld, however if we can increase our numbers while maintaining quality then I would be all for it. If, on the other hand, these schools are simply looking to become diploma mills then I have a large problem with it.

Goofyone: Btw it is the Bureau of Professional Education of the American Osteopathic Association that does all of the accreditation of the osteopathic schools

 

[Buck Strong]

Originally posted by Buster Douglas
MCAT and GPA have no correlation with board scores (or the quality of physicians).

Hmmm...I could start a whole other thread just based on that, but i think it's been done before, and usually, the thread just degenerated. But I have no need to do that...I'm just saying, if there's a need for more docs now, and in the future, go ahead and train them, in the most efficient way, without sacraficing quality. I just feel like all these branch satellite campuses sound a little fishy, and I don't see how they don't sacrafice quality for quantity.

 

[gioia]

Isn't there another angle to whole this whole thread? That of decreasing residency hours creating a need for qualified low-paid hospital labor.

While I am aware that not all residency programs actually put a cap on the hours their residents work (or put inordinate pressure on the residents who want to cap their hours), the AMA has published concerns that decreasing residency hours will decrease the available, cheap resident labor available to teaching hospitals. The assumed deficit of labor, they say, will impact the quality of care given to patients because hospitals can't afford to pay out more money for qualified workers.

If this is true, that capping resident hours will impact quality health care, then isn't it also true that simply increasing the NUMBER of residents at the same pay will off-set that problem?

If increasing the number of residents solves the capped-min. hours a resident works, then sending more DO's into allopathic residencies actually SOLVES a potential problem an restricted expansion could be healthy.

In Business, there are two ways for a company to grow: increase same store business or expand. It seems like the AOA is trying expansion.

Am I way off base?

 

[H0mersimps0n]

Originally posted by Buster Douglas
Problem: Shortage of primary care doctors and consistently high number of unfilled primary care residency positions.

Solution: Produce more doctors to fill these positions.

*We don't need more specialists. Thus, there's no need to create more residencies. There's plenty of primary care slots to go around. If that means the competitive residencies get a bit more competitive then so be it. It will force more people into areas of medicine where doctors are needed most. The 'mission' of osteopathic schools is to fill the void not widen the disparity.

That is THE worst solution I can possibly imagine. I think everyone that's posted has totally missed the boat as to why no one goes into the rural, high-demand areas. It's the money people.

HELLOOOOO! Average medical school debt is more than $100,000 and I know I myself personally will have more than $225,000 by the time I get out. No one in their right MIND would even phathom accepting a measely $90,000 a year practice in west-bumble F*(&% and be forced to live on M&C for another 30 years of their life while they try to make the $2200/month loan payment.

The math is simple, the solution is NOT. Making more docs, more debt, more people who can't and don't want to go to low paying places. It sucks, I understand those people need care too but lets be realistic, putting more students in the pool with higher debt than US is rediculously WORTHLESS!

 

[bgreet]

Homer: I think you are the one missing the boat here. If money is the issue, usually places out in " west-bumble F*(&%" pay a whole lot more than in the metropolitan area. Salary decreases by a HUGE amount when you work in a metropolitan area as opposed to a rural area. Just take a look at physicianrecruiting.com if you dont believe me.

 

[gioia]

It costs alot more to start a business than to graduate med school with a debt of 200K.

At least w/ physicians there is a guaranteed income stream even if it is 80-90K.

In Business, there is no guarantee.

Think of all the cash business you could do in rural medicine... um, I guess I won't talk about it, but rural physicians can do VERY well.

 

[Buster Douglas]

Originally posted by H0mersimps0n
That is THE worst solution I can possibly imagine. I think everyone that's posted has totally missed the boat as to why no one goes into the rural, high-demand areas. It's the money people.

Thanks.

What we're talking is money. If you scrolled down a bit and read what I said about FMGs, I think you'd have seen I did elaborate. I agree that 'making more docs = more debt, more people who can't and don't want to go to low paying places'... but what are they gonna do about it? Bitch about how their board scores suck too much be an ophthalmologist in the Upper Westside of Manhattan and sit on their asses? No, they're gonna take up a specialty that'll let them practice in a place where they can make a living. man...chill out.

 

[raspberry swirl]

rural docs make a lot of money. at lecom, we each have to shadow/assist a primary care doc once a week, and mine is in this piddly town full of amish people, and she's the only primary care doctor in the entire town. she sees everyone, from the babies to the old people. she has a zillion patients, the phone is off the hook with people calling because they need a doctor, so she's had to hire PAs so she can take on everyone. she's busy and her office is a zoo, but she's making a crapload and she's a local hero. not to mention the costs of starting up a practice are minimal in comparison with other areas, especially since the town and local institutions bend over backward to help you out. and your own personal costs of living are practically nothing. being stuck in rural primary care is not a bad way to start out . . .that is, homer, if you're doing it for the money

(to tie this in to the topic of the thread, i would say that "forcing people" to be rural docs might not be the worst idea in the world. . i wouldn't call it forcing, though. those taht don't want to do it, will keep applying for residencies until they get what they want, and the ones that choose to just take the primary care spots will do that . . .)

 

[Goofyone]

Actually, you guys might be surprised what is actually considered "rural medicine." In many cases, you are only minutes away from decent sized cities and it wouldn't be unfeasible to commute if you don't want to live in BFE.

And yes, many "rural" docs can and do make a killing.

 

[H0mersimps0n]

swirl,

I don't really buy into your example. One, your sample size is one and two, the doc you worked with (and almost any established doc from any example you state) didn't face a $200,000 debt so of course she was able to start up on her own and gradually get a patient base and earn real money.

It's infuriating to be accused of being in this occupation for the money. I've said it before and I'll say it again, I'm not in it for the money but if I'm going to be giving up what it takes to do well then when it's all said and done I want to be able to afford a roof over my head and not be stuck eating M&C the rest of my life. Take your mansons and fancy car's and shove them, I just want to do what I love and not have to worry if I can make my payments each month. Given the rural sitauation and health care these days it seems unreasonable and unintelligent to produce more in-debt students for positions they can't afford to fill.

Buster, sorry for being so headstrong, 8 hours of lecture really get's on your nerves...

 

[bigmuny]

Originally posted by gioia
It costs alot more to start a business than to graduate med school with a debt of 200K.

At least w/ physicians there is a guaranteed income stream even if it is 80-90K.

In Business, there is no guarantee.

Think of all the cash business you could do in rural medicine... um, I guess I won't talk about it, but rural physicians can do VERY well.

Yes, of course the difference is that when your new business fails(as many do, up to 90% in some sectors) you can file for bankruptcy on your debt(which they all do). There is no bankruptcy on educational debt, it is yours, and follows you the rest of your life whether you make 6 dollars an hour or a million a year.

 

[gioia]

Sure, Bigmuny. That's right.

However, being bankrupt follows you as well and makes it increasingly difficult to start over in business especially if that is your occupation.

You, as a doctor, are an awesome credit risk and can get a zillion loans to cover your butt while you wheedle away paying your debt at 90K a year.

It is really not a bad position to be in.

 

[gioia]

Oh, if you are prudent, there shouldn't be the need to be in educational straits that require filing bankruptcy for medicine.

Bankruptcy follows everyone, it is not just students.

 

[raspberry swirl]

Originally posted by H0mersimps0n
swirl,

I don't really buy into your example. One, your sample size is one and two, the doc you worked with (and almost any established doc from any example you state) didn't face a $200,000 debt so of course she was able to start up on her own and gradually get a patient base and earn real money.

i hate to get defensive, but it aggrivates me just a touch when people imply i don't know what i am talking about . . . . my sample size isn't small, actually. 75% of my classmates are in rural offices (because thats about all northwestern PA has to offer) and they all tell the same story- rural primary care doctors who do it all . . . and in fact, the doctor i work with actually did have a substantial debt, since she's just a few years older than most of us, and her own husband is a 4th year student as we speak. the town and its businesses have helped her considerably financially, and if i'm not mistaken, she built up her patient base in about a DAY, since she's literally the only primary care physician in the area. and while i'm not sure of her exact salary (which isn't my business, but i'd estimated it at over $200,00), the sole fact that she takes care of an entire REGION, has a huge practice with a ridiculous amount of staff, has 6 kids- no joke (her nurse has 8), and is the sole money maker in her family, i would say that she's doing much better than any other 30-something yr old specialist in any urban area trying to make some headway. not to mention she's doing a greater service.

how dare you say you don't buy into my example, homer. i am offended.

(sorry to everyone else for the tangent)

 

[bigmuny]

Originally posted by gioia
Sure, Bigmuny. That's right.

However, being bankrupt follows you as well and makes it increasingly difficult to start over in business especially if that is your occupation.

You, as a doctor, are an awesome credit risk and can get a zillion loans to cover your butt while you wheedle away paying your debt at 90K a year.

It is really not a bad position to be in.

Actually this really isn't true. Your company goes bankrupt not you as an indivdual, though you may be listed as a principal of the company that goes bankrupt(i've owned a business, not a bankrupt one though). Educational debt, is personal debt, and unlike any other other sort of debt, won't go away no matter what you do(look at your loan paperwork, they get paid no matter what). This really is not all that important. If we all get out of this making 90K(which i don't think is going to happen) a year, then we are in a bit of trouble. 90K a year minus your 2K/mo loan payment and taxes=the nurse is making more than you.

 

[hossofadoc]

Homer- Swril is right docs in rural areas make a killing. I know being a second generation and knowing many docs in rural America. In rural part of the nation I'm from the average family practice doc brings in $450,000-$500,000....the specialist bring in about 100K-600K more.

 

[MacGyver]

gioia,

your argument might have some merit, except for the fact that ALL OF THESE NEW DO PROGRAMS WERE PROPOSED BEFORE THE NEW RESIDENT WORK HOURS WERE AN ISSUE.

Clearly, resident working hours had NOTHING to do with the motivation behind opening 10 new DO schools in 10 years with another 5 or 6 on the way.

Its about $$$. These schools want to open up new branches cause they know they can get lots of people to drop serious cash on it.

The AACOM or whoever regulates/accredits these schools needs to put a freeze on new schools. Its getting ridiculous.

 

[sophiejane]

I think if MacGyver would spend less time whining about how PAs, NPs, and DOs are going to drive down his income and more time learning to be a good doctor, he might have a shot at a making a decent living someday.

 

[MacGyver]

Originally posted by sophiejane
I think if MacGyver would spend less time whining about how PAs, NPs, and DOs are going to drive down his income and more time learning to be a good doctor, he might have a shot at a making a decent living someday.

Doesnt matter how good you are if the docs ahead of you sellout the profession so they can make quick $$$ and cash out before the "fruits" of their labor start making serious consequences for the whole field.

 

[Adapt]

Originally posted by MacGyver
What the hell is the AOA thinking? Do they really think its in theri best interest to see dozens of new schools opening in areas that dont even have doctor shortages?

This is totally foolish thinking. You will depress the wages of both DOs and MDs by pursuing this strategy, and for what?

Is increasing the number of DOs so valuable in terms of public perception that its worth a pay cut due to market saturation?

thats absolutely ridiculous.

I have stated this in another thread and I will state it here again. You have a weak argument and this is why.

The number of FMGs each year is far more than the number of DO graduates entering into continuing medical education. About 25% of allopathic residencies are filled by FMGs. The reason for this is that we do not have enough physicians in the US to keep up with the demand for physicians. Thus, you see an influx of large numbers of foreign physicians.

You mentioned previously that we have controls on the number of FMGs entering but we don't have controls on DO schools increasing. This is exactly the solution. In order to fulfill our country's need of physicians, we would be better off to help US med school graduates, MD or DO, serve our country's population than FMGs.

In increasing the number of DO schools, we will be increasing the number of physicians in our country. At the same time, we should enact those controls on limiting the amount of FMGs coming into this country.

In this way, we are not adding a greater amount of physicians in this country by producing more DO schools, but rather substituting DOs for FMGs.

This solves problems of supply and demand of physicians. Instead of ragging on the number of new DO schools made which only add 200 or so new physicians each year, why don't you rag on the FMGs that are coming to this country by the hundreds each year.

 

[Cowboy DO]

Originally posted by Slickness
I have stated this in another thread and I will state it here again. You have a weak argument and this is why.

The number of FMGs each year is far more than the number of DO graduates entering into continuing medical education. About 25% of allopathic residencies are filled by FMGs. The reason for this is that we do not have enough physicians in the US to keep up with the demand for physicians. Thus, you see an influx of large numbers of foreign physicians.

You mentioned previously that we have controls on the number of FMGs entering but we don't have controls on DO schools increasing. This is exactly the solution. In order to fulfill our country's need of physicians, we would be better off to help US med school graduates, MD or DO, serve our country's population than FMGs.

In increasing the number of DO schools, we will be increasing the number of physicians in our country. At the same time, we should enact those controls on limiting the amount of FMGs coming into this country.

In this way, we are not adding a greater amount of physicians in this country by producing more DO schools, but rather substituting DOs for FMGs.

This solves problems of supply and demand of physicians. Instead of ragging on the number of new DO schools made which only add 200 or so new physicians each year, why don't you rag on the FMGs that are coming to this country by the hundreds each year.

Word

 

[luckystar]

Originally posted by Slickness
The number of FMGs each year is far more than the number of DO graduates entering into continuing medical education. About 25% of allopathic residencies are filled by FMGs. The reason for this is that we do not have enough physicians in the US to keep up with the demand for physicians. Thus, you see an influx of large numbers of foreign physicians.

You mentioned previously that we have controls on the number of FMGs entering but we don't have controls on DO schools increasing. This is exactly the solution. In order to fulfill our country's need of physicians, we would be better off to help US med school graduates, MD or DO, serve our country's population than FMGs.

In increasing the number of DO schools, we will be increasing the number of physicians in our country. At the same time, we should enact those controls on limiting the amount of FMGs coming into this country.

In this way, we are not adding a greater amount of physicians in this country by producing more DO schools, but rather substituting DOs for FMGs.

This solves problems of supply and demand of physicians. Instead of ragging on the number of new DO schools made which only add 200 or so new physicians each year, why don't you rag on the FMGs that are coming to this country by the hundreds each year.

You are making a big assumption here. What makes you think that by increasing the output of DO grads, there will be a proportional increase in allopathic spots filled by DOs? How can you be so sure that allopathic institutions, or any institution for that matter, will indefinitely favor DOs over FMGs? Not all FMG's are from Caribbean schools(not that there's anything hugely flawed with that); in fact, many have been physicians in their home country and are required to complete the licensing exams and a residency in the US to practice here. Does that still make all FMGs less qualified than all DOs in your opinion? Many people, MD and DO, find themselves unmatched, and many positions go unfilled every year. It's unfortunate, but it's a form of quality control, and increasing the pool of applicants will not change that.

 

[Adapt]

Originally posted by luckystar
You are making a big assumption here. What makes you think that by increasing the output of DO grads, there will be a proportional increase in allopathic spots filled by DOs? How can you be so sure that allopathic institutions, or any institution for that matter, will indefinitely favor DOs over FMGs? Not all FMG's are from Caribbean schools(not that there's anything hugely flawed with that); in fact, many have been physicians in their home country and are required to complete the licensing exams and a residency in the US to practice here. Does that still make all FMGs less qualified than all DOs in your opinion? Many people, MD and DO, find themselves unmatched, and many positions go unfilled every year. It's unfortunate, but it's a form of quality control, and increasing the pool of applicants will not change that.

What are you talking about. I was presenting a rebuttal to MacGuyver about how he was attacking AOA for introducing new DO schools.

It is simple as this. Our country needs a certain number of physicians. Currently, a good amount of physicians working in the US are foreign physicians that help meet that demand. If more DO schools come into being, more DOs can help meet that demand and we wouldn't have to rely on the same number of foreign physicians. Instead, we can reduce that number.

I think everyone in the US including our government would agree that it would be better to have US trained physicians helping our country's patients than foreign trained physicians.

Obviously, if the amount of DOs increases and the amount of DO residencies stays the same, then these extra DOs WILL HAVE TO go into allopathic residencies. And yes the residencies will favor US med school graduates over FMGs. Why do you ask? Because the programs get paid by the US government and so they prefer US graduates, MD or DO. That's why.

I know many FMGs are not from the caribbean. I did not say FMGs are less qualified than DOs. Please do not put words in my mouth or insinuate things I did not say.

 

[bgibney]

The fact that there is this trend of opening new osteopathic schools is troubling. Half of the schools present now have been around for no more than 10 years, yet we have branch campuses opening under the name of these young schools.

What will this lead to is a logical question, and is the very one posed by MacGyver. Ostensibly this will only lead to a watering down of our education, much like the watering down of Major league baseball by expansion. Take for instance the new Bradenton school. Last time I checked, there was no large hospital in Bradenton, and in fact, most of the major hospitals in Florida are used by the current medical schools in the state (UF has Shands, USF has tampa gen, Miami has Jackson, NSU has Broward general and Mt. Sinai). Even FSU is fighting for good clinical spots. What situation does this leave these new students in? From all that I have spoken with, the clincal education is the most important in determining the outcome of one's education. For these new Bradenton students, their clinical future looks bleak, unless they are to be shipped across the country for a decent hospital.

What we should be looking at is the greed of these schools and the greed of the AOA. Clearly the biggest joke in osteopathic education is the post graduate training, or lack thereof. Very few AOA residencies provide one with adequate post graduate training, and this problem will only be compounded by opening new schools. Each issue of the DO, and the JAOA has something in it about osteopathies waning identity. All I have to say to these people is what do you expect? Keep opening schools and driving new graduates into allopathic programs (not that that is a bad thing, as I have alluded to, these are by and large superior programs) and soon the supposed identity of osteopathic medicine will indeed be lost. They keep pumping this seperate but equal slogan into our heads, and they do crap like opening these schools which only compounds the problem.

We as students should be ashamed of the lack of progress that our governing committees present us with. Unfortunatly, I don't share the optimistic view of Slickness when it comes to opening new schools, I can only hope he is right.

BTW, how are you going to tell me that Touro, having only graduated what, two classes, is going to opening up a branch campus.

 

[MacGyver]

Originally posted by Slickness
About 25% of allopathic residencies are filled by FMGs. The reason for this is that we do not have enough physicians in the US to keep up with the demand for physicians. Thus, you see an influx of large numbers of foreign physicians.

Thats your first mistake. The number of residencies in this country has NOTHING to do with demand for doctors.

It has EVERYTHING to do with money. Hospitals get paid 100k for each resident, per year. Thats a HUGE revenue stream.

You mentioned previously that we have controls on the number of FMGs entering but we don't have controls on DO schools increasing. This is exactly the solution. In order to fulfill our country's need of physicians, we would be better off to help US med school graduates, MD or DO, serve our country's population than FMGs.

that works ONLY if the # of residency slots remains fixed. Thats not going to happen.

In increasing the number of DO schools, we will be increasing the number of physicians in our country. At the same time, we should enact those controls on limiting the amount of FMGs coming into this country. In this way, we are not adding a greater amount of physicians in this country by producing more DO schools, but rather substituting DOs for FMGs

Again, that works ONLY if the total # of residency slots is constant. Thats not going to happen. New DO residency slots will be opening.

 

[moo]

I have to agree with MacGyver here. Opening more DO schools isn't necessarily going to solve the shortage of PCPs esp. in underserved areas. What we need is more active recruitment (loan forgiveness programs, etc.). If you open more DO schools, all that's going to happen is people will end up applying to competitive specialties... and pretty soon allopathic residencies will want to protect their own turf and will start favoring MDs over DOs (if that does not happen already). Then what are these students, who are 100k+ in debt, going to do?

 

[bigmuny]

Macgyver is correct about the residency issue. Additionally, just because and FMG does residency in the US does not mean they will be able to stay here when they are done(i think about 50% end up being able to stay), so their impact on the population of us physicians is not all that great, and it is controllable.

 

[Adapt]

As I stated before, the real problem is FMGs and not extra DOs.

The following is a link describing this problem.
http://www.imgi.net/internationalmedicalgraduate/corovofspecb1.html

Some quotes.

"...The number of such graduates who enter residencies (approximately 17,500 in 1994) has remained relatively constant for more than a decade. In contrast, there has been a marked increase in recent years in the number of graduates of foreign medical schools who enter residencies in the United States. In 1994, approximately 6750 graduates of foreign medical schools entered residency programs, or almost 40 percent of the number of graduates of U.S. medical schools who entered residencies.3 Seventeen percent of these graduates of foreign medical schools were U.S. citizens..."

"...Approximately 75 percent of the graduates of foreign medical schools who train in the United States ultimately establish practices here.5 If their number continues to increase, the specialty choices made by graduates of U.S. medical schools will have a diminishing influence on the specialty mix of the physician work force..."

"...I suggest that the federal government control the supply of physicians not by regulating the number of residency positions but by limiting the number of graduates of foreign medical schools who enter residency programs each year. In my view, it is not reasonable at this point to consider limiting access to residency training for graduates of U.S. medical schools..."

"...The effects of a continued stalemate are clear: the United States will invest substantial sums of money to educate physicians who are not needed, and some of the young men and women who pursue careers in medicine may find few professional opportunities when they finish their education..."

I was incorrect. FMGs make up 40% of those entering into allopathic residencies.

MacGuyver, obviously, this is a much larger and realistic threat that the government is trying to deal with now.

Again, your argument is weak first because it is not realistic to assume the AOA would accredit a substantial amont of new DO schools to put a dent into the number of new physicians in the US.

Secondly, there is a far larger problem with FMGs as the article states so there is no need to bash the AOA for wanting to accredit a few DO schools which would contribute 400 or so new graduates when FMGs come about 7,000 new each year.

 

[Seaglass]

It has EVERYTHING to do with money. Hospitals get paid 100k for each resident, per year. Thats a HUGE revenue stream.

Actually, it is not, as has been discussed on the match lawsuit thread. If compared to the actual costs of having residents then the hospitals at best break even. You have to remember the increased costs of health insurance, malpractice, decreased staff productivity, etc. I'd be interested to see if anyone can post some research that shows that having residents are a financial benefit.

Casey

 

[moo]

They're a bargain compared to attendings. How much do you have to pay an attending? 120-150k? Not to mention other perks, as well. A resident makes about 40-45k and works at least 2x as much as an attending.

 

[gioia]

bgibney : The new Bradenton School will have the SunCoast Hospital as one of there resources - and it is very close. Suncoast is a known DO rotation site, as is a hospital in Carollwood, FL.

"Sun Coast Hospital is a 300-bed acute care facility located in Largo, Florida. Sun Coast Hospital has a strong primary care physician network base, and offers a broad range of hospital services including medical, surgical, behavioral medicine and substance abuse treatment, oncology, outpatient pediatrics, and home health services. It includes an in-patient skilled nursing facility and a comprehensive in-patient rehabilitation center."

 

[gioia]

Another thing..

Has anyone mentioned BABY BOOMERS????? If any of you are familiar with popular retirement meccas, like Florida, then you will be aware of the impending shortage of physicians on the horizon.

They are the largest demographic and we are going to feel the sting of their health care needs in the next 10 years if we aren't prepared.

What would REALLY hurt health care is if the government gave chiropractics a license to issue Rx.