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  • The White Coat Investor
    replied




    Not going to touch the quality of applicant discussion, but agree that this whole thing hinges way more on personal characteristics than degree.

    I do really worry about these students though. It’s amazing to me that most of us enter med school thinking that as long as we get to be a doctor we’ll be happy and satisfied. Then by halfway through M3 we all realize that really only 2-3 specialties have any appeal to us and we are sufficiently uninterested in the others as to view the idea of practicing them with something like horror.

    Vagabond noted that his training program has never accepted an osteopath. I worry that there’s a myth out there in the med school/pre-med scene that only the VERY top programs in the most competitive specialties or at a few big name institutions take that route. In reality I think the relative disinterest in osteopathic applicants extends way farther down the ladder of desirable city/insitution/speciality etc than we commonly admit to ourselves. The line goes something like “as long as you don’t want to do Neurosurgery at Harvard…” whereas I think reality is even more difficult.

    So the challenge for me is that I just don’t think 22 year olds with a burning desire to wear a white coat can make an informed decision here.

    There’s also a persistant myth in pre-med and med school that struggling academically confers this paradoxical reaction of bedside skill because while one might have a hard time taking tests, that makes one more real in their bedside encounters. I think that is operating here and again is just divorced from the reality of getting a residency spot in the field you want.
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    I think my residency has only ever taken one DO in 30+ years. And nobody would put EM in the top 5 most competitive residencies to match into.

    Leave a comment:


  • MPMD
    replied
    Not going to touch the quality of applicant discussion, but agree that this whole thing hinges way more on personal characteristics than degree.

    I do really worry about these students though. It's amazing to me that most of us enter med school thinking that as long as we get to be a doctor we'll be happy and satisfied. Then by halfway through M3 we all realize that really only 2-3 specialties have any appeal to us and we are sufficiently uninterested in the others as to view the idea of practicing them with something like horror.

    Vagabond noted that his training program has never accepted an osteopath. I worry that there's a myth out there in the med school/pre-med scene that only the VERY top programs in the most competitive specialties or at a few big name institutions take that route. In reality I think the relative disinterest in osteopathic applicants extends way farther down the ladder of desirable city/insitution/speciality etc than we commonly admit to ourselves. The line goes something like "as long as you don't want to do Neurosurgery at Harvard..." whereas I think reality is even more difficult.

    So the challenge for me is that I just don't think 22 year olds with a burning desire to wear a white coat can make an informed decision here.

    There's also a persistant myth in pre-med and med school that struggling academically confers this paradoxical reaction of bedside skill because while one might have a hard time taking tests, that makes one more real in their bedside encounters. I think that is operating here and again is just divorced from the reality of getting a residency spot in the field you want.

    Leave a comment:


  • Lithium
    replied







    These are the stats from one of the for-profit schools that just opened in Utah:

    http://www.rvu.edu/wp-content/uploads/2016/08/Handout_Admissions_Fact-Sheet_2016.pdf

    Not going to vouch for the quality of education there, but those aren’t bad applicants.  Definitely better than the average Caribbean student.  MCAT is about a point below the average score at the University of Utah.

    Medical school is still so competitive that we could have dozens of these mills open before we really see a significantly lower standard in quality of students.  Unfortunately what it could mean is that the residency bottleneck will become more competitive not only for students from these new schools, but for everyone else.

    Access to care is a problem that isn’t going away, and we can fix it by either increasing the number of practicing MD’s and DO’s or let the physician substitutes fill the vacuum for us and demand we treat them as our peers with comparable pay and privileges.  We already saw an article a few weeks ago by an economist who thinks clinicians are as fungible as letter carriers, and presumably thinks flight attendants are qualified to start flying the planes.  But opening up more med schools before increasing residency slots does nothing to solve the problem and as mentioned above just leaves the students holding the bag in the end.
    Click to expand…


     

    A 504 MCAT which is a 28 on the old MCAT is not impressive and I would have been devastated getting that score in my area. This is a 67th percentile MCAT and there is not a single state allopathic school in my area that is taking a student with that score who is not an under represented minority overcoming serious adversity. The other way someone with a score like that could get in is through a masters or pHd program.  Most state schools in my area the average MCAT is a 511 (Old score 32) which is equal to the 86th percentile. This is an astronomical difference in difficulty level. The Private schools in NYC have an average MCAT in the 95th percentile or a 516 (35 old scale).

     

    It is common knowledge nowadays that to be looked at an allopathic school you need above a 510 (30 old scale) and that is really a toss up on whether or not you will get in. I would say that with a 512 (32/33 old scale) you are guaranteed interviews with a respectable GPA in my area.

     

    a 28 seems like the guarantee for interviews/ admission at DO schools based on my experience, which is truly not that hard of a score to get with the resources available to us via the internet.
    Click to expand...


    I don't think these students are likely on the same tier as the ones getting into NYU or Mt. Sinai.  I just wonder how much of a dropoff there is between them and those at the less competitive allopathic and a regular osteopathic school?  The least competitive public school in my home state averages an MCAT of 507, which is the same as schools like Rosalind Franklin and Drexel.  That's a score in the mid-70s in percentile.  I think we both agree that these students are probably the best of the ones who can't get into allopathic schools or in many cases no other osteopathic schools.

    I just think we have a long way to go before enrollment at these pop up schools increases to the point that a medical degree becomes as unimpressive as a law degree.  Compare the average GPA at any of these programs to a Tier 4 Law School and that's pretty obvious.

    Leave a comment:


  • Strider_91
    replied




    These are the stats from one of the for-profit schools that just opened in Utah:

    http://www.rvu.edu/wp-content/uploads/2016/08/Handout_Admissions_Fact-Sheet_2016.pdf

    Not going to vouch for the quality of education there, but those aren’t bad applicants.  Definitely better than the average Caribbean student.  MCAT is about a point below the average score at the University of Utah.

    Medical school is still so competitive that we could have dozens of these mills open before we really see a significantly lower standard in quality of students.  Unfortunately what it could mean is that the residency bottleneck will become more competitive not only for students from these new schools, but for everyone else.

    Access to care is a problem that isn’t going away, and we can fix it by either increasing the number of practicing MD’s and DO’s or let the physician substitutes fill the vacuum for us and demand we treat them as our peers with comparable pay and privileges.  We already saw an article a few weeks ago by an economist who thinks clinicians are as fungible as letter carriers, and presumably thinks flight attendants are qualified to start flying the planes.  But opening up more med schools before increasing residency slots does nothing to solve the problem and as mentioned above just leaves the students holding the bag in the end.
    Click to expand...


     

    A 504 MCAT which is a 28 on the old MCAT is not impressive and I would have been devastated getting that score in my area. This is a 67th percentile MCAT and there is not a single state allopathic school in my area that is taking a student with that score who is not an under represented minority overcoming serious adversity. The other way someone with a score like that could get in is through a masters or pHd program.  Most state schools in my area the average MCAT is a 511 (Old score 32) which is equal to the 86th percentile. This is an astronomical difference in difficulty level. The Private schools in NYC have an average MCAT in the 95th percentile or a 516 (35 old scale).

     

    It is common knowledge nowadays that to be looked at an allopathic school you need above a 510 (30 old scale) and that is really a toss up on whether or not you will get in. I would say that with a 512 (32/33 old scale) you are guaranteed interviews with a respectable GPA in my area.

     

    a 28 seems like the guarantee for interviews/ admission at DO schools based on my experience, which is truly not that hard of a score to get with the resources available to us via the internet.

    Leave a comment:


  • AR
    replied













    I have partners and other physicians who I work with at my hospital who are DOs, Carribean grads and FMGs of all stripes. Many of these people are outstanding, including former Chiefs of Staff of my hospital. Personally, I think the quality of residency training and of course the innate personal characteristics of each physician (such as their drive, compassion, honesty, etc) are bigger predictors of how good they are than which medical school or undergraduate they attended.

    I am not a big fan of discriminating based on which medical school people go to, particularly when there are thousands of midlevels, naturopaths, chiropractors etc masquerading as physicians. But to each his own.
    Click to expand…


    What does the bolded even mean?  It sounds like you are saying “I think all these other folks are lesser providers but saying DOs are not as good as MDs, in general, is just crazy talk”

    .

    I don’t even know what you mean by “discriminating”.  I mean literally no one is saying that a DO can’t be a good doc or that any given DO can’t be better than any given MD.  And when it comes down to evaluating any individual what school they went to should only be one of many factors.  But it’s not the entire picture.  That is both obvious and uncontroversial.

    .

    If someone were to prefer an MD over a DO despite the fact that the DO had more impressive accomplishments, experience, references, etc. That would be discrimination, and once again, literally no one is arguing for doing that.

     

    .

    But if someone were to claim that, in general, MDs receive better training or in general, MD students are higher achieving prior to matriculating it’s hard to argue against that.   I’m not a big fan of ignoring obvious facts.  But to each his own.
    Click to expand…


    Look boss, you and I are not going to agree. I have articulated my point above. Have a nice Thanksgiving.
    Click to expand…


    You guys are talking past each other.

    Hes essentially saying he understands where the discrimination stems from given historical factors he cited. While it may be stated argumentatively, its basically true even if things have changed on the ground the way people perceive DOs is unlikely to change fast.

    Didnt say he agreed with it, just he gets why it exists as it does within the community. Especially since no one really keeps up with this kind of thing attitudes change slowly. Since it was the attitude in the past, for all the stated reasons (true or not) its still likely to be so. Obviously it appears younger docs dont seem to hold similar views. However, if DO schools multiply greatly and dont really care about education as much as profit the views will gain again in the future.

    From my perspective most DO schools had switched to being osteopathic in name only and basically covert allopathic schools.
    Click to expand...


    I think this is true to the extent that they may have cut out the osteopathic part, but I still don't think they really make it to the covert allopathic school level.

    I think that one thing that sets the vast majority of allopathic schools apart is the quality and quantity of clinical and basic science research that goes on at them. I think that as a physician, even if one has no personal interest in being involved in research, I think being around it and people that do it for a living while one is a student gives one a much better understanding of where all of what we do comes from.  You can read about it in journals, but it's just not quite the same.  However, I'll admit, this is a pretty small thing in the overall grand scheme of things.  But it does have some value.

    Once again, I'm sure there are exceptions, but I think that in general, this is largely true.

    Leave a comment:


  • Zaphod
    replied










    I have partners and other physicians who I work with at my hospital who are DOs, Carribean grads and FMGs of all stripes. Many of these people are outstanding, including former Chiefs of Staff of my hospital. Personally, I think the quality of residency training and of course the innate personal characteristics of each physician (such as their drive, compassion, honesty, etc) are bigger predictors of how good they are than which medical school or undergraduate they attended.

    I am not a big fan of discriminating based on which medical school people go to, particularly when there are thousands of midlevels, naturopaths, chiropractors etc masquerading as physicians. But to each his own.
    Click to expand…


    What does the bolded even mean?  It sounds like you are saying “I think all these other folks are lesser providers but saying DOs are not as good as MDs, in general, is just crazy talk”

    .

    I don’t even know what you mean by “discriminating”.  I mean literally no one is saying that a DO can’t be a good doc or that any given DO can’t be better than any given MD.  And when it comes down to evaluating any individual what school they went to should only be one of many factors.  But it’s not the entire picture.  That is both obvious and uncontroversial.

    .

    If someone were to prefer an MD over a DO despite the fact that the DO had more impressive accomplishments, experience, references, etc. That would be discrimination, and once again, literally no one is arguing for doing that.

     

    .

    But if someone were to claim that, in general, MDs receive better training or in general, MD students are higher achieving prior to matriculating it’s hard to argue against that.   I’m not a big fan of ignoring obvious facts.  But to each his own.
    Click to expand…


    Look boss, you and I are not going to agree. I have articulated my point above. Have a nice Thanksgiving.
    Click to expand...


    You guys are talking past each other.

    Hes essentially saying he understands where the discrimination stems from given historical factors he cited. While it may be stated argumentatively, its basically true even if things have changed on the ground the way people perceive DOs is unlikely to change fast.

    Didnt say he agreed with it, just he gets why it exists as it does within the community. Especially since no one really keeps up with this kind of thing attitudes change slowly. Since it was the attitude in the past, for all the stated reasons (true or not) its still likely to be so. Obviously it appears younger docs dont seem to hold similar views. However, if DO schools multiply greatly and dont really care about education as much as profit the views will gain again in the future.

    From my perspective most DO schools had switched to being osteopathic in name only and basically covert allopathic schools.

    Leave a comment:


  • Physiciancouple.com
    replied







    I have partners and other physicians who I work with at my hospital who are DOs, Carribean grads and FMGs of all stripes. Many of these people are outstanding, including former Chiefs of Staff of my hospital. Personally, I think the quality of residency training and of course the innate personal characteristics of each physician (such as their drive, compassion, honesty, etc) are bigger predictors of how good they are than which medical school or undergraduate they attended.

    I am not a big fan of discriminating based on which medical school people go to, particularly when there are thousands of midlevels, naturopaths, chiropractors etc masquerading as physicians. But to each his own.
    Click to expand…


    What does the bolded even mean?  It sounds like you are saying “I think all these other folks are lesser providers but saying DOs are not as good as MDs, in general, is just crazy talk”

    .

    I don’t even know what you mean by “discriminating”.  I mean literally no one is saying that a DO can’t be a good doc or that any given DO can’t be better than any given MD.  And when it comes down to evaluating any individual what school they went to should only be one of many factors.  But it’s not the entire picture.  That is both obvious and uncontroversial.

    .

    If someone were to prefer an MD over a DO despite the fact that the DO had more impressive accomplishments, experience, references, etc. That would be discrimination, and once again, literally no one is arguing for doing that.

     

    .

    But if someone were to claim that, in general, MDs receive better training or in general, MD students are higher achieving prior to matriculating it’s hard to argue against that.   I’m not a big fan of ignoring obvious facts.  But to each his own.
    Click to expand...


    Look boss, you and I are not going to agree. I have articulated my point above. Have a nice Thanksgiving.

    Leave a comment:


  • Zaphod
    replied
    Agree residency and personal drive more important than undergrad or med school type. We sometimes overlook or for personal reasons dismiss the idea that medicine is very much an apprenticeship model. I'd wager you could take bright individuals (those with intellectual capacity/drive) with little formal science and no medschool training and make very good doctors with simply a decent residency, maybe a year longer.

    I mean you have nurses and all kinds of barely any training at all doing way above their head stuff. Residency alone would put a smart and dedicated person far above all these.

    Medicine is pretty mind numbingly algorithmic and more about repitition. Its only at the margins of extreme situations that any difference is remotely obvious to outsiders (who will be the judges ofc). In reality you'd have to have a massive amount of exceedingly mismanaged care that had immediate and obvious detriment to not only the patients themselves but also the broader public. The things that even a great increase in providers would end up treating 90+% of the time just dont fall into that category as those are mostly the domain of high acuity that naturally selects for the more ambitious and talented individuals.

    The differences have to be large to be noticeable by the public. I mean I notice surgeons that arent doing amazing work, but it gets by and serves the general purpose. Things only other docs notice arent going to cut it.

    Leave a comment:


  • Kamban
    replied




    I have partners and other physicians who I work with at my hospital who are DOs, Carribean grads and FMGs of all stripes. Many of these people are outstanding, including former Chiefs of Staff of my hospital. Personally, I think the quality of residency training and of course the innate personal characteristics of each physician (such as their drive, compassion, honesty, etc) are bigger predictors of how good they are than which medical school or undergraduate they attended.
    Click to expand...


    I agree with you but getting the residency slots depend on USMLE scores and DO overall (not individually) they are less likely to score as well than MD though I am sure that there will be quite a few in the 99th percentile. Once they are matched they are likely to do as well or better than MD residents.

    The problem is that with the proliferation of DO schools the percentage of DO who will will score high enough and match will decrease. That will be a shame, since these people have paid thousands of dollars to get the DO. But another casualty might be the low scoring MD from a poorly trained MD program who might see his slot taken away by an ambitious, hard working DO student. Likely to occur after 2020 with the common matching program.

    Leave a comment:


  • AR
    replied




    I have partners and other physicians who I work with at my hospital who are DOs, Carribean grads and FMGs of all stripes. Many of these people are outstanding, including former Chiefs of Staff of my hospital. Personally, I think the quality of residency training and of course the innate personal characteristics of each physician (such as their drive, compassion, honesty, etc) are bigger predictors of how good they are than which medical school or undergraduate they attended.

    I am not a big fan of discriminating based on which medical school people go to, particularly when there are thousands of midlevels, naturopaths, chiropractors etc masquerading as physicians. But to each his own.
    Click to expand...


    What does the bolded even mean?  It sounds like you are saying "I think all these other folks are lesser providers but saying DOs are not as good as MDs, in general, is just crazy talk"

    .

    I don't even know what you mean by "discriminating".  I mean literally no one is saying that a DO can't be a good doc or that any given DO can't be better than any given MD.  And when it comes down to evaluating any individual what school they went to should only be one of many factors.  But it's not the entire picture.  That is both obvious and uncontroversial.

    .

    If someone were to prefer an MD over a DO despite the fact that the DO had more impressive accomplishments, experience, references, etc. That would be discrimination, and once again, literally no one is arguing for doing that.

     

    .

    But if someone were to claim that, in general, MDs receive better training or in general, MD students are higher achieving prior to matriculating it's hard to argue against that.   I'm not a big fan of ignoring obvious facts.  But to each his own.

    Leave a comment:


  • Zaphod
    replied







    I find it curious that some of you seem very biased against DOs (honestly, a pretty antiquated mindset in my opinion). Are you guys aware that NPs and PAs are essentially independently practicing all over the country with about 1/8th the training of a DO (or MD) completing undergraduate, medical school and residency?

    This is not to say that I disagree with the point that schools should not open unfettered without more residency spots to train their graduates.
    Click to expand…


    Really?  Why is it curious?  We have a whole thread here devoted to the dilution on the quality of DO education.

    If all you know that someone is a DO, there is a possibility they went to one of these pathetic institutions.  Also the last time I looked in to it (it has been a long time, so I suppose it’s possible things have changed) average DO students have lower college GPAs, MCAT scores, etc.

    With all of that information in mind, it is understandable that someone might be biased against DOs and for MDs (in general).  Now it’s entirely possible for any individual DO to be excellent and overcome someone’s bias.  Just like it’s possible for an individual MD to be terrible and overcome any favorable view of MDs in general that someone may have.  But the fact that such a bias exists is not surprising in the least.

    I’m not sure what your whole point was about PAs and NPs.  Any bias that I’m aware of is in favor of MDs and against DOs.  I’ve never heard of a bias in favor of PAs or NPs over DOs (as far as competence is concerned).  Does that even really exist?
    Click to expand...


    Wasnt in regards to comptetence, I took it as NPs try to be seen as their own equal practitioner and PAs seem to understand and accept they are a 'mid' level and just do their role without the ego/autonomy attitude you may get with an NP. This is my take away, not necessarily my personal thoughts.

    Leave a comment:


  • Lithium
    replied
    These are the stats from one of the for-profit schools that just opened in Utah:

    http://www.rvu.edu/wp-content/uploads/2016/08/Handout_Admissions_Fact-Sheet_2016.pdf

    Not going to vouch for the quality of education there, but those aren't bad applicants.  Definitely better than the average Caribbean student.  MCAT is about a point below the average score at the University of Utah.

    Medical school is still so competitive that we could have dozens of these mills open before we really see a significantly lower standard in quality of students.  Unfortunately what it could mean is that the residency bottleneck will become more competitive not only for students from these new schools, but for everyone else.

    Access to care is a problem that isn't going away, and we can fix it by either increasing the number of practicing MD's and DO's or let the physician substitutes fill the vacuum for us and demand we treat them as our peers with comparable pay and privileges.  We already saw an article a few weeks ago by an economist who thinks clinicians are as fungible as letter carriers, and presumably thinks flight attendants are qualified to start flying the planes.  But opening up more med schools before increasing residency slots does nothing to solve the problem and as mentioned above just leaves the students holding the bag in the end.

    Leave a comment:


  • Physiciancouple.com
    replied
    I have partners and other physicians who I work with at my hospital who are DOs, Carribean grads and FMGs of all stripes. Many of these people are outstanding, including former Chiefs of Staff of my hospital. Personally, I think the quality of residency training and of course the innate personal characteristics of each physician (such as their drive, compassion, honesty, etc) are bigger predictors of how good they are than which medical school or undergraduate they attended.

    I am not a big fan of discriminating based on which medical school people go to, particularly when there are thousands of midlevels, naturopaths, chiropractors etc masquerading as physicians. But to each his own.

    Leave a comment:


  • AR
    replied




    I find it curious that some of you seem very biased against DOs (honestly, a pretty antiquated mindset in my opinion). Are you guys aware that NPs and PAs are essentially independently practicing all over the country with about 1/8th the training of a DO (or MD) completing undergraduate, medical school and residency?

    This is not to say that I disagree with the point that schools should not open unfettered without more residency spots to train their graduates.
    Click to expand...


    Really?  Why is it curious?  We have a whole thread here devoted to the dilution on the quality of DO education.

    If all you know that someone is a DO, there is a possibility they went to one of these pathetic institutions.  Also the last time I looked in to it (it has been a long time, so I suppose it's possible things have changed) average DO students have lower college GPAs, MCAT scores, etc.

    With all of that information in mind, it is understandable that someone might be biased against DOs and for MDs (in general).  Now it's entirely possible for any individual DO to be excellent and overcome someone's bias.  Just like it's possible for an individual MD to be terrible and overcome any favorable view of MDs in general that someone may have.  But the fact that such a bias exists is not surprising in the least.

    I'm not sure what your whole point was about PAs and NPs.  Any bias that I'm aware of is in favor of MDs and against DOs.  I've never heard of a bias in favor of PAs or NPs over DOs (as far as competence is concerned).  Does that even really exist?

    Leave a comment:


  • Strider_91
    replied
    @physiciancouple.com

    Yes I think most of us are aware and aren’t quite happy wth that either, but mid levels are not actual physicians. It is a whole other conversation. DO schools with low standards undermine the profession and takes away from the work it takes to get into medical school. More then that, they are opening schools but no residency spots which just makes their own students suffer! It is not all DO schools, some are competitive. Some quite simply are not. If it were MD schools that lowered standards and were saturating a market I think there would be an equal level of dissatisfaction.

    I would like to make it clear that I do not think that physicians trained by DO schools who match into a respectable program are sub par in any way, I would even venture to say that the bedside manner on the DO physicians I have shadowed is superior on average to MDs. I just don’t like the idea of lowering standards. Law School lowered standards and it ruined the profession. We should NOT do the same.

    Leave a comment:

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