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  • #46







    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.
    Click to expand…


    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.
    Click to expand...


    There are obviously thousands (tens of thousands?) of DOs in EM and many other competitive specialties. Many of whom are loyal readers of yours.

    Comment


    • #47




      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.
      Click to expand...


      My simpleton way of saying what you have more eloquently stated above is that the DO route, on average, will limit your options. If you come from a school known to be a for-profit DO Mill, one’s options will be even further limited. Until I see DO’s as Department chairs of neurosurgery or cardiology in places like Harvard and UCSF or as CEOs in systems like Cleveland Clinic or MD Anderson, I will believe this.

      This does not mean that one cannot be an excellent doc with a rewarding career as a DO. It’s just that the full spectrum of opportunities that exist for MDs will not likely be available to the DO graduate.

      Comment


      • #48










        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.
        Click to expand…


        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.
        Click to expand…


        There are obviously thousands (tens of thousands?) of DOs in EM and many other competitive specialties. Many of whom are loyal readers of yours.
        Click to expand...


        And most of them understand that there are still places/people/specialties where they're fighting an uphill battle. I'm acknowledging reality, not disparaging anyone.
        Helping those who wear the white coat get a fair shake on Wall Street since 2011

        Comment


        • #49










          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.
          Click to expand…


          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.
          Click to expand…


          There are obviously thousands (tens of thousands?) of DOs in EM and many other competitive specialties. Many of whom are loyal readers of yours.
          Click to expand...


          Yeah dude I really don't want to be misunderstood as questioning the quality of osteopathic providers b/c quite frankly I can't tell the difference any more than anyone else.

          We're talking about the reality of competitive training programs and my point is that sometimes there is a collective delusion that means neurosurgery at Mass Gen whereas the reality is probably even more grim from that. My training program (where I currently work as faculty) has not had an osteopathic resident that I know of -- not even making a value judgement on that it's just a factual statement.

          Comment


          • #50







            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.
            Click to expand…


            My simpleton way of saying what you have more eloquently stated above is that the DO route, on average, will limit your options. If you come from a school known to be a for-profit DO Mill, one’s options will be even further limited. Until I see DO’s as Department chairs of neurosurgery or cardiology in places like Harvard and UCSF or as CEOs in systems like Cleveland Clinic or MD Anderson, I will believe this.

            This does not mean that one cannot be an excellent doc with a rewarding career as a DO. It’s just that the full spectrum of opportunities that exist for MDs will not likely be available to the DO graduate.
            Click to expand...


            Well said and I think the issue is that it's really easy to go down the road of "well I don't care about working at a big name place." That is a fine position but not true for everyone.

            We're all agreeing with each other that the limitations on the spectrum of practice settings are more strict that I think is sometimes admitted, and it's not really a great argument to just throw out something like "well I wouldn't want to work at a place that didn't take DO residents."

            Comment


            • #51
              Interesting thread...I certainly agree that it is not good that there are potentially sub-par schools being opened for profit reasons, especially if they are churning out sub par doctors and not even ensuring a match into a residency. I totally understand why that is a problem.

              But, it also makes me wonder why the MD schools aren't responding by increasing their class sizes?  I mean, there's clearly a severe need for physicians, especially in the primary care world, so why aren't the MD schools helping out a little?  I was quite disturbed to learn the other day, for instance, that my wife has been seeing a NP as her "dermatologist" instead of an actual physician.  The group she goes to is all MD's.  So, why are they keeping their numbers so tight and then hiring NPs?  Makes no sense to me. Although, I guess they're doing it to keep their profits up?  They can pay a mid-level peanuts compared to what they pay themselves?

              If the MD programs want to keep patting themselves on the back for being so prestigious, that's fine, but don't then complain when you're intentionally keeping your numbers low even in the face of doctor shortages and wondering why there are "others" coming into the profession without the same high standards.  I think they need to step up to the plate by increasing their program size, increasing the number of residency slots, all while maintaining their high standards of education.  There's no shortage of highly qualified candidates for admission to MD schools.

              Comment


              • #52




                in the face of doctor shortages
                Click to expand...


                .
                Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

                Comment


                • #53
                  Not a shortage. A maldistribution. Incentivize people practicing in areas they wouldn't want to, or they won't go there. Who knew. Flooding market with docs won't fix "problem." they tried it with flooding mid-levels and surprise surprise they flock to relatively similar distributions.

                  As I said in another thread, yes DO schools are way easier to open. Really easy to find some PhDs to teach basic science. Then if you're a do school you just find a community hospital to take your students and stick them in a closet somewhere alld day for 3rd and 4th years. MD schools won't tolerate that

                  Comment


                  • #54





                    in the face of doctor shortages 
                    Click to expand…


                    Different topic but:

                    Is there a doctor shortage? There seems to be a consensus that there is a primary care shortage (though I’m not sure how that is assessed or by whom), but I’d be interested to know of any evidence that there is a broader doctor shortage (especially regarding cardiologists).

                    Genuinely curious.
                    Click to expand...


                    In our Hospital, you can’t swing a dead cat without hitting a cardiologist or two. Kidding aside, they are climbing all over each other competing for patients and procedures. They have won all of the turf battles against other specialties, and now the only turf left to take is from each other.

                    As I said in another thread, I wonder if we are suffering from an excess of doctoring, especially in the larger population centers, rather than a shortage of docs.

                    Comment


                    • #55




                      Not a shortage. A maldistribution. Incentivize people practicing in areas they wouldn’t want to, or they won’t go there. Who knew. Flooding market with docs won’t fix “problem.” they tried it with flooding mid-levels and surprise surprise they flock to relatively similar distributions.

                      As I said in another thread, yes DO schools are way easier to open. Really easy to find some PhDs to teach basic science. Then if you’re a do school you just find a community hospital to take your students and stick them in a closet somewhere alld day for 3rd and 4th years. MD schools won’t tolerate that
                      Click to expand...


                      .
                      Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

                      Comment


                      • #56




                        Interesting thread…I certainly agree that it is not good that there are potentially sub-par schools being opened for profit reasons, especially if they are churning out sub par doctors and not even ensuring a match into a residency. I totally understand why that is a problem.

                        But, it also makes me wonder why the MD schools aren’t responding by increasing their class sizes?  I mean, there’s clearly a severe need for physicians, especially in the primary care world, so why aren’t the MD schools helping out a little?  I was quite disturbed to learn the other day, for instance, that my wife has been seeing a NP as her “dermatologist” instead of an actual physician.  The group she goes to is all MD’s.  So, why are they keeping their numbers so tight and then hiring NPs?  Makes no sense to me. Although, I guess they’re doing it to keep their profits up?  They can pay a mid-level peanuts compared to what they pay themselves?

                        If the MD programs want to keep patting themselves on the back for being so prestigious, that’s fine, but don’t then complain when you’re intentionally keeping your numbers low even in the face of doctor shortages and wondering why there are “others” coming into the profession without the same high standards.  I think they need to step up to the plate by increasing their program size, increasing the number of residency slots, all while maintaining their high standards of education.  There’s no shortage of highly qualified candidates for admission to MD schools.
                        Click to expand...


                        One possible answer to your question (bolded) is that the existing owner dermatologists will be able to profit a lot more off of an extender than they can over another dermatologist employee.

                        Comment


                        • #57
                          I can only give anecdotes. While doing my osteopathic internship, I had third-year rotating students from three schools, two of which were out-of-state (one not even adjacent) and recently-opened. Nice folks, average to maybe slightly above average intelligence for that level of training, and the ones I kept in touch with got into relatively competitive ACGME residencies in various fields, including EM and rads.

                          But early in third year, they were woefully unprepared, even being outperformed by a few less-intelligent, less-hard working students from the local well-established school. The knowledge gap ironed out with effort, reading, and time, but I can ascertain from my own individual observation that these new schools did not at all seem to prepare their students as well those first two years.

                          I think, as was mentioned above, that since they can just farm their third- and fourth-year students to community hospitals or far-away osteopathic GME organizations as "core" sites - just as the Caribbean schools do - that all it takes is a relatively small core science faculty to get started, and it seems much easier to do so through COCA than LCME. It must take a lot of money, though, since these schools often charge over $40,000 a year, nearly all being private (and some for-profit).

                          This is what I think is the biggest obstacle DO students face, or rather, at least at these schools. Given the prevalence of prep courses and materials, these folks can get a respectable USMLE score, and assuming a self-aware, motivated, and intelligent individual, I think that come intern year, most of the gaps can be filled with a book in the hand, real living patients depending on them, and some involved clinical faculty in the first few months. You see a similar blending effect in most larger GME programs, I imagine, as come January, everyone has had six months of the same curriculum and rigorous workload, and where they went to medical school matters less and less as time goes on.

                          All in all, I think an individual is going to perform to his or her potential, more likely in spite of their school than because of it.

                          Comment


                          • #58
                            Agree with comments above about the shortage being in primary care, not the sub-specialties per se.  And yes this is due to the work conditions, relatively lower pay, and the overall BS factor that comes with working in primary care these days.

                            It would be wonderful to have the nations best and brightest rock star docs flocking to primary care instead of just the sub-specialities, but agree there would have to be an incentive for them to do so.  Lower the patient load, increase the pay, improve the hours, etc, etc.  I've heard many times from older docs that Internal medicine used to have some of the smartest, most talented, most highly respected doctors in existence.  Now a days that seems rare.  To me it seems related to lifestyle and pay more than anything else (with pay probably being the most important), which I can't blame anyone for.  It's a complex problem though.  There doesn't seem to be an easy fix.

                            Comment


                            • #59
                              are these schools going to focus on teaching to ace step 1?  if the students have a really high score, it's likely going to open doors, even if they are woefully underprepared in other areas.  that will attract future candidates as well.

                              doubtless there will be growing pains, but eventually hopefully they figure out a balance between teaching to the test and teaching information needed to prepare for clinical rotations.

                               

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