Allopathic Medical School Expansion

[drusso]

Interesting position brief by the AAMC:

Analysis of medical school expansion plans

"A 15 percent increase in allopathic enrollment would be about equal to an additional 2,400 students per year over 2003 levels. While osteopathic enrollment and graduations have grown by nearly 300 percent over the past 25 years, their continued growth alone will not meet the needs of the nation."

Osteopathic medicine took a lot of criticism for its expansion in the last 25-30 years, but one wonders if the osteopathic community actually read the tea leaves correctly.

Only very recently have MD-granting institutions begun thinking about expansion. However, my bet is that when new MD schools do begin opening, it will be it will be a more rational and conscientious expansion of existing programs. It will be interesting to see if these new MD-granting programs will follow the "osteopathic model" of free-standing, private, non-research university affiliated programs or opt for a more traditional arrangements.

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[USArmyDoc]

Interesting position brief by the AAMC:

Analysis of medical school expansion plans

"A 15 percent increase in allopathic enrollment would be about equal to an additional 2,400 students per year over 2003 levels. While osteopathic enrollment and graduations have grown by nearly 300 percent over the past 25 years, their continued growth alone will not meet the needs of the nation."

Osteopathic medicine took a lot of criticism for its expansion in the last 25-30 years, but one wonders if the osteopathic community actually read the tea leaves correctly.

Only very recently have MD-granting institutions begun thinking about expansion. However, my bet is that when new MD schools do begin opening, it will be it will be a more rational and conscientious expansion of existing programs. It will be interesting to see if these new MD-granting programs will follow the "osteopathic model" of free-standing, private, non-research university affiliated programs or opt for a more traditional arrangements.

Interesting. We really do need more physicians. However, I think what a lot of people on these boards are arguing is that we do not want the standards to Osteopathic schools to drop much more.

 

[heech]

I think the one key lost in all of this discussion is the recognition that the medical system has changed drastically over the past 20 years. The old system, in which medical doctors were allowed to dictate terms by virtue of their widely acknowledged moral/intellectual superiority, is over. Note that medical doctors (with any degree) aren't even masters of their own practice + operating rooms, any more! I'm sure all of us are familiar with the vocal frustration this has generated amongst some.

The balance has shifted. Medical care in this country is more of a "science" than ever. The Doctor-as-God has been replaced by managed-care-as-God. Corporate bureaucrats are running statistical analysis to determine the best (aka, least expensive) way of providing medical service to their patients. Medical doctors are agents of the medical system, with very little room for autonomy.

In my opinion, the huge explosion of osteopathic medical schools is in response to this shift in paradigm. From a purely quantative point of view, does anyone believe that a McDO graduate will be less capable of providing quality care... at least for 99% of the primary care patients out there? And if they're equally capable of providing care, why would the insurance company "care" about prestige + undergraduate research?

The bottom line will determine the outcome of this. With the skyrocketing cost of health-care, it's time to think like businessmen. As long as these new osteopathic hospitals are producing licensed graduates capable of providing quality care (as determined by the insurance companies), then they will thrive in this marketplace.

The fact that these DO graduates might be "looked down upon" by their MD-trained peers is really irrelevant, in the larger scope of things.

 

[(nicedream)]

drusso, I think the allopathic world will follow their traditional route of expansion through large universities. Already here in FL there are plans for an enormous medical education program at University of Central Florida, and one at Florida Atlantic University (or maybe Florida International, I get them confused).

heech, I think you're right on about the lack of importance of where education/training is done in most cases today. Any physician taking medicare/insurance assignment is just a cog in the wheel of the healthcare machine. Just look at the clinics sprouting up at WalMarts, called RediClinic. I just read an article about them in Fortune. They are staffed entirely by nurse practitioners and charge a flat rate of $45 for routine-type visits (colds etc). Their patients love it because they can walk in whenever they want (longer hours than dr offices (7am-7pm plus weekends), don't need an appointment, don't wait, pay less, and get their prescription filled right then and there. That's what patients want: speed, efficiency, and thrift.

 

[Bill_Brasky]

I think the one key lost in all of this discussion is the recognition that the medical system has changed drastically over the past 20 years. The old system, in which medical doctors were allowed to dictate terms by virtue of their widely acknowledged moral/intellectual superiority, is over. Note that medical doctors (with any degree) aren't even masters of their own practice + operating rooms, any more! I'm sure all of us are familiar with the vocal frustration this has generated amongst some.

The balance has shifted. Medical care in this country is more of a "science" than ever. The Doctor-as-God has been replaced by managed-care-as-God. Corporate bureaucrats are running statistical analysis to determine the best (aka, least expensive) way of providing medical service to their patients. Medical doctors are agents of the medical system, with very little room for autonomy.

In my opinion, the huge explosion of osteopathic medical schools is in response to this shift in paradigm. From a purely quantative point of view, does anyone believe that a McDO graduate will be less capable of providing quality care... at least for 99% of the primary care patients out there? And if they're equally capable of providing care, why would the insurance company "care" about prestige + undergraduate research?

The bottom line will determine the outcome of this. With the skyrocketing cost of health-care, it's time to think like businessmen. As long as these new osteopathic hospitals are producing licensed graduates capable of providing quality care (as determined by the insurance companies), then they will thrive in this marketplace.

The fact that these DO graduates might be "looked down upon" by their MD-trained peers is really irrelevant, in the larger scope of things.

 

[GregsAnatomy]

drusso, I think the allopathic world will follow their traditional route of expansion through large universities. Already here in FL there are plans for an enormous medical education program at University of Central Florida, and one at Florida Atlantic University (or maybe Florida International, I get them confused).

It is University of Central Florida and Florida International that are planning to open allopathic medical schools. Florida Atlantic operates a joint program where 100 students complete their first 2 years at FAU, then finish the 3rd and 4th years with University of Miami. Barry University in North Miami (which already has a podiatry school) currently has plans to open an osteopathic medical school.

 

[MacGyver]

Great lets just build 5000 new medical schools, one for every medium sized city.

After all, we wouldnt want a student to have to travel 20 miles to attend med school!

We are already dipping into the lower half of the med school applicant pool. Once all these schools come about (about 25 recently built or planned schools), 75% of applicants will get accepted. Thats LAW SCHOOL NUMBERS, folks

 

[OSUdoc08]

Great lets just build 5000 new medical schools, one for every medium sized city.

After all, we wouldnt want a student to have to travel 20 miles to attend med school!

We are already dipping into the lower half of the med school applicant pool. Once all these schools come about (about 25 recently built or planned schools), 75% of applicants will get accepted. Thats LAW SCHOOL NUMBERS, folks

Would you rather have a physician shortage?

Have you ever heard of baby boomers?

 

[vegangirl]

what happens though after the boomers, when their was a drop in births between 1958-1968 ( http://en.wikipedia.org/wiki/Baby_Busters_) What will we do with the surplus supply of physicians??? Im not saying that growth is bad, it just should be done in a controlled/regulated manner

 

[homeboy]

Great lets just build 5000 new medical schools, one for every medium sized city.

After all, we wouldnt want a student to have to travel 20 miles to attend med school!

We are already dipping into the lower half of the med school applicant pool. Once all these schools come about (about 25 recently built or planned schools), 75% of applicants will get accepted. Thats LAW SCHOOL NUMBERS, folks

I think Mac has a point, but I also think that everyone who gets into medical school isn't necessarily going to be a good doctor, and everyone that doesn't isn't necessarily NOT going to be a good doctor.
We need to have more people involved in the sciences and medicine rather that open arms to everyone willing (ie. increase the pool, not just accept more).
More PA schools would help, too. In a primary care setting, PAs statistically perform 80-85% of the same tasks as an FP. This is good for healthcare, having mid-level providers that will consume a smaller dollar amount, but frustrating if you're an FP (as well as a PA, knowing you're going to be doing essentially the same thing and getting paid half as much).

 

[FutureNavyDOc]

Would you rather have a physician shortage?

Have you ever heard of baby boomers?

I'd much rather have a less than ideal number of qualified intelligent physicians than an overabundance of unqualified docs who only got in because they applied to a new school that needed butts in the seats and tuition checks in the bank!

I know of an instance where the new Florida school accepted a girl with a 2.80 GPA and a 15 MCAT right before the year started. She's a friend of mine and even at that, it scares me she will be a physician someday (after/if she eventually passes boards).

 

[heech]

I'd much rather have a less than ideal number of qualified intelligent physicians than an overabundance of unqualified docs who only got in because they applied to a new school that needed butts in the seats and tuition checks in the bank!

I think the real question to be asked here is, who should be in charge of judging whether a doctor is "qualified" to practice?

- Should it be the medical school admission boards, after 4 years of undergrad-equivalent courses, a 1-day standardized test, a personal statement, and a 30 minute interview?

- Or should it be the medical licensure boards after 2 years of rigorous pre-clinical education, 2 years of clinical education, 3 comprehensive board licensing examinations, and 1 year of full-time internship?

Personally, I think the latter process is a more than sufficient evaluation of a potential doctor's competency. I don't see why we have to be horrified by the idea that the first door is being opened wider.

I think there's plenty of time for hand-wringing and fear if/when USMLE/COMLEX standards are lowered. There's no indication that will be the case.

 

[FutureNavyDOc]

I think the real question to be asked here is, who should be in charge of judging whether a doctor is "qualified" to practice?

- Should it be the medical school admission boards, after 4 years of undergrad-equivalent courses, a 1-day standardized test, a personal statement, and a 30 minute interview?

- Or should it be the medical licensure boards after 2 years of rigorous pre-clinical education, 2 years of clinical education, 3 comprehensive board licensing examinations, and 1 year of full-time internship?

Personally, I think the latter process is a more than sufficient evaluation of a potential doctor's competency. I don't see why we have to be horrified by the idea that the first door is being opened wider.

I think there's plenty of time for hand-wringing and fear if/when USMLE/COMLEX standards are lowered. There's no indication that will be the case.

I agree that the latter choice is the better option as well, but are we doing anyone a service when people are accepted because of lowered standards due to the increasing number of schools?

Especially when such people are undoubtedly less likely to pass all of their courses and boards.

Who benefits when someone has to drop out of med school after 2/3 years with $100,000 in loans because they can't pass Step I?

Is it really fair to bring that person in, get their hopes up only to part ways 2 years later the school $80,000 richer and the student $100,000 in debt when maintaining high standards would have prevented all of this?

I realize that people with low MCATs and GPAs have done very well in med school in the past, however I would imagine that number is small in comparison to similar applicants who have struggled.

 

[OSUdoc08]

I'd much rather have a less than ideal number of qualified intelligent physicians than an overabundance of unqualified docs who only got in because they applied to a new school that needed butts in the seats and tuition checks in the bank!

I know of an instance where the new Florida school accepted a girl with a 2.80 GPA and a 15 MCAT right before the year started. She's a friend of mine and even at that, it scares me she will be a physician someday (after/if she eventually passes boards).

In order to increase the amount of physician requires dipping lower into the applicant pool.

What that being said, college GPA doesn't determine competence as a physician.

 

[MacGyver]

what happens though after the boomers, when their was a drop in births between 1958-1968 ( http://en.wikipedia.org/wiki/Baby_Busters_) What will we do with the surplus supply of physicians??? Im not saying that growth is bad, it just should be done in a controlled/regulated manner

Exactly right......

politicians screaming for new med schools because of baby boomers...

after all the baby boomers die and we have a doctor surplus, are those same politicians going to say "OK the baby boom is over, we have too many doctors, time to cut back on med schools"?

Hell no they arent going to say that.

Once a new med school is built, its PERMANENT. Once these schools are built, they are here to stay.

Increasing med schools to fit baby boomers is a PERMANENT solution to a TEMPORARY PROBLEM

 

[(nicedream)]

Didn't most of those baby boomers have kids? The population isn't going to decrease after they die is it?

 

[FutureNavyDOc]

Didn't most of those baby boomers have kids? The population isn't going to decrease after they die is it?

Yes, however they did not have as many kids as their parents did.

Even if they did, baby boomers didn't start having their own kids in Kindergarten, the next surge in births would have been about 25-30 years after the start of the baby boomers, which would be about 1971-1985. This 2nd generation boomers would be somewhere between 20 and 35 now and won't be needing elderly amounts of health care for at least 30-40 years. In the meantime, assuming the average boomer dies at 75-80, the boomers will be gone in 20-25 years. What are all the extra docs supposed to do in that 15-20 year gap?



The reason politicians are so anxious about having enough docs around for the boomers is because it's their generation as well as the generation that is the most politically active in a financial sense. Anything they can do that helps the boomers boosts their campaign donations and re-election chances.

 

[kristing]

Who says we are going to have a surplus? The was an article in the NEJM a few years ago (they update this topic every few years, if I recall) that gave statistics of approximately 1/4 of residency slots going to FMGs. It would take A LOT of new schools to compete for those numbers.

 

[FutureNavyDOc]

Who says we are going to have a surplus? The was an article in the NEJM a few years ago (they update this topic every few years, if I recall) that gave statistics of approximately 1/4 of residency slots going to FMGs. It would take A LOT of new schools to compete for those numbers.

The number of residencies doesn't necessarily correlate to the amount of physicians needed. For the DO Class of 2004, only 68% of budgeted Osteopathic Internships were filled, yet due to the AOA's continued stubbornness, these spots went un-filled while MD and FMG students may have taken them.

The real solution to the 32% that remained empty is a combined match. Many many DO students each year (48% in 2004) only do the ACGME match, one of the main reasons for this is because of the automatic withdraw rule. This rule says if you enter the AOA and ACGME matches that if you match to ANY AOA program on your list, you must go there and withdraw from the ACGME match.

Getting back to your point, just because spots exist doesn't necessarily mean there is a need for their graduates, just means there is funding for those spots.
As it stands right now, there can be NO MORE residency programs started with federal funding. So the AOA's stubbornness again is preventing new AMA and AOA residencies from opening up while 32% of AOA residencies (many FP) sit unused.

Not sure if I replied to your post at all, I'm just a little peeved at the AOA good old boys club in general right now. I guess I should be thankful I'm military and don't have to deal with the AOA after I graduate in 2008!

 

[drusso]

Fixing the doctor shortage

 

[MD2b20004]

I think the one key lost in all of this discussion is the recognition that the medical system has changed drastically over the past 20 years. The old system, in which medical doctors were allowed to dictate terms by virtue of their widely acknowledged moral/intellectual superiority, is over. Note that medical doctors (with any degree) aren't even masters of their own practice + operating rooms, any more! I'm sure all of us are familiar with the vocal frustration this has generated amongst some.

The balance has shifted. Medical care in this country is more of a "science" than ever. The Doctor-as-God has been replaced by managed-care-as-God. Corporate bureaucrats are running statistical analysis to determine the best (aka, least expensive) way of providing medical service to their patients. Medical doctors are agents of the medical system, with very little room for autonomy.

In my opinion, the huge explosion of osteopathic medical schools is in response to this shift in paradigm. From a purely quantative point of view, does anyone believe that a McDO graduate will be less capable of providing quality care... at least for 99% of the primary care patients out there? And if they're equally capable of providing care, why would the insurance company "care" about prestige + undergraduate research?

The bottom line will determine the outcome of this. With the skyrocketing cost of health-care, it's time to think like businessmen. As long as these new osteopathic hospitals are producing licensed graduates capable of providing quality care (as determined by the insurance companies), then they will thrive in this marketplace.

The fact that these DO graduates might be "looked down upon" by their MD-trained peers is really irrelevant, in the larger scope of things.

Very smart response, your defintely someone who knows whats going on in this world. America is a freakin' capitalist country, no matter what field your in, if you want to make money you HAVE to end up in the business side of things. Its unfortunate, but true. Business savvy people with bachelors degrees or even no degrees (experience) are running the lives of doctors and all professions. It sucks when you have to put 12 years in school, and all lost time and tuition just to be told what to do from a dumb a$$ business person who knows jack.

 

[MD2b20004]

drusso, I think the allopathic world will follow their traditional route of expansion through large universities. Already here in FL there are plans for an enormous medical education program at University of Central Florida, and one at Florida Atlantic University (or maybe Florida International, I get them confused).

heech, I think you're right on about the lack of importance of where education/training is done in most cases today. Any physician taking medicare/insurance assignment is just a cog in the wheel of the healthcare machine. Just look at the clinics sprouting up at WalMarts, called RediClinic. I just read an article about them in Fortune. They are staffed entirely by nurse practitioners and charge a flat rate of $45 for routine-type visits (colds etc). Their patients love it because they can walk in whenever they want (longer hours than dr offices (7am-7pm plus weekends), don't need an appointment, don't wait, pay less, and get their prescription filled right then and there. That's what patients want: speed, efficiency, and thrift.

Very interesting, did not know that. Very scary to think about it too. Makes you wonder whats next, and they wonder why physicians who have true passion for medicine sway away from primary care, its because primary care is run by PAs and NPs, I do not know how it is where you live but next time you go to your ER you will notice, 99% of the ER is run by Nurses and PAs, and they prob. have like one ER doc on duty for the major cases. Its getting crazy, CRNAs are taking over Anes. docs jobs, whats next a new program for all specialties to take over all specialties, example midlevel Pyschiatrist that can prescribe meds versus a full fledge doctor. The days of the doctor glory and money was back in the 80's and 90's, I think we are screwed, not only from the financial aspect, but from the aspect of how we can not even treat our patients the way you want to. With HMOs they want you in and out with a patient, and patients think doctors are cocky or a$$holes who don't listen to all their symptoms or do not give them enough time, well its because if they do they will be broke out of their a$$es and again it goes back to the fact that we can not avoid the fact that America is all about the bottom line. Its a CAPITALIST COUNTRY in every way you look at it.

 

[medhacker]

Fixing the doctor shortage

great article, thank you

I agree with the solution Dr. Rockey proposes. I wonder (and hope) the AOA GME is doing something similar and plans to find ways to lift the caps.

 

[mdub]

Increasing med schools to fit baby boomers is a PERMANENT solution to a TEMPORARY PROBLEM

What a ******ed argument. The Baby Boomers are going to be old and frail for decades. The lull you refered to is Gen X. After that there's Gen Y, which is much bigger than Gen X.

 

[mdub]

What are all the extra docs supposed to do in that 15-20 year gap?

Silly elective and cosmetic surgeries.

 

[drusso]

Call for More Doctors


From Inside Higher Ed

Underlying the [AAMC] medical college association’s statement is the assumption that while doctors educated at “osteopathic schools and schools outside the U.S.” will “continue to contribute importantly to meeting the health care needs of the United States,” physicians trained at traditional medical schools accredited by the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education should make up “the vast majority of licensed physicians” in the country. So while the AAMC statement looks to traditional medical colleges in the United States to fill most of the perceived void, it offers recommendations

As a result, it recommends that:

Enrollment in U.S.-accredited allopathic medical schools grow by 30 percent (from 2002 levels) over the next decade, both by expanding “capacity” at existing schools and encouraging state officials and others to establish new ones. Enrollments at existing medical schools have already begun to grow and medical schools have recently been created in Florida, while others are contemplated in Georgia and other states.

The federal government increase support through Medicare’s graduate medical education program to fund more residency positions.

The AAMC help colleges identify successful ways to improve the cost effectiveness of medical education and to enroll more underrepresented students.

The association work with medical school experts inside and outside the United States to find a “formal, voluntary process” for assessing the quality and rigor of medical schools outside the country, and to “expand collaboration between medical schools and teaching hospitals in the U.S. with those in less developed countries.”

Note: This was discussed several months ago on another SDN thread

The AAMC study the geographic distribution of physicians and find ways to increase the supply of doctors in underserved areas.


Food for thought and discussion:

1) Should the LCME and ACGME pathway be the preferred pathway for medical education accreditation in the USA? If so, why? How come the authors would recommend this? Is there a rationale for a competing accreditation pathway such as the AOA's? If so, on what basis would it be justified?

2) Too what extent are the physician maldistribution issues outlined by the authors an unintended consequence of the predominant LCME/ACGME medical education model? i.e. favoring the development of large, tertiary care training environments over smaller, community-based venues more popular in the AOA model of medical education. Given the current issues in health care which model should be pursued?

3) How should the osteopathic profession advocate and mobilize to ensure that its inadequately funded GME programs receive a fair share of new government funding when it becomes available?

4) How should the country deal with FMGs and US graduates from foreign medical schools. Should the education of US students off-shore be discouraged and instead should more opportunities be provided to them in either LCME/ACGME or AOA pathways? Alternatively, should the development of more PA and NP programs be fostered?

Please post your thoughts.

 

[medhacker]

The federal government increase support through Medicare’s graduate medical education program to fund more residency positions.

This is perhaps the best part of the entire news, IMHO

1) Should the LCME and ACGME pathway be the preferred pathway for medical education accreditation in the USA? If so, why? How come the authors would recommend this? Is there a rationale for a competing accreditation pathway such as the AOA's? If so, on what basis would it be justified?

I disagree it should be the preferred pathway. The authors have, IMHO, their own political agenda in suggesting it be the preferred one. Having a national physician constituency of mostly MDs is preferrable if you are the AAMC - if you know what I mean chilly bean...

3) How should the osteopathic profession advocate and mobilize to ensure that its inadequately funded GME programs receive a fair share of new government funding when it becomes available?

By explaining that the AOA pathway has the greatest potential to undo the maldistribution issues through its own education pathway - the opportunity is golden to get a greater piece of the pie I think

 

[Mixmaster]

This worries me as a future D.O. With M.D. schools growing more and more lower qualified students will be forced to go D.O. which will make the strong D.O.'s look bad and "water down" the degree. As it stands many strong applicants matriculate at osteopathic schools. I doubt this will continue if these applicants have more options. The reality is that MOST people would rather be MD's and with more MD schools most people will choose to go MD. Its a reality. The osteopath's need to start thinking about the future from NOW. Do we really want to be know as the backup schools? Do we want to be known to have lower MCAT's? Do we want to be known as having lower standards in education and accreditation than LCME schools? (I say this knowing there are many DO schools that blow away some MD programs - so I ask again why do the DO programs that are better have lower admission stats? - and please dont tell me that the DO schools look more at the applicant, because although this maybe somewhat true at some institutions it is not at all or even most) Do we want most grads to go or prefer ACGME? Do we want our grads who paid $200K and dedicated there lives to medicine to have people ask "what is a D.O.?" I have seen some brilliant students/doc's that are DO"s, just brilliant but the reality is most not all PD's will choose the MD with the exact same stats over the DO. Do we really want to always fight for equality? Is this all worth it? Just because we learned OMT in our first 2 years of medschool.

 

[newyorkcougar]

The concern that accepting more students will mean accepting lower quality students is both frequently raised and frequently addressed. The answer is that the growing applicant pool continues to supply increasing numbers of qualified applicants. Each year large numbers of well-qualified applicants are denied admission. Increasing class size will simply mean that more of these qualified students will get in.

Another myth that continues is that the osteopathic schools are getting the least qualified applicants. This line of thinking leads to the conclusion that lower admission standards (which are not going to happen) would lead to AOA schools admitting very underqualified applicants. The problems with this logic are that 1) standards are not falling, and 2) that many highly qualified students are choosing AOA schools over LCME schools. I, for example, got a 33R on my MCAT and had As in my science classes from a prestigious private university. I easily could have gained admission in an LCME school. I am not the only such student in my class. AOA schools are not simply catching the dregs of the application pool. They are accepting an increasingly competitive pool, and will continue to do so even as class sizes increase.

 

[exmike]

The concern that accepting more students will mean accepting lower quality students is both frequently raised and frequently addressed. The answer is that the growing applicant pool continues to supply increasing numbers of qualified applicants. Each year large numbers of well-qualified applicants are denied admission. Increasing class size will simply mean that more of these qualified students will get in.

Another myth that continues is that the osteopathic schools are getting the least qualified applicants. This line of thinking leads to the conclusion that lower admission standards (which are not going to happen) would lead to AOA schools admitting very underqualified applicants. The problems with this logic are that 1) standards are not falling, and 2) that many highly qualified students are choosing AOA schools over LCME schools. I, for example, got a 33R on my MCAT and had As in my science classes from a prestigious private university. I easily could have gained admission in an LCME school. I am not the only such student in my class. AOA schools are not simply catching the dregs of the application pool. They are accepting an increasingly competitive pool, and will continue to do so even as class sizes increase.

You are an exception to the rule, and you know that. In fact, as the DO slots have increased in recent years, the stats for DO students have remained stagnant or fallen, while the #of MD slots has remained about the same and the averages have gone up. There is no denying that expansion of medical school slots will lower averages for ALL schools of medicine. What impact this has on medical care remains to be seen.

If allopathic schools expand enrollment by 30% as encouraged by the AAMC, they'll essentially swallow up the entire DO school population. (4,500 additional slots). A great porportion of DO enrollees would probably choose to enroll in the MD schools. Who would fill those DO slots vacated by due to the new MD slots? I really do think that there comes a point when the quality of students will start to suffer. Noone wants a US medical school with 40-50% attrition rates like the Caribbean scohols.

 

[medhacker]

You are an exception to the rule, and you know that. In fact, as the DO slots have increased in recent years, the stats for DO students have remained stagnant or fallen, while the #of MD slots has remained about the same and the averages have gone up. There is no denying that expansion of medical school slots will lower averages for ALL schools of medicine. What impact this has on medical care remains to be seen.

If allopathic schools expand enrollment by 30% as encouraged by the AAMC, they'll essentially swallow up the entire DO school population. (4,500 additional slots). A great porportion of DO enrollees would probably choose to enroll in the MD schools. Who would fill those DO slots vacated by due to the new MD slots? I really do think that there comes a point when the quality of students will start to suffer. Noone wants a US medical school with 40-50% attrition rates like the Caribbean scohols.

Not too exceptional, I agree with that poster. It has also been addressed about how stats have actually increased in some cases of osteopathic medicals schools, a search will reveal the sources.

 

[USArmyDoc]

The thing we have to do is make the DO route popular....start education premeds, etc

 

[Mixmaster]

Not too exceptional, I agree with that poster. It has also been addressed about how stats have actually increased in some cases of osteopathic medicals schools, a search will reveal the sources.

Yeah increased ok but these highly qualified applicants would likely go MD if they could have or if the location they wanted had an extra MD spot open. Look at this http://www.kcom.edu/faculty/chamberlain/ranmcat.htm now what would you think if the DO schools started granting MD"s (and even still taught OMT)? I bet the average of all these schools would go up. Funny how two letters changes things, and that's all it is really 2 letters.

 

[drusso]

Well, here's some recent AACOM data:

http://www.aacom.org/data/presentations/2006NEAAHP.ppt#1

Also, you can read the comprehensive (3MB) report on the State of Osteopathic Medicine:

http://www.aacom.org/data/special-report.html

I don't know if increasing the number of MD spots will necessarily decrease the quality of DO students but it might have the potential to do so. It depends how sincere you believe DO-applicants are when they say that they want to acquire an osteopathic worldview...

My gut has been that about 1/2 of Do-applicants apply to both MD and DO schools and go either based upon a whole variety of factors including location, "feelings," cost, etc; about 1/4 really want to be DO's; and about 1/4 (usually vocal and somewhat ill-tempered) are "MD wannabes."

So, expanding MD enrollment will definitely take the 1/4 of MD wannabes out the mix, some percentage of the large middle might also elect to go to MD schools because of more options. So, you have to imagine what would be the long-term consequences for the profession of losing the MD-wannabes? Remember, these individuals *COULDN'T* get into an MD school and not always because they lacked the academic credentials!

The other variable is that the LCME, the AOA, and the feds are going to probably begin curtailing the importation of FMGs and US-FMGs (caribbean students). You can already here "whispers" of these policy discussions in certain venues--especially at the national licensure and accreditation level--many people are uncomfortable with having physicians from unaccredited schools have easy access to the US hospitals. So, individuals who would have gone to the caribbean will have more MD and DO options.

I think it does come back to promoting the field at increasingly earlier levels of training. I'm surprised how many pre-meds still don't know about the osteopathic profession even with the Internet, blogs, and resources like SDN. 10 years ago I had to bend over backwards to get accurate information about DO's. Maybe the more things change, the more they stay the same.

 

[exmike]

I think you guys are missing my point re: poaching of students.

The fact of the matter is that the problem for the medical profession in general is making sure that it is financially feasible for those interested in medicine to pursue medicine. There are many would be med students that are put off by the potentially tremendous debt burden coupled with the significant opportunity cost of putting off making real money for at least seven years post college.

I personally feel that the AAMC is being quite shortsighted, addressing only the output of medical students from medical schools and completely ignoring the input side. Even if 50% of DO students are poached by MD schools, that ISNT GOOD for medicine in general. We want HIGH QUALITY CARE from the most competent and brightest students possible - something that MD and DO schools are currently doing quite well.

What the AAMC needs to do FIRST is to initiate legislation that will create FINANCIAL incentives (ie scholarships, grants, lowered loan burdens) for students to pursue medicine as well as programs in high school and college that will guide students towards a career in medicine. What is the point of dramatically increasing the number of medical school slots if the people that fill those slots are substantially less qualified? Are we willing to compromise the quality of health care we provide just to fill a quota for the number of doctors we need to address future health care needs? Lets say DO and MD schools increased their slots 30% over night, the acceptance rates to each would approach 70%!! I'm not saying we need to be elitist with acceptance, but our current standards have created a atomosphere of relatively high quality care and I would not want to compromise that just to achieve a target number of physicians. The AAMC's solution is far from comprehensive.

 

[MoxieDO]

You are an exception to the rule, and you know that. In fact, as the DO slots have increased in recent years, the stats for DO students have remained stagnant or fallen, while the #of MD slots has remained about the same and the averages have gone up. There is no denying that expansion of medical school slots will lower averages for ALL schools of medicine. What impact this has on medical care remains to be seen.

If allopathic schools expand enrollment by 30% as encouraged by the AAMC, they'll essentially swallow up the entire DO school population. (4,500 additional slots). A great porportion of DO enrollees would probably choose to enroll in the MD schools. Who would fill those DO slots vacated by due to the new MD slots? I really do think that there comes a point when the quality of students will start to suffer. Noone wants a US medical school with 40-50% attrition rates like the Caribbean scohols.

Funny how there are many exceptions to "that" rule (which you really need to define, there are a lot to think about when choosing a medical school)

The problem with Osteopathic education is the lack of promotion for it, so we keep getting ignorant responses like this. The fact is that both US DO and MD schools give a great education. Although yes there are some DO schools that are below par, but there are just as many MD schools that are that way too, in the US, and no one mentions it. DOs have made great strides in the past century to get where they are now (read The DOs by Gevitz) and I doubt they will let something like this get DOs down. As the applicant pool gets more competative, people will start to look towards alternative or new directions/philosophies/trainings to pursue being a doctor and more competative applicants will continue to turn to a DO education. Already in a short period of time many DOs have become equal to or above MD schools Also with top schools like Harvard looking into OMT, others schools will surely follow and then nothing will really separate DO from MD. So the real weakness in your arguement is the failure to see that the pool of people applying to medical school is growing rapidly. While for a while standards at all schools *might* be slighly lowered to fill spots, I doubt there will ever be a lack of qualified medical applicants. I do not know what the political future holds for MDs and DOs-expansion, merger, socialism [please no discussion just mentioning hot topics], the only thing I would be concerned with, as far as admissions, is the increase of less qualified FMGs entering the system and the ramifications to the healthcare system in terms of quality care and malpractice. There is also the ever growing NP debate (other threads, oye!)

 

[UserNameNeeded]

The fact of the matter is that the problem for the medical profession in general is making sure that it is financially feasible for those interested in medicine to pursue medicine. There are many would be med students that are put off by the potentially tremendous debt burden coupled with the significant opportunity cost of putting off making real money for at least seven years post college.

I totally agree on that point. There's no excuse to for medical schools to play up the humanitarian nature of this profession (when seeking applicants) and then turning around and effectively enslaving those accepted applicants to huge life-long financial debt. There are many, many undergraduate students who come from lower socioeconomic classes and who are now turning towards other professions because of the scary debt numbers they see for medical graduates. This is effectively wiping out a portion of the applicant pool that could have very well served minorities and underserved areas.

Look at this http://www.kcom.edu/faculty/chamberlain/ranmcat.htm

The MCAT average for UNTHSC-TCOM is wrong. It's been at 28 for at least the last couple of years and before that was 27. It ranks above, at least, 3 Texas MD schools in MCAT averages and/or GPAs.

While I would normally think gradually expanding the class sizes might lower applicant quality (in stats), there really seems to be upward momentum in GPAs and MCAT scores every year. For example, during the last several years in Texas all of the 7 state schools (of which UNTHSC-TCOM is one) have been expanding class sizes state-wide and will continue to do so. The MCAT and GPA numbers on students has either stayed steady or has gone up for every school.

 

[drusso]

Interesting Editorial in Academic Medicine:


Increasing the Aggregate Supply of Physicians


"Let us assume for the moment that the number of allopathic medical school graduates does increase substantially in the coming years. If so, what impact will that have on the aggregate supply of physicians for the country? It should not surprise anyone to learn that the impact might be quite small. How can that be? Quite simply because the aggregate supply of physicians is determined by the number of entry-level positions in the country's graduate medical education (GME) system, not the number of graduates from U.S. allopathic medical schools.

At present, the number of entry-level positions in the GME system exceeds by almost 50% the number of this country's allopathic medical school graduates (USMGs). It is almost a given that GME programs that now accept graduates of non-U.S. medical schools (IMGs) and/or graduates of osteopathic medical schools (DOs) into those positions will preferentially accept any additional graduates of U.S. allopathic schools. Thus, if the total number of entry level positions in the GME system remains relatively constant while the number of USMGs increases, some IMGs and DOs who might otherwise have been accepted into allopathic GME programs will not be accepted in the future. The end result will be that the number of physicians entering practice will remain relatively constant.

Now some might not see this is a likely scenario. In their minds, teaching hospitals will respond to the impending shortage of physicians by increasing the number of positions they currently fund. Well, maybe, but certainly not to the degree that would be required to provide new positions for all of the additional USMGs. Again, it is important to realize that the current system could accommodate a 30% increase in USMGs simply by limiting the number of IMGs and DOs entering the system. But even if hospitals were inclined to increase the number of entry-level positions they sponsor, I think it is highly unlikely that the number will increase substantially unless the Centers for Medicare and Medicaid Services agrees to provide Medicare funding for those positions by removing the Medicare caps currently imposed on GME sponsors. And even if that were to occur, hospitals would still be faced with providing from their patient care revenues a significant increase in funding to cover the total costs of expanding residency positions. Although nonteaching hospitals that decide to start new GME programs are not affected by predetermined caps, the number of hospitals that are likely to embark on this course is, in my opinion, quite small, and the number of new positions likely to be funded by those that do so will be small. So whatever the increase in enrollments in allopathic medical schools, it is highly unlikely that it will result in a proportionate increase in the aggregate supply of physicians."


Some things to consider:

1) How should the osteopathic profession position itself given the scenario outlined above?

2) Is the author correct in stating that "it is a given" that ACGME-accredited programs will likely preferentially accept any MD-graduate, even less qualified ones, over DO-graduates if the total number of MD-graduates increases?

3) If fewer DO's match into ACGME-accredited residency programs where will they train?

3a) If more DO's train in AOA-accredited programs that would help strengthen osteopathic GME; however, it may limit the options that DO graduates have in what kind of post-graduate training opportunities they pursue.

3b) There has been a recent shift in osteopathic GME, and the allocation of GME slots, away from primary care residencies and more toward specialty and subspecialty programs. Should this shift be formal policy and strategy? Do we need more osteopathic specialists trained in AOA-accredited programs?

4) How should student leadership be responding to these events?

 

[jgrady]

Speaking for Phoenix, we seem to be a microcosm of this topic. AZ has the UofA allopathic school two hours south in Tucson and AZCOM in suburban Phoenix. Because our students weren't allowed into ward-based rotations until recently, only about 15% of our graduates stay in AZ. Moreover, we're one of the only private med schools in the West and a top ranked one (based on Boards scores) at that.

So Phoenix, now about the 5th biggest city in the country, faces a shortage of physicians. The problem is being addressed by:

1) AZCOM students are being allowed to rotate in Phoenix residency programs by state mandate. In fact, our school is going to limit the out of state rotations we can do in 3rd year to encourage more graduates to stay.

2) AZCOM is increasing its class size from about 150 to over 250 students.

3) The state is funding a new medical school in downtown supported by both ASU and UofA. In classic political doublespeak, this is supposed to both provide more primary care docs locally and launch a biotech research boom in a new technology center.

4) Creighton is opening an allopathic branch campus in suburban Phoenix.

5) Kirksville is opening an osteopathic branch campus close to Creighton's location.

Even though AZCOM draws heavily from many western states (UT, WA, OR, CA, CO, etc.) you can't logically believe these schools won't have to dig deeper into the applicant pool to fill their slots and maintain their funding. Even some of my Professors are concerned about future student quality - and how that will effect our envious Boards results record.

It's going to be hard for osteopathic schools like AZCOM to justify $40k per year when ASU/UofA will probably charge less than $20k.

 

[homeboy]

Interesting Editorial in Academic Medicine:

Some things to consider:

1) How should the osteopathic profession position itself given the scenario outlined above?

2) Is the author correct in stating that "it is a given" that ACGME-accredited programs will likely preferentially accept any MD-graduate, even less qualified ones, over DO-graduates if the total number of MD-graduates increases?

3) If fewer DO's match into ACGME-accredited residency programs where will they train?

3a) If more DO's train in AOA-accredited programs that would help strengthen osteopathic GME; however, it may limit the options that DO graduates have in what kind of post-graduate training opportunities they pursue.

3b) There has been a recent shift in osteopathic GME, and the allocation of GME slots, away from primary care residencies and more toward specialty and subspecialty programs. Should this shift be formal policy and strategy? Do we need more osteopathic specialists trained in AOA-accredited programs?

4) How should student leadership be responding to these events?

Good post, and you raise some interesting questions, particularly the ones about AOA GME.

 

[exmike]

It has been mentioned before. The bottleneck is at the point of medicare funded GME residencies. Until the cap is raised, all that increasing the number of US med school slots does is push out some IMGs/lower performing US students from matching.

 

[gildas]

Yes, however they did not have as many kids as their parents did.

Even if they did, baby boomers didn't start having their own kids in Kindergarten, the next surge in births would have been about 25-30 years after the start of the baby boomers, which would be about 1971-1985. This 2nd generation boomers would be somewhere between 20 and 35 now and won't be needing elderly amounts of health care for at least 30-40 years. In the meantime, assuming the average boomer dies at 75-80, the boomers will be gone in 20-25 years. What are all the extra docs supposed to do in that 15-20 year gap?

Guys, I personally do not beleive that there will be a surplus of Medical Doctors in the near future because of the fact that the US population will continue to grow even though the growing rate might slow down after the baby boomer generation. Will Medical Schools produce qualified Doctors with the expansion? Yes, There have being reports that claimed that more than half of the applicants rejected by the Medical School Admissions are academically qualified. And as many of you might noticed, there are many doctors that thrive in the profession, after being rejected numerous time during their application process (mainly due to their undergrade academic performance). GPA and MCAT alone do not dictate a person's capability to succeed in Medicine.
However, what I might be more concerned about the number of positions available for clinical rotations and residencies with the expension of medical schools. What good will it do to accept more students if there would not be enough space and staffs in clinical institutions to provide clinical experiences.

 

[homeboy]

It has been mentioned before. The bottleneck is at the point of medicare funded GME residencies. Until the cap is raised, all that increasing the number of US med school slots does is push out some IMGs/lower performing US students from matching.

Mike has a great point that is often overlooked: the number of residencies is dependent on medicare funding...we could start a handful of residencies at the hospitals in my town, but we wouldn't get funding for them.

 

[FutureNavyDOc]

Mike has a great point that is often overlooked: the number of residencies is dependent on medicare funding...we could start a handful of residencies at the hospitals in my town, but we wouldn't get funding for them.

However while there is a lack of funding for new residencies, the AOA has dozens go unfilled every year mainly because they are too stubborn to do a combined match and they don't allow MD's to take even the un-used spots.


Moral of the story: It is better to be stubborn than right.

 

[iliacus]

Seems like there's a medical vacuum out there that osteopathic medicine stepped up to fill...Although I don't advocate the "starbucks" model of opening new DO schools on every block, it's going to be interesting to see how things pan out the next 20 years.

 

[Al2VCOM]

drusso, I think the allopathic world will follow their traditional route of expansion through large universities. Already here in FL there are plans for an enormous medical education program at University of Central Florida, and one at Florida Atlantic University (or maybe Florida International, I get them confused).

The first class of UCF will be 40 MDs. Their target is 120. I see this as judicous with the aging Fl population, but the DO school expansion is disturbing. The proposed [colorado] school had better get temp accreditation before 2007, cuz AOA has upped the cash needed to start a school starting sometime in 2007. Maybe that will keep the unwanted folks out, NavyDoc. It is scary when those credentials get accepted, but time will tell.

 

[fuegorama]

1) How should the osteopathic profession position itself given the scenario outlined above?

The AOA must change its focus from "the DO is different....really" to "we can function as well as our allo colleagues and we have a skill set that pts like even if it lacks evidence". The focus of the AOA is the preservation of the DO as a unique entity. If osteopathy dies as a profession b/c of this attitude, it makes no difference to the boyz in Chicago.
Solution-A.Challenge LCME accreditation in every COM. The survivors can still play. B. Create a pre-lim osteo internship for MDs to gain admission to DO residencies. C. Kill the current Comlex. Everybody takes the USMLE. Create an OMM specific exam that the MD pre-lim grads can take and that all the DO grads must take.

2) Is the author correct in stating that "it is a given" that ACGME-accredited programs will likely preferentially accept any MD-graduate, even less qualified ones, over DO-graduates if the total number of MD-graduates increases?

Not immediately, but if the overall quality of the DO grads decreases as a result of the McCOMs and the lower tier apps. get absorbed by new MD programs, then yes you will see the DO looked over for the allo grad.

3) If fewer DO's match into ACGME-accredited residency programs where will they train?

Michigan

3a) If more DO's train in AOA-accredited programs that would help strengthen osteopathic GME; however, it may limit the options that DO graduates have in what kind of post-graduate training opportunities they pursue.

Agreed

3b) There has been a recent shift in osteopathic GME, and the allocation of GME slots, away from primary care residencies and more toward specialty and subspecialty programs. Should this shift be formal policy and strategy? Do we need more osteopathic specialists trained in AOA-accredited programs?

Yes. The primary care focus of the osteo profession is 180 degrees away from reality. The mid-level explosion is here. Today's FP grads will be shrapnel casualties. The NP has basically filled the role of the PCP. We must be specialists to justify our training. It's an uncomfortable truth.

4) How should student leadership be responding to these events?

What is student leadership? I haven't ever seen it

 

[Krisss17]

What a ******ed argument. The Baby Boomers are going to be old and frail for decades. The lull you refered to is Gen X. After that there's Gen Y, which is much bigger than Gen X.

Not to mention that fact that our young people (children and teens) are increasingly suffering conditions due to obesity. The rise of diabetes type 2 has grown exponentially within the last decade...

(Since I'm at the tail-end of the BB, I get confused over the Gen Y and Gen X populations).

 

[VaEMTGuy]

Interesting position brief by the AAMC:

Analysis of medical school expansion plans

"A 15 percent increase in allopathic enrollment would be about equal to an additional 2,400 students per year over 2003 levels. While osteopathic enrollment and graduations have grown by nearly 300 percent over the past 25 years, their continued growth alone will not meet the needs of the nation."

Osteopathic medicine took a lot of criticism for its expansion in the last 25-30 years, but one wonders if the osteopathic community actually read the tea leaves correctly.

Only very recently have MD-granting institutions begun thinking about expansion. However, my bet is that when new MD schools do begin opening, it will be it will be a more rational and conscientious expansion of existing programs. It will be interesting to see if these new MD-granting programs will follow the "osteopathic model" of free-standing, private, non-research university affiliated programs or opt for a more traditional arrangements.

Getting back to the original post of this thread. Here's the announcement from January 3rd for one of the first new medical schools It will be opened in Roanoke, Virginia in conjunction with Virginia Tech. The impact of this on VCOM and its agreements with VT remain to be seen.

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From the Virginia Tech News:

Virginia Tech, Carilion will create joint medical school in Roanoke

By Larry Hincker

BLACKSBURG, VA., January 3, 2007 -- Gov. Timothy M. Kaine joined Virginia Tech President Charles W. Steger and Carilion CEO Dr. Edward G. Murphy Wednesday to announce the creation of a new medical school in Virginia. Virginia Tech and Carilion will create a jointly operated private medical school, located in downtown Roanoke, adjacent to Carilion Roanoke Memorial Hospital.

"I am very pleased to support this important initiative to help meet the health workforce and medical research needs of our state, as well as to strengthen the economy of the region," Gov. Kaine said.

"This will be a great asset for the medical community and the region," said Murphy. "It will make the area more attractive for doctors we’re recruiting now, and increase the number of doctors who are likely to stay in the area after their medical training."

Key facts and statistics related to the new school are posted online, as is a site plan (PDF) showing the future location.

According to the Association of American Medical Colleges (AAMC), 30 million people are currently affected by physician shortages, including many communities across Virginia. Critical shortages are expected by 2020, unless medical school enrollment increases by 30 percent. With only half of U.S. medical schools even considering enrollment expansion, AAMC concludes that new medical schools must be created.

Patterned after Harvard Medical School’s Health Sciences and Technology (HST) program and Cleveland Clinic’s Lerner College of Medicine, the new school will have a small class size and be dedicated to training physician researchers. Class size is projected to be 40 students per year. In addition to a traditional medical school curriculum, all students will receive training in research methods, conduct original research and write a thesis as a condition of graduation. To accommodate the expanded graduation requirements, the school will have a five year curriculum instead of the traditional four year curriculum.

The combination of a medical school and research institute on the campus of a major medical center will move Virginia Tech closer to its goal of becoming one of the country’s top 30 research universities. The school and research institute will also provide valuable support to Carilion’s conversion to a clinic model.

"Virginia Tech’s nationally ranked research program and our close association with Carilion create a unique opportunity," said Steger. "We can create a respected medical education program that will improve the region’s healthcare, generate economic growth and enhance the overall research profile of the university."

Research will be a key component of the school’s curriculum; with the goal of training physicians who want to make research part of their medical career. Virginia Tech’s partnership with Carilion provides opportunities to expand important research programs at Virginia Tech, including: bioinformatics, computer science, and engineering, along with epidemiology, health services, basic sciences and clinical research. Students will have the option of earning a master’s degree at the same time they complete their medical training. This curriculum will also put a Ph.D. within reach for students who would like to pursue one.

According to Murphy, "Our graduates will make a unique and special contribution to any medical specialty they choose."

The presence of a medical school on the Carilion Clinic campus will add to the growing South Jefferson corridor and further efforts to build a robust and exciting economic climate in downtown Roanoke. The school will be co-located with the future Virginia Tech-Carilion Medical Research Institute, in close proximity to Carilion Roanoke Memorial Hospital, the Jefferson College of Health Sciences, and the Roanoke Higher Education Center.

The school will bring economic benefits to the entire region. According to an AAMC study, every dollar spent by a medical school or teaching hospital creates an additional $1.30 in economic activity. Even though most AAMC schools are not-for-profit and tax exempt, economic activity associated with the schools generated $14.7 billion in state tax revenue.

Eastern Virginia Medical School and its affiliated hospitals contribute $923 million to the state’s economy. Penn State College of Medicine and its affiliated medical center had a $613 million statewide economic impact in 2002. Ohio’s seven medical schools and affiliated teaching hospitals had a $20 billion impact on state business volume.

One of the country’s newest medical schools will open at Florida International University in 2008. A recently commissioned economic impact study determined that the school would generate a $58 million economic impact in its first year of operation and grow to $1.1 billion in less than 20 years. The school is expected to generate more than 11,000 new jobs and contribute $22 million annually to the local tax base.

Although the school’s financial plan is not yet finalized, Carilion and Virginia Tech are in a unique position to develop a cost effective, financially self-sustaining school. The key academic infrastructure needed for a medical school is already in place at Virginia Tech and Carilion. Virginia Tech currently teaches most of the basic science courses needed for a medical school curriculum.

Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital have been part of a strong and successful medical education program for more than 50 years. Carilion currently sponsors seven medical residency programs with more than 100 full-time faculty physicians. Virginia Tech and Carilion will rely on current resources plus tuition to meet the new school’s operating needs. Philanthropic gifts are anticipated to fund future programs.

Construction on the medical school and research building will begin in early 2008 with the school welcoming its inaugural class in 2009 or 2010.

http://www.vtnews.vt.edu/story.php?relyear=2007&itemno=5

--------------------------------------------------------------------------

 

[NRAI2001]

Wont a 30% increase (I think someone stated it was a proposed 30% increase) basically put DO schools out of business? I think when I read the original article by the AMA president it seemed as though the 30% increase has some questionable motives behind it; seemed mainly to put carribean and DO schools out of business.....remember him saying something about how we have a responsibilty to train our own doctors and to allow our own citizens to train in the US instead of sending them to carribean schools and DO schools....etc.

But seriously a 30% increase if I remember was something like 4 thousand more accepted students to US MD schools, which is close to the number of students that attend the top 3 carribean schools and all the DO schools put together.. I m just worried that a DO degree maybe laughed at or scoffed at in the future if this were to occur and all the DO schools ended up closing???

Anybody thought about this?