Addressing Osteopathic Medicine’s Vulnerabilities: The View through an External Lens

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This is a version of a talk I gave in November 2021 to a group of osteopathic medical school deans, who invited me to share my opinions on the vulnerabilities of osteopathic medicine and osteopathic medical education as a prelude to their own strategic planning.
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SECTIONS:
I. TUITION (6:35)
COMs are more dependent on tuition revenue than allopathic medical schools… which means they’re uniquely sensitive to anything that disrupts the flow of tuition dollars. But what if lenders began to use some underwriting standards?
II. STUDENT LOAN DEBT (16:30)
Osteopathic students take on more debt than their MD colleagues, then enter careers with less earnings potential. We may be in an “education bubble market” - could the bubble burst?
III. MATCH OUTCOMES (24:16)
MD students enjoy greater success in the Match than DOs, and the more competitive the specialty, the greater the disparity. But it’s hard to sell a more expensive product that leads to fewer job opportunities.
IV. EXPANSION (37:59)
The number of accredited COMs has increased exponentially over the past 20 years. But there is real danger to osteopathic medicine and the DO degree if expansion comes at the expense of educational quality.
V. DISTINCTIVENESS (53:36)
Many things about osteopathic medicine are distinctive. But which are the essential features that should be defended? And which are just different for different’s sake?
VI: FINAL THOUGHTS (1:00:11)
We used to have two professional basketball leagues in the U.S: the NBA and the ABA. In 1976, they merged. So who “won” the NBA-ABA merger?
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NOTES:
1. This version is slightly longer than the one I actually delivered, which had to fit within an hour time slot - so some of the discussion at the end is a bit more fleshed out here.
2. The lecture received a mixed response. Some deans, I think, appreciated hearing the opinions of an outsider. But certain others were put off both by some of the things I mentioned and the way that I mentioned them. In particular, my opinions about the National Board of Osteopathic Medical Examiners (NBOME) were not favorably received. Certainly, others are entitled to their opinions… but I stand by mine.
If you’re interested, I’ve written before about how the NBOME seems like an organization that’s outlived its usefulness on the Sheriff of Sodium site:
thesheriffofsodium.com/2020/1...
I’ve also debated the merits of a “separate but equal” examination system in an article and series of correspondence in Academic Medicine (including some from the CEO of the NBOME himself).
Here are those articles, in sequence:
a. Original article:
journals.lww.com/academicmedi...
b. First letter to editor:
journals.lww.com/academicmedi...
c. Our reply to the first LTE:
journals.lww.com/academicmedi...
d. NBOME CEO’s reply to our reply:
journals.lww.com/academicmedi...
e. Our reply to the NBOME CEO:
journals.lww.com/academicmedi...
3. In my Q&A, I invited anyone who had concerns to please reach out to me, because although we may disagree about the inference, the data I present should be good. If you find something that seems incorrect, please let me know - I want to get it right.
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ADDENDUM (12/4/2021):
There are incorrect figures presented on two slides in the talk. These figures relate to the number of osteopathic medical school applicants and matriculants from Idaho and Montana, and appear at 38:47 and 40:27, respectively.
I mistakenly used 2021 data from AACOM - but these figures are preliminary. I should have used their figures from 2020, which would have shown that there were 143 osteopathic medical school applicants and 64 matriculants from Idaho, and 48 applicants and 18 matriculants from Montana.
Full AACOM data are here:
www.aacom.org/docs/default-so...
Upon careful consideration, I’ve chosen not to take down the video, because these data are not central to the point I was making in that section. Whether there’s 1 or 64 medical students from Idaho is honestly irrelevant to my central point, which is that if you expand medical school enrollment faster than you expand your supply of highly-qualified applicants, you put the quality of your degree at risk.
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MUSIC
“Clutch,” by Nicolas Major.

Опубликовано:

19 июн 2024

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Комментарии : 38

@jonfilibuster8499 2 года назад

Very well put together presentation. As a DO student, you hit everything perfectly, especially when talking about rotation sites and how not everyone is meant to be a doctor.

@WeirdLittleDreams 2 года назад

You brought up the lack of research on Osteopathic treatment methods!!!! That was bold!!!!

@rickypen 11 месяцев назад

I dont think even osteopaths argue with the lack of scientifically tested evidence for a lot of the stuff we have to learn in DO programs. I mean...a lot of it, I'm not even sure you you would test lol. The stuff like muscle energy, or HVLA would be more easily tested than other treatment modality. And I would argue most DO students just see learning all the OMT as the DO tax. Learning all the chapmans points (magic voodoo buttons) for COMLEX is frustrating, but I am pretty sure most students drop them.

@jacobthiessen7027 2 месяца назад

It's not even bold. It's supposed to be how science works. For some reason DO programs like to stick the heads in the sand when students and outsiders being it up though...

@jessi74 2 года назад

I very much enjoyed this talk, as I usually do. It would be fascinating to have someone do the same sort of thing from the MD side

@sheriffofsodium 2 года назад

I’d be happy to do it… AAMC, you interested?

@soccerdreams7955 2 года назад

Another banger that was expected 🤑🥱🥱🥱🥱🥱🥱🥱🥱

@wol_ves 3 месяца назад

I can't imagine this was a very popular presentation hahaha but I think you made some excellent points. I would love to hear some responses or thoughts from some of the DO deans--we all have our blind spots, and the way they think about things could be very different in some cases but I'm not a DO so I don't have the necessary background. Regardless, I think this was a great presentation that seems to very accurately not only diagnose some of the potential issues or challenges facing DO schools but also suggest some potentially difficult but necessary recommendations. Thank you for sharing it with us!

@sheriffofsodium 3 месяца назад

It was not a very popular presentation. But honestly, that’s all the more credit to Dr. Robert Cain, AACOM’s president, for not only having the courage to ask someone outside the fold to give a talk, but also for having the integrity to let that person speak freely. He didn’t demand to see my slides ahead of time or give me any rules about what I could or couldn’t say. I think he got some grief for giving me a platform, though.

@mr.medtech731 2 года назад

Totally agree.

@WeirdLittleDreams 2 года назад

Sir!!!! Why do you have audiobook voice?!?!?

@brennengodeen3796 2 месяца назад

If AI is capable of replacing physicians, I question its capacity to replace many other professions. I also ask patients I encounter on rotations about their thoughts on the future and predictions of AI in the workplace. I typically ask while I am trying to stall and make some small talk. They frequently respond with hesitancy and skepticism. Many prefer the patient doctor interaction and this response is especially common among primary care services. However, I do hear positive feedback from patients who are not currently receiving care and yet to develop a report with a PCP. Few answer positively and with optimism because they say that their prior healthcare experiences were “robotic” or their concerns were not heard and addressed appropriately. Almost as if they were being moved through an assembly line and that they provider didn’t perform a physical examination and that AI could produce comparable results.

@oliverallen5324 3 месяца назад

I've been in EMS a long time, and I tell those new to the field that working in a rural setting is likely more rewarding as you mature, but at the beginning you need that big city volume of calls to even sort out what you're doing. You need repetition, 10s of thousands of calls. I'm working on my return to medical school and I don't figure it's any different at the MD level as it is with the EMT-B/A/P levels. It's getting tough everywhere. You're going to have to be the best at w/e you do to get your spot.

@sheriffofsodium 3 месяца назад

Great points. Thank you.

@rachelgrubbs 2 года назад

Is there a transcript of this?

@sheriffofsodium 2 года назад

I didn’t make one - I just spoke from my notes for the live presentation and this recording.

@davidr4523 Год назад

What an excellent presentation and one not encouraging for hopeful medical students to choose the DO route. Without question, USA MD programs are superior to USA DO, which you have clearly proven. The bigger question now is Caribbean MD a better option than USA DO?

@DEFENDERd25 Год назад

Not if you want to match. International medical graduates have a much harder time securing spots relative to American grads, MD and DO.

@sjc8947 3 месяца назад

I’m curious, what is your opinion on Puerto Rico US MD medical schools compared to US the old medical schools?

@leewisnioski95 2 года назад

One can not research Osteopathic PRINCIPALS (not Techniques) the same way you research Allopathic treatments. If you do, then half the time the treatment will work and the other half of the time it will not.

@sheriffofsodium 2 года назад

I’m honestly interested to hear more. Could you explain why, or how osteopathic principles ought to be studied?

@leewisnioski95 2 года назад

@@sheriffofsodium When a research project is put together it is determined which symptom is to be treated. Then, it is determined which "Technique" will be utilized. This is Allopathic. Not Osteopathic. In the philosophy of Osteopathy almost any symptom can be caused by almost any dysfunction. If you wanted to measure the result of an Osteopathic treatment. Then you would have to allow the practitioner to determine where the dysfunction existed and how it was to be treated. Every human being is different. Every cause may elicit an individual symptom. Love your presentation by the way. I bet you caused some dysfunctions.

@leewisnioski95 2 года назад

Just to gild the lily. Most importantly the sequence in which the practitioner to decides to treat the dysfunctions, they diagnosed while screening, will vary with each patient. Ask the following question. How important is the sequence of actions in most, if not all, procedures. Example, If I put the toothpaste on the toothbrush after I brush my teeth. How effective is the procedure.

@rickypen 11 месяцев назад

Gun control has around that favorability, im pretty sure access to safe abortion at least up until 15 weeks. I think even some type of Medicare for all or govt funded medical access. There is actually a lot of agreement for a lot of issues, it just seems a lot more divided than it is.

@NhanTran-tm9hu Год назад

You have no idea what you are talking about. You are living in the 1980s

@TheExclusiveB13 2 месяца назад

MD med school reject

@JL-kk9hl 2 года назад

I just don't know how we can reasonably consider an osteopathic education equivalent to an MD- they seem very different....

@abrahamo8934 2 года назад

You have not worked in the field obviously. The end both get too is the same it's md training + osteopathic principles. That's it. In the real world nobody sees a difference.

@alameriki123 2 года назад

Stupid take , they all train in ACGME residency programs

@dr.pakalupapito6015 2 года назад

In this video, Dr. Carmody talks about the flaws within the DO medical schooling system. This has nothing to do with the content of education provided by these schools. All these schools are World Directory of Medical Schools registered medical schools that deliver a full medical and surgical education. There are many flawed “MD educationing systems” around the world that we consider equivalent to an MD via ECFMG. So no, the one thing Dr. Carmody will never question is the education of DOs as compared to MDs. Many MD schools may have a well established system, but DO=MD in knowledge and practice. You can have an opinion about it, but it won’t change the facts or laws.

@JL-kk9hl 2 года назад

@@dr.pakalupapito6015 Then what's with the DO schools and the tiny hospitals for core rotations? Is this a problem at US MD schools nowadays, too?

@JL-kk9hl 2 года назад

@@alameriki123 Absolutely. But med school training seems different, although maybe it's irrelevant?