Friday, July 02, 2004
Future of the Osteopathic Internship
Letters on future of the Osteopathic Internship
This is a couple of letters written by faculty of West Virginia School of Osteopathic Medicine. While they make some good points (the first one) and somewhat reinforces my idea of the need to dually accredit more programs (AOA/ACGME) to accomodate the growing number of osteopathic school graduates, they do not really tell the whole story.
The first letter, "Future of the Osteopathic Internship," tells of the osteopathic philosophy of generalist first, specialist later. While this is a noble goal (and just so you know, I will probably complete an osteopathic internship), I think it is somewhat outdated. Most residency programs train a physician in a number of fields included in the traditional internship (OB/GYN, Family medicine, Int Med, Surg, Peds) in their first year of postgraduate training anyway, so why the need for an additional year of "generalist" training. It has been postulated that this is still an AOA requirement to ensure the few "Osteopathic" hospitals that remain that they will have a renewable source of cheap labor. This is definitely a possibility. Another hypothesis involves something akin to brainwashing. Proponents say that by the time you are done with this internship, you are so deeply indoctrinated into the ways of osteopathy that you would never dare to leave its arms.
I have a tendency to take a third view, somewhat comprised of the others, but still unique. If the AOA requires an osteopathic internship for licensure (and the 5 key states of PA, FL, WV, OK, and MI do as well), then students who wish to either practice in one of these 5 states or be recognized in the future by their accrediting body are forced to obtain this training. This, of course, ensures cheap labor for the struggling osteopathic hospitals. It also gives the training physicians a year to pressure the intern to stay in their program or at least go to another osteopathic program. Finally, it makes finding placement in an allopathic (ACGME) residency after the internship more difficult. Let me explain:
1) There are several residency programs that will not consider any applicant with prior training, no matter what. This takes this number out of the possible training pool.
2) The rigors of the internship year are not conducive to application to residency programs and residency interviews. This further encourages the resident to stay at the current institution or go to another nearby institution.
3) The aforementioned rigors of the intern year are such that not many would want to repeat them; something which is a distinct possibility if the student goes to an ACGME residency after their intern year - most ACGME residencies do not recognize an AOA traditional rotating internship and will require the student to start over again at the bottom of the barrel.
4) Money. The Centers of Medicare and Medicaid (CMS or whatever) has decided how many years each specialty should take to train. Therefore, if a resident starts one residency and decides to go to another specialty mid-training, there is the distinct possibility that the residency program would get decreased funding for the last 1-2 years of the resident's training. This is another hurdle that an osteopathic resident must overcome - convincing the residency program to take a loss on their training in order to attend their institution. In today's age of medical cutbacks and shortfalls, this is a very hard case to argue. This, again, makes it difficult for an osteopathic resident to make the transition from osteopathic internship to ACGME residency.
All of these factors add up to make life difficult for the osteopathic resident/student. While they may want to follow their osteopathic roots and complete the osteopathic internship, their post-internship choices are decidedly limited. This is unfortunate, for I find myself in this position.
more to come... ¶ 4:44 PM
This is a couple of letters written by faculty of West Virginia School of Osteopathic Medicine. While they make some good points (the first one) and somewhat reinforces my idea of the need to dually accredit more programs (AOA/ACGME) to accomodate the growing number of osteopathic school graduates, they do not really tell the whole story.
The first letter, "Future of the Osteopathic Internship," tells of the osteopathic philosophy of generalist first, specialist later. While this is a noble goal (and just so you know, I will probably complete an osteopathic internship), I think it is somewhat outdated. Most residency programs train a physician in a number of fields included in the traditional internship (OB/GYN, Family medicine, Int Med, Surg, Peds) in their first year of postgraduate training anyway, so why the need for an additional year of "generalist" training. It has been postulated that this is still an AOA requirement to ensure the few "Osteopathic" hospitals that remain that they will have a renewable source of cheap labor. This is definitely a possibility. Another hypothesis involves something akin to brainwashing. Proponents say that by the time you are done with this internship, you are so deeply indoctrinated into the ways of osteopathy that you would never dare to leave its arms.
I have a tendency to take a third view, somewhat comprised of the others, but still unique. If the AOA requires an osteopathic internship for licensure (and the 5 key states of PA, FL, WV, OK, and MI do as well), then students who wish to either practice in one of these 5 states or be recognized in the future by their accrediting body are forced to obtain this training. This, of course, ensures cheap labor for the struggling osteopathic hospitals. It also gives the training physicians a year to pressure the intern to stay in their program or at least go to another osteopathic program. Finally, it makes finding placement in an allopathic (ACGME) residency after the internship more difficult. Let me explain:
1) There are several residency programs that will not consider any applicant with prior training, no matter what. This takes this number out of the possible training pool.
2) The rigors of the internship year are not conducive to application to residency programs and residency interviews. This further encourages the resident to stay at the current institution or go to another nearby institution.
3) The aforementioned rigors of the intern year are such that not many would want to repeat them; something which is a distinct possibility if the student goes to an ACGME residency after their intern year - most ACGME residencies do not recognize an AOA traditional rotating internship and will require the student to start over again at the bottom of the barrel.
4) Money. The Centers of Medicare and Medicaid (CMS or whatever) has decided how many years each specialty should take to train. Therefore, if a resident starts one residency and decides to go to another specialty mid-training, there is the distinct possibility that the residency program would get decreased funding for the last 1-2 years of the resident's training. This is another hurdle that an osteopathic resident must overcome - convincing the residency program to take a loss on their training in order to attend their institution. In today's age of medical cutbacks and shortfalls, this is a very hard case to argue. This, again, makes it difficult for an osteopathic resident to make the transition from osteopathic internship to ACGME residency.
All of these factors add up to make life difficult for the osteopathic resident/student. While they may want to follow their osteopathic roots and complete the osteopathic internship, their post-internship choices are decidedly limited. This is unfortunate, for I find myself in this position.
more to come... ¶ 4:44 PM
