PERSONALIZED MEDICINE: The UBThisSummer Lecture Series opens at 4 p.m. on Wednesday with a lecture on personalized medicine and pharmacogenomics by pharmacy faculty member Gene Morse. Click on the link for more info.
HEART REPAIR: UB researchers have demonstrated for the first time that injecting adult bone marrow stem cells into skeletal muscle can repair cardiac tissue, reversing heart failure. Please click on the link for more information.
D.O.s Could Play Key Role in Bolstering Primary Care Workforce, Say Academy Leaders
By Barbara Bein
5/19/2009
Like many students graduating from the nation’s colleges of osteopathic medicine, Richard Gray has chosen family medicine as his specialty. In fact, Gray, an AAFP student member from Fort Worth, Texas, and other soon-to-be doctors of osteopathic medicine, are an important part of the primary care workforce, says an Academy physician workforce expert.
“Traditionally, the osteopathic medical schools have attracted a larger proportion of young people interested in family medicine,” Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, told AAFP News Now.
OSTEOPATHIC SCHOOL ENROLLMENT SEES STEADY RISE
For the past several years, enrollment at the 25 member colleges of the American Association of Colleges of Osteopathic Medicine, (2-page PDF; About PDFs) or AACOM, has been growing steadily.
Last fall, first-time enrollment among osteopathic medical students reached 4,768, an increase of 360 students, or about 8 percent, compared with the enrolling class of fall 2007, according to Tom Levitan, AACOM’s vice president for research and applicant services.
Most of the increase stemmed from the opening of two new osteopathic medical colleges in Yakima, Wash., and Parker, Colo. AACOM is expecting even more students to enroll this fall, with the opening of three new satellite campuses in Pennsylvania and Michigan.
The first-year enrollment growth in the osteopathic medical colleges parallels that in U.S. allopathic medical schools, which enrolled a historic high of 18,036 students last fall, according to the Association of American Medical Colleges (6-page PDF; About PDFs)
PRIMARY CARE REMAINS CHOICE OF MANY OSTEOPATHIC GRADS
D.O.s have a long history of choosing primary care specialties, including family medicine, general internal medicine and general pediatrics, Levitan said. Even so, he noted, the results of annual AACOM surveys of graduating osteopathic medical students have shown a decline in self-reported interest in primary care from 40 percent of osteopathic graduates in 1999 to slightly less than 28 percent in 2007.
Interestingly, Levitan said, more osteopathic medical students opt for primary care specialties at the time they graduate than the number who said they planned to go into primary care when they entered school. For example, nearly 22 percent of students entering the nation’s colleges of osteopathic medicine in 2004 said they were interested in primary care. When those students graduated in 2008, slightly more than 29 percent chose primary care specialties.
According to the National Resident Matching Program, 45.1 percent of overall Match participants in 2008 chose residencies in family medicine, internal medicine (categorical) or pediatrics (categorical). By comparison, 55.3 percent of osteopathic medical students who participated in the 2008 Match chose one of those primary care specialties.
Levitan said he believes that osteopathic medical schools may provide a model for ways to produce more students interested in primary care careers.
Pugno agreed. For one thing, faculty at the osteopathic medical colleges who serve on admissions committees seem to seek students with characteristics that make them more likely to choose family medicine and primary care, such as coming from a rural background, he said. He noted that admissions policies are one component of the Academy’s overall strategy for attracting students interested in family medicine.
EXPOSURE TO PRIMARY CARE CAN GUIDE SPECIALTY CHOICE
Gray became a newly minted D.O. when he graduated May 16 from the Texas College of Osteopathic Medicine, or TCOM. In a few weeks, he will start his training in the St. Louis University/Scott Air Force Base family medicine residency in Belleville, Ill.
Gray said he learned about osteopathic principles as a physical therapy student at East Carolina University in Greenville, N.C. He worked full time as a physical therapist for eight years before entering TCOM in 2005.
During his first two years at TCOM, Gray said he was exposed to primary care repeatedly in the classroom, the clinic and the hospital. He did a preceptorship with a family physician in Fort Worth who still delivers babies. He also did a rural rotation with a group of four family physicians — three M.D.s and one D.O. — in the town of Littlefield in West Texas where he observed them practicing the full spectrum of family medicine.
“Excellent experiences with good family medicine preceptors throughout my four years at TCOM sparked my interest in the specialty. I believe that a family medicine residency will help me become the kind of physician I have always wanted to be,” Gray said. About 45 percent of the 128 students in his graduating class plan to go into primary care, he added.
Jason Dees, D.O., of New Albany, Miss., the new physician member of the AAFP Board of Directors, graduated from the West Virginia School of Osteopathic Medicine, or WVSOM, in Lewisburg and did his family medicine residency at The Medical Center in Columbus, Ga.
Dees said he considered becoming a surgeon, but chose family medicine as his career after his third year of medical school.
“WVSOM required every third-year student to do community-based family medicine as our first rotation,” he said. “As I saw the relationships that developed between doctor and patient, I was hooked. The focus on whole-person care was also very appealing to me.”
Pugno said both allopathic and osteopathic physicians are needed to meet the demand for more primary care health professionals in the coming years. ”We are partners with the American College of Osteopathic Family Physicians and other osteopathic physicians’ groups in our endeavors to make a difference in American health care,” he said.
This information and link was forwarded to Prehealth Advising Services at UB from a veteran prehealth advisor in the US.
TED (Technology, Entertainment, Design) has a set of popular science and medicine presentation videos at the link. The commercials are short. Enjoy!
Jefferson Medical College’s rural Physician Shortage Area Program (PSAP)
Informational meeting on Friday, May 15, 2009 for interested pre-medical students from rural areas or small towns planning to practice in similar areas.
Jefferson Medical College located in Philadelphia, PA is hosting an informational meeting on Friday May 15, 2009 (10:00 AM – 2:00 PM) for pre-medical students who are interested in the rural Physician Shortage Area Program (PSAP). This program is specifically geared for those students (freshman through seniors):
1. who have grown up or lived in a small town or rural area (i.e. not urban and not suburban), and who are also
2. committed to practicing in a small town or rural area (not necessarily their home town).
Additional information about Jefferson’s PSAP can be found at the link.
During this day, students will be provided with more specific information regarding the PSAP and the admissions process – and will have an opportunity to meet with faculty and students involved in the program. Lunch will be provided, and a campus tour will be offered after the meeting for those who are interested.
Interested students can sign up for the program, or obtain additional information, by contacting contact Carolyn Little, MEd, Education Coordinator, via email at Carolyn.Little@jefferson.edu (or by phone at 215-955-2362). (There is limited space, so please RSVP early.)
Family-Medicine Residencies Shrink Again as Doctors-to-Be Get Assignments
By KATHERINE MANGAN
Record numbers of medical-school seniors ripped open envelopes on Thursday in ceremonies across the country and learned where they will spend the next three to seven years training as physicians. While the numbers were heartening to educators worried about future physician shortages, they also revealed a disappointing drop in family-medicine residencies, which have declined for nine out of the last 10 years.
The assignments were revealed at 1 p.m. Eastern time in simultaneous Match Day ceremonies at medical schools across the United States.
After a slight uptick last year, the number of positions offered in family medicine declined this year. The number of those positions filled by seniors in traditional American medical schools also dipped, by 8 percent. U.S. medical seniors filled just 46 percent of the 2,311 slots, while the remaining positions went mostly to graduates of foreign medical or osteopathic schools.
This decline prompted a statement of concern from the president of the American Academy of Family Physicians, Ted Epperly.
“If America’s medical schools continue to generate a physician work force that is going into subspecialties, we are not meeting the needs of America’s communities,” he said. “America’s medical schools then become part of the problem and not part of the solution of meeting America’s work-force needs.”
In an interview on Thursday, Dr. Epperly said the association “will redouble our efforts to drive home the message that we need to increase the work force of family physicians in this country.”
Many students, faced with debts of more than $150,000, are shying away from family medicine because of the field’s relatively low salaries, he and other educators concur. The most competitive specialties this year included dermatology, orthopedic surgery, and neurological surgery.
Rising Participation
Nearly 30,000 applicants participated in the match, which is an all-time high. Of those, 15,638 were seniors in American medical schools, 10,874 were graduates of international medical schools, and 2,015 were students and graduates of osteopathic schools. An additional 1,222 were physicians who had graduated from medical school earlier, but had not yet matched to residencies, sometimes because of illness or pregnancy.
“We saw an across-the-board increase in match applicants this year, particularly among U.S. medical-school seniors,” said Mona M. Signer, executive director of the National Resident Matching Program, which is sponsored by several groups, including the American Hospital Association, the American Medical Association, and the Association of American Medical Colleges.
“This is likely the result of medical-school expansion across the nation in anticipation of a future physician shortage,” she added. “Existing medical schools have increased their class sizes, and new medical schools are in development.”
The 29,890 applicants who participated in the match this year represented a 4-percent increase over last year and a 15-percent jump over five years ago.
Medical educators are concerned, though, that the number of residency slots remains constrained by the federal government’s cap on the number of positions that Medicare pays for. Ninety-three percent of U.S. medical-school seniors matched to a residency program this year, with 82 percent of them ending up with one of their top three choices.
New Orleans’s two medical schools had cause to celebrate this year. Tulane University School of Medicine filled all but three or four of its 200 positions, officials there said, and Louisiana State University Health Sciences Center filled 113 of its 117 openings. That’s a welcome change from 2006, the year after Hurricane Katrina, when both programs struggled to fill residency positions in the devastated city.
More Than One Kind of Match
The matching program uses a computer algorithm to match, as closely as possible, the choices entered by both applicants and the directors of teaching hospitals’ training programs.
For one medical-school senior, Match Day was especially memorable. Julie Contes, a senior at the University of South Florida College of Medicine, stepped forward when her name was called and opened her envelope as her parents and friends looked on. Instead of her placement, it contained a marriage proposal from her boyfriend, Johnny Gibbs, a medical resident in Fort Worth who had traveled to the ceremony to surprise her.
“I was crying and shaking, and I dropped the paper,” Ms. Contes said. Then, when he emerged from the crowd and got down on his knees, she said yes.
A few minutes later, she was handed another envelope, which informed her that she had been placed in a residency program at the University of Texas Southwestern Medical Center at Dallas. “It was the only anesthesiology position that would allow me to be near him, and it was my top choice,” she said. “What an unbelievable day.”
INCREASED RISK
People who sleep less than six hours a night during the workweek have a higher risk of developing diabetes, according to a new UB study. Read more about this research by click on the link.
VIRUS IMPLICATED
UB researchers have co-authored a study indicating that the virus that causes mononucleosis appears to play a role in the progression of multiple sclerosis. Learn more about the study by clicking on the link.
HEART FUNCTION
A drug used to treat high cholesterol may be able to prevent the development of heart disease by regenerating diseased heart muscle, according to UB medical research.
Read more about the drug by clicking on the link.
RESEARCH MILESTONE: Research expenditures across the disciplines at UB increased to a record $348.2 million in the fiscal year ending June 30, 2008. Please click on the link for more information.
INCREASED RISK: People who sleep fewer than six hours a night during the work-week have a higher risk of developing diabetes, according to a new UB study. Please click on the link for more information.
STEM CELLS: UB will receive $4.9 million in funding for research on stem cells as part of a new investment in stem cell research by New York State. Please click on the link for more information.
TOP STORIES
HEART FUNCTION: A drug used to treat high cholesterol may be able to prevent the development of heart disease by regenerating diseased heart muscle, according to UB medical research. Please link on the link to read the full story.
UB VENTILATOR: A new ventilator developed at the university that delivers anesthesia to the lungs has the potential to shorten the length of patients’ stays in hospital intensive care units while reducing complications and habituation to sedatives. Please click on the link to read the full story.
Medical Schools Should Re-Examine Admissions and Training Methods, Experts Say
By KATHERINE MANGAN
Medical schools should take advantage of the first major expansion in 30 years to update an outmoded physician-training model that has resulted in the wrong mix of people being trained in the wrong settings at too high a cost, according to a report released on Thursday by the Josiah Macy Jr. Foundation.
The report, “Revisiting the Medical School Educational Mission at a Time of Expansion,” calls on medical schools to adopt sweeping changes in order to attract students of more diverse economic and ethnic backgrounds, train them in community settings as well as hospitals, and, in some cases, compress the time it takes to become a physician. (A summary of the report is available on the Macy foundation’s Web site.)
The report is based on the work of 36 educators who met at a three-day brainstorming session in October and a series of commissioned studies. Jordan J. Cohen, who was president of the Association of American Medical Colleges from 1994 to 2006, led the panel of educators.
Amid warnings of a looming shortage of physicians in the United States, nine new schools for training medical doctors are being built or planned, and 108 of the nation’s 126 traditional medical schools are expanding their class sizes. Some are also opening new branches (The Chronicle, January 12, 2007).
In addition, the number of osteopathic schools, which tend to graduate larger proportions of primary-care doctors than traditional medical schools do, has grown from 19 in 2000 to 28 today, with more in the works.
“We feel this is a unique moment in time—the first expansion of medical schools and medical-school enrollments in 30 years in this country, combined with the need and real possibility of health-care reform” under the Obama administration, said George E. Thibault, president of the foundation, which is in New York.
Dr. Cohen concurred. “The overarching message is that medical schools must accelerate the pace of change in order to meet the rapidly evolving needs of society.”
The staggering debt loads that doctors in training incur are scaring away many potential students, including minority-group members, and discouraging graduates from considering careers in primary-care medicine. The report notes that 80 percent of new physicians owe $130,000or more in student loans. One strategy the panel suggests is to follow the lead of some Canadian medical schools and examine ways to compress four years of medical education into three, possibly by combining the fourth year of medical school with the first year of residency training.
De-emphasizing standardized-test scores and looking at applicants more holistically could enable medical schools to diversify what is too often a predominantly white and affluent student body, the report notes.
Medical students and residents should also spend more time in a variety of practice settings, it says.
“Increasingly … much more medicine is being practiced outside the hospital, in clinics, doctors’ offices, and even in the home,” Dr. Cohen said. “We need to provide more opportunities for our students to practice in the real world, as well as the hospital.”
