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Dean of MSUCOM Talks About Mission to Increase Canadian DOs

Session 264

Dean Bill Strampel from Michigan State University College of Osteopathic Medicine joined us to talk about his school and what they are doing for Canadian premeds.

Michigan State University College of Osteopathic Medicine has an interesting mission, which is to increase the awareness and the availability of osteopathic physicians in Canada. The school reserves a certain number of seats for Canadian students. If you’re a Canadian and you want to come to U.S. medical school and interested in osteopathic medicine, this episode is a must-listen.

We also cover topics around AOA and ACGME merger, which he clarifies through a good history lesson.

[01:45] His Interest in Becoming a Physician and Overcoming Hurdles

Bill has always wanted to be a physician even when he was younger than 4 years old. But as he grew up and went through college, he thought he couldn’t do it right away. So he worked for the U.S. Department of Labor for a couple of years but hated it.Then his wife suggested that he went back to medicine and so he did.

The main reason he was so hesitant was the thought of being married and having kids. So he didn’t think he could afford to go. But he’s a great example that it can be done. Bill goes on saying that his wife runs the organization for the spouses of married physician. There is an end in sight and you can get through it but you’ve got to work at it. It requires both people to work at it.

Back in Episode 251, I had Sarah Epstein who is the author of Love in the Time of Medical School.  Sarah is a marriage and family counselor intern while her husband is a resident. So she wrote a book on how to keep that relationship going through med school.

Bill agrees how this is an important issue which requires a lot of work since there are stressors in all levels.

[04:00] The Biggest Changes for Getting Into Med School

Bill explains there are four generations involved in medicine. The Traditionals, who are still running hospitals and being involved, the Baby Boomers, the Gen Xers are those that have a participation trophy, and the Gen Y.

The biggest change Bill has seen is that medicine is so competitive that desire isn’t what takes. You’ve got to be able to accomplish, not that you desire to be a physician. It doesn’t matter how good of a person you are with people. But you have to be able to get to the gates of the medical boards and licensing exams.

Bill adds that there is little percentage students that go to foreign and Caribbean schools that get graduate medical education in the U.S. Back in 1960, you could go out from medical school and go practice. You could be a general practice doctor without having to go to an internship. But there’s no state now that would grant you a license to practice medicine unless you have at least 1-3 years postgraduate medical education. The last state that allowed doctors to practice right out of medical school was Indiana and that was 25 years ago.

[08:05] How to Prove Yourself to a Medical School: Minimum Scores and Personal Statement

Bill explains that the admissions committee of any medical school is generally made up of 10-12 faculty members and staff. They establish in their own mind the screening criteria for the applications.

In their institution, they get about 7,000 applications a year for 300 spots. The committee looks at that by establishing a minimum GPA science GPA, and overall GPA. Second, they look at how well you did on the standardized test like the MCAT.

This won’t make you a good physician. They know that. But with 7,000 applications, they have to have a screening criteria. Otherwise a person that falls below a 500 MCAT score won’t be looked upon. And they’re thinking of moving that level up. Other schools won’t look at an application with an MCAT less than 505. They tell you they will, but they really don’t. They screen out half of two-thirds of those applications right away.

Then they start looking at the application in detail. The look at how well you did in specific courses. In the old MCAT scores, they have 30 years of history looking at those numbers where if you get lower than 6 in Reading, 90% of the time, students won’t do well in medical school. So they wouldn’t look at those who scored 6 in Reading, no matter what your total MCAT score is.

As the application moves down, they read the personal statement. Bill says that about 80% of the personal statements would say they know someone who had this disease and they watched them suffer or die. So they wanted to help people because of this and decided to apply.

You really have to make it a personal statement. What is really going on with you? Why do you really want to do this? And that makes a difference. People will read that and would be interested in that. He has also noticed that they’d interview 500-600 for 300 admissions. So you’ve got one in two chance if you get interviewed.

Bill says one common mistake students make with their personal statements is they don’t have someone proofreading it. The grammar sucks or you use the wrong word, whatever that is, you have to be able to present in a way that it’s more than just an afterthought that you wrote the thing down because you were filling up space to do that.

[13:45] A Look Into the Osteopathic World

Bill explains that the osteopathic medicine has been around 140 years ago. The five original schools in Kirksville, Kansas City, Des Moines, Chicago and Philadelphia are still in business and exist to this day.

Michigan State was the sixth (seventh, counting the Los Angeles school that closed) that came. It was formed by the Osteopathic physicians in the state of Michigan.They decided they wanted their own school. They’ve been practicing a long time. They’ve been granted full practice privileges of Michigan since 1902.

They decided to raise the money. They taxed themselves. Back in 1964, they’ve decided that every osteopathic physician in Michigan would give $2,000 a year for five years. Back in 1964, you could buy a brand new Thunderbird convertible for $1,700. That would be the equivalent of the state organization you may belong to, giving $50,000 to $60,000 a year to the state organization for five years.

It’s not a lot, but they actually did it. They put together this osteopathic fund and started the Osteopathic College in Michigan as a private school in Pontiac. Then state politics intervened by making a state law. So Michigan State University became the first university to publicly recognize an osteopathic medical school as a state supported school. So they’ve been removed from Pontiac, Michigan to Michigan State University in 1969, And they’ve been there ever since as a full member.

With that, Michigan State University has caused the explosion of osteopathic medicine across the United States. And there’s four of them now, all directly related in the last 30 years. It became recognized that this wasn’t just something in the background but it’s what people wanted.

[17:07] Applying to MD and DO Schools and a Merger in the Works?

Bill has come across students who said they’re only applying to osteopathic medical schools. And he asks them whether they really want to be in medicine or they want to be in a specific school.

He explains that the real issue is that if you really want to be in medicine, then you take every advantage you can get to try to get there. That being said, you apply to both MD and DO schools.

Bill clarifies that it’s not a merger but the integration of the residency programs in the United States under one accreditation standard. So this has nothing to do with a merger of the professions.

The reason they call it residencies is because you used to live in the hospital and you could not be married. When President Johnson and Kennedy created the Great Society, the same argument was there in terms of the Medicare and other issues. And in order to prove that Medicare is a successful thing, they need to create more physicians that were trained in this issue. So under Medicare, they decided that for the federal government for the first time would fund residencies.

[19:52] A Brief History: The Big Boom in Residencies and the Federal Government Wanting Control

Between 1964 and 1984, residency programs exploded in the hospitals across the United States because for the first time, they got 100% for every salary and benefit for every intern or resident. They also got an indirect medical education payment for every intern or resident that run somewhere between $80,000 and $140,000 a year, depending on your location in the country.

MD programs went crazy and some DO programs too, although they didn’t have as many being smaller programs. But over the years, they wanted as many people in graduate education. Until the government realized this was costing too much at about $11-$12 billion a year to do this. So they started looking at it, particularly the Congress. They’re asking whether they’re getting a bang for their buck. And the Institute of Medicine then, produced a paper that said that graduate medical education wasn’t producing people to do primary care. Instead, they’re producing left-brained neurologists. The problem is that this does not take care of the vast majority of people that need to be taken care of.

So the institute said that the House of Medicine (MD and DO)  was doing a terrible job at how they were training people for the future. So there was a big push against giving money to the AOA and ACGME. These are the organizations that ran the money for the federal government. Since they wanted more bang for their buck, they decided to take over directly.

As a result, everybody panicked and the House of Medicine wanted to have control over what they’re doing in training rather than letting the federal government running it directly. This was the impetus for combining the education piece.

[23:15] The Effect of the ACGME and AOA Integration on Training

The combination of the ACGME and AOA should not affect your training. Bill says that if you’re good, you will get accepted. They’ve had DOs who were the sergeant general of the army. So there won’t be any problem with that. In fact, Bill was the senior commander in the army for 30 years.

Speaking for their institution, Bill says they have 40 hospital partners and 1,968 intern/resident spots in 210 graduate medical education programs affiliated with their institution. So there is more than enough spots there.

Somehow, it’s affected in a way that competition has gone higher because now, for the first time, DO’s would already have competition fro the foreign medical graduates. In the DO program, they never took a foreign medical graduate into an osteopathic residency program. Now, moving into this new change, they have to take all comers since that’s the ACGME standard.

That being said, the competition has gone stronger. Although he’s not worried about it, they’re paying attention to it. They point out to the students that the pool got a lot bigger so they can’t rely on their degree only. They have to be able to produce and they have to meet the standards. He reiterates that there’s no participation trophy for this.

[25:45] Turning the Spotlight on Canada

Bill gives a little backstory as to why they’re specifically allotting seats for Canadian students. He explains how osteopathic medicine exists in Kirksville, spreading to other parts of the country and then to London and New Zealand, Australia, Italy, France, Germany, Russia, and Norway.

So osteopathic medicine per se, is all over. But osteopathic medicine in the American model is different. Canada is similar to the American model. Prior to 1920, there were more osteopathic physicians in Canada than there were in the U.S. Then the Practice Consolidation Act in Canada decided that they only wanted osteopathic physicians to just do manual medicine. This made a lot of osteopathic physicians in Canada very unhappy.

Michigan was a direct beneficiary. Many of the hospitals in Michigan were started by Canadian physicians that came back across the border to practice in Michigan where they can still practice full privileges. The first female dean of the medical school in Los Angeles was a Canadian physician. She went to the osteopathic school they started in Los Angeles.

Bill got involved with Canada as a consultant. The Ontario Osteopathic Association and the Canadian Osteopathic Association called him to ask if he could advise them on starting a school in Canada. So he did some consulting in Canada to listen to their story. He then realized they didn’t have enough horsepower because of the way their residency programs in Canada are controlled. The 12 Canadian medical schools pay directly to the hospitals and all the money run from the hospitals to the universities.

So what Bill proposed was for the Canadian school to start with 50 students that they’re going to train for the first two years. Then Michigan will take them for their third and fourth year medical spots. Then the schools can decide on what they want to do.

To run a graduate school program in Canada, you’ve got to be certified by the MInister of Education. However, after talking with other medical schools in Canada, he was told the Minister of Education in Canada was never going to approve this.

First, Western Ontario University doesn’t want Michigan State University across the border having had enough competition with this. Second, when they raised the slot in Canada, it cost the taxpayers about $1 million per slot. And Bill coming in with a model where they can fund this for about $44,000 a year and if this got out, he’d be putting all 12 Canadian medical schools in jeopardy.

Instead, he talked to the board of Michigan State and asked for 25 slots for Canadians. He never advertised this but they got hundreds of applications every year. And they have been very successful for the last eight or nine years.

[32:00] Canadians as Foreign Grads with Their DO

In one of the provinces in Canada, they assumed that Michigan State was just like anything else so they’d be considered as an application. Bill requires all his Canadian students when they go there to take the Canadian equivalent of the foreign medical graduate (FMG) test. He also helps them take the Clinical Skills portion of that exam so they all remain qualified for the same pool of Canadians coming back in, having training either in the Caribbean or in Michigan or other schools outside their country.

[34:25] Shadowing Experience for Canadians

Many Canadians complain they’re not able to get as much shadowing experience in Canada as students would in the U.S. Bill says that Michigan being close to Canada, Canadians can easily cross the border. So there are lots of Canadians that go back and forth all the time.

Additionally, Bill has a relationship with two hospitals in Canada where if students want to do rotations, they could go back to Canada and work in the Canadian hospital as part of their clinical rotations. He restricts this to just Canadian citizens going back.

[35:56] Why Michigan State

Bill prides on the fact that the Michigan State University College of Osteopathic Medicine is one of the leading medical schools. They’ve been ranked as the fifth school in the whole nation. And they’ve been in the top 10% of that list for the last 15 years. It has to do with the faculty and the clinical faculty. They have in the state with about 6,000 clinical faculty members that take their students, mentor and train them because they love what they’re doing and the love what the students are doing. He considers this as their single biggest strength.

If you want to practice medicine and you want to learn medicine, Bill believes this is the place to go because they have the exposure of both DOs and MDs. In fact, many of thei MD students take manual medicine course as an elective because they want to learn the same thing DO students are doing, and vice versa.

Links:

MedEd Media

Michigan State University College of Osteopathic Medicine

Love in the Time of Medical School by Sarah Epstein

Episode 251: How to Protect Your Relationships as a Premed and Med Student

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