residency...on the corner

[Guest guest]

Why not have a program where graduates follow eithier a practitioner with

over 5 to 10 years experience, or follow an MD, in a paid position. For

the past 2 years I have worked for a MD and receive a paycheck every two

weeks, with pay per patient. Also have earned a title as Director of

Acupuncture and Oriental Medicine, at the facility. I have had the

opportunity to see 100's of patients, and have performed 1000's of

treatments, some long term and some short. Not to mention most all of the

cases I have seen, are by far worse or more complex then any I saw, as an

intern at PCOM. Working with a MD has given me the opportunity to build my

private practice. All together seeing 30 to 40 patients per week (the

majority are in private practice), and all my patients see me for about 1

hour. In addition I have learned more about operating a business, how to do

insurance and to build a referral system.

 

I am seriously debating returning to school for the DAOM. The debate lays

with will I recieve any credit for all the treatments I have done, will I

receive credit for time spent in China, and will I receive credit for the

300 hour post graduate study I did, with Dr. Fred Lerner in his Acupuncture

Orthopedic Program?

 

In health,

Teresa

 

 

 

 

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" " <

 

Sunday, July 20, 2003 11:12 AM

Re: on the corner

 

 

> ,

> wrote:

>

> > I see one fault of the student clinics is that patients are encouraged

> > to stick with one intern as long as possible. While the intern gets to

> > see the follow-up, sometimes it gets where a patient with liver qi

> > stagnation issues is seen week after week for a year, depriving the

> > student of seeing more of those 15% difficult cases.

>

> Its a tough one to call. How long should an intern get with a patient.

Patients

> don't like getting traded, but that could be explained away as a new

rotation or

> some such thing. What is best for patient care, though? Fact is, when

you do

> the math, clinical internship is quite limited. One already will only get

to see a

> handful of ongoing patients under the current system. In the best case

> scenario, one would see 25 patients for three months each, maybe a few a

little

> less and few a little more. that would get you your 250 patient visits

for

> graduation. But that's not how it goes. So maybe you actually get to

follow 5-

> 10 cases for an extended time. And maybe 0-2 are the serious complex

cases

> to which I refer. So if you force a student to give up maybe the only

case he

> has of this nature just so another can learn from it, I am not sure anyone

is

> served.

>

> I am not sure we could recruit enough patients to meet an increased

> internship requirement. Has your school clinic been very busy this

summer?

> I find hard economic times hit the school clinic hard. We don't accept

> insurance, so the vast majority of our patients are cash patients with low

or

> fixed incomes. This impacts frequency of treatments and herb compliance,

too.

> I do think the main difference in outcomes in learning TCM in china and

the US

> stems from the disparity in clinical training.

>

> I studied chinese herbology with Subhuti Dharmananda for three years while

I

> went 20-30 hours per week to Naturapthic School, then went to OCOM for

> 3,ooo hours, then spent three years working in the school herbal pharmacy

> about 15 hours per week while running my own private practice out of the

> school clinic. It was at the end of 9 years of continuous education and

> interaction with my teachers on a regular basis that I finally began to

> understand this practice. I believe this time could have been greatly

reduced

> if there had been more good work available in english and/or I could read

> chinese. However, that was not the case, so...

>

> Now I was fortunate on one hand to have this opportunity, but I also chose

to

> make this sacrifice and was still earning less than $15 per hour 3 years

after

> graduation (plus fluctuating income from private practice). In hindsight,

it is

> hard to recommend this path to all, though. Without this consistent

> reinforcement from experienced teachers, I easily would have strayed down

a

> variety of odd tangents, no doubt. However, my personal debt was immense

> because of the time I did not spend devoted to marketing, etc. I don't

think I

> really deserved much more than the school paid me since I was a recent

grad,

> but the point is that the current educational structure does not really

balance

> economic and educational realities. I have also chosen to make other what

> others might consider sacrifices in order to live a decent lifestyle

pursuing

> things I like. But this clearly would not work for a student who has

children

> and has already deprived themselves and their families for 4 years of

school.

>

> so what to do. even paid residencies are pretty meagre wages. Lets face

it.

> While I still think 2 years is enough to train acu techs, if we really

want to

> achieve MD status, when are our proposals going to really bite the bullet

and

> get serious. If we do go the entry level DAOM route or if that becomes

one

> option in a tiered system, do we we really need more classroom education

as

> part of this process. Or do we need more clinical training that actually

> achieves the desired outcomes. MD's get 4 years of med school. the rest

is

> clinic. Lets consider whether additional training leading to a doctorate

should

> mainly be clinical (perhaps with case report writing). Who says we have

to

> adopt ACAOM's version of the DAOM anyway. 2 years of fulltime supervised

> residency could give another 4000 hours in clinic. I think that might do

the

> trick.

>

> This would require profit making clinics that made part of their profit by

> having low paid residents on staff. Yes, I said paid. I do not think we

can

> realistically expect people to pay for six years of school. MD's pay for

4, then

> they start to get paid (dirt, but they get paid and their loans are on

hold and

> they can even cancel them altogether latr if they want to work in a rural

area).

> Its really a catch-22. Without a requirement for residency, there will

not be

> enough folks who go this route to make it profitable for clinic owners to

> develop such programs. But with a requirement for residency, there will

not

> be enough opportunities to serve the grads.

>

> The only solution is to use mainstream hospitals are our residency

facilities.

> Thus, more attention to integration may be the best plan for making

possible a

> real DAOM program, entry level or multi-tiered. Otherwise, it is somewhat

a

> sham. I believe the title doctor should be reserved for those who have

seen

> extensive patients in their specialty. On the other hand, if ND's and

DC's

> deserve the title, so do we. the question is, do they?

>

> Of interest, while researching this, I came across the fact that the

average med

> student incurs about $75,000-100,000 in debt, much less if they go to an

in

> state school. could be as low as 50,000. You could specialize in

internal

> medicine and finish your studies including residency in 7 years after

> graduating college. And you would get paid an average of 34,000 for those

> last three years. It is hard to see how many people would be willing to

pay

> tuition for six years, do unpaid internships and get so little guaranteed

ROI.

> Some entry level DAOM proposals will grandfather existing L.Ac. into

elevated

> status and effectively close out the field to most new applicants, thus

> eliminating most future competition. It would also drive most of the

schools

> out of business as the student population plummets. Unless an entry level

> DAOM includes a paid residency, I will be highly suspect of the

motivations or

> value behind it.

>

>

 

>

>

>

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