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Letters to the Editor  |   August 2008
Response
Author Affiliations
  • Ronnie B. Martin, DO, RPH
    Rocky Vista University College of Osteopathic Medicine Parker, Colo
    Chief Academic Officer and Dean
Article Information
Medical Education / Pediatrics / Preventive Medicine / Professional Issues / Curriculum
Letters to the Editor   |   August 2008
Response
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 458-460. doi:10.7556/jaoa.2008.108.8.458
The Journal of the American Osteopathic Association, August 2008, Vol. 108, 458-460. doi:10.7556/jaoa.2008.108.8.458
In his most recent letter to the editor, George Mychaskiw II, DO, continues to express a deeply convicted personal position on the evils of for-profit education, as he has before in JAOA—The Journal of the American Osteopathic Association (2007;107:246-277). However, he is not able to present facts to support his position. Rather, Dr Mychaskiw chooses to make his points through conjectural attempts at linking together disparate and unrelated events. 
Dr Mychaskiw and I agree that there are substantial problems with the current healthcare system in the United States. In this regard, it should be pointed out that organizations like the one that employs Dr Mychaskiw are classic examples of a healthcare delivery system centered around academic and tertiary care medical centers with reliance on tertiary care medical specialists. Such systems—which tend to reward procedures (eg, quadruple coronary artery bypass grafting, aggressive cancer management at the end of life) rather than concentrating on access to timely primary care, wellness, preventive care, and quality of life—are systems designed for failure. This is precisely the kind of approach to healthcare that has led the United States to impending crisis. 
Nevertheless, it is hard to conceive how the establishment of Rocky Vista University College of Osteopathic Medicine (RVUCOM) or any other new medical school—regardless of tax status—could have a direct effect on this dysfunctional healthcare system or on the aging and uninsured populations of the United States. It almost seems as if Dr Mychaskiw is implying that the last 40 years of healthcare policy in the United States have been the result of the establishment of RVUCOM in 2006. In that vein, I am surprised that the impending disasters projected to result from global warming have not also been credited to the recent establishment of RVUCOM. 
Dr Mychaskiw uses speculation to describe what RVUCOM may or may not do to provide for its students—without commenting on or having direct knowledge of the quality of our programs, facilities, faculty, or curriculum—or of our established commitments to public service. He acknowledges that RVUCOM will graduate competent osteopathic physicians. However, he also feels that RVUCOM may jeopardize all patients of DOs by embarrassing the osteopathic medical profession. 
I do not understand how competent osteopathic physicians who provide access to high-quality healthcare for medically disadvantaged patients are an embarrassment to the osteopathic medical profession. But, of course, Dr Mychaskiw is entitled to his opinion. 
Dr Mychaskiw also implies that when the impending healthcare funding crisis occurs, for-profit educational institutions and their students will suffer. However, he neglects to explain that RVUCOM provides access to an osteopathic medical education for our students and to expanded medical services for the public without using scarce state or federal funding resources. 
If all medical schools followed our model, think of the billions of dollars currently directed to support medical schools and faculty that could be freed up to provide healthcare for millions of “baby boom” retirees, patients without health insurance, and other individuals without appropriate access to healthcare. 
Dr Mychaskiw deemphasizes the fact, or entirely misses the point, that no institution can be successful without operating an efficient business model, producing a high-quality product, maintaining the support of its customer base, and meeting the expectations of society. These necessities apply to all other current medical schools as well as they apply to RVUCOM. 
As a for-profit institution, we will have fewer excuses if we do not meet these expectations. We will not be able to blame any shortcomings on state budget cuts, increased expenses, or lack of student preparedness. We are and will continue to be responsible for our own outcomes—and we are prepared to deal with that reality. 
At RVUCOM, we are confident of the professional performance of our graduates because we have planned and engineered our educational systems and curriculum to make their success possible. We provide our students with strong role models in osteopathic primary care. These role models are involved in all aspects of student education. Our clinical education program exposes students to community-based experiences with excellent university-credentialed faculty, in addition to a challenging hospital-based curriculum. Students rotate during their third year of medical school in community and underserved settings with primary care providers—before they make their residency choices. This approach allows the students to be exposed to the professional opportunities and rewards provided by such disciplines as family practice, pediatrics, internal medicine, public health, and women's health. The community-based experiences of our students also include required rotations in osteopathic manipulative medicine designed to strengthen their appreciation and use of the profession's distinct philosophy. 
In addition, RVUCOM has other public service requirements and opportunities for students, ranging from local and in-state to international medical experiences. The “shadowing” experiences of our students throughout their first 2 years of medical school are predominately in community and public health settings. Such experiences encourage students to maintain the spirit they expressed when entering medical school—the spirit of wanting to make a difference in the lives of people and to serve individuals who are disadvantaged and in need of healthcare. 
It is not merely our students who will provide service to our community. In another example of our public service commitments, many members of our faculty have agreed to work with several local schools to foster the interests of young students in the sciences and medical professions. Other RVUCOM faculty members provide leadership for the osteopathic medical profession through the American Osteopathic Association and affiliated organizations. 
We are proud to hold our commitment to service up to public scrutiny because striving to improve the lives of those with whom we interact is an integral part of our mission and vision—and it coincides with the strong commitment to excellence that we expect from our students, faculty, and all those associated with RVUCOM. 
If RVUCOM is to grow and expand as a university, as currently planned, the resources for this success must come from our own efforts. We will not be able to go to government agencies or other funding resources to obtain an endowed auditorium, a standardized patient laboratory, or a clinic building. Instead, we will have to fund such infrastructure improvements out of that “excess revenue” to which Dr Mychaskiw refers. 
As Dr Mychaskiw is surely aware, research in the United States is not funded principally by the “excess revenue,” or “profits,” of medical schools. These meager funds would not support the level of commitment that is required to expand medical knowledge and support medical research. At RVUCOM, we are committed to expanding medical knowledge and contributing to research. Our faculty will be expected to develop research projects and concepts and compete for grants to support these research efforts from extramural sources (eg, state and federal governments, private foundations), just as faculty at other medical institutions compete for such funds. As Dr Mychaskiw knows, research grants obtained from these sources are very specific regarding how the funds can be used. The funds cannot simply be added to “profits.” They must be fully accounted for and used as intended to support the research and the researcher. In other words, RVUCOM is required to play by the same rules as any other medical research institution. 
I acknowledge that the education of our osteopathic medical students; the careers of our faculty; and our service to the profession as well as the citizens of our state, region, and nation represent the primary missions and goals of RVUCOM. At this point in our development, research is not our principle vision. Only time will tell if and how this aspect of our work may change in the future. 
In my more than 30 years in the osteopathic medical profession, I have found that it is not the research that suffers at many medical schools. Instead, it is the schools' commitment of resources and faculty to teaching, public health, and public service that often becomes downgraded. I have heard, in my private conversations, many a dean lament that the education of his or her students and the support of core faculty are frequently overlooked under our current medical school system, in which the “holy grail” consists of the income generated by the medical specialists on faculty (who typically practice more than they teach), the hospital, and the research grants. These considerations often take priority over the education of the students. 
At RVUCOM, by contrast, we believe that our primary obligations are to the education of our students and the advancement of our faculty. We have acted and will continue to act with these primary obligations foremost in mind. 
We recognize that we have an obligation to consider “social consequences,” more so than does a private manufacturer or a corporate operator of hospitals because we are engaged in the business of preparing medical students to serve and advocate for improve ments in the lives and healthcare of others. Our commitments to service, professionalism, and humanity are reflected in the ways in which we have designed our curriculum, selected our students and faculty, and dedicated our resources. 
I respect Dr Mychaskiw's commitment to his beliefs and his willingness to engage in debate on this subject. Critical examination is required to improve any process—and all of us wish for improvement in the health of our citizens and in the healthcare system of our country. Dr Mychaskiw and I diverge regarding how the needs of medical students and patients can best be served. Unlike Dr Mychaskiw, I believe there is room for and a need for both for-profit and nonprofit models in educational establishments. 
I continue to believe that RVUCOM is the right school in the right place at the right time for our osteopathic medical students and for the citizens of Colorado and the western United States. History will judge which one of us is correct in our beliefs.