Monthly Archives: May 2011

To Med or Not to Med: A Viable Question for this Century


Careers usually have popular topics for scholarly review and debate.  The field of medicine has a plethora of topics that are newsworthy.  Healthcare reform and medical education are at the top of the list.  Members of the American Council of Women and Diversity in Medicine, Science, and Business have been researching the sudden explosion of new medical schools.  The team has been diligent in analyzing the research and design of medical schools, for the past four years.  The mission statements of many of these schools reference the shortage of primary care physicians that should impact this country by the year 2020.  Some even mention under-served populations as a motivation for building their program.  The new schools are opening with as few as 20 students and as many as 50.  Even existing medical schools are opening satellite campuses in remote areas.  The ideas are phenomenal.  It just makes sense to open new schools instead of watching our students go abroad to be guaranteed a seat in medical school.

The erection of new institutions for medical education seems exciting.  Until four years ago, the last allopathic medical school was built in the 1970’s.  In Miami, Florida alone, three new medical schools have received accreditation, and four more await decisions.  Usually, I write scholarly material and allow my sophisticated audience to make the necessary inferences.  However, some thoughts just will not stop invading the frontal lobe of my brain.  Will diverse and under-served populations have a fair chance at the seats in the new medical schools?  Will the new medical schools become just another group of big businesses?  The list of questions increases.

The American Medical Association issued an apology to African-American physicians due to previous inequality against the group.  The formal apology was issued in July of 2008.  Anne C. Beal, MD, MPH declared this apology an “important first step”.  “The matter is not ‘ancient history,’ because if it were, we wouldn’t be dealing with racial disparities in health care and health care outcomes. This is still something we’re working with and dealing with today,” said Dr. Beal, assistant vice president for the Program on Quality of Care for Under-served Populations at the Commonwealth Fund in New York City. (http://www.ama-assn.org/amednews/2008/07/28/prsb0728.htm)

In 1870, the American Medical Association barred African-American members.  It was not until 1968 that the AMA House of Delegates announced that it would expel states that did not allow African-American members.  I am sure that these historical facts will not surprise anyone who has studied American history, however, it is important to know that the AMA is working to correct the institutional injustices in which it played a significant role.  Today, the AMA utilizes the Minority Affairs Consortium to send African-American physicians to schools in under-served areas to motivate students.  The American Medical Association contributes over $100,000.00 annually to scholarships for diverse populations.  In 1910, 2.5% of medical doctors and medical students in the United States were African-American.  In 2006 the percentage decreased to 2.2%.  As a pioneering personality, I am elated to see the explosion in the building of new medical schools.  I will continue to report the progress that we make in the field regarding leadership and diversity.  My personal mission of empowering women and diverse populations to become leaders in the field, has been adopted by the ACWD-MSB.

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Gender Disparities in Medicine


Gender disparities in careers and education are as relevant today in America, as in 1970.  This type of discrimination increases the likelihood that employers will deny women promotions and positions of leadership, due to the possibility that they might move or need a sabbatical after marriage or childbirth.  As a result, women are given jobs with few opportunities for advancement.  The term ‘glass ceiling’ has been coined to describe this systematic type of discrimination.  Features of the glass ceiling include any practice that favors men over equally qualified and motivated women.  As the glass ceiling analogy implies, a transparent or artificial barrier exists which keeps women from achieving substantial leadership roles.  Historically, earnings discrimination has been a part of the pollutions theory.  This theory suggests that a career looses technical expertise as women are admitted to the field.  In essence, the field has lost clout and men will soon leave.

Women entered the workforce in America, in large numbers in the 1960’s, however, careers still remain categorized by gender.  Librarians, customer service representatives, and teachers are female dominated fields, and pilots, executives, and engineers are considered male dominated fields.  The income disparity has closed some, but still exists.  Women’s earnings have increased and men’s earnings have reached a plateau.  Just because the cavity is not as deep does not imply that the void is insignificant.

Historical data should assist in the comparison of progress for women and diverse populations.  (Note:  The term diverse populations will be used as a substitute for the term minority.)  In 1965 only 5% of the enrollees in professional schools were women, however, the percentage increased to 40 % in 1985 in law and medicine, and 30 % in dentistry and business.   Highly effective oral contraceptives have allowed women to defer family additions and pursue careers of their choice.  This represents significant progress for a twenty-year time frame, while on the contrary may explain why disparities exist today.  In a historical sense,  the movement to correct the disparities is in its infancy.  Women are still underrepresented in executive leadership positions and boards of large corporations.  Medicine in its delivery, training, and education is not exempt from gender disparity.  We often expect disparities in incomes and careers in developing countries, but act shocked that this problem still exists at home.

A study conducted by Andra L. Blomkalns, M.D., et al, was printed in The Journal of the American College of Cardiology in March, 2005.  This study entitled “Gender Disparities in the Diagnosis and Treatment of Non–ST-segment Elevation Acute Coronary Syndromes: Large-Scale Observations from the CRUSADE (‘Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation’ of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, gives a current analyses of gender disparity in medical treatment.  Blomkalns, et al, hypothesized that significant differences treatment exist between male and female patients presenting with non-ST-segment elevation (NTSE) acute coronary syndromes (ACS).

Women represented 41% of the participants of this study, of 35,875 total, and were older.  The median age of women was 73 vs. 65 for men.  The women of this study more often had diabetes and hypertension.  They were less likely to receive heparin, glycoprotein IIb/IIIa inhibitors, angiotensin converting enzyme inhibitors, and statins at discharge.  The use of cardiac catheterization and revascularization was higher in men.  Among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men.  “Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women.”  Blomkalns, M.D. et al.  In conclusion, women with NSTE ACS were treated less aggressively than men, despite presenting with higher risk characteristics.  This is just one example of a well defined study outlining gender differences in the delivery of care.

Explore the data regarding the admittance of women and diverse populations in medical careers.  Over 800,000 physicians practice in America.  Approximately 30,000 or 4% are African-American according to the U.S. Census Bureau.  Women have entered the field of clinical medicine in record numbers, However, women are underrepresented in academic medicine.  As the medical community prepares for the shortage of primary care physicians by the year 2020, women physicians are being covertly blamed for working fewer hours due to family obligations.  (Note this century’s adjustment of the pollutions theory:  High tech fields lose clout after women enter!)

As a leader in academic medicine, I am highly opinionated, but strive to deliver the facts.  It gives me great pride to allow my sophisticated readers to make the necessary inferences.  I reiterate that our job has just begun at the American Council of Women and Diversity in Medicine, Science, and Business.  Please support our non-profit women’s advancement organization as we live by the philosophy, “Necessity is the mother of invention.”  We are active in four states, and would love to start a chapter in your home town.  We are building female directed enterprises; closing gender, financial, and diversity gaps in the most technical and difficult careers.  This summer, I plan to enjoy the first summer of strict publishing, fundraising, and devotion to women in medicine, science, and business.

Dr.  Danna McKella

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D.O. or M.D.?


Physicians in America have one of two degrees, either M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine).  There are some differences and some similarities, but both are legal and qualified to practice in any specialty area.  Allopathic (M.D.) and osteopathic (D.O.)  physicians complete similar pre-professional and professional education.  Both must obtain bachelor’s degrees prior to completing  four years of medical school.  The most distinct difference is that osteopaths receive additional education in osteopathic principles and practice.  During this course D.O’s learn to perform osteopathic manipulative treatment (OMT), which gives an additional tool to aid in diagnosis.  OMT also aids in treating musculoskeletal dysfunctions that may affect other body systems.  The four key tenets of osteopathic medicine form the foundation of osteopathic philosophy.  This philosophy focuses on the body as a whole and emphasizes searching for the cause of the disease, as opposed to treating and masking symptoms.  The tenets of the philosophy are listed below.

-The body is a unit.  The person is a unit of mind, body, and soul.

-The body is capable of self-regulation, self-healing, and health maintenance.

-Structure and function are reciprocally interrelated.

-Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship  of structure and function.  (www.msha.com.  Mountain States Medical Group, J. Nathan Elliott, D.O.)

Perhaps the most underrepresented fact is that the field of osteopathic education has never experienced a plateau or a cessation of growth.  Many articles are being written about the current resurgence of growth of medical schools.  Allopathic medical schools experienced a cessation of growth in the 1970’s and are growing at an enormous rate right now.  But osteopathic medical schools have continued to grow at a steady rate.  The mission of many new medical schools is to fill the shortage of primary care physicians.  Ironically, over 60% of osteopathic physicians practice in primary care, which places their discipline at the gateway of medicine.  Physicians regardless of degree, complete similar education, training, and certification processes to enable patients to receive comprehensive and high quality care.

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