Amardeep Parhar, DO (left), and Elizabeth Luengas, DO, graduated last week from Touro College of Osteopathic Medicine. They have been volunteering at a drive-through COVID-19 testing site for the last few weeks.
Extraordinary circumstances

Fourth-year osteopathic medical students to graduate early due to COVID-19

Students may be volunteering in hospitals or starting residency before July to help fight the virus.

Typically, fourth-year osteopathic medical students graduate at some point in May, then enjoy some well-earned time off before the rigors of residency begin on July 1. During this time, they might decompress with family, travel or get married. Many move to a new location and take the time to house-hunt and get settled before starting residency.

This time will look quite different for many of 2020’s fourth-year osteopathic medical students. Some colleges of osteopathic medicine are allowing eligible fourth-years to graduate early so they have the option of assisting in the fight against the novel coronavirus disease (COVID-19).

Where students are graduating early

The New York Institute of Technology College of Osteopathic Medicine (NYITCOM) allowed eligible students to graduate a month early on April 15. Virtually all fourth-years at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM) are graduating three weeks early, on April 18.

Eligible students who attend Touro College of Osteopathic Medicine’s two New York campuses are also graduating this week. Fourth-years at Rocky Vista University College of Osteopathic Medicine (RVUCOM) will graduate two weeks early on May 1.

What will life after early graduation look like?

Some hospitals are looking to have early graduates join their team as volunteers or paid early-career physicians, while some residency programs are interested in having early graduates join their programs early. However, the Accreditation Council for Graduate Medical Education (ACGME) is recommending that new residents begin their placements on the intended NRMP start date, which in many cases would be July 1.

In a recent statement, ACGME raised concerns about institutions that are battling a pandemic having the resources to offer new residents comprehensive orientation and PPE training. The NRMP’s COVID-19 FAQ also includes information about starting residency early as it relates to the match participation agreement.

Below are descriptions of how COMs in three different states are handling early graduation.

New York

Many students graduating early from NYITCOM in New York will be volunteering or working in the U.S. city with the largest COVID-19 outbreak. NYITCOM’s early grads will not be starting residency early, but will likely work in hospitals at the level of an intern while not directly affiliated with a formal residency program, says Jerry Balentine, DO, dean of NYITCOM.

New York Governor Andrew Cuomo issued executive orders that allow the state’s fourth-year medical students to receive their physician licenses upon graduation, so they can begin working right away, says Dr. Balentine, who notes that roughly 80% of NYITCOM’s early graduates will be doing this.

“We spoke with all the New York state hospitals when we were working out the details of these arrangements,” he says. “We made sure they had adequate PPE for our students and the resources to onboard them.”

Some hospitals are offering to pay early graduates the same salary that a first-year resident would receive, while others are seeking volunteers, he says.

“As a health care institution, we have a responsibility to step in when there is a crisis,” he says. “At the same time, our students showed an incredible level of interest in volunteering and helping out. As a dean, this is a really proud moment for me, to see so many of my students stepping up to the plate.”

Colorado

When the pandemic began hitting the nation’s East and West Coasts, students at Colorado’s RVUCOM, many of whom had matched into residencies in hard-hit areas, asked the school’s leadership for early graduation, says Thomas Told, DO, dean and chief academic officer of RVUCOM.

Although some of RVUCOM’s fourth-years were receiving requests to start their residency programs early, Dr. Told is advising students who wish to contribute right away to instead work as volunteers and start their residencies in July.

“I fully agree with the ACGME that students should not begin residency before the allotted date because the CMS funding is so specifically tied to a set number of months for each program,” he says. “Alterations of those dates require major policy changes by governmental agencies.”

Before they enter residency, RVUCOM’s soon-to-be graduates will not be able to receive physician licenses in most states, Dr. Told notes, so the school’s leadership has urged students to be vigilant about what they can and can not do as unlicensed volunteers.

“We know there is a burning desire among our students for service. They want to make a difference in this most epic of national health emergencies,” he says. “We have felt that passion and wish to honor that desire, but by the same token we want our students to remain as well-trained volunteers and not feel that they are able to act as physicians until they are duly licensed in an accredited program with a program director.”

Ohio

OU-HCOM’s health care partners had reached out to ask about taking students as residents early, says Kenneth Johnson, DO, the executive dean of OU-HCOM. Because the school’s curriculum is 30% longer than the minimum length required by the Commission of Osteopathic College Accreditation, it was well-positioned to let students graduate early so that they would have the option of joining their residency programs before July.

“We do significant planning and preparation at OU-HCOM,” Dr. Johnson says. “Part of our planning is considering what the worst-case scenario looks like. In my mind, that’s out-of-control disease, health care completely overwhelmed, and a call for all hands on deck. In that worst-case scenario, the safest place for students is to be in their residency program early. I wanted to create a pathway for that to be a possibility for these students.”

Some residency programs at OU-HCOM’s health care partners are considering a staggered early start to residency, Dr. Johnson says. This could involve bringing in a small cohort on May 1, a second cohort on May 15, a third on June 1, and so on. Doing this would allow more experienced residents to assist in training new residents and avoid the program being inundated with a large number of inexperienced residents all at once.

Because CMS only funds a resident for a specified amount of time—say, three years—residents who start early will likely receive their typical pay right away, then graduate from residency weeks or months early as well, Dr. Johnson said. So a family medicine resident who starts on May 1, 2020, would finish on April 30, 2023.

To help mitigate the pressure some students might feel to join residency early, OU-HCOM is acting as a liaison between fourth-years and their residency programs and helping students communicate with their programs about starting early, Dr. Johnson says.

Students’ lives changed

Before the pandemic, Scott Wong, OMS IV, of OU-HCOM, had planned to attend the school’s three-day graduation event in Athens in May. Afterward, he was hoping to take his husband on a cruise to celebrate finishing medical school, then spend some time with his family before starting residency.

In a matter of weeks, those plans rapidly changed, like they did for so many other osteopathic medical students. Wong matched into the internal medicine residency program at Mount Carmel Medical Systems in Columbus, Ohio. He contacted the program to ask if they were taking residents early, but at this time, they are not.

He’s open to starting residency early if things change in the coming weeks and the program decides to accept residents before July 1, he says—though, understandably, he has some anxiety and trepidation.

“Right now, physicians are working day after day after day in this incredibly stressful environment,” he says. “The idea of entering into that environment to assist the heroes of today and work on something the world hasn’t seen in 100 years is stressful, but it’s also one of the things where I’m saying, let me step up and help.”

If Wong’s program doesn’t ask him to join early, he and his husband, who was recently laid off from his job as a marketing director, are considering volunteering for a COVID-19 symptom call center in Ohio. As the past president and national representative for OU-HCOM’s Student Government Association, Wong is also currently assisting OU-HCOM’s third-years with navigating the pandemic’s effects on their training, and he will continue to do so in the coming months.

“I want to be in the best place possible to make a difference,” he says. “And with the early graduation decision that OU-HCOM made, I am in the position to help in the best way that I can.”

Related reading:

Osteopathic medical students may be graduating early to fight COVID-19

COVID-19 updates: California DO set up testing sites in underserved areas

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