Caribbean Now or US Later?

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Haha I like the DOPE mnemonic.

Right now I'm planning to apply to my state med schools, then finish my bachelor's, and re-apply if I don't get in the first time (to US MDs, DOs, and Caribbeans). Do y'all see anything wrong with this plan?

@mimelim and others consistently and thoroughly told you to stay away from Caribbeans, so get that thought out of your mind.

Your plan is flawed because the objective is to apply with the strongest app first time around, since it's a bad thing to be a reapplicant. Why not just apply DO along with your state schools?

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**** it, I'll just wait a year and apply to MD and DO. Bueno?
 
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OP. This is simple. If you want MD, you're probably not getting into state or OOS MD schools with a 27 in New York if you apply this year. Drop all your applications and take a gap year. (Notable exceptions include LSU-Shrevport and some southern schools - word of mouth). If you want DO, go in right now and apply! (getting close to opening day). If you want the best you can get (i.e. MD and DO backup) I say take a gap year.

During the gap year I agree that you should finish your bachelors. Like others have told you, stay away from Caribbean altogether (can't confirm but I would GUESS DO holds a higher academic pedigree than Caribbean). Spend the summer doing whatever it is MCAT studiers have to do these days (I feel so old) to achieve a 90%+ MCAT. Get that score and you're good to go. If during that gap year you're not achieving the desired MCAT, apply for DO only the following year and get into medical school.

Why not just apply DO this year and continue studying for the MCAT and if MCAT doesn't work well, go with the DO? (which saves a year?)

This is my personal opinion, but I believe it's extremely difficult to gun for two things at once. To have half your mind focused on applying and the other half on studying hardcore to receive an excellent MCAT score is a tall order! If you go in with a back-up in mind, I don't think you'll give it your all on the MCAT.
 
hy not just apply DO this year and continue studying for the MCAT and if MCAT doesn't work well, go with the DO? (which saves a year?)

I completely understand your reasoning. I am just afraid that when I'm 50, I'll regret trying to save a year instead of applying to my fullest. Also I'm sure I'd regret going to a DO school when I'm applying for residencies... :/
 
I completely understand your reasoning. I am just afraid that when I'm 50, I'll regret trying to save a year instead of applying to my fullest. Also I'm sure I'd regret going to a DO school when I'm applying for residencies... :/
DO matched 78% into MD residencies in 2014. When DO residencies are included, they matched 95%+. Wanna guess what the numbers are for Caribbean grads?
 
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I'm done with Caribbean, haha.

Right now I'm trying to compare "wait a year and apply for US MD" or "apply now for US DO". In the long run, I feel the first would be the wiser option (more competitive residency, more respect, etc.).
 
I'm done with Caribbean, haha.

Right now I'm trying to compare "wait a year and apply for US MD" or "apply now for US DO". In the long run, I feel the first would be the wiser option (more competitive residency, more respect, etc.).

Fair enough. You'll get people vouching for both sides with their own opinions on here but no one really knows exactly what the right answer is because the answer is specific to each individual's ability, the future prospects of this merger (which no one understands fully yet), and chance. I don't want to make your decision for you OP, but from what I can see, I think you seem to be leaning towards just taking a gap year and then applying MD/DO.

If you want to apply to a few DO schools, the problem is that...what if you get interviews? What if you go to these interviews and realize, hey!...D.O. schools are pretty good. Why don't I just do this? Then you'll stop focusing on the MCAT to the point where it wasn't worth it to study for it any way.

The "MD later or DO now" has no definitive answer and will depend on your gut feeling. However, what is definitive is that you should focus on only one thing and put your energy towards that.
 
Edit: You know what I don't care enough to discuss the DO thing.

To the OP, probably applying next year might be a better idea. However, despite what the people above are claiming some international medical schools (including a couple in the Caribbean) have fantastic reputations.

If you are stating what you are stating, then you need to look into it more. Medical schools in general are standardized and it is all a matter of how hard you work that determines how good of a "pre-intern" you become. Thusly will also translate to how good a doc you will be as well. Only the lay man who has done cookie cutter research on the topic believes what you are stating (those article by journalists on DOs make me cringe). It is not like the match rates are at 50% for the big 4. However, it definitely isn't in the 90 percentile like DO schools.

Carribean schools don't have a fantastic reputation. I think that's a pretty safe consensus.
I also don't believe that DOs have a lower standard. You might not have to have as high stats to get in, but once you're in it's a similar standard. Same medicine + OMT.
Most DOs I know don't do OMT.
In the future all the residencies are in one pool, but until 2020 DOs take COMLEX and then can also take the USMLE and get the same residencies as MDs.

On SDN and in the majority of medical world (meaning USA) they have a terrible reputation. However, among the family members and friends who have went to the caribbean, they have a great one. This is why you will still see hoards of premeds going down their went US MD is out of the picture. Thus perpetuating the cycle.

Concur with everything else you say though.
 
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Carribean schools don't have a fantastic reputation. I think that's a pretty safe consensus.

St. George isn't a decent school?

In any case by fantastic, I'm referring to English medical Oxford, Cambridge, UCL, or the Aussie schools Melbourne, Sydney, NSW med, med schools in Singapore, Hong Kong, Germany, Switzerland etc. which have fantastic reputations.
 
St. George isn't a decent school?

In any case by fantastic, I'm referring to English medical Oxford, Cambridge, UCL, or the Aussie schools Melbourne, Sydney, NSW med, med schools in Singapore, Hong Kong, Germany, Switzerland etc. which have fantastic reputations.

Of course those foreign schools have fantastic reputations because they are meant to train students for those areas. You don't want to do your education there because PDs want students who train in the US and have an understand of US protocols in hospitals. Thus these PDs will select US students first and foremost. If you did your training in the US and wanted do a residency in Europe, you would meet even worse resistance. This is why it is best to do training on US soil.
 
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St. George isn't a decent school?

In any case by fantastic, I'm referring to English medical Oxford, Cambridge, UCL, or the Aussie schools Melbourne, Sydney, NSW med, med schools in Singapore, Hong Kong, Germany, Switzerland etc. which have fantastic reputations.
No, St. George isn't a decent school.

Yes Oxford and Cambridge are fantastic. But if you want to practice in the U.S. Not the best idea. You have to take the USMLE on top of what you've taken in the other country. You have to take Step 1 and Step 2, usually after you finish, so you're a couple years off of your basic science for taking the Step 1 which is a significant disadvantage. Also expect for Step 2 to be a lot different because common diseases in the U.S. you may be tested on might not be so common in the UK so you have to work towards American epidemiology. If you know you want to practice in the U.S. going to a foreign school just isn't the best option.
 
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St. George isn't a decent school?

In any case by fantastic, I'm referring to English medical Oxford, Cambridge, UCL, or the Aussie schools Melbourne, Sydney, NSW med, med schools in Singapore, Hong Kong, Germany, Switzerland etc. which have fantastic reputations.

As mentioned, a school which is established to train its own nationals is looked at very differently than a Caribbean school set up simply to be a second chance at medicine for US or Canadian students. I don't agree that all the national programs you listed would actually be regarded as fantastic by US residencies but certainly the British and German ones are. But because they aren't focused on training people for US wards you'd have a much steeper learning curve and thus wouldn't be a PDs first choice. Medical knowledge is universal, but medical practice/culture isnt. If you want to practice in the US do your schooling in the US.

As for SGU and offshore schools, I think the ACGME numbers speak for themselves. Caribbean schools have high attrition and then much lower match rates, usually into primary care. Lots of matches into dead end prelim years too. And lots of bogus data you can find on schools websites because they aren't jurisdictionally covered by any US consumer protection/false advertising laws, so they really can just make up stuff (unlike US schools). They are places designed to separate desperate people from their $, and work like a casino -- odds are just good enough to keep people playing... For the moment.
 
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Caribbean schools get bashed so much on this site. If you study hard you can make it through. Although this is a biased sample but EVERY single one of my fb friends who decided on Caribbean are doing just fine and the ones who graduated matched back in the states. These people were not special by any means (partied it up in undergrad).
 
Caribbean schools get bashed so much on this site. If you study hard you can make it through. Although this is a biased sample but EVERY single one of my fb friends who decided on Caribbean are doing just fine and the ones who graduated matched back in the states. These people were not special by any means (partied it up in undergrad).

People don't just bash the schools for no reason. The chances at matching (assuming you graduate, which statistics say many do not) are SIGNIFICANTLY lower than either MD or DO schools. Of those that do match, very few go anywhere they want to be, or do anything they want to do. Based off of this, it is downright irresponsible for a person here to encourage somebody to attend one of these schools and put their future in jeopardy. The horror stories exist, just do a search. They continue trying to match, while banks await the payments on the hundreds of thousands of dollars they took out in loans.

The bottom line:
If you are an AMERICAN and practicing medicine in AMERICA is your goal, you should be able to make it into an AMERICAN school.
 
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Caribbean schools get bashed so much on this site. If you study hard you can make it through. Although this is a biased sample but EVERY single one of my fb friends who decided on Caribbean are doing just fine and the ones who graduated matched back in the states. These people were not special by any means (partied it up in undergrad).

Look, here's the thing.

If you make it to graduation, you have about a 75% placement rate from the caribbean schools.

In terms of sheer odds, that's not bad. It's also why you hear so many anecdotal success stories.

However, that number needs to be looked at through the proper perspective:

1. That 75% number is only for people who make it through. SGU has, based on various sources online, 25-30% attrition. Ross has more like 40-50%, same for Saba, maybe more for some of the other schools. The schools don't directly report those numbers but this has been gleaned from numerous journals/reports/lay press articles over the years. In contrast, the attrition rate in US schools is typically <5%.

2. That 75% number is really only for primary care fields. For EM (a reasonably but not insanely difficult specialty for a US student to match into), the IMG match rate was 30%. For the super competitive fields like ortho, there aren't even high enough numbers to report data on.

3. That 75% number is, largely, made up of programs that US students don't even apply to. There are certainly exceptions to this but that is the most common.

4. Even if we ignore (1-3), let's revisit that 75% number. While 75% may not seem "bad", the flip side of that is that you have a 1-in-4 chance of spending 4-6 years and accumulating 6 figures of debt and not having a career at the end of it all. If a US school - MD or DO - had a 75% placement rate, it would be shut down. Collectively, US MD schools have a 95% match rate and a 98% placement rate (placement includes the match and the soap/scramble). DO schools similar.

5. When a US student goes unmatched, the most common reason for this is that they were applying for a competitive field such as derm or ortho (out of the unmatched US students this year, about half of them were applying for uber competitive fields). While this sucks tremendously to not match, the ultimate long-term fate of these students is not that bad. They were at least decently competitive students in the first place to even be applying for ortho, etc in the first place. So they either snatch up the good spots in the SOAP, or they reapply the following year with a different strategy in the match. The fate of an unmatched US student is much kinder than the fate of an unmatched caribbean grad.

TL;DR:
IMG: 75% chance of a residency if you manage to graduate + 30-40% attrition rate = when you enroll in the school you have a 50% shot at making it.
US-MD (or DO): 98% chance of a residency if you manage to graduate + <5% attrition rate = when you enroll in the school you have a 95% shot at making it.
 
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Caribbean schools get bashed so much on this site. If you study hard you can make it through. Although this is a biased sample but EVERY single one of my fb friends who decided on Caribbean are doing just fine and the ones who graduated matched back in the states. These people were not special by any means (partied it up in undergrad).
Your anecdotal experiences don't overshadow the data, which don't bode well for Caribbean schools.
 
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Ok ok ok...I get it...I won't apply to the Caribbean.
 
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Caribbean schools get bashed so much on this site. If you study hard you can make it through. Although this is a biased sample but EVERY single one of my fb friends who decided on Caribbean are doing just fine and the ones who graduated matched back in the states. These people were not special by any means (partied it up in undergrad).

Even the ones who make it will feel the backlash. There is also the quality of those programs to be considered. They may make it, but is it in a program with excellent training and will it lead into a competitive fellowship? There are tiers when comparing medical schools in the US, but it doesn't matter as much as tiers of residency. The most competitive residencies will go to top applicants in the US and the least competitive will go to the bottom of the barrel (as well those who trained off US soil). Those that are at the bottom of the barrel have a very low shot at a competitive fellowship and will end up sub-par doctors as well.
 
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Look, here's the thing.

If you make it to graduation, you have about a 75% placement rate from the caribbean schools.

In terms of sheer odds, that's not bad. It's also why you hear so many anecdotal success stories.

However, that number needs to be looked at through the proper perspective:

1. That 75% number is only for people who make it through. SGU has, based on various sources online, 25-30% attrition. Ross has more like 40-50%, same for Saba, maybe more for some of the other schools. The schools don't directly report those numbers but this has been gleaned from numerous journals/reports/lay press articles over the years. In contrast, the attrition rate in US schools is typically <5%.

2. That 75% number is really only for primary care fields. For EM (a reasonably but not insanely difficult specialty for a US student to match into), the IMG match rate was 30%. For the super competitive fields like ortho, there aren't even high enough numbers to report data on.

3. That 75% number is, largely, made up of programs that US students don't even apply to. There are certainly exceptions to this but that is the most common.

4. Even if we ignore (1-3), let's revisit that 75% number. While 75% may not seem "bad", the flip side of that is that you have a 1-in-4 chance of spending 4-6 years and accumulating 6 figures of debt and not having a career at the end of it all. If a US school - MD or DO - had a 75% placement rate, it would be shut down. Collectively, US MD schools have a 95% match rate and a 98% placement rate (placement includes the match and the soap/scramble). DO schools similar.

5. When a US student goes unmatched, the most common reason for this is that they were applying for a competitive field such as derm or ortho (out of the unmatched US students this year, about half of them were applying for uber competitive fields). While this sucks tremendously to not match, the ultimate long-term fate of these students is not that bad. They were at least decently competitive students in the first place to even be applying for ortho, etc in the first place. So they either snatch up the good spots in the SOAP, or they reapply the following year with a different strategy in the match. The fate of an unmatched US student is much kinder than the fate of an unmatched caribbean grad.

TL;DR:
IMG: 75% chance of a residency if you manage to graduate + 30-40% attrition rate = when you enroll in the school you have a 50% shot at making it.
US-MD (or DO): 98% chance of a residency if you manage to graduate + <5% attrition rate = when you enroll in the school you have a 95% shot at making it.

First, it's not really 75% that end up with careers because a number of those matches end up being "dead end" prelims (one year positions that necessitate going back into the match again the following year). So let's generously say 70%. Second, as you mentioned, I think even the 70% is misleading and shouldnt be used, because it's 70% of the 60% that aren't culled out as attrition -- which is more like 43% of those shelling out cash to these schools in year one. so let's call it like it is -- there was about 43% chance of someone starting in the Caribbean four years ago becoming a doctor here. And those odds are going to get progressively less every successive year -- US attrition is steadily increasing faster than residency slots. It's not difficult math. And you'll pay a higher tuition for 43% odds of what -- the lower end specialties in the least desirable places. This isn't your ticket to doing a surgical subspecialty at an academic hospital -- if you are lucky maybe you'll get to do IM at a community hospital in some area of urban blight.

And to Anicetus, yes we all know a person or two who went through the Caribbean and did fine. A 43% success rate means some of the thousands of people who go Caribbean each year will make it. That was my point about operating like a casino above -- just enough people win to keep people playing. I also know a lottery winner -- but that doesn't mean his path is a smart career path to success.

To be fair, if you have awful stats and can't bring them up even after multiple efforts trying to rehabilitate, but you know in your heart you can turn things around, maybe it's worth some money to you just to give yourself that hail Mary long shot. I don't know. It's just a very low percentage play. Worse odds than putting your house on the line to bet on black for one roulette spin. Kudos to you if you are successful, but I kind of prefer the sound judgement of the person who puts their money back in their pocket and walks away from this bet.
 
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Even the ones who make it will feel the backlash. There is also the quality of those programs to be considered. They may make it, but is it in a program with excellent training and will it lead into a competitive fellowship? There are tiers when comparing medical schools in the US, but it doesn't matter as much as tiers of residency. The most competitive residencies will go to top applicants in the US and the least competitive will go to the bottom of the barrel (as well those who trained off US soil). Those that are at the bottom of the barrel have a very low shot at a competitive fellowship and will end up sub-par doctors as well.

I think you go a little far in your last sentence. Your career is definitely limited and you likely won't train with the big shots, and fellowship opportunities will be more limited. But I think if you overcome all these hurdles and actually make it through training coming from this starting point, I tip my hat to you and say kudos, not saddle them with a label of "subpar". They are probably fine -- they rose to the top of their pile, which probably isn't much worse than the bottom of the stateside pile. (In fact, as US enrollment increases, it's this top couple of percent that would have otherwise had to go offshore that is getting sopped up.) it's the bad odds that I frown on, not the people per se.
 
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Maybe I should elaborate. Ok let's be honest, most people can get into a Caribbean school. I do believe that if a student from a very respectable undergrad who had a 3.6 and a 29 on the Mcat had to go to the Caribbean that they will be just fine. Whereas a student with a 2.6 and a 21 on the Mcat is just going to be a donation to the Caribbean med schools.

These schools I have to believe are on a curve so if you were pretty smart and just unlucky in the us cycle, you'll feel like you're competing with monkeys to overcome the attrition rate. It's not like trying to compete against your fellow allopathic US med school classmates.
 
Maybe I should elaborate. Ok let's be honest, most people can get into a Caribbean school. I do believe that if a student from a very respectable undergrad who had a 3.6 and a 29 on the Mcat had to go to the Caribbean that they will be just fine. Whereas a student with a 2.6 and a 21 on the Mcat is just going to be a donation to the Caribbean med schools.

These schools I have to believe are on a curve so if you were pretty smart and just unlucky in the us cycle, you'll feel like you're competing with monkeys to overcome the attrition rate. It's not like trying to compete against your fellow allopathic US med school classmates.
That's probably true. Though if you have those stats you could've gone to a DO school, but you didn't. Which makes me think you care more about the MD title than actually practicing medicine.
 
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That's probably true. Though if you have those stats you could've gone to a DO school, but you didn't. Which makes me think you care more about the MD title than actually practicing medicine.
This is what a PD will think too.
 
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My learned colleague has just given the clinical definition of "magic thinking".


To be fair, if you have awful stats and can't bring them up even after multiple efforts trying to rehabilitate, but you know in your heart you can turn things around,...
 
No one cares where you went to medical school, unless, of course, you went to the Caribbean. You have a good chance with DO schools; don't risk not matching into a residency (and being in just as much, if not more, debt than your American-graduate counterparts) by going to one of those schools.
 
I think you go a little far in your last sentence. Your career is definitely limited and you likely won't train with the big shots, and fellowship opportunities will be more limited. But I think if you overcome all these hurdles and actually make it through training coming from this starting point, I tip my hat to you and say kudos, not saddle them with a label of "subpar". They are probably fine -- they rose to the top of their pile, which probably isn't much worse than the bottom of the stateside pile. (In fact, as US enrollment increases, it's this top couple of percent that would have otherwise had to go offshore that is getting sopped up.) it's the bad odds that I frown on, not the people per se.

I don't believe students themselves are sub-par by any means and I think it is a great accomplishment to even match. However, their choices in training will be limited. You can't deny the difference in quality of each residency. There are some fields where a residency only in an academic center will give the best education. If they can't train in quality places, this affects how use to certain cases they are. Thus how knowledgeable they are when they finish residency.
 
I don't believe students themselves are sub-par by any means and I think it is a great accomplishment to even match. However, their choices in training will be limited. You can't deny the difference in quality of each residency. There are some fields where a residency only in an academic center will give the best education. If they can't train in quality places, this affects how use to certain cases they are. Thus how knowledgeable they are when they finish residency.

I think that gets into a whole different debate. There are fields where if you go to the small community places you get hands on experience on a higher volume of routine cases much earlier but don't see many of the zebras, while if you go to the academic centers you see all the zebras but end up years behind your community colleagues technically as they have been handling more bread and butter volume years earlier. There are also fields where if you go to academic centers you'll be working under many fellows who can be a great resource but also may grab all the cool cases, while if you go to a smaller community place you don't have as many layers of hierarchy and do more. So the training is very different, and the opportunities will be different, and you'll get less in terms of didactics and working with big name guys, but I think using "subpar" and worse "quality" is a mistake. For some routine things they might actually come out of residency much better trained than if they are coming out of a big academic center. They will never be the world renowned expert or work on zebras or make the news, but might be a good person to go to if you need something very routine done because they've been doing a much higher volume of it since earlier in their training. (and FWIW I think your comment relates to the community residencies the lower end of US grads may go to -- not just offshore grads, because the days of exclusively offshore residencies more or less ended with the "all in" rule.)

Residency is about seeing and doing as much as you can before you have to go out into the world and do it yourself. So while more zebras is an example of seeing everything you might encounter once in a career, and the big advantage of academic centers, I think for most it's just not that much more valuable than getting your hands dirty earlier working with directly under the attending, without fellows swooping in. Some of these small high volume procedure mills that offshore grads may end up in train really good technicians. So it will shape out as a very different series of "opportunities" but I think you go too far if you think it's about "quality". It isn't. If you had to send your kid for X routine procedure, you'd be better off sending him to a Caribbean grad who's coming out of a place where he'd already been doing them with the attending daily since his first year of residency over the Harvard grad who only wrestled a handful of X procedures away from the fellows in his last couple of years. By contrast if your relative had condition Y, which only 150,000 people in the US are known to have, you'd be crazy to go to some community hospital grad. I don't think either is per se subpar, but I think both have their wheel houses in Th medical landscape.
 
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I think that gets into a whole different debate. There are fields where if you go to the small community places you get hands on experience on a higher volume of routine cases much earlier but don't see many of the zebras, while if you go to the academic centers you see all the zebras but end up years behind your community colleagues technically as they have been handling more bread and butter volume years earlier. There are also fields where if you go to academic centers you'll be working under many fellows who can be a great resource but also may grab all the cool cases, while if you go to a smaller community place you don't have as many layers of hierarchy and do more. So the training is very different, and the opportunities will be different, and you'll get less in terms of didactics and working with big name guys, but I think using "subpar" and worse "quality" is a mistake. For some routine things they might actually come out of residency much better trained than if they are coming out of a big academic center. They will never be the world renowned expert or work on zebras or make the news, but might be a good person to go to if you need something very routine done because they've been doing a much higher volume of it since earlier in their training. (and FWIW I think your comment relates to the community residencies the lower end of US grads may go to -- not just offshore grads, because the days of exclusively offshore residencies more or less ended with the "all in" rule.)

Residency is about seeing and doing as much as you can before you have to go out into the world and do it yourself. So while more zebras is an example of seeing everything you might encounter once in a career, and the big advantage of academic centers, I think for most it's just not that much more valuable than getting your hands dirty earlier working with directly under the attending, without fellows swooping in. Some of these small high volume procedure mills that offshore grads may end up in train really good technicians. So it will shape out as a very different series of "opportunities" but I think you go too far if you think it's about "quality". It isn't. If you had to send your kid for X routine procedure, you'd be better off sending him to a Caribbean grad who's coming out of a place where he'd already been doing them with the attending daily since his first year of residency over the Harvard grad who only wrestled a handful of X procedures away from the fellows in his last couple of years. By contrast if your relative had condition Y, which only 150,000 people in the US are known to have, you'd be crazy to go to some community hospital grad. I don't think either is per se subpar, but I think both have their wheel houses in Th medical landscape.
But the residents at academic programs also do rotations at community programs, right? And wouldn't this give them exposure to a good amount of bread and butter cases?
 
But the residents at academic programs also do rotations at community programs, right? And wouldn't this give them exposure to a good amount of bread and butter cases?

Depends on the program. Also depends on what you mean by 'exposure', even if a program has a 'community' rotation, that could be 2 months out of a 5 year residency. That is great, but hardly helpful from a numbers perspective.
 
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Depends on the program. Also depends on what you mean by 'exposure', even if a program has a 'community' rotation, that could be 2 months out of a 5 year residency. That is great, but hardly helpful from a numbers perspective.
Thanks!
 
That's probably true. Though if you have those stats you could've gone to a DO school, but you didn't. Which makes me think you care more about the MD title than actually practicing medicine.

Or they really don't want to learn OMM.
 
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