DO Psychiaty residencies?

[nkirsh]

Looking for info on realistic Psychiatry residency opportunities for DO student with only Comlex. Open to any US location but currently a 3rd year student in midwest (MSU). Any suggestions or info very helpful/appreciated. Thanks!

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[ObsequiousAplomb]

I'm a little confused by the question. I don't think that allopathic programs are against DOs. Everywhere I interviewed had DO residents.

 

[D.O.noHarm]

Most psychiatry residencies will accept either/or both the USMLE and/or COMLEX.. There are no longer DO specific residency programs.

 

[nexus73]

Is there any reason you think you are a weak applicant?

 

[nkirsh]

Hi, I am starting to look into this for my daughter. At the time she took the Comlex, she had to repeat it and then passed. (she either took it 2 or 3 times!) She had intended to also take the USMLE but didn't out of fear of failing it and thought it better to not take it than fail. Plus she was overwhelmed with studying, at the time. She has not done research while in this program but did as an undergrad. She is not in any groups or professional organizations either, but had done so much of that as an undergrad. Plus, some ask for experience. She worked as a scribe in the ED a few years ago and volunteered with hospice and was a big sister or something like that. Spent time and really bonded with an at risk child through a program. Loved it. I am not sure if these things make her a weak candidate? She is lovely, articulate, interviews well and writes a beautiful essay! They will love her if she can gain the needed interviews. Is it too late to join some groups/volunteer/gain psych experience or engage in research? Any ideas on doing these things?
Her very first rotation in 3rd year was psych. They saw a pt. with possible Covid induced bipolar illness and the Dr asked if she would like to write a something up on it. (case study?) My daughter wrote the whole thing and emailed it to her, but that Dr is terrible at returning emails and never responded. She made a few attempts. So disappointing! (How will she get a letter of reference from her!?)
I'm panicked she won't match (or find enough programs to apply to), now that I understand that so many programs require the USMLE. And she has no current research, and no psych experience. She was really interested in Palliative Care at one time, but now definitely Psychiatry.
I'm an RN and have worked in a large university hospital for 34 years, many in OR, PACU, GI, IR. So I've seen a lot in medicine. How does she
get to know she doesn't like anesthesia, OB, PM&R. IR (areas I'd like her to at least consider) since she has to start applying soon and hasn't rotated there yet? How do we find the programs that accept DO students, as she will soon be applying to them? How can she strengthen her application? Any advice is welcome! I come off as a bit of a helicopter mom but just doing some recon since things are about to get super busy with tests, applying, auditioning, etc... Looking stuff up for her since I have time.

 

[heartsink]

At the time she took the Comlex, she had to repeat it and then passed. (she either took it 2 or 3 times!) She had intended to also take the USMLE but didn't out of fear of failing it and thought it better to not take it than fail.

This will make things hard. Its one thing to pass all the COMLEX stuff and not try the USMLE (which will make you less competitive, but not out of the running) - but to fail a COMLEX and then not try USMLE will probably give a lot of programs some pause. If she takes and passes Step 1/2 it would assuage any concerns her failed COMLEX might create. Out of everything you asked about and brought up, this stands out as the most important to me.

 

[shoomer]

COMLEX failure(s) and no USMLE will hurt your daughter's application unfortunately. She will be screened out by some programs off of these factors alone.

My advice:
1. Research programs around the country. Go on each program of interest's website, go on FRIEDA, look through forums etc. and see if they have DOs at all in their program. There are some places that do not take DOs. Also see if they have foreign graduates as that can be an indicator of lower competitiveness.

2. Look at programs that did not fill all of their positions within the match in the past 1-2 years. This amount is getting smaller and smaller as Psychiatry as a whole is getting tougher to get into. You can find this data on the NRMP Match Reports. Also look at the list of newly accredited programs throughout the year as some get started even during interview season.

3. Do 4th year sub-internship rotations at places of interest and work hard to impress. Focus on those within the region as there's the greatest chance of success there. You can overcome "red flags" on an application even with this approach.

4. Get Letters of Recommendation from multiple psychiatrists, especially Program Directors/Department Chairs in training programs. The CV can also be added to with memberships to APA, AACAP (Child and Adolescent Psych), AACLP (Consultation-Liaison Psych). etc. and volunteer experiences. Not sure how much time there is for her, research might be hard to complete at this point.

5. Think about backup plans. It is not impossible to match with working hard, reaching out to places, and developing connections. But a contingency plan is necessary. Either apply into a "backup specialty" (i.e. Family Medicine) in addition, or accept that not matching is a possibility and an extra year will be spent doing research/scribe work or something along those lines.

 

[Stagg737]

First things first, get your daughter on here. It's good that she's got a strong advocate in her corner, but we'll be able to help more by hearing things directly from her. I'm a young attending at an academic hospital with a psych residency, so some (though minimal) experience from the attending side. Addressing some of your questions/points individually:

She is not in any groups or professional organizations either, but had done so much of that as an undergrad. Plus, some ask for experience. She worked as a scribe in the ED a few years ago and volunteered with hospice and was a big sister or something like that. Spent time and really bonded with an at risk child through a program. Loved it. I am not sure if these things make her a weak candidate?.... And she has no current research, and no psych experience. She was really interested in Palliative Care at one time, but now definitely Psychiatry. Is it too late to join some groups/volunteer/gain psych experience or engage in research? Any ideas on doing these things?

All of these are great experiences and I would include them all in her CV/app if she spent any significant amount of time doing them. Psych is a much more interpersonal field, so activities where you actually connect with other humans are valued. It is not too late to join groups or gain psych experience, as most med students don't decide on what they want to do until their clinical years. Research is also less necessary in psych, though if she can get the case study published it would be helpful as showing interest. Don't volunteer just to check a box though, that gets sniffed out pretty easily and wouldn't be helpful at this point.

I'm panicked she won't match (or find enough programs to apply to), now that I understand that so many programs require the USMLE. At the time she took the Comlex, she had to repeat it and then passed. (she either took it 2 or 3 times!) She had intended to also take the USMLE but didn't out of fear of failing it and thought it better to not take it than fail.

The USMLE is not a "requirement" at most programs anymore after the DO and MD matches were merged. I'm a DO with no USMLE scores and had no problems getting interview invites ~5 years ago, even at programs that said they did not interview people with scores as low as mine were. The failures will be a red flag to overcome, as programs will be concerned about her passing Level 3 (if she doesn't she cannot complete residency). The best way to address this is to take Level 2, crush it, and be able to give a good plan for how she will pass Level 3 (or even just take level 3 and pass it, but that's usually just done when someone fails to match).

How does she
get to know she doesn't like anesthesia, OB, PM&R. IR (areas I'd like her to at least consider) since she has to start applying soon and hasn't rotated there yet?

Do elective rotations, she could ask to shadow but this would be unlikely to get her a good, immersive feel for what it's like. If she's not competitive for psych, she'll have a harder time with anesthesia, IR, and likely OB. PM&R has also gotten more competitive, but is historically one of the most DO friendly fields. Unfortunately, medical school is not geared towards getting students full exposure to all fields so many specialties require much more work to get exposure to.

How do we find the programs that accept DO students, as she will soon be applying to them?

She can go on FREIDA and look at a breakdown of who programs accept, minimal scores, etc. However, FREIDA is not always accurate. As I said above there were 2 programs that said I they don't consider applicants with Level scores below X or Y and I got interviews there with scores below their cutoff. When I applied, I literally printed a list of every program in the country, looked at FREIDA for each one, and went to every program's website to figure out where I had a chance if applying. Most programs today will consider DO students, but I would look at programs based on geography (near her med school or near where she has family) as well as programs that have previously taken students from her school.

 

[nkirsh]

COMLEX failure(s) and no USMLE will hurt your daughter's application unfortunately. She will be screened out by some programs off of these factors alone.

My advice:
1. Research programs around the country. Go on each program of interest's website, go on FRIEDA, look through forums etc. and see if they have DOs at all in their program. There are some places that do not take DOs. Also see if they have foreign graduates as that can be an indicator of lower competitiveness.

2. Look at programs that did not fill all of their positions within the match in the past 1-2 years. This amount is getting smaller and smaller as Psychiatry as a whole is getting tougher to get into. You can find this data on the NRMP Match Reports. Also look at the list of newly accredited programs throughout the year as some get started even during interview season.

3. Do 4th year sub-internship rotations at places of interest and work hard to impress. Focus on those within the region as there's the greatest chance of success there. You can overcome "red flags" on an application even with this approach.

4. Get Letters of Recommendation from multiple psychiatrists, especially Program Directors/Department Chairs in training programs. The CV can also be added to with memberships to APA, AACAP (Child and Adolescent Psych), AACLP (Consultation-Liaison Psych). etc. and volunteer experiences. Not sure how much time there is for her, research might be hard to complete at this point.

5. Think about backup plans. It is not impossible to match with working hard, reaching out to places, and developing connections. But a contingency plan is necessary. Either apply into a "backup specialty" (i.e. Family Medicine) in addition, or accept that not matching is a possibility and an extra year will be spent doing research/scribe work or something along those lines.

Thank you!! Much great advice! Speaking of foreign graduates, I did notice a program (in Detroit) which appeared to have ALL foreign graduates! odd, I thought. I've now found an abundance of programs in the state with a number of DOs in their residency.
Would emergency medicine be an attainable back up specialty? I have a former co-worker with a connection to a residency program where his son and 3 buddies all attended, and from the same DO program as my daughter, They had a great experience there, and it's something we can look into. This isn't her real interest (I'm not sure why!) but there is lots of mental health stuff in the ED so....
Or maybe Family Medicine and then later a fellowship in Palliative Care.

First things first, get your daughter on here. It's good that she's got a strong advocate in her corner, but we'll be able to help more by hearing things directly from her. I'm a young attending at an academic hospital with a psych residency, so some (though minimal) experience from the attending side. Addressing some of your questions/points individually:


All of these are great experiences and I would include them all in her CV/app if she spent any significant amount of time doing them. Psych is a much more interpersonal field, so activities where you actually connect with other humans are valued. It is not too late to join groups or gain psych experience, as most med students don't decide on what they want to do until their clinical years. Research is also less necessary in psych, though if she can get the case study published it would be helpful as showing interest. Don't volunteer just to check a box though, that gets sniffed out pretty easily and wouldn't be helpful at this point.



The USMLE is not a "requirement" at most programs anymore after the DO and MD matches were merged. I'm a DO with no USMLE scores and had no problems getting interview invites ~5 years ago, even at programs that said they did not interview people with scores as low as mine were. The failures will be a red flag to overcome, as programs will be concerned about her passing Level 3 (if she doesn't she cannot complete residency). The best way to address this is to take Level 2, crush it, and be able to give a good plan for how she will pass Level 3 (or even just take level 3 and pass it, but that's usually just done when someone fails to match).



Do elective rotations, she could ask to shadow but this would be unlikely to get her a good, immersive feel for what it's like. If she's not competitive for psych, she'll have a harder time with anesthesia, IR, and likely OB. PM&R has also gotten more competitive, but is historically one of the most DO friendly fields. Unfortunately, medical school is not geared towards getting students full exposure to all fields so many specialties require much more work to get exposure to.



She can go on FREIDA and look at a breakdown of who programs accept, minimal scores, etc. However, FREIDA is not always accurate. As I said above there were 2 programs that said I they don't consider applicants with Level scores below X or Y and I got interviews there with scores below their cutoff. When I applied, I literally printed a list of every program in the country, looked at FREIDA for each one, and went to every program's website to figure out where I had a chance if applying. Most programs today will consider DO students, but I would look at programs based on geography (near her med school or near where she has family) as well as programs that have previously taken students from her school.

Such good advice, thanks!!

 

[nkirsh]

Thank you!! Much great advice! Speaking of foreign graduates, I did notice a program (in Detroit) which appeared to have ALL foreign graduates! odd, I thought. I've now found an abundance of programs in the state with a number of DOs in their residency.
Would emergency medicine be an attainable back up specialty? I have a former co-worker with a connection to a residency program where his son and 3 buddies all attended, and from the same DO program as my daughter, They had a great experience there, and it's something we can look into. This isn't her real interest (I'm not sure why!) but there is lots of mental health stuff in the ED so....
Or maybe Family Medicine and then later a fellowship in Palliative Care.

This will make things hard. Its one thing to pass all the COMLEX stuff and not try the USMLE (which will make you less competitive, but not out of the running) - but to fail a COMLEX and then not try USMLE will probably give a lot of programs some pause. If she takes and passes Step 1/2 it would assuage any concerns her failed COMLEX might create. Out of everything you asked about and brought up, this stands out as the most important to me.

Could she still take step 1? I brought it up but she said it was too late, implied she is too far along or something.

 

[nkirsh]

Thank you!! Much great advice! Speaking of foreign graduates, I did notice a program (in Detroit) which appeared to have ALL foreign graduates! odd, I thought. I've now found an abundance of programs in the state with a number of DOs in their residency.
Would emergency medicine be an attainable back up specialty? I have a former co-worker with a connection to a residency program where his son and 3 buddies all attended, and from the same DO program as my daughter, They had a great experience there, and it's something we can look into. This isn't her real interest (I'm not sure why!) but there is lots of mental health stuff in the ED so....
Or maybe Family Medicine and then later a fellowship in Palliative Care.

 

[shoomer]

Thank you!! Much great advice! Speaking of foreign graduates, I did notice a program (in Detroit) which appeared to have ALL foreign graduates! odd, I thought. I've now found an abundance of programs in the state with a number of DOs in their residency.

Programs that have all international grads are often malignant environments from what I've seen. Not 100% the case, but they tend to view foreign grads as desperate and easier to overwork. These places may ignore even a more qualified DO because of that.

Would emergency medicine be an attainable back up specialty? I have a former co-worker with a connection to a residency program where his son and 3 buddies all attended, and from the same DO program as my daughter, They had a great experience there, and it's something we can look into. This isn't her real interest (I'm not sure why!) but there is lots of mental health stuff in the ED so....

Emergency medicine may be a back up specialty now, but I can't speak to that definitively. This last year was the least competitive EM has been in many years, with many unfilled spots in the match. There's less interest due to COVID exposing a lot of the downsides of being in the ED, a purely hospital-based specialty.

It might stay less competitive, but EM requires a specific type of recommendation letter (called a SLOE) that can only be obtained from EM doctors. So might be hard to keep as a backup.

Or maybe Family Medicine and then later a fellowship in Palliative Care.

Palliative Care, Addiction Medicine, even Sleep Medicine are possible fellowship options to get more Psych involvement as an FM doc. There's also lots and lots of Psych treatment in FM alone anyway...many of my patients start treatment with their PCP before being referred.

If she is to use FM as a backup, I would strongly recommend at least one sub-internship rotation and getting letters because FM knows they are often used as a backup and try to evaluate for genuine interest in the field. It's possible to fake it with foresight.

Could she still take step 1? I brought it up but she said it was too late, implied she is too far along or something.

If she has already taken COMLEX 2, or is about to study for it, then it will be difficult to study for step 1. There is overlap but plenty of step 1 exclusive material that will take time to go over. Balancing that between rotations and extracurricular work may not be a good idea.

 

[nkirsh]

Programs that have all international grads are often malignant environments from what I've seen. Not 100% the case, but they tend to view foreign grads as desperate and easier to overwork. These places may ignore even a more qualified DO because of that.

Emergency medicine may be a back up specialty now, but I can't speak to that definitively. This last year was the least competitive EM has been in many years, with many unfilled spots in the match. There's less interest due to COVID exposing a lot of the downsides of being in the ED, a purely hospital-based specialty.

It might stay less competitive, but EM requires a specific type of recommendation letter (called a SLOE) that can only be obtained from EM doctors. So might be hard to keep as a backup.

Palliative Care, Addiction Medicine, even Sleep Medicine are possible fellowship options to get more Psych involvement as an FM doc. There's also lots and lots of Psych treatment in FM alone anyway...many of my patients start treatment with their PCP before being referred.

If she is to use FM as a backup, I would strongly recommend at least one sub-internship rotation and getting letters because FM knows they are often used as a backup and try to evaluate for genuine interest in the field. It's possible to fake it with foresight.

If she has already taken COMLEX 2, or is about to study for it, then it will be difficult to study for step 1. There is overlap but plenty of step 1 exclusive material that will take time to go over. Balancing that between rotations and extracurricular work may not be a good idea.

Thanks, so much good advice and things to think about! And yes, I got a real bad feeling looking at that program with all international grads. Every one of them looked miserable and my daughter definitely would not fit in. Plus they looked way older...she's 24. She has no interest in EM but has worked there as a scribe, at a few affiliated hospitals. She was well liked, but it was not for her. She's not a fan of internal or family medicine either.
I'd definitely do anesthesia if it were me! In fact she initially was interested in PA school but I talked her into the CRNA route. She visited her dad who lived out of state and came home wanting to go to med school! She was lucky/put in the work in undergrad to get interviews for MD and DO early decision programs. She got accepted into DO and literally had a month off (maybe 6 weeks!) from finishing her Biological Science degree and starting this program. I know she is tired but still keeps going, studying so much, rotating, and now has to think about auditioning and where to apply for residency.
Any/all comments and advice are much appreciated!

 

[nkirsh]

Thanks, so much good advice and things to think about! And yes, I got a real bad feeling looking at that program with all international grads. Every one of them looked miserable and my daughter definitely would not fit in. Plus they looked way older...she's 24. She has no interest in EM but has worked there as a scribe, at a few affiliated hospitals. She was well liked, but it was not for her. She's not a fan of internal or family medicine either.
I'd definitely do anesthesia if it were me! In fact she initially was interested in PA school but I talked her into the CRNA route. She visited her dad who lived out of state and came home wanting to go to med school! She was lucky/put in the work in undergrad to get interviews for MD and DO early decision programs. She got accepted into DO and literally had a month off (maybe 6 weeks!) from finishing her Biological Science degree and starting this program. I know she is tired but still keeps going, studying so much, rotating, and now has to think about auditioning and where to apply for residency.
Any/all comments and advice are much appreciated!

Thank you!! Much great advice! Speaking of foreign graduates, I did notice a program (in Detroit) which appeared to have ALL foreign graduates! odd, I thought. I've now found an abundance of programs in the state with a number of DOs in their residency.
Would emergency medicine be an attainable back up specialty? I have a former co-worker with a connection to a residency program where his son and 3 buddies all attended, and from the same DO program as my daughter, They had a great experience there, and it's something we can look into. This isn't her real interest (I'm not sure why!) but there is lots of mental health stuff in the ED so....
Or maybe Family Medicine and then later a fellowship in Palliative Care.

Such good advice, thanks!!

This will make things hard. Its one thing to pass all the COMLEX stuff and not try the USMLE (which will make you less competitive, but not out of the running) - but to fail a COMLEX and then not try USMLE will probably give a lot of programs some pause. If she takes and passes Step 1/2 it would assuage any concerns her failed COMLEX might create. Out of everything you asked about and brought up, this stands out as the most important to me.

Hello, The great news is I was wrong and she passed COMLEX on the first try. It was the practice exam she failed twice. Kept studying and passed the actual test. I'm so glad I was wrong!

 

[nkirsh]

Programs that have all international grads are often malignant environments from what I've seen. Not 100% the case, but they tend to view foreign grads as desperate and easier to overwork. These places may ignore even a more qualified DO because of that.

Emergency medicine may be a back up specialty now, but I can't speak to that definitively. This last year was the least competitive EM has been in many years, with many unfilled spots in the match. There's less interest due to COVID exposing a lot of the downsides of being in the ED, a purely hospital-based specialty.

It might stay less competitive, but EM requires a specific type of recommendation letter (called a SLOE) that can only be obtained from EM doctors. So might be hard to keep as a backup.

Palliative Care, Addiction Medicine, even Sleep Medicine are possible fellowship options to get more Psych involvement as an FM doc. There's also lots and lots of Psych treatment in FM alone anyway...many of my patients start treatment with their PCP before being referred.

If she is to use FM as a backup, I would strongly recommend at least one sub-internship rotation and getting letters because FM knows they are often used as a backup and try to evaluate for genuine interest in the field. It's possible to fake it with foresight.

If she has already taken COMLEX 2, or is about to study for it, then it will be difficult to study for step 1. There is overlap but plenty of step 1 exclusive material that will take time to go over. Balancing that between rotations and extracurricular work may not be a good idea.

Hello, The great news is I was wrong and she passed COMLEX on the first try. It was the practice exam she failed twice. Kept studying and passed the actual test. I'm so glad I was wrong! But everything you said will still be very helpful.

 

[nkirsh]

This will make things hard. Its one thing to pass all the COMLEX stuff and not try the USMLE (which will make you less competitive, but not out of the running) - but to fail a COMLEX and then not try USMLE will probably give a lot of programs some pause. If she takes and passes Step 1/2 it would assuage any concerns her failed COMLEX might create. Out of everything you asked about and brought up, this stands out as the most important to me.

Hello, The great news is I was wrong and she passed COMLEX on the first try. It was the practice exam she failed twice. Kept studying and passed the actual test. I'm so glad I was wrong!

 

[nkirsh]

I'm a little confused by the question. I don't think that allopathic programs are against DOs. Everywhere I interviewed had DO residents.

There are a few programs I looked at that don't take DOs but most do. She is interested in being in Chicago, will apply there and throughout Michigan and a bunch of other places. A psych resident she met said he applied at 40 places. Is this realistic? We were thinking 30 but willing to do 40 (or more) in order to match.

 

[nkirsh]

Any advice on how a third yer DO student interested in psychiatry chooses where to audition? Does she go to her top choice programs or the local ones, or the ones most likely to match with her? She is pretty much an average student, passed first Comlex exam (on first try), and very interested in visiting programs in person rather than just the zoom interviews (when that time comes!). She is willing to take a residency anywhere (prefers not Texas or Florida), is at school in Michigan and grew up here. Would chose Chicago as her top pick. Thanks!!

 

[Stagg737]

Michigan is a pretty DO friendly state, so she should have some good luck there. Chicago is close enough that it would likely be seen as geographically friendly. I'm a DO and applied to ~75 programs and got 8-10 ii's. Depending on where she wants to apply I've heard people in her situation applying to around 50, but I certainly would not apply to less than 30 in her situation.

Unfortunately, the zoom interviews may be a permanent thing moving forward and in-person interviews for residency may not return. For "audition rotations" I would go to programs that are near her top choices where she feels she needs a leg up. Be warned, these can backfire as much as they can help, so if she is not very strong in person it may be better to avoid them. She should be able to gauge that based on comments from clinical rotations and LoRs.

 

[BobbyKoch]

So I’m a pre match 4th year student, but I took usmle and comlex, did slightly below average but right around the average for matched psych applicants. No research experience or publications. I applied to 102 programs to net 15 interviews. For DOs, >10 contiguous ranks puts you around 90% chance of matching and it improves from there. I would be nervous to apply to anything less than 70-80 programs. I would use your geographic and program signals on the supplemental app wisely—don’t signal Harvard or Stanford or whatever. Target the five programs that are perhaps on the upper edge of realistic. Try to schedule a few auditions for before eras is due, get 2-3 psych letters and one letter from IM, FM, peds or the like. Get them asap. I think in addition to having all your normal eras ducks in a row, a compelling story goes a long way in psych. So encourage her to think deeply about any personal experiences and reasons for her interest in the field and start writing them down. Best of luck, feel free to reach out in March if you want more insight into a recent applicant’s experience.

 

[LeaveNoTrace]

As far as signaling...how you signal as a weaker applicant really depends. If you really want psych you might split your signals: two or three on the programs that are on the upper edge of realistic...and the rest on programs that you would be OK attending but are much less competitive.

 

[MacDonaldTriad]

DOs should keep in mind that just because USMLEs are not required, doesn't mean they are not preferred. If you find yourself looking for programs that don't require "X", "X" is usually helpful, and by extension, not having "X" is inversely harmful relative to other applicants with "X". These are all admittedly blunt instruments to distinguish between applicants and everyone agrees about this. None the less, this is what programs are given and this is what they have to use.

 

[calvinhobbes]

Check out NUMC in Long Island, NY. They are an AOA program that is now ACGME. So is Orange Regional in Middletown, NY. Plenty of NY programs takes DOs with just Comlex!