DO's ability to match into general surgery after the merger?

[squidwardscissorhand]

Always wanted to be a surgeon, MD or DO doesn't matter to me. But will this goal be attainable as a DO after the merger? I realize that in the past, DO's had an advantage through AOA surgery programs.
I have consistently done well on standardized testing (97-99th percentile MCAT) so I am confident I can do well on the USMLE and COMLEX. Of course I know that doesn't mean anything, but I'm willing to work towards my goal. I just want to know if it is decently attainable.

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[AlteredScale]

Always wanted to be a surgeon, MD or DO doesn't matter to me. But will this goal be attainable as a DO after the merger? I realize that in the past, DO's had an advantage through AOA surgery programs.
I have consistently done well on standardized testing (97-99th percentile MCAT) so I am confident I can do well on the USMLE and COMLEX.

Going MD will make the path to surgery much easier and it goes far beyond just a DO bias. If your Mcat is that high (99th percentile) you should be applying for MD.


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[squidwardscissorhand]

Going MD will make the path to surgery much easier and it goes far beyond just a DO bias. If your Mcat is that high (99th percentile) you should be applying for MD.


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I did but it appears likely that I will not get in. I'm not in a position to reapply so I would rather go DO. Already have some IIs so it's looking better on that front.

 

[NecrotizingFasciitis]

From the little reading I've done (I'm interested in GS too.. & also FM) it seems like yes it will be possible, but us future DO's will have to put in extra work to stand out.

 

[cyang55]

I did but it appears likely that I will not get in. I'm not in a position to reapply so I would rather go DO. Already have some IIs so it's looking better on that front.

In that case, I would go with the DO and don't look back. Surgery might be a bit harder to obtain as a DO than an MD, but it really does depend on your USMLE scores and LOR. Not sure which schools you have IIs to, but if you have more than one choice, I would recommend looking into how well they prepare you for the USMLE. Some DO schools don't require it (so I'm not sure how well they will prepare you for it) and some do require it (and will prepare you for it). But it is definitely d0-able. We have students every year that match into MD gen surg residencies, and even some MD ortho residencies. If you are personally willing to work hard for it, it is definitely possible. Also, most the AOA programs should all still be around, and they might still have a preference for DO students. (not sure what will happen in the future, but I heard a lot of the AOA residency programs will still lean towards accepting DO students.)

Going to an MD school won't secure a gen surg residency spot for you just because you have an MD after your name, and going to a DO school won't prevent you from securing a spot even with a DO after your name.

 

[AnatomyGrey12]

Going to an MD school won't secure a gen surg residency spot for you just because you have an MD after your name

Eh it makes it a heck of a lot easier. MDs between 200-210 still have above a 50% of matching GS. There are so many spots in the MD world that most who want it get it.

Now with that being said just looking at the numbers even average DO students could get GS through the AOA route formerly. IMO the future of DO matching potential depends completely on how many programs survive the merger. There are so many MD spots that MDs can get I can't really see MDs applying to the former AOA program en masse. If most of the programs survive then DOs will probably still continue to match GS as long as you are a decent applicant, if a good amount don't make it then GS will probably become a specialty that you will want a 240+ to feel good about your chances, kind of like how going for ACGME is currently. (Obviously people without a 240 match into ACGME programs but multiple students have told me it is more of a gamble than if you have a 240 or higher)

 

[WhereMyLiberalsAt]

Eh it makes it a heck of a lot easier. MDs between 200-210 still have above a 50% of matching GS. There are so many spots in the MD world that most who want it get it.

Now with that being said just looking at the numbers even average DO students could get GS through the AOA route formerly. IMO the future of DO matching potential depends completely on how many programs survive the merger. There are so many MD spots that MDs can get I can't really see MDs applying to the former AOA program en masse. If most of the programs survive then DOs will probably still continue to match GS as long as you are a decent applicant, if a good amount don't make it then GS will probably become a specialty that you will want a 240+ to feel good about your chances, kind of like how going for ACGME is currently. (Obviously people without a 240 match into ACGME programs but multiple students have told me it is more of a gamble than if you have a 240 or higher)

What pressures would make a program not survive in the new climate? I'd imagine its funding related. And if it is funding related can you explain in a nutshell how that funding is currently, and what changes in the merger?

 

[AnatomyGrey12]

What pressures would make a program not survive in the new climate? I'd imagine its funding related. And if it is funding related can you explain in a nutshell how that funding is currently, and what changes in the merger?

Unfortunately that is out of my knowledge range and understanding. I do know that some AOA programs struggle to get the right amount of surgical numbers though.

 

[WhereMyLiberalsAt]

Unfortunately that is out of my knowledge range and understanding. I do know that some AOA programs struggle to get the right amount of surgical numbers though.

I found this article: The Progress and Consequences of the ACGME Merger: A Call for Action Norman Gevitz, PhD http://c.ymcdn.com/sites/www.aocd.org/resource/resmgr/bulletin/DrGevitz_SASPaper.pdf

On pages 7-8 it talks about the 50% of the AOA programs that are applying for Pre-Accreditation Status have failed to pass.... "Already, some AOA-only accredited programs have announced they will not file for ACGME pre-accreditation status and will voluntarily shut down because their sponsoring institutions have determined they do not have the fiscal or personnel resources or the patient load necessary to convert their programs into ACGME accredited programs."

So maybe those contributing factors are

1) Funding
2) Resources
3) Patient load

Good read... Kinda unnerving, but good read nonetheless....

EDIT: This is a counter argument against that paper http://www.osteopathic.org/inside-a...Documents/buser-single-gme-update-sept-16.pdf

I seem to side with the historian of osteopathic medicine from the oldest DO then the groups that are ok'ing every new DO.... This is purely my opinion though

 

[AnatomyGrey12]

I found this article: The Progress and Consequences of the ACGME Merger: A Call for Action Norman Gevitz, PhD http://c.ymcdn.com/sites/www.aocd.org/resource/resmgr/bulletin/DrGevitz_SASPaper.pdf

On pages 7-8 it talks about the 50% of the AOA programs that are applying for Pre-Accreditation Status have failed to pass.... "Already, some AOA-only accredited programs have announced they will not file for ACGME pre-accreditation status and will voluntarily shut down because their sponsoring institutions have determined they do not have the fiscal or personnel resources or the patient load necessary to convert their programs into ACGME accredited programs."

So maybe those contributing factors are

1) Funding
2) Resources
3) Patient load

Good read... Kinda unnerving, but good read nonetheless....

EDIT: This is a counter argument against that paper http://www.osteopathic.org/inside-a...Documents/buser-single-gme-update-sept-16.pdf

I seem to side with the historian of osteopathic medicine from the oldest DO then the groups that are ok'ing every new DO.... This is purely my opinion though

The Gevitz paper is sensationalistic and not accurate. I wouldn't put much stock into it at all. I have no idea where he gets his numbers from because the ACGME reports show a different story.

 

[squidwardscissorhand]

.

 

[AlteredScale]

I seem to side with the historian of osteopathic medicine from the oldest DO then the groups that are ok'ing every new DO.... This is purely my opinion though

There will be AOA programs that won't apply and that's a fact. Many of these programs don't have the faculty nor the resources nor the funds to uphold the acgme requirements but the ACGME and the AOA is doing everything in they can to support these programs so they can at least apply and receive pre-accred. Once that occurs, the ACGME will perform a site visit and discuss where these programs need to improve to achieve initial accreditation.

If you go to the ACGME and look up info on the merger there are numerous resources and powerpoint discussing exactly how this transition will occur. If the acme was out to just shut out AOA and DO's they would not ave appointed DO's into the acgme nor formed an entire osteopathic recognition committee to review these programs when the transfer over. So I see more to the AACOM's response that Dr. Gevitz has a "sky is falling" mentality. He is a PhD with no real experience as a program director nor any real experience within GME or CME administration.

 

[AlteredScale]

I'm not in a position to reapply so I would rather go DO.

Why are you not in a position to reapply? Monetary reasons? If you cannot see yourself going into another field besides surgery your best bet is to withdraw from the AACOMAS, rebuild your application and reapply to MD schools. If you are fine with an uphill battle and being limited to a few academic residencies for surgery (while most community hospital AOA surgery residencies will still be open to you) then continue on and choose a DO school with an internal surgical department if possible.

Also with that high of an MCAT, there had to be something else there in your application that prevented you from getting an MD interview. Do you have any ideas?

 

[squidwardscissorhand]

Why are you not in a position to reapply? Monetary reasons? If you cannot see yourself going into another field besides surgery your best bet is to withdraw from the AACOMAS, rebuild your application and reapply to MD schools. If you are fine with an uphill battle and being limited to a few academic residencies for surgery (while most community hospital AOA surgery residencies will still be open to you) then continue on and choose a DO school with an internal surgical department if possible.

Also with that high of an MCAT, there had to be something else there in your application that prevented you from getting an MD interview. Do you have any ideas?

reasons I'm not going to reapply
1) grades are seriously suffering this year
2) money
3) impatience

My gpa is low for MD, slightly below 3.5. I also was complete around labor day for most places. I don't think there's any glaring red flags since I'm getting DO interviews.
Anyway reapplying just isn't an option for me. I'm ok doing primary care at the end of the day.
Btw wdym that most community hospital AOA residencies will be open to me? I thought they'd all be ACGME by 2021 when I graduate? And what's wrong with a community hospital residency?

 

[AlteredScale]

Btw wdym that most community hospital AOA residencies will be open to me? I thought they'd all be ACGME by 2021 when I graduate? And what's wrong with a community hospital residency?

They will be ACGME but they WERE AOA. I wasn't focused on the pedantics of it. And there's no guarantee all AOA surgery programs will become ACGME, some will not apply and close, while others will apply for pre-accred and miss the mark multiple times to meet the requirements to achieve initial accred and will subsequently be shut down.

And there's nothing wrong with going to a community hospital but should you decide to fall in love with academic medicine and want to do surgery at a university program then as a DO, you have seriously limited yourself to a few places. That's all I'm saying. If you are fine with that then fine, go for it. But my advice to anyone looking to do something competitive and to maximize there chances and not be barred of from any residency is to go MD and try again.

 

[gamieg]

as a previous poster mentioned above, going to a DO school won't prevent you from obtaining a surgery residency.

whether you want to reapply or go to a DO program this year is up to you, but I tend to be of the belief that it's not about how much total work you put into something, it's when you put in that work. as a reapplicant, the work would be before and during you apply. as a DO student, the work would be during medical school and rotations. you'd probably want to take both the COMLEX and USMLE (I don't think there will be one test by the time you apply for residencies), which will mean extra work. and while not all residencies may hold this view, general biases may require you put in more work to "prove yourself" competitive against your MD counterparts.

best of luck with whichever path you choose.

 

[AngryMan]

They will be ACGME but they WERE AOA. I wasn't focused on the pedantics of it. And there's no guarantee all AOA surgery programs will become ACGME, some will not apply and close, while others will apply for pre-accred and miss the mark multiple times to meet the requirements to achieve initial accred and will subsequently be shut down.

And there's nothing wrong with going to a community hospital but should you decide to fall in love with academic medicine and want to do surgery at a university program then as a DO, you have seriously limited yourself to a few places. That's all I'm saying. If you are fine with that then fine, go for it. But my advice to anyone looking to do something competitive and to maximize there chances and not be barred of from any residency is to go MD and try again.

How is academic medicine different from a community hospital? Is it the research presence?
Once you finish your residency at a community hospital are you treated any differently than someone who finished at an academic center?

 

[AlteredScale]

How is academic medicine different from a community hospital? Is it the research presence?
Once you finish your residency at a community hospital are you treated any differently than someone who finished at an academic center?

Easier to get fellowships, research opportunities, didactic training with leaders in the field to understand what's on the horizon in clinical and translational medicine.

If you finish residency at a community hospital your chances of gaining fellowship or professorship or simply being in academics is far less. If that's not improtant to you that's fine and it shouldn't matter at all.


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[TheBoneDoctah]

Again, if you can go to an MD school, do that.

However, if you attend a DO school, yes you can still become a surgeon.


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[AnatomyGrey12]

How is academic medicine different from a community hospital? Is it the research presence?
Once you finish your residency at a community hospital are you treated any differently than someone who finished at an academic center?

I asked this exact question to one of the general surgeons I shadowed (head of trauma, used to be involved with residency programs, trained at a big university program, etc.)

He said that specifically for general surgery there are some differences between the two. The first is the fellowships like AS mentioned. University programs have more research components, bigger name faculty for networking, that kind of thing. The second is that they subtly focus on different things. He said that the university programs see a lot more of the zebra cases, more of the unique pathology, while focusing a lot on the academic side of surgery. On the other hand, community programs can focus on the technical skill of surgery and have a lot of exposure to the bread and butter of GS. They just don't always see some of the crazy things that turn up at a major academic center.

The bottom line though is that he said both will train you to be a good surgeon and that it's more a matter of your career interests. Obviously these are most generalizations but the other surgeons sitting nearby when he said this all agreed with him

 

[Matthew9Thirtyfive]

I asked this exact question to one of the general surgeons I shadowed (head of trauma, used to be involved with residency programs, trained at a big university program, etc.)

He said that specifically for general surgery there are some differences between the two. The first is the fellowships like AS mentioned. University programs have more research components, bigger name faculty for networking, that kind of thing. The second is that they subtly focus on different things. He said that the university programs see a lot more of the zebra cases, more of the unique pathology, while focusing a lot on the academic side of surgery. On the other hand, community programs can focus on the technical skill of surgery and have a lot of exposure to the bread and butter of GS. They just don't always see some of the crazy things that turn up at a major academic center.

The bottom line though is that he said both will train you to be a good surgeon and that it's more a matter of your career interests. Obviously these are most generalizations but the other surgeons sitting nearby when he said this all agreed with him

For what it's worth, that's what I've heard from the two dozen surgeons I worked with. That's also been my experience working at a small community hospital, a large community hospital with a residency, and doing clinicals at a university hospital.

 

[SurgDoc95]

Would it put you at a disadvantage if you say went to a community hospital for gen surg and then wanted to be involved with a DO school? Are they going to turn you down from teaching or being involved with rotations if you didn't go to an MD affiliated academic hospital center?

 

[AnatomyGrey12]

Would it put you at a disadvantage if you say went to a community hospital for gen surg and then wanted to be involved with a DO school? Are they going to turn you down from teaching or being involved with rotations if you didn't go to an MD affiliated academic hospital center?

No seeing as most DOs train at community programs

 

[Goro]

What did OP do to get smacked by the Banhammer?

Just as a teaching moment, Gen Surg is hard to get into, but I suspect that this is due to personality type. About 5% of my grads have gone into Gen Surg residencies. For MD schools it's about 10-15%. Interestingly, the numbers are at the higher end from smaller schools, like Mercer or U WV.

 

[Mad Jack]

What did OP do to get smacked by the Banhammer?

Just as a teaching moment, Gen Surg is hard to get into, but I suspect that this is due to personality type. About 5% of my grads have gone into Gen Surg residencies. For MD schools it's about 10-15%. Interestingly, the numbers are at the higher end from smaller schools, like Mercer or U WV.

It's more than just personality type- surgery has gotten substantially more competitive since the hour restrictions went into place on residencies. Last year, only 50% of DOs that attempted to get into ACGME surgery matched, a number that I predict will hold relatively steady as DO programs merge into the ACGME system or are closed altogether.

 

[TRPMinus]

What did OP do to get smacked by the Banhammer?

Just as a teaching moment, Gen Surg is hard to get into, but I suspect that this is due to personality type. About 5% of my grads have gone into Gen Surg residencies. For MD schools it's about 10-15%. Interestingly, the numbers are at the higher end from smaller schools, like Mercer or U WV.

Why does personality type make GS hard to get into? What do you mean by that?

 

[Goro]

I didn't say that; I'm saying that even at MD schools, only a small % of grads go into Gen Surg. Surgeons wanna Surg.

Why does personality type make GS hard to get into? What do you mean by that?

 

[AnatomyGrey12]

Why does personality type make GS hard to get into? What do you mean by that?

I think he meant that a lot of students don't go into GS because it takes a certain type of personality, they avoid it.

 

[0dee]

In terms of quality of training and "prestige", where does a county residency program fall under? community or academic?

 

[Matthew9Thirtyfive]

In terms of quality of training and "prestige", where does a county residency program fall under? community or academic?

If it isn't affiliated with a university hospital, then it's community.

 

[AlteredScale]

In terms of quality of training and "prestige", where does a county residency program fall under? community or academic?

Most county hospitals are going to be community however there are a few that are affiliated with universities (called "communiversity" hospitals). One I can think of is the USC-LA County affiliate.


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[AnatomyGrey12]

Most county hospitals are going to be community however there are a few that are affiliated with universities (called "communiversity" hospitals). One I can think of is the USC-LA County affiliate.


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This. I've also been told that some community programs actually have good research and are highly competitive because they allow high resident autonomy and the residents come out with phenomenal technical skill. Learning about how different residencies work is fascinating I think.

 

[WhereMyLiberalsAt]

Most county hospitals are going to be community however there are a few that are affiliated with universities (called "communiversity" hospitals). One I can think of is the USC-LA County affiliate.


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USC-LA feels kinda like its cheating... The most populous county in the country

 

[Matthew9Thirtyfive]

Most county hospitals are going to be community however there are a few that are affiliated with universities (called "communiversity" hospitals). One I can think of is the USC-LA County affiliate.


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I believe they are listed as Community-University Affiliated. I have worked at one of those, and they are sort of in between community and university programs as far as acuity and case load goes.

 

[Danbo1957]

Some county hospitals are academic if run by a medical school, like UT-Southwestern and Parkland in Dallas. USC-Keck was founded as a county hospital medical school, although in recent years they've tried to restructure and expand their mission to that of other major US academic-research programs.

 

[zero0]

http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Osteopathic-2016.pdf

Personally, I don't like those odds, and I expect things to only get worse in the upcoming years.

 

[Ho0v-man]

http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Osteopathic-2016.pdf

Personally, I don't like those odds, and I expect things to only get worse in the upcoming years.

That report is definitely something everyone should keep in mind. However, it's severely limited by the lack of usmle data. For all we know, >50% of those applicants didn't even take it.

It seems ridiculous to those of us in the SDN bubble, but I asked about Usmle prep at every one of my interviews and always got the same answer: "We just take the comlex. No need to take both." And these were people shooting for academic IM, ACGME EM and rads. We all know that's suicide, but it would seem that most DO students don't. Out of 5 interviews, I only met one person that intended to take step 1.


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[AnatomyGrey12]

That report is definitely something everyone should keep in mind. However, it's severely limited by the lack of usmle data. For all we know, >50% of those applicants didn't even take it.

Not only that if you look at the number of rank positions I think that is telling. The students I have talked to have said that a 235+ (The average for GS) step 1 has gottten them multiple interviews, enough to match. I wonder if this means that a lot of those students with only one or two rank positions (and interviews I would assume) are applying with less than GS average step scores, or are limiting the amount ignore programs they apply to. Really only the people with 1-3 rank positions are the ones playing roulette with their matching

http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Osteopathic-2016.pdf

Personally, I don't like those odds, and I expect things to only get worse in the upcoming years.

With the AOA match the percentage is much higher. It all depends on how many AOA programs survive the merger whether or not these statistics will hold strong IMO.

 

[AnatomyGrey12]

It seems ridiculous to those of us in the SDN bubble, but I asked about Usmle prep at every one of my interviews and always got the same answer: "We just take the comlex. No need to take both." And these were people shooting for academic IM, ACGME EM and rads. We all know that's suicide, but it would seem that most DO students don't. Out of 5 interviews, I only met one person that intended to take step 1.

If I have one more person tell me that the merger will make it so every program will take the COMLEX then I will strangle them....

Bottom line here IMO. Plan on taking USMLE from day 1. If you think you might like something outside of primary care then bust your butt to get good grades and bust it even harder come board time to get a good score. If you do that then you will be fine for almost all specialties outside the uber ones (if you want those know it from day one and be top of the class and try to kill step 1).

 

[Ho0v-man]

If I have one more person tell me that the merger will make it so every program will take the COMLEX then I will strangle them....

Bottom line here IMO. Plan on taking USMLE from day 1. If you think you might like something outside of primary care then bust your butt to get good grades and bust it even harder come board time to get a good score. If you do that then you will be fine for almost all specialties outside the uber ones (if you want those know it from day one and be top of the class and try to kill step 1).

I often wonder if that's why RVU is considered so "great". They make everyone take step 1 so their students aren't getting to fourth year and realizing that they're either going primary care or maybe one of the AOA specialties if they're lucky just because they didn't take step 1.

Of course, we're both premeds so what do we know? It's all conjecture.



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[Danbo1957]

Note, many residencies will still only take AMG MDs no matter the merger, especially in general surgery.

 

[AlteredScale]

Note, many residencies will still only take AMG MDs no matter the merger, especially in general surgery.

Definitely agree. And that goes for a lot of specialties as well outside of surgery.


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[AkhandBharat]

If I have one more person tell me that the merger will make it so every program will take the COMLEX then I will strangle them....

Bottom line here IMO. Plan on taking USMLE from day 1. If you think you might like something outside of primary care then bust your butt to get good grades and bust it even harder come board time to get a good score. If you do that then you will be fine for almost all specialties outside the uber ones (if you want those know it from day one and be top of the class and try to kill step 1).

So basically:
Do well on the USMLE and Gen Surg is attainable as a DO?

 

[TheBoneDoctah]

So basically:
Do well on the USMLE and Gen Surg is attainable as a DO?

Yes


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[AnatomyGrey12]

So basically:
Do well on the USMLE and Gen Surg is attainable as a DO?

Pretty much. If you look at the charting outcomes it appears that research is not that important just for matching in GS. I'm sure if you are trying to get into mid-tier university surgery then you will want it but just matching GS seems to be all about the step 1 score

 

[AkhandBharat]

Pretty much. If you look at the charting outcomes it appears that research is not that important just for matching in GS. I'm sure if you are trying to get into mid-tier university surgery then you will want it but just matching GS seems to be all about the step 1 score

How does matching work btw? Are you only allowed to apply to gen surg residencies if that's what you want? Or can you apply to that and IM, FM, etc. as a safety? What can you do if you don't match into any gen surg spots?

 

[AlteredScale]

How does matching work btw? Are you only allowed to apply to gen surg residencies if that's what you want? Or can you apply to that and IM, FM, etc. as a safety? What can you do if you don't match into any gen surg spots?

You can apply to other specialties as a back up but just know that your letters and personal statement when applying will be geared to gen surg. So if FM programs will know you really don't want to do it and are using them as a backup.

If you don't match initially you will go through the NRMP SOAP process (Google nrmp soap), then you will scramble probably looking for leftover gen surg programs or leftover TRI/prelim spots.


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[sab3156]

I think the same concerns can be echoed about other surgical specialties. I am concerned about very good AOA orthopedic surgery residency programs like PinnacleHealth... I am sure there will be a lot of strong applicants from the allopathic pool.

 

[acapnial]

That report is definitely something everyone should keep in mind. However, it's severely limited by the lack of usmle data. For all we know, >50% of those applicants didn't even take it.

It seems ridiculous to those of us in the SDN bubble, but I asked about Usmle prep at every one of my interviews and always got the same answer: "We just take the comlex. No need to take both." And these were people shooting for academic IM, ACGME EM and rads. We all know that's suicide, but it would seem that most DO students don't. Out of 5 interviews, I only met one person that intended to take step 1.


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Why would we need to get a DVD player? We have all these perfectly good VHS tapes!

 

[SurgDoc95]

Why would we need to get a DVD player? We have all these perfectly good VHS tapes!

This is my great grandparents LOL!