GI Question

[Parrothead]

I have a fairly specific question, could potentially play a big role in my ROL. Most programs I am considering keep their own residents for GI, and I assume this is somewhat uniform across the field.

So here's the question...do I rank program A that does well in placing both inside and outside for GI, even though I may not want to stay there for fellowship? Or do I go to program B which I may be more interested in staying at for fellowship, and which also obviously keeps its own, but only sporadically places people outside?

This would seem like an easy question, but here's the kicker. As a DO, I wonder if my chances for fellowship outside my residency will be hurt? Obviously I think my best chance will be at my (residency) home institution. But I wonder, even if I am from an outstanding residency program with great GI placement, will I get weeded out at outside GI fellowships for being a DO?

Long story short, bottom line...what are a DO's chances for going outside his/her own residency for GI?

Sorry for the multiple questions, but any input would be appreciated. Thanks.

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[PCN]

Just curious,

I don't know much about DO's but I was wondering if a DO goes to an MD residency can he or she still apply for a fellowship in an osteopathic hospital?

I always thought it was a little unfair that DO's get a choice to go either osteopathic or allopathic for residency. For IM it probably doesn't matter since a DO is not going to bump a lot of american medical graduate MD's. However, for stuff like opthy/rads/ortho it is much less competative to match into an osteopathic program. MD's obviously can't match into an osteopathic, not for any specialty.

The logic goes that if it is easier to match into an osteopathic hospital for competative specialties, then coming from an allopathic program would you be more competative at an osteopathic hospital for a GI fellowship?

I have a fairly specific question, could potentially play a big role in my ROL. Most programs I am considering keep their own residents for GI, and I assume this is somewhat uniform across the field.

So here's the question...do I rank program A that does well in placing both inside and outside for GI, even though I may not want to stay there for fellowship? Or do I go to program B which I may be more interested in staying at for fellowship, and which also obviously keeps its own, but only sporadically places people outside?

This would seem like an easy question, but here's the kicker. As a DO, I wonder if my chances for fellowship outside my residency will be hurt? Obviously I think my best chance will be at my (residency) home institution. But I wonder, even if I am from an outstanding residency program with great GI placement, will I get weeded out at outside GI fellowships for being a DO?

Long story short, bottom line...what are a DO's chances for going outside his/her own residency for GI?

Sorry for the multiple questions, but any input would be appreciated. Thanks.

 

[bansheeDO]

Just curious,

I don't know much about DO's but I was wondering if a DO goes to an MD residency can he or she still apply for a fellowship in an osteopathic hospital?

I always thought it was a little unfair that DO's get a choice to go either osteopathic or allopathic for residency. For IM it probably doesn't matter since a DO is not going to bump a lot of american medical graduate MD's. However, for stuff like opthy/rads/ortho it is much less competative to match into an osteopathic program. MD's obviously can't match into an osteopathic, not for any specialty.

The logic goes that if it is easier to match into an osteopathic hospital for competative specialties, then coming from an allopathic program would you be more competative at an osteopathic hospital for a GI fellowship?

You are right; you don't know much about DO's. Let me educate you. It's much more difficult for a DO to match into an osteopathic opth/rads/ortho spot because there are very few osteopathic versions of those competitive fields. A lot of M.D.'s like you have this misconception because you think there are a fair number of osteopathic residencies in the competitive fields like derm, optho, rads etc. If that were true, then you would be correct in your assessment and it would be unfair that a DO could go to either while an M.D. would be limited to just the allopathic residencies. However, that's far from being the case. There are very few osteopathic versions of the most competitive fields like derm, rads and optho. It doesn't even compare. Case in point, there are only 14-20 derm spots a year compared to 260 allopathic derms spots. And I think there are maybe 4 or 5 DO optho residencies in existence. This is why osteopathic fields are limited to DO's because we are essentially barred from allopathic fields which is why we have to preserve the few opportunities that are available to DO's. I hope that erased any confusion you had?

Anyway, let's not turn this into an MD vs. DO thread. If you want to continue this discussion just PM me.

 

[Parrothead]

Just curious,

I don't know much about DO's but I was wondering if a DO goes to an MD residency can he or she still apply for a fellowship in an osteopathic hospital?

I always thought it was a little unfair that DO's get a choice to go either osteopathic or allopathic for residency. For IM it probably doesn't matter since a DO is not going to bump a lot of american medical graduate MD's. However, for stuff like opthy/rads/ortho it is much less competative to match into an osteopathic program. MD's obviously can't match into an osteopathic, not for any specialty.

The logic goes that if it is easier to match into an osteopathic hospital for competative specialties, then coming from an allopathic program would you be more competative at an osteopathic hospital for a GI fellowship?

Your reply has absolutely nothing to do with my question. Funny how you think a DO is not going to "bump an american MD" from a spot, as if that spot has been granted to you until proven otherwise by some sort of divine entity, and it shouldn't go to a DO, even if they are obviously more qualified. Grab a clue, because it obviously happens, and it happens for a reason...like the DO deserves the spot. I'd rather you not hijack my thread as this is a serious question that I'm actually looking for some help in figuring out. The only thing that your reply brings up, which maybe I should've included, is that ideally I am not interested in a DO GI fellowship. Although yes, it would be an option, but that is not what I was referring to in my initial post.

 

[medstud03]

Well, I cannot address the "DO" portion of your question, but in terms of applying to GI fellowship...

I am currently a PGY-2 at a top 10 Internal Medicine program that is commonly talked about here on scutwork.com. My program routinely keeps a large number of its own residents for fellowship, including GI. 75-100% of the GI spots at my program are typically filled with internal applicants...and I do not believe that is uncommon, particularly for GI...regardless of MD or DO! The process can be especially competitive because there is no match for GI...giving way to a lot of underhandedness. Though I am not saying it's impossible to be accepted to programs outside of your home program, you do have a significant advantage at your home program...if you're a good resident and the GI attendings like you, that is.

That being said, you should pick the residency program that fits you the best. While its true you have a "home advantage" you still have to be happy with your decision. And the happier you are with your residency program, the better job you will do...and the more likely the attendings you interact with will like you. While it's good to be thinking about GI fellowship now, it should not be the number 1 factor in your decision making process.

Good Luck!

 

[Crypt Abscess]

Good question(s) parrothead. Fellowship (GI) placement played an important role in my ROL. As you know GI has gotten VERY competitive- bottom line is that your best chance of fellowship is AT the program you did your residency at. I would say about half of programs are unofficially closed to outside applicants. Another important factor is the academic reputation of your program- ie if you match at a top 10-25 IM program with big names in GI who write you good letters, you have a good chance of matching somewhere. As for the DO part of your question, we all know that DO=MD, but some of the older GI chiefs are probably still biased. If you went to a big allopathic program with 40-50 residents per year, and 8-10 residents are applying for 3-4 GI fellowship slots (assuming all else is equal) you may get bumped by an MD. Just my two cents. Good luck to you. Crypt

 

[PCN]

Dear bansheeDO and parrothead,

A big appology goes out to both of you. In no way was my reply meant to belittle DO physicians. Perhaps you are correct in saying I do not know much about DO's. This was echoed in my first sentence. The few DO residents with whom I worked with were good and very capable physicians. The only difference compared to an MD was a DO on their name tag.

With that being said, the main point of my reply (and perhaps I wrote too much) was that in a competative specialty/subspecialty what benefits a DO is that they have an option of applying to a DO or an MD program. You explained it very eloquently that there are a limited number of spots for DOs for a competative specialties. I was under impression that there are proportionately more DOs wanting to go into primary care and you would be at an advantage applying for a competative subspecialty with options of potentially applying for an osteopathic and allopathic GI programs. This is however, irrelevent to your question and so I feel I should end it at this point. In regards to comments about DO's not bumping AMG MDs, it was not meant to say that DOs are second class, but rather that there are many spots in IM, and many programs in this country end up unfilled. In other words, DOs don't influence match rate on MD's and MD's don't influence match rates for DOs into allopathic IM residencies to a significant extent. This is to contrast with what I was implying is an advantage in more competative specialties like derm/opthy/ortho for DO physicians. Of course, I stand corrected, as explained above.

Again, I appologize for assuming a lot of things. I just wanted to ask you if you would be competative for an osteopathic spot in GI after an allopathic residency (obviously in a different institution). If this would have been the case I thought that would have been a great opportunity for you.

I did not mean to hijack your post.
FOR ANYONE READING MY REPLY: PLEASE PLEASE DON'T REPLY TO WHAT I WROTE ABOVE. PLEASE REPLY TO THE QUESTION. PARROTHEAD HAS A GREAT QUESTION AND IT IS MUCH MORE WORTHY OF A GOOD DISCUSSION THEN WHAT HAS COME OUT OF MY COMMENT.

You are right; you don't know much about DO's. Let me educate you. It's much more difficult for a DO to match into an osteopathic opth/rads/ortho spot because there are very few osteopathic versions of those competitive fields. A lot of M.D.'s like you have this misconception because you think there are a fair number of osteopathic residencies in the competitive fields like derm, optho, rads etc. If that were true, then you would be correct in your assessment and it would be unfair that a DO could go to either while an M.D. would be limited to just the allopathic residencies. However, that's far from being the case. There are very few osteopathic versions of the most competitive fields like derm, rads and optho. It doesn't even compare. Case in point, there are only 14-20 derm spots a year compared to 260 allopathic derms spots. And I think there are maybe 4 or 5 DO optho residencies in existence. This is why osteopathic fields are limited to DO's because we are essentially barred from allopathic fields which is why we have to preserve the few opportunities that are available to DO's. I hope that erased any confusion you had?

Anyway, let's not turn this into an MD vs. DO thread. If you want to continue this discussion just PM me.

 

[Parrothead]

Thanks for the good insight. I have presumed all along that my best chance for a GI spot will be at my own eventual residency program, and that within my own residency, MD/DO will not be an issue since they will know me and work with me all the time.

What I had overlooked was that although overall GI placement--inside and outside--is a very important selection criteria in my ROL, I'm afraid that being a DO will make outside GI placement a non-issue. I say this because since outside programs won't know me, they won't look beyond the DO, even if I am from a top 10-20 residency program. Anyone think this is a true or false statement? Or will the top 10-20 residency program cancel out the "DO factor" at outside fellowship programs? Or am I overthinking this one to death? I'm starting to think that's actually the case.

Thanks again.

 

[medstud03]

Your biggest mistake is to consider your degree a handicap. It is not. You are not a Doctor of Osteopathy...you are a doctor. Having a "DO" instead of an "MD" does not make you a second class citizen. Thinking of yourself in that way will only cause you trouble down the line. I have many "DO" friends from college who are doing quite well with fellowship interviews/offers at this time. (Peds, not IM...but still doing well.) Be proud of your accomplishments. Pick the residency program that's right for you. Worry about fellowship after you make it through your intern year...that will be tough enough!

 

[maximuum]

I had a quick question about GI fellowship training. Is it 2 or 3 years? On the FREIDA website, all of the programs have a 3 year training length. However, I was under the assumption that the 3rd year of training was for hepatology.

 

[june015b]

I had a quick question about GI fellowship training. Is it 2 or 3 years? On the FREIDA website, all of the programs have a 3 year training length. However, I was under the assumption that the 3rd year of training was for hepatology.

Yes. general GI, hepatology & nutrition training is 3 years like cardiology. There are some people seeking an additional year training in transplantation (hepatology, pancreas, small bowel, etc.), interventional endoscopic surgery, motility, inflammatorry bowel disease, and few others. In many programs, the programs still teach you everying above in 3 years but there are some academic programs using 4th year fellow(s) for interventional EUS, etc. GI is becoming specialized and there are more new drugs/treatments and endoscopic procedures (extra GI luminal/intraabdominal bx, esophageal resection and suturing, endoscopic bariatric surgery, radioactive implanting of pancreatic cancer, etc.)

 

[bla_3x]

Yes. general GI, hepatology & nutrition training is 3 years like cardiology. There are some people seeking an additional year training in transplantation (hepatology, pancreas, small bowel, etc.), interventional endoscopic surgery, motility, inflammatorry bowel disease, and few others. In many programs, the programs still teach you everying above in 3 years but there are some academic programs using 4th year fellow(s) for interventional EUS, etc. GI is becoming specialized and there are more new drugs/treatments and endoscopic procedures (extra GI luminal/intraabdominal bx, esophageal resection and suturing, endoscopic bariatric surgery, radioactive implanting of pancreatic cancer, etc.)

So, for the procedures mentioned at the end of your post

extra GI luminal/intraabdominal bx, esophageal resection and suturing, endoscopic bariatric surgery, radioactive implanting of pancreatic cancer, etc.

Does one need to have that fourth year fellowship...or are these things covered in the 3yrs and the fourth is for official certification and such?
I have heard that these fourth year interventional spots are next to impossible for "anyone" to get. Is this true? Also. are there GI docs who come back and do the year fellowship after being in practice for a while?

 

[june015b]

So, for the procedures mentioned at the end of your post
Does one need to have that fourth year fellowship...or are these things covered in the 3yrs and the fourth is for official certification and such?
I have heard that these fourth year interventional spots are next to impossible for "anyone" to get. Is this true? Also. are there GI docs who come back and do the year fellowship after being in practice for a while?

In most programs. you don't have to worry about an additional year of training. They will teach you all. The 4th year is fonly or those who are interested in one particular aspect of GI and Liver (like internvetional, transplant, etc.). If you want to learn all in 3 years, you may want to go to a smaller program since there are no competition to get more interventional stuffs with other fellows like 4th year at big programs. Most GI fellows get job right out of fellowship given a good lifestyle with great compensation. Some even get job offers during their 2nd year of training. The job satisfaction rate is very high in GI.