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Matching in Psychiatry ("Big 4" Caribbean vs. Osteopathic)

Discussion in 'Psychiatry' started by HirsuteAnthony, May 30, 2012.

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  1. HirsuteAnthony

    HirsuteAnthony

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    Are DO's always ranked higher than "Big 4" Caribbean (e.g. St. George's, AUC) grads with similar stats?
  2. peppy

    peppy Senior Member

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    Not necessarily. There are plenty of subjective factors that go into a rank list (like how well you get along with the interviewers or if the program coordinator thinks you're creepy - yes, that actually was brought up as an issue about one applicant during a rank meeting I had the chance to sit in on).
    However, under most circumstances, you're generally better off staying in the US for med school if you have the option.
  3. Bluemirage

    Bluemirage Senior Member

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    You are much better off staying in the US and I would go D.O. vs a Caribbean school any day of the week, regardless of what specialty you end up choosing. Your odds are much better given that there is an increasing pool of graduating medical students but the number of residency slots have remained about the same.
  4. HirsuteAnthony

    HirsuteAnthony

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    Well, I'm 99% certain that I want to go into psychiatry, and I would prefer to have an MD over a DO because I'm a bit uncomfortable having a degree that the public is mostly ignorant of (though I have absolutely no bias against DOs myself).
  5. HirsuteAnthony

    HirsuteAnthony

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    Thanks for the info. As long as I have a good chance of matching at some psychiatry program from a big 4 carib (assuming that I get a decent score on step 1 on my first try, and I show a genuine interest in psych) I'm satisfied.
  6. Abider

    Abider

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    It's your call but a better criteria would be cost location and connections to your desired residency location. The DO schools have the obvious advantage of being within this country. Lecom has a decent price as would the state funded schools I would imagine. NyCom and the carib prices are obscene from my investigations.

    But with seismic economic shifts afoot. I would've only gone carib pre-2008. Way too many risks for that kind of money and for that little stateside connection. Do as you like though.
  7. islandCrazy

    islandCrazy

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    Well as a Caribbean student I can tell you that you will face harsher criticism from both the general public as well as the medical community. Also there are so many headaches that I have to deal with on a day-to-day basis, half the time I have no idea what my next step will be. Our pass rate for USMLE is lower, we struggle to get good rotations sites and finance is just the top of my stress list.
  8. HirsuteAnthony

    HirsuteAnthony

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    The clinical situation is actually pretty good at St. George's and AUC. You can do all of your clinicals at NYC hospitals and NYC is where I'd want to match.
  9. HirsuteAnthony

    HirsuteAnthony

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    What Caribbean school do you go to? IMHO there is a lot of variation in the quality of Caribbean schools just as there is in the quality of DO schools. As far as I can tell, the main advantage of going to a DO school is having access to the DO residencies, but the prospect of having a degree that the public is ignorant of mostly negates that advantage (in my mind, at least).
  10. digitlnoize

    digitlnoize Rock God

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    DO student here, matched at my #1 MD program.

    I would say that, in general, DO's tend to be ranked higher. My biggest caveat would be that some programs are very Carribean or IMG heavy, and tend to draw more from those applicant pools.

    The "recognition" of DO's amongst the public is more of a local phenomenon. Some areas are VERY well populated with DO's and the public is very aware.

    It will be very difficult to ignore DO's in the coming years. We make up ~5% of practicing physicians, but around 20% of graduating medical students. We are legion. :laugh:

    When people wonder, I usually just explain. I like to use the DDS vs DMD analogy, or just explain the history a bit.
  11. Bones McCoy

    Bones McCoy

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    I went to a Carib school (one of the Big 4), matched at my #1 choice after receiving over 20 interview invites. It's all about how hard you are willing to work I.e. good step scores, excel in rotations particularly in away rotations at programs you are applying to for residency. Honestly I was faced with the same dilemma, DO vs Carib MD, and I can say I am very happy to have the MD after my name instead of the DO. Just know going in that you will have to work much harder than your U.S. counterparts and you will spend $275k when all is said and done. PM me if you have any questions
  12. gametown19

    gametown19

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    You seem to have done a lot of research. It is better to have a degree that the public is ignorant about but the medical community is very aware of because it will be doctors that will decide who gets the residency slot. There are variations in Carib schools but the bottom line is Carib equals harder work sometimes with less payout and pretty much no safety net. It is easier for DOs to schedule audition rotations so you actually get to introduce yourself to the place that you want to land a residency at. The attrition rate at the Carib schools are pretty high. Caribs have to worry about clinical rotations and make sure they are greenbook (ACGME) or what not to practice in 50 states. Not to mention DOs have their own residencies some of which goes unfilled every year. If you have made up your mind go to Carib but listen to what others are saying because you are thinking Carib, but we are already in it. The Prestige of MD is useless if you can't practice medicine.

    I am from one of the Big 3 Carib school. The 4th one you mention doesn't have federal financial aid, which means a lot of stress for funding unless of course you have someone to pay for your degree.
    Last edited: May 31, 2012
  13. kdur

    kdur

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    The D.O. ignorance is really just a premed paranoia. The truth is that people want good, caring physicians. They don't care what the initials are after your name. There are some who are M.D. snobs but they are few and becoming less and less relevant every year.

    Don't go to a school for a pair of initials. Get the best education you can. Work hard and the rest will sort itself out.

    (Also, if they do slash GME funding in the future being a FMG/IMG will be a definite liability)
  14. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net

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    DO vs. Carib ignorance or not, the fact that I saw no DO or Carib folk on the residency interview trail and only MDs from recognized name schools should highlight the point that you should aim for the best program you can land. At psych interviews at Stanford, Harvard, the UCLAs, UCSD, UCSF, Yale and the like were graduates from.... well... Stanford, Harvard, the UCLAs, UCSD, UCSF, Yale and the like.

    To be fair, you don't need to attend a big name program to be an excellent doctor. Two of my roll models were DO physicians and they were awesome, one in psych and one in PM&R.

    It's funny when people speak of the Big 3 or Big 4 Carib schools. That's like saying I own a yellow Pinto, a much more respectable and prestigious car than your blue Chevy Nova.
  15. TexasPhysician

    TexasPhysician Moderator

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    My program matched one D.O. each of the last 2 years.

    My program did not interview a single Carib grad in 2 years I believe.

    DO > Carib in most instances.
  16. whopper

    whopper Former jolly good fellow

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    I graduated from SGU (in the Carribean). I've noticed at least several hospitals in the NYC area had a favorable view of SGU grads so in those hospitals it may have been an advantage to at least go to SGU vs DO or other Carribean schools.

    I, however, can tell you that I did not like being in SGU. The facilities were badly run, staff were lazy and slow (something breaks down like the AC, it doesn't get fixed, and the guy supposed to fix it is sitting on his butt drinking, staff members frequently making cat calls at female students), and while the USMLE pass rates were phenomenal, it was common practice (at least while I was there) for professors to say something would not be on the exam, then it was, or for the professors to make you memorize something you really didn't need to know that was tedious to memorize especially since you're overloaded with data anyways. In clinically oriented classes such as physical examinations, the Grenadian doctors had a condescending attitude and frequently they scolded a student for doing a PE the way they were taught by another doctor in the same class because each doctor did it differently. You didn't do it their way, they're going to lambaste you even though you did it the way you were told to do it.

    Psychologically the whole experience was difficult and I'd expect it'd be far better to be in a DO school in that regard. Medschool is already difficult but to be in a situation where you can't print your notes because the printer's broken and the guy who's supposed to fix it is sitting on his butt not doing anything, or the power going out in the middle of the night while you're studying (with the lights out), so you're studying by candlelight can be downright infuriating. I do respect SGU's board pass rates, exceptionally nice facilities, and rotations set up on the US (that several foreign schools do not have), but I don't think those things made it better than a DO school. The only real advantage I can see is that you'll have an M.D. after your name instead of a DO because of the ignorance that DOs as a whole are worse. (Yes I don't agree with it, but the ignorance is out there).

    The other thing, but this doesn't exactly make it more enticing, is that living in that difficult type of environment may be a character-builder, kinda like going through basic training in the Army.
    Last edited: May 30, 2012
  17. snarfer

    snarfer

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    A few years from now, these same guys/gals from the big name schools and residency programs will likely work alongside DO and Ross/SGU grads, treating the same group of patients and earning similar income.
  18. splik

    splik

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    I did not meet a single DO applicant or resident on the interview trail though there was the odd program that had DOs. There was one caribbean applicant I came across but he went to one of the dodgy ones and it turned out the medschool he went to was not recognized by the state medical board! oops. met some caribbean residents at some so called top programs in less desirable locations. So the answer is, it varies. Some will take any warm body, some will prefer DOs, others might prefer caribbean students.

    There are many different letters that can allow one to practice medicine. I have some more unusual ones being foreign. There are only two letters that matter and they are D and R. If your patient is concerned enough about you being a DO they'd probably be more concerned that you went to some school in the caribbean.
  19. digitlnoize

    digitlnoize Rock God

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    I don't know where you guys were interviewing. I went on 15 interviews (over 25 invites), and at almost every interview, the DO applicants outnumbered the MD applicants.

    As a general rule, most DO applicants aren't interested in the high powered research places. In fact, that's one reason I went to DO school. I'm not a researcher and don't want to do it.

    I didn't apply to Stanford, UCLA, or Yale, and neither did any of my DO psych applying classmates. Mostly because I had ZERO interest in living in those places.

    I should add that the places I did go where places like UVA, MUSC, UK, WVU, Indiana, Iowa. Good University programs for the most part.
    Last edited: May 31, 2012
  20. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Just one small thing: outside the US, being a DO might not be accepted - period. The foreign schools are just that - so the MD is accredited by the government (and that's what gets them listed in the "Green Book"). The MD is accepted at par with the MBBS, MBBCh, MBBChBAO, the titulo, and all the other national equivalents. Outside of North America (actually, the US and Canada), you might not even make it through the door as a DO, as a matter of law.

    It's quite a small point, but just one. Osteopaths in the UK are, from what I know, much more in the spirit of Andrew Taylor Still, but also resemble chiropractors. Osteopaths in the UK cannot work as GPs or consultant physicians.
  21. digitlnoize

    digitlnoize Rock God

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    This is somewhat true, but it's less of a problem than you think. US trained DO's have full practice rights in many countries, including the UK. Most of the main english-speaking countries should be fair game. I'm not sure why Australia is grey, I know that DO's do practice there, but maybe it's on a case-by-case basis. But, England, New Zealand, Canada, and most of Europe is fair game.

    Here is a map:

    [​IMG]
  22. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    I should have researched further. What I knew about the UK and DOs changed in 2005.

    Thanks for the update.
  23. digitlnoize

    digitlnoize Rock God

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    No problem. This is actually one area the AOA has been doing great work in. One of their main goals is to increase the international licensing opportunities for US-trained DO's and they've been doing a very good job at it.
  24. notdeadyet

    notdeadyet Still in California Moderator

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    That doesn't fit my experience. I interviewed at some of those programs and many like it and the applicant pool was WAY more diverse than that. I didn't see any Carib folks, but I definitely saw some DOs and also MDs from a big variety of programs, including some that would not be top-half ranked by whoever is doing that.

    Keep in mind, psych being psych, prestigious programs will match people from much less prestigious medical schools.
    Might be where you interviewed or regional. Most interviews I did were at academic west coast programs and I only ran into a few.
  25. notdeadyet

    notdeadyet Still in California Moderator

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    May be the case for you, but the argument doesn't fly as a whole. I also heard almost every DO talk about wanting to do primary care at the jump but most of these folks seem to end up wanting to do the same thing as every other doctor.

    Most folks who apply to and match at high powered research places DO NOT have any research background or plan to do any research. The reason people apply to UCLA, UCSF, and Yale isn't to do research but because these places have some of the best clinical experiences and training in the business. There are a few community programs that have the same breadth and depth of clinical opportunities, but they are very rare.

    Through sheer numbers of growing DOs and the relative lack of interest in psych, you will see DOs breaking into top end programs that doesn't typically take them. Watch these programs and I guarantee that you will see the applications from DO's skyrocket in spite of DOs not being "interested" in high powered research places.
  26. notdeadyet

    notdeadyet Still in California Moderator

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    Also, for folks making the DO vs. IMG route, take care in what school you choose. Everyone talks about the Big Four or Big Five in the Carib. This is because there are a lot of Caribbean schools you DO NOT want to go to.

    But folks seem to paint DO schools all with the same brush, which is just not the case.

    I won't name names, but you would be wise to look at DO schools in priority of something along these lines:

    1st rate: DO schools that that have their own hospitals. Almost all allopathic schools have done it this way forever. That's because it works. Don't buy the DO school that says "we give you the opportunity to work at a wide variety (i.e.: infinite) of sites around the country, giving you a wide diversity of experiences." This is cover for the fact that they don't have a hospital. Working at a different hospital every couple of months for two years means you learn a new EMR, a new culture, a new hierarchy, a new system every time, which is time robbed from learning actual clinical skills.

    2nd rate: DO schools that have relationships with a few hospitals that don't have other medical schools. Not ideal, but better than nothing. If the osteopaths are the faculty at these hospitals, all the better. You will have folks pulling for you to get the clinical experience you look for outside of the day-to-day.

    3rd rate: DO schools that have relationships with a few hospitals that do have other medical schools. Unless the other medical schools on site at the hospital are smaller osteopathic programs, your program is probably second billing. Not ideal, but it beats 4.

    4th rate: You are the bird seed. You have a list of hospitals over hill and dale and are expected to travel around to piece together the entirety of your pre-residency clincial experience. Ugh. Lots of wasted time, wasted effort, and you will forever be a visiting medical student. This is hard to appreciate as a pre-med until you actually see that visiting medical students are forever second class citizens.

    I wanted to go allopathic and did, but also looked into osteopathic and Carib. DO >>> Carib in my book, but they are not all created equal. Allopathic schools, despite what people seem to think, all give pretty much the same education and opportunities. Harvard grads rock it because Harvard Med can select only rock stars for their incoming class. There is nothing secret in the sauce. But osteopathic schools do not have a similar quality control.

    If I were to choose a program, I'd choose according to the above, and after that, dear god, I'd choose the cheapest. Tuition at some of the DO programs is insulting.
  27. belle54321

    belle54321

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    Lots of allopathic students aren't interested in research, and just want to do their residencies at community programs. Not all allopathic students are gunners. I know a classmate who didn't do any research and ended up matching in psych (granted it was St. vincent's-which is now closed/yes, it was awhile ago) and doing a C+A fellowship at NYU. I think for someone who is premed, it is way too early to predict which program will take you depending which med school you will end up at. Unfortunately, the easiest way to your desired residency program is probably the US allopathic route. The good thing is psychiatry, at least for now, still one of the least competitive specialty, so if you are a good student, DO, carib, or vanilla US allopathic, you will probably get a residency spot somewhere. But as the number of US allopathic graduates increases, there may be less spots for DOs and carib grads in the future.
    Last edited: May 31, 2012
  28. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net

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    This makes sense. It appears that we didn't apply to the same programs at all. I hit the big name programs, including a few outstanding county programs that I thought offered better training than some of the famous names (for example, I thought UCLA-Harbor offered more thorough and rigorous training as compared to Stanford and Yale even). If this is a reflection of where MDs and DOs apply in general, then it explains the completely different experiences and demographics seen. Thanks digitlnoize for sharing.
  29. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus

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    I'm also unaware of my program interviewing any caribbean grads in the past two years, but we regularly interview DOs. Personally I'd go DO if I were in that situation.
  30. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus

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    Agreed. I interviewed at the more "prestigious" west coast programs (except UCSF -- didn't apply, don't know if I'd get an interview), and while most applicants were MDs, they weren't only from top medical schools. My no name state school was adequate for me to get interviews there. Leo tends to exaggerate the competitiveness of psychiatry. Interestingly, one of the programs that he mentions regularly as being super competitive (UCLA-Harbor) regularly matches DOs.
  31. Leo Aquarius

    Leo Aquarius Anxiety.org Schizophrenia.com DepressionHealth.net

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    I'm just a med student so my barometer for programs is probably off. I'm just sharing my perspective. Everyone's is different I'm sure. As for Harbor, it matches just one DO per year and it looks like from the same institution recently. But then again I though UCSF and UCLA-NPI were very competitive too, but that's just me.
  32. digitlnoize

    digitlnoize Rock God

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    No problem! I certainly wouldn't say this applies to all DO's, just as I wouldn't say that ALL MD students want to do tons of research. But as a general rule, I would say that DO students tend to be less interested in big, academia-type places, and the atmosphere that tends to go along with that.

    I had about 8 classmates from my DO school match into psych. 2 went to Vanderbilt. 1 to UVA. 1 to MUSC. 1 to a DO program in her hometown.

    People tend to go where they want to go. I knew one guy that interviewed at a couple places in Cali, but ultimately chose not to go that route. I just plain didn't apply to any "Ivy" type places. More because I didn't like the locations. California is too far from home, and I hate the northeast.

    From everything I've heard and seen, I would totally go to school in the US if at all possible. If that's NOT possible, then a caribbean place isn't the end of the world, but between the headaches of island life, the lack of certain "luxuries" you might be used to here in the states, tropical weather/storms, cost of flights to come home for holidays and rotations, cost of moving there, and the perceived stigma/bias...I think DO wins.

    Now, if your interest is island medicine, or tropical infectious disease, then carib. might be your best option. If your interest is research or academia, then MD is totally your best option. If your interest is vanilla private practice, then MD or DO would suit your needs and go to the school with the best combination of tuition, training, and location that you can get into.
  33. BobA

    BobA Member

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    I agree with the consensus DO>>Carib

    Especially at the better DO programs you'll do well
  34. peppy

    peppy Senior Member

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    [looking at that map posted above] So they don't allow DOs to practice in North Korea huh? I'm heart-broken. :)
    I can only think of one or two times that a patient has commented on my being a DO since I started my psych residency. I really don't think most of the patients even notice. Honestly, a lot of patients don't even know that psychiatrists are doctors in the first place. Lots of them will think you're their "psychologist".
    I have on rare occasions had a patient ask "Where did you go to med school?" on our first meeting. If someone is going to balk at a DO, they're probably also going to have a problem with finding out their doc went to med school outside the US.
    Honestly though, I don't picture it being an issue UNLESS you're looking to build a practice full of very entitled narcissistic personality disorder patients.
  35. aphenomenon

    aphenomenon

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    Last edited: May 31, 2012
  36. st2205

    st2205

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    I'm surprised nobody's mentioned the third path yet: DDS -> maxillofacial surgery fellowship where you earn MD in process -> ACGME match -> psych residency.
  37. notdeadyet

    notdeadyet Still in California Moderator

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    Those folks are rock stars. Going to dental AND med school? I've only met a handful of them but they were all incredibly bright. Must self select.
  38. DebDynamite

    DebDynamite Attending

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    Thank you for cheering me up. This is the funniest thing I have read all morning!

    I had a friend years ago who wanted to be an MD, until he figured out how much money maxillary facial surgeons made. He's rollin' in it somewhere. Last time I saw him, he was leaving for dental school.
  39. st2205

    st2205

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    One of the surgeons I was with did dental -> maxillofacial surgery -> general surgery residency. I would have personally just done maxillofacial, but despite being able to make more apparently he really hated dentistry.
  40. notdeadyet

    notdeadyet Still in California Moderator

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    If he was a maxofaciallary (sp?) surgeon, he IS an MD. The path is dental school--> dental internship --> medical school --> MFS residency....
  41. digitlnoize

    digitlnoize Rock God

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    I could be wrong, but I'm pretty sure there are a couple of DO schools with dental school that offer this with the DO degree.

    I think NSU in Ft Lauderdale might. Or Michigan state. LECOM just opened a dental school in Bradenton and could very well offer this degree in the future, but not yet.

    I could, of course, be wrong.

    I could be wrong.
  42. Dharma

    Dharma

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    The Carib MD is not on par with the US DO in terms of international practicing rights. You will have a much harder time finding nations that will allow you to practice as a Carib grad than as a US DO (I believe 55 nations for DO vs 40 for SGU).

    http://www.sgu.edu/about-sgu/recognition-standardssom.html

    http://en.wikipedia.org/wiki/Osteopathic_physician#International_practice_rights

    Regardless, how many people are really interested in relocating to practice abroad? Doctors Without Borders will gladly take DOs or Carib MDs, if you need a bit of adventure.

    All-in-all if OP is really THAT concerned about the letters following his name, he should not go DO. Have fun on the islands...
    Last edited: Jun 5, 2012
  43. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    I think you are putting things in the wrong order. The St. George's list is where people have gone to practice. The list you provided is not an all-encompassing list where, if a nation is not on it, the grad cannot practice there.

    Just please try to be objective, instead of the pro-DO slant. "Much harder time"? It sounds like it is pretty difficult for DO's in the list on Wiki (provided by the AOA).

    I didn't go DO because I do not believe in the osteopathic philosophy. I did not want to take a spot from someone who did. I was guessing that 50% of DO's were "true believers"; a person I know that went DO said "try 10%" - that 90%, in his estimation, didn't believe in it.
  44. loveoforganic

    loveoforganic -Account Deactivated-

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    You don't necessarily need either (although I have no idea if DO programs exist at all). Some OMFS programs don't include an MD component. I don't know of the practice rights by state. I know a state board dentist pushing for DDS/MD only OMFS practice in their state, but that's about it.
  45. st2205

    st2205

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    I still, for the life of me, can't figure out the utility of this degree.
  46. Dharma

    Dharma

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    I stand corrected regarding the St. George's list. I admittedly did not read through the link thoroughly. My apologies. That said, the DO list is not that shabby. But as I said earlier, for most people international practicing rights mean very little if anything at all. For those outliers looking to set up shop overseas, well, they'll certainly have their fair share of hoops and hurdles to traverse, regardless of degree.

    I respect that you didn't go DO because you did not believe in the philosophy, especially with thoughts of other applicants in mind. I think there are those of us who go into it with an open mind and many others who sit down for their first class with a good deal of skepticism. (I tend to lean more towards the open-minded end of the spectrum, but I'm keeping my skepticism folded up neatly in my back pocket, just in case. I'm hoping there will be something useful I can extract from the experience). OPs concern isn't philosophy though.

    His concern is geared towards recognition (or lack of) and certain negative stigmas that may be attached to the degree. Personally, I feel this is a bit naive, but an individual should feel content with his decision, regardless of reason or the opinions of others (even if said reason seems to be based on other's opinions, hence the regardless... hehe).
  47. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus

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    I don't think all the programs give you the MD. I was talking to some people in the program here about this, and that's what they told me. Brutal path, imo, regardless. But yes, maybe lots of money, and maybe super enjoyable for some folks.

    BTW, it's not the schooling part that sounds miserable. The folks here have to do TWO surgery internships. Yikes.
  48. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Back when I was an intern, the Mt. Sinai program in NY had a 4 year OMFS track for the dentists, but, if they did the 6 year program (optional), they got the MD, too. However, I do not know the specifics (that was 10 years ago!).
  49. nancysinatra

    nancysinatra

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    These people are frightening. One of them took out my tonsils and wisdom teeth at the same time. (So, ENT and OMFS I guess.) I will never ever forget the pain that followed.
  50. vistaril

    vistaril

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    pretty much.....but even if a few programs prefer SGU or Ross grads over DO grads, that is still a HORRIBLE reason to go to a carrib school over an AMERICAN MEDICAL SCHOOL.

    The crap that students put up with going to carrib schools is just not worth it. And med school is 4 years Anyone who says they prefered going to a carrib school over an AMERICAN MEDICAL SCHOOL is a liar. Whether they admit it or not.
    I went to an allopathic med school, but if I had happened to be close to a DO school, I would have been happy going there. Doesnt make a whole lot of difference to me....american is american.

    Also, the idea that we as psychiatrists would worry about how people view initials after doctors names is absurd. You are PSYCHIATRISTS. If a DO psychiatrist is "looked down on", it's 500x more likely it's because they are a psychiatrist and not a DO.

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