MD vs DO

[Damia]

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[Nasrudin]

You make a good point about the increase in MDs without residencies available, so I'm curious what residencies are *not* challenging for a DO.

Also, SDN has given me the impression that at this point the MD schools are paralleling the values/goals that once made DO schools so different, so it really seems as if the residency issue is the only issue left in deciding which to shoot for. Yes/no?

Most fields are hospitable to DO's. Only a few fields make the degree more difficult. And only a few locales and settings.

The opinions against pursuing it come from people for whom these few aspects are of pivotal concern. So it is applicant-specific criteria we're talking about.

The DO option gives the applicant a lot more choice in medical schools. So these particulars must be evaluated against loosing options. For extremely competitive candidates loosing options may be less concerning. For marginally or less than competitive applicants not applying to a wider selection of schools including DO schools is a real gamble.

Residency, local connections, cost, other location issues like speedwagon's, school curriculum...these are the things to hinge your choices on.

Most of us. Myself included. Don't know what we're going to do or will be able to do at this point. A few of us despite this add wanting to maximize options to a cautious or preemptive degree to the factors influencing this choice.

So it's little more complicated than just one thing or another in most people's decision process.

 

[mspeedwagon]

Like was said above, most fields are still open for DOs. Primary care fields are especially DO friendly. The fields that are not DO friends are to some extent not friendly to the majority of MDs. For those fields, not only is an MD a must, but being toward the top of your MD class with high board scores is a must (derm, plastics, neurosguery etc.).

If you have the option to go to an MD school, opt for this almost always. The reason being the road will always be easier as an MD for getting into residency (the philosophical gap has pretty much closed). There are very good reasons to consider DO (you don't have the stats for MD or you have a strong geographical preference).

You make a good point about the increase in MDs without residencies available, so I'm curious what residencies are *not* challenging for a DO.

Also, SDN has given me the impression that at this point the MD schools are paralleling the values/goals that once made DO schools so different, so it really seems as if the residency issue is the only issue left in deciding which to shoot for. Yes/no?

 

[Law2Doc]

Most fields are hospitable to DO's. Only a few fields make the degree more difficult. And only a few locales and settings.
...

I think you are underplaying this a lot - sort of depends on what you mean by "hospitable". Most US allo programs are "hospitable" to DO's in that they have maybe taken one now and then. It would be unrealistic to suggest that DOs are on equal footing in most US allo residencies though. They are really on such footing in a minority of US allo residencies in MOST specialties and locales. It is still the minority of the country where DOs have made significant penetration. They do have their own residencies in a lot of fields so there is some offsetting advantages. But to the extent you are suggesting that there isn't a disadvantage you are kidding yourself. For this reason, if US allo is an option, I still think this keeps open a LOT more doors in a more realistic way.

 

[Nasrudin]

I think you are underplaying this a lot - sort of depends on what you mean by "hospitable". Most US allo programs are "hospitable" to DO's in that they have maybe taken one now and then. It would be unrealistic to suggest that DOs are on equal footing in most US allo residencies though. They are really on such footing in a minority of US allo residencies in MOST specialties and locales. It is still the minority of the country where DOs have made significant penetration. They do have their own residencies in a lot of fields so there is some offsetting advantages. But to the extent you are suggesting that there isn't a disadvantage you are kidding yourself. For this reason, if US allo is an option, I still think this keeps open a LOT more doors in a more realistic way.

I'm erring on being polite. And meant it broadly. If one is speaking in terms of simply matching period then one can find a home in most cases in a particular field outside of the really competitive ones.

I've got a buddy that matched into a serious MD ED program out of a degree mill DO program. He's not a med school rockstar. Weak anecdotes possibly. But I'm not interested in statistical exactitude at the expense of not being encouraging within reason.

But I'm happy to acknowledge your point.

 

[Law2Doc]

I'm erring on being polite. And meant it broadly. If one is speaking in terms of simply matching period then one can find a home in most cases in a particular field outside of the really competitive ones.

I've got a buddy that matched into a serious MD ED program out of a degree mill DO program. He's not a med school rockstar. Weak anecdotes possibly. But I'm not interested in statistical exactitude at the expense of not being encouraging within reason.

But I'm happy to acknowledge your point.

We've all "got a buddy". I also have a buddy who won six digits playing lotto. Doesn't mean we should all go out and buy a ticket. Short answer is that more doors will be open to you with US allo. Next comes US DO. Thereafter comes the "big 4" caribbean schools. And after that the other caribbean schools.

 

[mspeedwagon]

I would argue that after US DO, comes Cornell-Qatar (since it's a Cornell degree... though per my understanding you are still considered a foreign IMG, though I could be wrong), then the Caribbean Big 4 and schools like Sackler, U of Queensland, Royal College of Surgeons, then the Polish/Czech/Irish schools and other programs in the Americas that are approved in all 50 states by CA and then finally the at the very bottom are the other Caribbean schools.

We've all "got a buddy". I also have a buddy who won six digits playing lotto. Doesn't mean we should all go out and buy a ticket. Short answer is that more doors will be open to you with US allo. Next comes US DO. Thereafter comes the "big 4" caribbean schools. And after that the other caribbean schools.

 

[MLT2MT2DO]

Like was said above, most fields are still open for DOs. Primary care fields are especially DO friendly. The fields that are not DO friends are to some extent not friendly to the majority of MDs. For those fields, not only is an MD a must, but being toward the top of your MD class with high board scores is a must (derm, plastics, neurosguery etc.).

If you have the option to go to an MD school, opt for this almost always. The reason being the road will always be easier as an MD for getting into residency (the philosophical gap has pretty much closed). There are very good reasons to consider DO (you don't have the stats for MD or you have a strong geographical preference).

To be fair I'm not sure a PCOM grad (DO) would have a harder time matching into a highly sought out residency (derm/optho) than a grad from say Meharry (MD).

 

[mspeedwagon]

I don't disagree. However, you are taking the top DO program in the country (arguably) and comparing it to one of the very bottom MD programs (per USNews rankings).

I personally will very likely go DO (for geographical reasons). However, I still maintain that for most people, if they have that opportunity to go MD, then they should do so.

To be fair I'm not sure a PCOM grad (DO) would have a harder time matching into a highly sought out residency (derm/optho) than a grad from say Meharry (MD).

 

[MLT2MT2DO]

I don't disagree. However, you are taking the top DO program in the country (arguably) and comparing it to one of the very bottom MD programs (per USNews rankings).

I personally will very likely go DO (for geographical reasons). However, I still maintain that for most people, if they have that opportunity to go MD, then they should do so.

I'll agree, especially if you can get in-state tuition. When one gets into the ridiculously hard residencies there is much more going on than DO vs MD.

I am the same boat as you, and am 95% sure I want to go into primary care so for me it is a wash.

 

[Law2Doc]

To be fair I'm not sure a PCOM grad (DO) would have a harder time matching into a highly sought out residency (derm/optho) than a grad from say Meharry (MD).

Yeah, actually I'm fairly confident they would. You will see when you get further down the road.

 

[Law2Doc]

...and am 95% sure I want to go into primary care so for me it is a wash.

Most people change their minds at least once during third year of med school. That remaining 5% may switch to 50% before your education is up.

 

[MLT2MT2DO]

Most people change their minds at least once during third year of med school. That remaining 5% may switch to 50% before your education is up.

Most people aren't 30 years old with 10 years of working in clinical care either. I understand I may change my mind (hence why I said 95% and not 100%). If I had any reason to believe going to an osteopathic program would hold me back, I would apply insanely broadly in the allopathic world and probably get in somewhere.

As it is, geographical concerns are a bigger issue for me than what someone thinks about my degree.

If someone asks "What is a DO" I won't throw a fit, claiming someone disrespected me, I'll politely explain and have no problem with it.

If the U.S. Market ever becomes saturated with Doctors like it is with Lawyers, then the day may come when a D.O. degree can hold me back, until then I'm not too worried.

 

[illegallysmooth]

Thank you for saving me the time of having to anger google things.

How's your keyboard holdin up, Jag?

 

[TriagePreMed]

Law school is becoming a joke, unfortunately. They are even regrading all their students to give them higher GPAs. Some schools are paying employers to hire their students. It's really a worthless degree now like the MBA, except if you go to a top tier program.

Most people aren't 30 years old with 10 years of working in clinical care either. I understand I may change my mind (hence why I said 95% and not 100%). If I had any reason to believe going to an osteopathic program would hold me back, I would apply insanely broadly in the allopathic world and probably get in somewhere.

As it is, geographical concerns are a bigger issue for me than what someone thinks about my degree.

If someone asks "What is a DO" I won't throw a fit, claiming someone disrespected me, I'll politely explain and have no problem with it.

If the U.S. Market ever becomes saturated with Doctors like it is with Lawyers, then the day may come when a D.O. degree can hold me back, until then I'm not too worried.

 

[Law2Doc]

...Some schools are paying employers to hire their students. ...

You'll need to elaborate on this-- it sounds improbable. Law schools have always had a mission to make a profit, and so it's unlikely they will be paying employers anything. The key difference between law school and med school is that they don't serve a gatekeeper function. For med school, if you get in, you are 90+% certain to become a doctor. However for law school, there is still poor odds of becoming a practicing lawyer. They use attrition to weed down the class (something US med schools don't do), and even then in some states as few as 60% pass the bar. The state bar plays the role of gate keeper. Law schools promise nothing except an education. So many get through law school and never are able to practice. However it makes no sense whatsoever for a law school to pay out money on behalf of a student as described above. So either give some more info or I'm not buying it.

 

[TriagePreMed]

buy it:

http://blogs.wsj.com/law/2010/05/18/test-drive-law-school-paying-firms-to-hire-graduates/

You'll need to elaborate on this-- it sounds improbable. Law schools have always had a mission to make a profit, and so it's unlikely they will be paying employers anything. The key difference between law school and med school is that they don't serve a gatekeeper function. For med school, if you get in, you are 90+% certain to become a doctor. However for law school, there is still poor odds of becoming a practicing lawyer. They use attrition to weed down the class (something US med schools don't do), and even then in some states as few as 60% pass the bar. The state bar plays the role of gate keeper. Law schools promise nothing except an education. So many get through law school and never are able to practice. However it makes no sense whatsoever for a law school to pay out money on behalf of a student as described above. So either give some more info or I'm not buying it.

 

[Law2Doc]

buy it:

http://blogs.wsj.com/law/2010/05/18/test-drive-law-school-paying-firms-to-hire-graduates/

Fascinating. That's only 1 school (out of better than 400, an insignificant percentage) and it's mostly relating to summer jobs for 2Ls to get their foot in the door, not actual jobs (although the article does mention 3 3Ls being "sponsored" in this way, toward a relatively insignificant percentage of their salary. It also sounds like it's motivated by the desire to make SMU sound better in the job-placement statistics (which in turn will net them more tuition money when the next crop of applicants flock to them). Probably a lot more smoke an mirrors than actually buying folks jobs. But thanks for sharing this -- it's certainly news to me.

I don't think this really makes your case that "law school is becoming a joke" however. SMU isn't a top law school, but it's not a bottom one either, and its graduates do reasonably well regionally, even without the gimmicks. This is more of an experiment calculated to allow the program to look better in its brochures, in order to keep a steady tuition stream.

The rest of my post stands. Medicine differs from law significantly based on where the gatekeeper function comes into play. Which means law schools are happy to take your money and offer nothing in return -- it's the bar that actually decides if you can ever practice. Medicine is nicer -- if you actually get into a US allo med school you are pretty much definitely going to be a doctor.

 

[TriagePreMed]

Any top program in any field is not "a joke," but when you have Pat Robertson having a law school and then a new one popping here and there every week, it's hard to take it as seriously as it was before.

 

[Silverfalcon]

Law school is becoming a joke, unfortunately. They are even regrading all their students to give them higher GPAs. Some schools are paying employers to hire their students. It's really a worthless degree now like the MBA, except if you go to a top tier program.

The reason some law schools are doing is to increase the chance of employment (source: http://www.nytimes.com/2010/06/22/business/22law.html?pagewanted=all). This is not a sign that they are becoming "a joke."

Law schools are tough, but in different ways. Furthermore, a lot of any career in legal areas are through connections. You can argue as much as you want that law schools are not that difficult, but the real work in law school comes outside the courses where you are going in different places, gaining internships and spending time under clerks and other lawyers.

I also disagree that MBA is an useless degree mainly because I'm not sure on what context you are using the word "useless." Anyway, my point in all these is that there are good and bad things about programs other than medicine. I'm not trying to defend MBA or JD here, but it is incorrect for someone to bluntly say that all MBA and JD programs are no longer good unless they are "top." The truth is, however, on the individuals and opportunities that open up following the graduation.

 

[TriagePreMed]

Well, lets first clarify that I said that law school is becoming a joke, not that it is. Second, I said that top programs aren't a joke, which doesn't mean that programs below it must be a joke.

It really doesn't matter why they are regrading people. The fact is that those people have not earned the new grades. Where is my undergraduate regrading so that I can find a better job?

I also don't know in what context I used the word "useless," mainly because I didn't use the word at all. I searched the entire page for the word and it only comes up in your criticism.

EDiT: I see where I said that it is a "worthless" degree, and I admit that's an exaggeration. I most accurately believe it is becoming less and less "worthy" than it was in the past. However, when it comes to an MBA, I do believe it is mostly a useless degree. Companies force employees to get it just to seem like they have more impressive executives. Many in the MBA business agree that the degree is mostly a waste of time. You can even get them off University of Phoenix and other online schools.

The reason some law schools are doing is to increase the chance of employment (source: http://www.nytimes.com/2010/06/22/business/22law.html?pagewanted=all). This is not a sign that they are becoming "a joke."

Law schools are tough, but in different ways. Furthermore, a lot of any career in legal areas are through connections. You can argue as much as you want that law schools are not that difficult, but the real work in law school comes outside the courses where you are going in different places, gaining internships and spending time under clerks and other lawyers.

I also disagree that MBA is an useless degree mainly because I'm not sure on what context you are using the word "useless." Anyway, my point in all these is that there are good and bad things about programs other than medicine. I'm not trying to defend MBA or JD here, but it is incorrect for someone to bluntly say that all MBA and JD programs are no longer good unless they are "top." The truth is, however, on the individuals and opportunities that open up following the graduation.

 

[releehw]

So if I want to be an ENT is DO still okay? Someone on here said specialties aren't likely with DO and I want to verify if that's true

 

[DrMidlife]

#1 most pointlessly argued topic on SDN. If you want the answer to "will I be okay if I go DO?" then:

1. Pick a specialty or two.
2. Find a half dozen mixed-variety residencies in that specialty. Google FREIDA.
3. Find the current residents listed on the web pages for those residencies.
4. Look for DO's.
5. Repeat until educated.

 

[Goro]

100% agree with my learned colleague.

Another way is to simply google "osteopath" and [speciality]

like this:

http://www.aocoohns.org/

I honestly don't remember if any of my grads have gone into ENT. But I know we've sent people to ROADs (especially R and A), Neurology, I.M, and Emergency Medicine. Most of my students pre-select us because we (and many other schools) like Primary care, and they go more for ACGME than AOA residencies.

#1 most pointlessly argued topic on SDN. If you want the answer to "will I be okay if I go DO?" then:

1. Pick a specialty or two.
2. Find a half dozen mixed-variety residencies in that specialty. Google FREIDA.
3. Find the current residents listed on the web pages for those residencies.
4. Look for DO's.
5. Repeat until educated.

 

[DrMidlife]

Can't really use ACGME vs. AOA anymore, since all the residencies are under ACGME now. You now need to look at whether a particular residency supports the DO requirements (typical in IM, FM) or if you have to do a transition year at a program that supports DO requirements (maybe an extra year). The residencies that used to be AOA residencies (very few for ENT) will presumably continue to support DO requirements, and presumably will start taking MD grads. Currently you can see the former AOA residencies listed in a separate category but by the time the OP is choosing residencies that line will be much blurrier.

The merger helps [edit] willing orgs and residencies manage two sets of requirements, but adds yet more confusion for premeds trying to wrap their brains around MD vs. DO. That's where the AOA needs to step up and stop with all the nonsense about holistic medicine and "treating the patient not the disease" etc. That's pure marketing - you won't find a single MD who endorses silo medicine or ignoring the patient.

 

[AlbinoHawk DO]

Can't really use ACGME vs. AOA anymore, since all the residencies are under ACGME now. You now need to look at whether a particular residency supports the DO requirements (typical in IM, FM) or if you have to do a transition year at a program that supports DO requirements (maybe an extra year). The residencies that used to be AOA residencies (very few for ENT) will presumably continue to support DO requirements, and presumably will start taking MD grads. Currently you can see the former AOA residencies listed in a separate category but by the time the OP is choosing residencies that line will be much blurrier.

The merger helps [edit] willing orgs and residencies manage two sets of requirements, but adds yet more confusion for premeds trying to wrap their brains around MD vs. DO. That's where the AOA needs to step up and stop with all the nonsense about holistic medicine and "treating the patient not the disease" etc. That's pure marketing - you won't find a single MD who endorses silo medicine or ignoring the patient.

As far as I know, there hasn't been any official news about requirements for MD entering formerly AOA residencies, so extra year and all this other stuff you state is pure speculation. Most people believe a unified match is going to be in place by 2018 with 2020 being the latest date There's no "confusion" for the DO world. It's almost as before. DO can match into any program but by 2020 without restriction of choosing one match over another. There's also a lot of talk about implementing USMLE as the only licensing exam with COMLEX being an additional test just for OMM competency.

If you ask me, the entire MD vs DO thing is about to erode. The next step is to force DO schools into LCME standards, and they will comply. I bet money will be injected into DO schools. Whether DO as a degree will persist or not will be seen in the future.

 

[DrMidlife]

I assume you're used to thoughtless DO bashing. I don't do that. I take issue with AOA policy, not with DO's. Not the same thing. The AMA isn't a bunch of heroes either.

"Extra year" is the Transitional year that DO's doing ACGME residencies have often been required to do to get their DO-specific licensing requirements met, for decades. Residencies who don't want to teach those requirements have never been required to teach them.

There are ways around the required transitional year, which put the burden of meeting requirements on the DO resident, along with the rest of the duties of residency. With some effort you can get a transitional year to be your intern year.

Some of the residencies (IM & FM at least) that take MD and DO grads have a published curriculum in support of their DO residents. Not hard to find.

...and all of the above is why the perennial MD vs. DO argument on SDN is so useless. It fails to inform pre-DOs about the actual small details that are big fat inconvenient surprises later.

 

[AlbinoHawk DO]

I assume you're used to thoughtless DO bashing. I don't do that. I take issue with AOA policy, not with DO's. Not the same thing. The AMA isn't a bunch of heroes either.

"Extra year" is the Transitional year that DO's doing ACGME residencies have often been required to do to get their DO-specific licensing requirements met, for decades. Residencies who don't want to teach those requirements have never been required to teach them.

There are ways around the required transitional year, which put the burden of meeting requirements on the DO resident, along with the rest of the duties of residency. With some effort you can get a transitional year to be your intern year.

Some of the residencies (IM & FM at least) that take MD and DO grads have a published curriculum in support of their DO residents. Not hard to find.

...and all of the above is why the perennial MD vs. DO argument on SDN is so useless. It fails to inform pre-DOs about the actual small details that are big fat inconvenient surprises later.

I never said you were bashing DOs.

Transitional year is required by a few states unless you apply to resolution 42, which has never rejected an MD residency and forced someone to do a transitional year, so effectively there's never been an extra year. With the merger, such requirement is no longer necessary as all residencies will be ACGME.

I don't know what residency curriculums published you speak of because the fact is that such rules have not been made available or official. If a residency wants to write up a piece of paper saying something about curriculum, good for them, but it isn't a valid document. The new ACGME will be in charge of putting all requirements for MD and DO applicants.

There are no "big fat inconvenient surprises."

 

[releehw]

I appreciate you both pointing out details that I was unaware of. I will continue to research this, but any other two cents is appreciated!