What was the motive for ACGME to merge with the AOA?

[AnatomyGrey12]

Outside of surgical-subs, Derm, and Rad Onc DOs match fairly consistently.

because they had their own protected spots to match into which MDs cannot. what do you think is going to happen when the MDs can match into those spots? Obviously some MDs will match into previously DO only spots. The question is at what frequency.

DOs matching into DO derm or DO ortho programs doesn't make your argument, it undermines it. Show me DOs matching into MD derm or MD ortho, that is where you make a point if there is one.

I don't know what issue you have with what I said. Read my above quote. MD rads, gas, Middle tier IM--> IM subs, neurology, GS are all matched on a decent basis from most DO schools. I never said that a good number of DOs matched into highly competitive specialties like Ortho or Derm.... Also the best DO students often passed on the NRMP match because they knew they could match into an AOA residency. These students will now be able to rank all the programs they want to. The DO students who were competitive for these specialties in the first place will still match just fine, the ones who snuck into the bottom AOA programs in these fields through audition rotations will not.

I honestly would be a little surprised if competative MD applicants flocked to these AOA spots. Some will for location but I can't really see an MD student gunning for a community ortho program unless they probably weren't going to have a shot at the specialty otherwise. If a DO student can't compete with a below average MD applicant (for the specialty) then they don't deserve the spot anyway

---

Members don't see this ad.

 

[Rekt]

They absolutely will. Mark my words. The primary goal of those PDs is to fill their programs. As DOs start having an opportunity to rank former AOA programs alongside ACGME programs some of these former AOA programs will basically be forced to interview and rank IMGs because some of the DOs that they depended on to fill thier spots will start diffusing into ACGME programs.

Logic. You should give it a try.

because they had their own protected spots to match into which MDs cannot. what do you think is going to happen when the MDs can match into those spots? Obviously some MDs will match into previously DO only spots. The question is at what frequency.

DOs matching into DO derm or DO ortho programs doesn't make your argument, it undermines it. Show me DOs matching into MD derm or MD ortho, that is where you make a point if there is one.

You're right that many PDs of historically DO residencies (HDORs, pronounced Hodors) will have some brand recognition. But the fact remains that DOs have been able to apply to MD residencies all along, so nothing will change with MD residencies. The only change is that MDs will be able to apply to HDORs, and will add competition to DO students who traditionally went to HDORs.

Let's just say, for argument sake, that 90% of HDORs PDs agree to throw out all MD applications on principle. Even so, it will still make matching more competitive for DOs as 10% of programs would be looking at other applications.

MDs also stick to brand loyalty, I don't think that US MD programs will suddenly stop that now. The rapid expansion of USDO schools will actually only hurt the DOs from longstanding, well respected schools.

This just sounds like reallocation to me. Removing the thought of hypercompetitive specialties, because I do agree that matching into those will exponentially increase in difficulty. You guys are saying that MDs will matriculate into legacy AOA spots, but what about the spots they would have normally taken if the merger didn't exist? My thought is that any legacy AOA spots would be considered low-tier by MD students. That leaves "open" ACGME spots. So it seems to me, the more competitive DO applicants (probably top quartile students) will fill the spots that the garbage MD applicants couldn't. Eventually, with the proliferation of DO schools, opening at a much faster rate than residencies are, will have an extremely negative effect obviously, but within in the first few years of the merger?

 

[username456789]

I don't know what issue you have with what I said. Read my above quote. MD rads, gas, Middle tier IM--> IM subs, neurology, GS are all matched on a decent basis from most DO schools. I never said that a good number of DOs matched into highly competative specialties like Ortho or Derm.... Also the best DO students often passed on the NRMP match because they knew they could match into an AOA residency. These students will now be able to rank all the programs they want to. The DO students who were competative for these specialties in the first place will still match just fine, the ones who snuck into the bottom AOA programs in these fields through audition rotations will not.

I honestly would be a little surprised if competative MD applicants flocked to these AOA spots. Some will for location but I can't really see an MD student gunning for a community ortho program unless they probably weren't going to have a shot at the specialty otherwise. If a DO student can't compete with a below average MD applicant (for the specialty) then they don't deserve the spot anyway

Please please please learn how to spell "competitive."

 

[Donald Juan]

This just sounds like reallocation to me. Removing the thought of hypercompetitive specialties, because I do agree that matching into those will exponentially increase in difficulty. You guys are saying that MDs will matriculate into legacy AOA spots, but what about the spots they would have normally taken if the merger didn't exist? My thought is that any legacy AOA spots would be considered low-tier by MD students. That leaves "open" ACGME spots. So it seems to me, the more competitive DO applicants (probably top quartile students) will fill the spots that the garbage MD applicants couldn't. Eventually, with the proliferation of DO schools, opening at a much faster rate than residencies are, will have an extremely negative effect obviously, but within in the first few years of the merger?

I can't comment on how much it will affect DO students at matching, and I think you're correct that it will affect competitive residencies more than the less competitive residencies. I also think that DO students going into primary care will continue to not have issues at matching.

However, the point I always make in this discussion and I did above, is that even if 1 spot out of 10 in a HDOR goes to an MD (USMD, FMG, IMG, whatever), it means that it has pushed out a USDO. It means it is now more competitive for DOs.

 

[username456789]

I can't comment on how much it will affect DO students at matching, and I think you're correct that it will affect competitive residencies more than the less competitive residencies. I also think that DO students going into primary care will continue to not have issues at matching.

However, the point I always make in this discussion and I did above, is that even if 1 spot out of 10 in a HDOR goes to an MD (USMD, FMG, IMG, whatever), it means that it has pushed out a USDO. It means it is now more competitive for DOs.

I think he is incorrectly assuming that the MD program that this MD student would've otherwise matched into (had he not chosen the HDOR) will be likey to eschew any DO bias they already held and welcome the displaced DO with open arms.

 

[Goro]

This, I agree with!!

Again, an evolutionary process.

You're right that many PDs of historically DO residencies (HDORs, pronounced Hodors) will have some brand recognition. But the fact remains that DOs have been able to apply to MD residencies all along, so nothing will change with MD residencies. The only change is that MDs will be able to apply to HDORs, and will add competition to DO students who traditionally went to HDORs.

Let's just say, for argument sake, that 90% of HDORs PDs agree to throw out all MD applications on principle. Even so, it will still make matching more competitive for DOs as 10% of programs would be looking at other applications.

MDs also stick to brand loyalty, I don't think that US MD programs will suddenly stop that now. The rapid expansion of USDO schools will actually only hurt the DOs from longstanding, well respected schools.

 

[Rekt]

I think he is incorrectly assuming that the MD program that this MD student would've otherwise matched into (had he not chosen the HDOR) will be likey to eschew any DO bias they already held and welcome the displaced DO with open arms.

I was talking about ACGME programs that already accept DO students. I know those particular NYC and Ca programs aren't magically going to accept DOs

 

[PL198]

This just sounds like reallocation to me. Removing the thought of hypercompetitive specialties, because I do agree that matching into those will exponentially increase in difficulty. You guys are saying that MDs will matriculate into legacy AOA spots, but what about the spots they would have normally taken if the merger didn't exist? My thought is that any legacy AOA spots would be considered low-tier by MD students. That leaves "open" ACGME spots. So it seems to me, the more competitive DO applicants (probably top quartile students) will fill the spots that the garbage MD applicants couldn't. Eventually, with the proliferation of DO schools, opening at a much faster rate than residencies are, will have an extremely negative effect obviously, but within in the first few years of the merger?

you're not understanding what I'm saying. I'm not saying ortho MD studs are gonna take a DO ortho spot. I'm saying a 240 MD kid is gonna take a DO ortho spot, in which he/she previously wouldn't have matched into ortho.

 

[PL198]

That's not the point he is make, he agrees with the difficulty of matching into ultra competitive specialties. He is arguing against medium level specialities and programs. DOs have matched into such program like surgery or EM and even mid-tier program in Anesthesia. This will most likely not change.

I'm not getting the last point of your statement. We all know that is insanely difficult to get into MD derm or MD ortho (and yes DOs have matched into these fields, just look at the NRMP reports). The one thing you are not acknowledging is that now osteopathic student can put all former AOA residencies and ACGME into their rank list without being removed from the ACGME match. Put this factor in and it becomes far less predictable as to how osteopathic students do. For example, look at optho, there is fair amount of DOs who do match into this field. I don't believe for a second the DO bias is the weakest amongst the ultra competitive specialties, in fact I think it is about as strong as Rad Onc. The big difference is that the SF match happens before the AOA, thus you have more DOs matching into ACGME spots.

Again, we understand that it will still be insanely competitive to match into these fields and that MDs will match into former AOA specialties. However, this is not to say all of osteopathic matching will be nothing but negatives. The combined match is still a positive.

There is nothing positive for DOs. you gained nothing and lost protected spots

 

[mehc012]

There is nothing positive for DOs. you gained nothing and lost protected spots

It will be interesting to see how not having to juggle the two match processes/timelines impacts the placement of the top DO graduates, though. I think it's a bit shortsighted to pretend that the old setup didn't make it harder/riskier for them to match MD spots.

I think overall, it will be a negative for the majority of DO students due to the loss of their protected spots and the continued existence of DO stigma, but for that subset at the top, integrating the systems and thus simplifying the process might make it easier to aim high.

 

[Brorthopedic]

I'm excited for the merger, I'll only have to do one match and will be able to snag an ACGME spot from an average MD applicant. It's a shame this hadn't happened earlier, maybe @MeatTornado would be in primary care where he belongs

 

[username456789]

I'm excited for the merger, I'll only have to do one match and will be able to snag an ACGME spot from an average MD applicant. It's a shame this hadn't happened earlier, maybe @MeatTornado would be in primary care where he belongs

DO students have been able to apply to ACGME programs for quite some time. That didn't change with the merger.

Your odds didn't suddenly increase. In the most optimistic view, they have simply remained the same as they were.

It's just that now a bunch of borderline (for ortho) MD students are going to be encroaching upon DO ortho slots that used to be closed to them.

 

[Dr. Death]

The point was to fill my primary care spots. DOs will effectively be non-competitive for medium and high competitive specialties. This will occur via a two-fold mechanism: 1) some DO programs will be shut down 2) the average MD applicant is more competitive than the avg DO. Some DO programs with DO residency directors will continue to take DOs but I presume this will be the minority. The net effect will be that DOs will be more likely to apply for primary care positions, and we will more effectively address the shortage.

Nope. Primary care spots were already filled before.
Nope. DOs have been consistently matching into ACGME medium competitive fields and this will continue to be the case, especially given that there are a good amount of HDOR coming over that are in these medium competitive fields
Nope. Number of spots not changing so there will be no increase in primary care physicians due to the merger. Furthermore there is no shortage, they are merely not spread out well enough.

 

[Brorthopedic]

DO students have been able to apply to ACGME programs for quite some time. That didn't change with the merger.

Your odds didn't suddenly increase. In the most optimistic view, they have simply remained the same as they were.

It's just that now a bunch of borderline (for ortho) MD students are going to be encroaching upon DO ortho slots that used to be closed to them.

Nah, in the past some DO students had to choose which match to go through. That choice often being AOA for the sake of better odds.

 

[QualityProcess]

There is nothing positive for DOs. you gained nothing and lost protected spots

the two positives for DOs are
1. all residencies will at least meet the minimum standards for ACGME (i.e., close the embarrassing bottom feeder AOA programs)
and
2. DOs are still eligible for ACGME fellowships

to expand on #1... not all DOs want protected spots. I don't. Those who can hack it will be fine in ACGME, and those who can't will sink.

 

[mehc012]

Nah, in the past some DO students had to choose which match to go through. That choice often being AOA for the sake of better odds.

Exactly. Having to juggle two match systems or pick between them while completing one of the most stressful applications that determines your future career...it's difficult to pretend that this doesn't have an impact on the rate of applications to the AGCME match by top DO students, or their outcomes.

 

[235009]

I'm excited for the merger, I'll only have to do one match and will be able to snag an ACGME spot from an average MD applicant. It's a shame this hadn't happened earlier, maybe @MeatTornado would be in primary care where he belongs

Ummm what? I suspect you are very confused on many levels. Do you think "primary care" is some sort of insult? First of all I was not an "average" MD applicant. Second, I actually did go to a "primary care" residency (IM)....one that does not consider DOs and will continue to disregard their applications even after the merger as it is only getting more competitive.


Sent from my iPhone using SDN mobile app

 

[Brorthopedic]

Ummm what? I suspect you are very confused on many levels. Do you think "primary care" is some sort of insult? First of all I was not an "average" MD applicant. Second, I actually did go to a "primary care" residency (IM)....one that does not consider DOs and will continue to disregard their applications even after the merger as it is only getting more competitive.


Sent from my iPhone using SDN mobile app

No I don't think primary care is an insult, but the way you constantly talk about it makes it seem like it is

 

[IslandStyle808]

There is nothing positive for DOs. you gained nothing and lost protected spots

Problem is you are looking pre-residency and not post. You won't have hospitals pondering about whether you are a DO from some bottom tier AOA residency during your job search. You won't have fellowship PDs wondering whether you came from a bottom tier residency. The standards of residencies will be raised. This is huge during residency and after.

The combined match is still a positive whether you want to believe it or not.

 

[235009]

No I don't think primary care is an insult, but the way you constantly talk about it makes it seem like it is

I never disparage primary care and always speak out when some ***** uses it as some sort of insult (as you very clearly did). Get your facts straight. You clearly know nothing about me beyond the caricature you've made up.


Sent from my iPhone using SDN mobile app

 

[NontradCA]

I never disparage primary care and always speak out when some ***** uses it as some sort of insult (as you very clearly did). Get your facts straight. You clearly know nothing about me beyond the caricature you've made up.


Sent from my iPhone using SDN mobile app

You should smoke a joint and relax for a bit. You touch your patients with those fingers? Potty hands.

 

[hallowmann]

Actually doesn't the AOA have a decent number of Ortho spots? Get ready for those to get hit with a high number of applicants with 240+ and good research.

I always thought this would be a negative for DOs in competitive specialties since they will now compete with a lot of highly qualified people. Though maybe this will be a positive for less competitive specialties? Idk honestly.

Most DOs I know that confidently match AOA Ortho already have 700+, 240+, and tons of research. This isn't a decade ago where if you had a good work ethic you could match AOA ortho easily. I actually know a few that failed to match AOA with 700-750s and 240-250s. Heck, most DOs I know with 240s and 250s aren't even going for AOA Ortho, they're going for ACGME Rads, EM, and Anesthesia.

Sure some of the borderline DOs will be dropped from surgical subspecialties, but lets be honest their chances were questionable anyway, especially with ever expanding DOs with higher stats in the top quartile.

...As a side note, could ACGME be trying to cut the growth of DO schools by now controlling their residencies? COCA and the AOA now can't keep opening schools while 1) not expanding residency spots and/or 2) opening up poor residency spots that graduates gain nothing from. Seems like a strategic move to control the devaluing of the medical profession as a whole. COCA could continue opening up schools, but ACGME most likely won't do anything to help residency wise and/or will not approve or allow crappy residency programs to support unnecessary medical school growth.

The AOA has consistently been expanding OGME at a rate much faster than ACGME expansion for the last few years. It's the reason why in 4 years the AOA PGY1 positions went from ~2500 to ~3000. 100+ new PGY1 positions have been added every year, which really amounts to 300-400 new positions every year spread across the residency period.

This is all meaningless, however, because they already started with significantly less OGME than DO grads and they also aren't expanding OGME at a rate to match DO expansion. To give you an idea, the grad rate has increased by the same amount every 1-2 years as OGME expands every 4.

because they had their own protected spots to match into which MDs cannot. what do you think is going to happen when the MDs can match into those spots? Obviously some MDs will match into previously DO only spots. The question is at what frequency.

DOs matching into DO derm or DO ortho programs doesn't make your argument, it undermines it. Show me DOs matching into MD derm or MD ortho, that is where you make a point if there is one.

You missed the point. A ton (like 50%) already apply and compete against MDs in the NRMP match, and many of them regularly match in specialties, even those considered moderately competitive. This isn't changing anytime soon.

Question: roughly how many former AOA residency positions are anticipated being added to the NRMP?

~3000, some may be lost, but some might also be gained in that time. I suspect a wash.

you're not understanding what I'm saying. I'm not saying ortho MD studs are gonna take a DO ortho spot. I'm saying a 240 MD kid is gonna take a DO ortho spot, in which he/she previously wouldn't have matched into ortho.

See above. Plenty of DOs with 240s and 250s already make up the top quartile of DOs competing for AOA Ortho.

DO students have been able to apply to ACGME programs for quite some time. That didn't change with the merger.

Your odds didn't suddenly increase. In the most optimistic view, they have simply remained the same as they were.

It's just that now a bunch of borderline (for ortho) MD students are going to be encroaching upon DO ortho slots that used to be closed to them.

You're significantly underestimating the handicap that being in 2 matches that occur at different times places on competitive DOs. It might hurt the weak ones sure, but many of the competitive DOs have to forego the NRMP match altogether, or eliminate a bunch of programs in the specialty they want. It's no fun having to take a risk like that, and most don't, they go AOA and never get a chance to compete in the NRMP match.

We honestly don't know how those DOs will perform in a combined match.

 

[Ho0v-man]

Disregard my last post about the merger. The real purpose of the merger was to see how frequently the same ~30 ish people can talk about it in SDN.


Sent from my iPhone using SDN mobile

 

[YoungDoc25]

The AOA has consistently been expanding OGME at a rate much faster than ACGME expansion for the last few years. It's the reason why in 4 years the AOA PGY1 positions went from ~2500 to ~3000. 100+ new PGY1 positions have been added every year, which really amounts to 300-400 new positions every year spread across the residency period.

This is all meaningless, however, because they already started with significantly less OGME than DO grads and they also aren't expanding OGME at a rate to match DO expansion. To give you an idea, the grad rate has increased by the same amount every 1-2 years as OGME expands every 4.

More of my point was about the quality of this expansion. I think everyone on here knows that a significant amount of that residency expansion has been resulting in subpar training due to the spots being in below average hospitals/clinics, of which the ACGME will not maintain. This year alone there have been two schools open (ARCOM and Incarnate Word) and will account for 250+ of those new residency spots. My post was wondering more if the ACGME takeover will end this. If they not only slow down the expansion of residency spots, but shutdown 10% of the current OCGME residency programs because of them not meeting their standards, how will this effect DO school expansion? Surely COCA won't keep it going. My main point/question was if this was a strategic move by allopaths/ACGME to combat the expansion of schools taking in underqualified applicants and the production of poorly trained physicians due to poor AOA residency programs, all of which begins to tarnish the value of being a physician.

 

[VisionaryTics]

I don't get the people saying, "It's not a net loss for DOs because the DOs will be competitive against MDs [e.g. "Those who can hack it will be fine in ACGME, and those who can't will sink."] ".

That may be true in fields like IM or anesthesia or neurology where there has been historically less of a DO bias. But look at specialties like ENT or neurosurgery or orthopedics. It was incredibly rare for DOs students to match into ACGME residencies, so the AOA residencies were their only realistic option. Now those are in jeopardy because, 1) a good number of them are closing because they can't meet ACGME requirements, and 2) that 20-30% of MD applicants who historically didn't match into an ACGME program get a crack at those spots.

Quote from a surgical subspecialty AOA program director: "Thank God for the merger, I never have to take a ****ing DO ever again."

 

[QualityProcess]

I don't get the people saying, "It's not a net loss for DOs because the DOs will be competitive against MDs [e.g. "Those who can hack it will be fine in ACGME, and those who can't will sink."] ".

I didnt mean to imply that it was a net loss or net gain. Personally im not concerned with the net losses or gains of the DO community. Only concerned with an endpoint of merit-based opportunity. If thats even possible...

 

[jw3600]

Quote from a surgical subspecialty AOA program director: "Thank God for the merger, I never have to take a ****ing DO ever again."

Lol. That's great. Kind of brutal though. It's a little ridiculous to not acknowledge that there are rock star DO students. It's not really hard to understand that the kid with a 38 MCAT but a 3.2 UGPA in physics or engineering stuck at [ insert random DO school here] with a 265 step 1 isn't an incredibly gifted, hard working applicant. It's akin to not drafting Steph Curry because he played at Davidson and not Duke.

 

[Goro]

Why do you think that this will happen? Because of a USMLE score?

you're not understanding what I'm saying. I'm not saying ortho MD studs are gonna take a DO ortho spot. I'm saying a 240 MD kid is gonna take a DO ortho spot, in which he/she previously wouldn't have matched into ortho.

 

[Psai]

Lol. That's great. Kind of brutal though. It's a little ridiculous to not acknowledge that there are rock star DO students. It's not really hard to understand that the kid with a 38 MCAT but a 3.2 UGPA in physics or engineering stuck at [ insert random DO school here] with a 265 step 1 isn't an incredibly gifted, hard working applicant. It's akin to not drafting Steph Curry because he played at Davidson and not Duke.

If they were so smart, gifted and hard working why are they stuck at a random do school

 

[QualityProcess]

If they were so smart, gifted and hard working why are they stuck at a random do school

I had geographic limitations, personally. Not that all these wondeful attributes apply to me.

 

[Mr Roboto]

If they were so smart, gifted and hard working why are they stuck at a random do school

**** luck and a poor choice of UG.

 

[jw3600]

If they were so smart, gifted and hard working why are they stuck at a random do school

Because if your goal at the time isn't med school getting a few random B's in computer science, physics, Chem E isn't a big deal and is in fact the norm. Then senior year you have a 3.3 GPA to drag down your otherwise impressive application (95th percentile MCAT, research, whatever) so you end up at a DO school. It's silly and illogical to let a "sub par" undergrad performance hinder an applicant who clearly stands out in medical school.

Or as the other poster mentioned, SO location, ties to a school, DO propaganda can all cause these types to be stuck at said school.

 

[hallowmann]

More of my point was about the quality of this expansion. I think everyone on here knows that a significant amount of that residency expansion has been resulting in subpar training due to the spots being in below average hospitals/clinics, of which the ACGME will not maintain. This year alone there have been two schools open (ARCOM and Incarnate Word) and will account for 250+ of those new residency spots. My post was wondering more if the ACGME takeover will end this. If they not only slow down the expansion of residency spots, but shutdown 10% of the current OCGME residency programs because of them not meeting their standards, how will this effect DO school expansion? Surely COCA won't keep it going. My main point/question was if this was a strategic move by allopaths/ACGME to combat the expansion of schools taking in underqualified applicants and the production of poorly trained physicians due to poor AOA residency programs, all of which begins to tarnish the value of being a physician.

The majority of recent OGME expansion has actually been in primary care, and many of them will make the transition. Take the FM program at Marian Regional Medical Center in Santa Maria, CA. It opened up a few years as an AOA program, and this last year it attained ACGME accreditation.

It's actually much easier for a recently created residency program to adjust and conform policies to become accredited by the ACGME.

The real shutdowns will be in the surgical subspecialties (and most likely deservedly so), and to be honest there hasn't been a ton of OGME growth in those areas lately.

Plus, have you seen some of the low tier ACGME residencies? AOA primary care (and most specialty) residencies will have no problem adjusting policies to meet ACGME requirements.

And don't get me wrong, DOs will lose spots to MDs, and they might not recoup those spots from the MD programs, but at least the ones that make it will know they are in surgical programs where they'll have the procedure numbers to be confident in all aspects of the field by the time they're done. At least they'll know they won't have to pay or work free at a Derm residency based in a "beauty clinic". At least they'll know their training is recognized internationally.

The merger fixes issues on the AOA side, but again that wasn't the purpose, the purpose was power for the ACGME.

**** luck and a poor choice of UG.

Add on poor test taking strategy, undergrad not catered to the MCAT, and a lack of funds for a review course. I have a classmate that got a 24 on the MCAT. He learned how to study in med school and got high 220s on Step 1 and 240 on Step 2.

 

[Psai]

I had geographic limitations, personally. Not that all these wondeful attributes apply to me.

There are medical schools all over the country. NY schools probably have more californians than california

Track record matters. If you're starting from behind, you only have yourself to blame.

 

[NotAProgDirector]

I'm late to this thread.

The ACGME's interest in the merger was probably due to several issues:

1. Money. Drives the world, no? Programs all pay the ACGME fees every year to be part of the system, that's how the ACGME makes it's money. AOA programs would pay the AOA instead. So as all these programs shift to ACGME, all of those fees now will flow to the ACGME. It will increase their workload to some extent, managing all of those new programs. But probably a financial win for the ACGME.

2. Power -- as mentioned, this gives the ACGME a complete monopoly on GME. That said, I don't see this as a huge driver, since there isn't much the ACGME can do with their monopoly. They can't force medical schools to do anything. They can't just increase their fees to exorbitant levels (or, to be fair, they could have done this before the merger as MD programs couldn't just join the AOA instead). And the ACGME doesn't really get any further power in Congress because of this. So, overall, this isn't a big issue.

3. Quality management -- as mentioned above this allows them to hold all programs to a single standard.

4. Bigger politics. The merger essentially results in the NRMP taking over for the AOA match. And, it will end up with the ABMS boards taking over from the AOA boards. Wouldn't surprise me if those two outcomes are really what drove the merger. hardy: <-- that is a tinfoil hat. Why is there no better tinfoil hat emoji?)

 

[NotAProgDirector]

The discussion above mirrors my thoughts about what the merger of the NRMP and AOA match will do:

1. Very competitive DO programs might decrease in size or be closed due to the new standards.
2. DO's interested in the very competitive fields will initially be at a disadvantage, as there (may be) less spots, and MD's will be able to apply to previously DO only programs.
3. DO's interested in mid or lower competitive fields will be at an advantage. Rather than having to pick the AOA vs NRMP match, there's only one match and they can apply to all programs, rank in any order. Allows mid competitive DO's to apply to "reach" programs without penalty.

In the long term, expect some programs to open "OMM training seminars" for IMG's, and then IMG's will be applying to programs that incorporate OMM.

 

[235009]

In the long term, expect some programs to open "OMM training seminars" for IMG's, and then IMG's will be applying to programs that incorporate OMM.

Keep in mind though that it appears the early trend is for these programs to forego applying for osteopathic recognition anyway so OMM isn't even going to be a barrier for the IMGs.

 

[jw3600]

There are medical schools all over the country. NY schools probably have more californians than california

Track record matters. If you're starting from behind, you only have yourself to blame.

I mean you clearly have an impressive pedigree based off how hard you're pushing this narrative but this is very flawed thinking. See my comment about Steph. He's the back to back MVP and the scouts and GMs didn't hold it against him that his HS track record was mediocre (hence him playing at Davidson) but when they saw what he was capable of. He was given a chance. Undergrad performance is a useless thing to consider for residency selection. Barring some extreme examples like Rhodes scholar or crazy research/patent accolades.

 

[jw3600]

The discussion above mirrors my thoughts about what the merger of the NRMP and AOA match will do:

1. Very competitive DO programs might decrease in size or be closed due to the new standards.
2. DO's interested in the very competitive fields will initially be at a disadvantage, as there (may be) less spots, and MD's will be able to apply to previously DO only programs.
3. DO's interested in mid or lower competitive fields will be at an advantage. Rather than having to pick the AOA vs NRMP match, there's only one match and they can apply to all programs, rank in any order. Allows mid competitive DO's to apply to "reach" programs without penalty.

In the long term, expect some programs to open "OMM training seminars" for IMG's, and then IMG's will be applying to programs that incorporate OMM.

As usual. Reasonable, unbiased, and logical. And in a few years we can add accurate to the list.

 

[QualityProcess]

There are medical schools all over the country. NY schools probably have more californians than california

Track record matters. If you're starting from behind, you only have yourself to blame.

Your second point is true but I'm not sure what you mean by your first. You seem to have forgotten the crapshoot element in application to med school. My 3.7/32 was decent when I applied but by no means does it guarantee admission to one of two MD schools in a specific location.

 

[username456789]

I mean you clearly have an impressive pedigree based off how hard you're pushing this narrative but this is very flawed thinking. See my comment about Steph. He's the back to back MVP and the scouts and GMs didn't hold it against him that his HS track record was mediocre (hence him playing at Davidson) but when they saw what he was capable of. He was given a chance. Undergrad performance is a useless thing to consider for residency selection. Barring some extreme examples like Rhodes scholar or crazy research/patent accolades.

After observing what clinical education seems to consist of at a "good DO school" (they rotated at my community hospital where I did my TY), I can definitely see how even the brightest and hard working students (who may have had a few hiccups along their journey) are at a disadvantage going DO. The concern I would have as a PD in taking DO students is that the quality of the clinical years is and can be very poor. Not to say that every MD has perfect third year rotations, but for many DO schools across the board it just cannot and does not compare.

People like Steph Curry are very obviously the exception. It doesn't mean the NBA is going to start looking at Davidson to fill their rosters.

 

[QualityProcess]

The concern I would have as a PD in taking DO students is that the quality of the clinical years is and can be very poor.

People like Steph Curry are very obviously the exception. It doesn't mean the NBA is going to start looking at Davidson to fill their rosters.

Both good points. my core clinical rotations were at a major hospital with acgme residency programs (and i had mostly MD attendings), but many students at my school rotated at 200 bed community hospitals for their core rotations and i think thats a disservice. It will take a while before mid tier acgme programs decide for themselves when/if they will emphasize standardizing factors like USMLE over non-standardized elements of med education like clinical rotations, which they assume to be of poor quality at a DO school.

with regard to elite residencies... If you already have a large pool of near-optimal quality to choose from, why waste resources taking a chance? Dont even bother with tiny state school X (unless they know someone) or DO school Y. Just take students from harvard/stanford/michigan, known commodities, standardize them further with usmle, and interview them to make sure theyre not sociopaths. A simple low risk high reward process. Can afford to take a crappy resident by mistake every once in a while, but cant make a habit of it.

 

[Goro]

Because they made mistakes early on in their academic careers, and then recovered, or were solid B+ students gunning for schools that want and get A+ students, or have more trouble with the MCAT.

OR, they don't want to go to an MD school east of the Mississippi, if they're my students. Staying closer to home means something to them.


Newsflash: said DO students handle med school and medicine just fine (as long as their OMSIII and IV years are good...that's the rub the profession faces...see username's comment above). I could plop my students into the seats at Yale and they're handle the med school just fine there.

If they were so smart, gifted and hard working why are they stuck at a random do school

 

[EmergDoc2B]

My USMLE's are on par with top tier MD students and I'm at a random DO school. The shame of it all for those MD students.

 

[username456789]

with regard to elite residencies... If you already have a large pool of near-optimal quality to choose from, why waste resources taking a chance? Dont even bother with tiny state school X (unless they know someone) or DO school Y. Just take students from harvard/stanford/michigan, known commodities, standardize them further with usmle, and interview them to make sure theyre not sociopaths. A simple low risk high reward process. Can afford to take a crappy resident by mistake every once in a while, but cant make a habit of it.

Exactly. This is why my former Dermatology residency program has never (and according to them, will never) bother interviewing DO students. There are more than enough high quality MD students fighting to get interviews, so no need to take a chance otherwise.

 

[EmergDoc2B]

Who wants to look at rashes all day and work banker hours anyway.

 

[FiveOClock]

Your wrong here. DOs have consistently matched medium competative specialties and a decent number actually break into highly competative ones. The merger won't really change this. I think you are underestimating how competative some of the top 10-20% of DO students are these days. Outside of surgical-subs, Derm, and Rad Onc DOs match fairly consistently. The average DO has a number of specialty options available and is definitely not pigeonholed into general IM, FM, or Peds

DOs already filled primary care spots in large numbers and if that was the "goal" of the merger then it was pointless because that was already the case. It really is most likely a combo of $$$ and having a solitary accreditation body and standardized graduate training.

because they had their own protected spots to match into which MDs cannot. what do you think is going to happen when the MDs can match into those spots? Obviously some MDs will match into previously DO only spots. The question is at what frequency.

DOs matching into DO derm or DO ortho programs doesn't make your argument, it undermines it. Show me DOs matching into MD derm or MD ortho, that is where you make a point if there is one.

Right exactly. My point was that no more DOs will match into ANY specialties at a rate higher than they currently are. They will only match into LESS (relatively) competitive specialties and at lower rates. So logical conclusion has to be that only the cream of the crop DOs will have a shot at something with middle competitiveness. Therefore, MORE must be matching into lower competitive specialities (or not matching at all). This is not rocket science, it's a simple logical deduction.

Nope. Primary care spots were already filled before.
Nope. DOs have been consistently matching into ACGME medium competitive fields and this will continue to be the case, especially given that there are a good amount of HDOR coming over that are in these medium competitive fields
Nope. Number of spots not changing so there will be no increase in primary care physicians due to the merger. Furthermore there is no shortage, they are merely not spread out well enough.

Crying about it won't make it better. No one is saying that no DOs will match medium competitive fields. Excellent applicants will continue to. And if you think all primary care spots were filled last year by US grads, you should learn to use google. Although, I wholeheartedly agree with your point that maldistribution is the real culprit.

 

[Psai]

Your second point is true but I'm not sure what you mean by your first. You seem to have forgotten the crapshoot element in application to med school. My 3.7/32 was decent when I applied but by no means does it guarantee admission to one of two MD schools in a specific location.

Many people don't have their choice of location. It doesn't change the fact that location is generally a pretty crappy rationale for choosing a medical school and in reality, people aren't choosing do over md because of location. They just didn't have the choice of md available in the first place. The preclinical education 0f medical school is basically standardized at this point. However, clinical education varies greatly. If you're a do or img rotating through community hospitals, it doesn't matter if you get to be first assist if you're not learning how to be a doctor. Also, your peers and superiors greatly affect your education. The hidden curriculum is, at many times, more important than the curriculum outlined in the syllabus.

I have a decent amount of experience with md and do medical students and residents. The difference in quality between the two groups is noticeable. Yes, there are superstars at every school. But the exceptions prove the rule. No one singles out the exceptional md students because being exceptional is expected.

 

[Back 5]

For those of us graduating in 2018 and potentially starting an AOA residency that turns into ACGME in 2020, will we still be considered AOA program graduates or will that turn into an ACGME certification?

 

[QualityProcess]

Many people don't have their choice of location. It doesn't change the fact that location is generally a pretty crappy rationale for choosing a medical school and in reality, people aren't choosing do over md because of location. They just didn't have the choice of md available in the first place. The preclinical education 0f medical school is basically standardized at this point. However, clinical education varies greatly. If you're a do or img rotating through community hospitals, it doesn't matter if you get to be first assist if you're not learning how to be a doctor. Also, your peers and superiors greatly affect your education. The hidden curriculum is, at many times, more important than the curriculum outlined in the syllabus.

I have a decent amount of experience with md and do medical students and residents. The difference in quality between the two groups is noticeable. Yes, there are superstars at every school. But the exceptions prove the rule. No one singles out the exceptional md students because being exceptional is expected.

location is a crappy rationale for choosing a medical school? Not everyone matriculating is 22 with no strings attached and can just go wherever. Many people have families that need them to stay local.

Frankly, I don't think you've had much exposure to DO training. I don't think your point about "hidden curriculum" is valid because it can't be supported by any evidence. The huge majority of my attendings have been MDs. Two trained at Yale, one at U Michigan, one went to Cornell. The two surgeons I worked with went to regular old mid tier state school residencies in the midwest and in NY. At least 2 from U Miami. The point, of course, is that DOs are certainly not universally subjected to rotations where they shadow other DOs who went to branch XYZ of Timbuktu COM. Lots of us are taught by teachers who went to legitimate training programs.

Honestly I dont know why I responded at such length because your last sentence that MD students "being exceptional is expected" is a total clown comment.