Enough osteopathic residencies?

There are currently about enough DO residencies to hold 1/2 of all osteopathic medical students.

sylvanthus said:

There are currently about enough DO residencies to hold 1/2 of all osteopathic medical students.

Click to expand...

Why is this the case and why are some programs sub-par? I am entering c/o 2016 and I just don't get why there aren't adequate DO residency programs.

AOA would rather make more schools than worry about what happens to students post med school.



Don't worry they are working for YOU! They had that in one of their emails what a joke.

Many of the DO residencies aren't as good because they aren't in big med centers or universities. So I imagine you have less range of patients, research opportunities, and what not.

Plus if your interested in cards or another field that requires a fellow there are not many of them.

Why not try and do MD IM, and Cards. They are trying to pass the new rule that you can't do a AOA IM res and then ACGME cards fellow.

zach175 said:

I'm a newly admitted student for osteopathic medicine for the class of 2016 and can't wait to get started in the Fall.

I had a question though regarding residency positions. Hypothetically, what would happen if the AMA ever decided to stop allowing DO students to the ACGME residencies? This is the one thing I guess I don't understand enough. DO residencies don't allow MD students, but ACGME residencies allow both.

Knowing that, what would be the explanation as to why it is very unlikely that DO students would ever be denied from applying to ACGME residencies?

Would there be enough DO residencies to cover things? Is this extremely unlikely to ever happen?

Click to expand...

I'm also a fellow class of 2016er. But honestly I feel that yes it is extremely unlikely that the AMA would ban DO grads from entering ACGME residencies by the time we apply for post grad spots at least. There way too many ACGME positions than US MD grads right now, probably more than double. Sure MD/DO schools are expanding and GME cuts are looming, but still things shouldn't change drastically in the near future.

FWIW...

In 2016
~18750 US MD grads
~5500 US DO grads
Countless IMG/FMG

In 2011
~23421 ACGME PGY 1 Positions (sf match, military etc excluded)
~2553 AOA PGY 1 Positions

A lot can change in a few years, though.

Well they are already trying to stop the AOA rotating year. I don't really understand resolution 42, but to me it seems like the writing is on the wall. I don't know if I'd go to a DO school in 10 years.

zach175 said:

Yea I guess it will be too soon for those of us starting next year to significantly affect us. Does make you wonder how it will all play out though. If DO schools keep expanding and popping up, the residencies are definitely going to need to increase.

Any reason why there arent more DO residencies? Funding issue? If so, why so many allo residencies? And I thought residencies were supported by federal funding? Am I wrong there? If so, why the separation at all?

Click to expand...

The number of residency spots that are funded through medicare was essentially capped 10-15 years ago. All hospitals that currently have >= 1 residency program cannot add more residency spots. They can "transfer" spots from FM to surgery or whatever, but for the most part, they cannot create new spots at their hospital. If a hospital that does not currently have a residency program wants to start one up they can, but whatever numbers they start with (maybe there is a time frame involved) is the number they they are stuck with.

As it is, most hospitals with the volume, capability and desire to have residency programs already have them, so it is very difficult for the AOA to coax hospitals into starting programs, especially when so many smaller hospitals and community hospitals have services managed by private practice groups. Also, despite what AOA folks will tell students, many hospitals don't want to be labeled as an "osteopathic hospital," especially if they have the choice of affiliating with an MD school. If some hospital actually has a need for a FM residency, why would they start up a DO program, when they run the extreme risk of not being able to fill their available positions (as is the case in many DO programs), when they can open an MD program and be almost guaranteed to fill (due to IMGs and DOs who want ACGME training)?

Unfortunately the only DO residencies that the AOA will be opening up any time soon will be at small hospitals with low volume that are in "undesirable" locations (that is obviously subjective). There is NO way that the AOA is going to create enough spots to cut down the gap between # of students and # of spots. They have been touting how they have created all these spots in the past year, but they haven't even kept up with the ridiculous increase in number of seats at DOs schools. And if COCA keeps rubber stamping new schools from random universities and groups that want to open up a new medical school, this problem will only get worse.

zach175 said:

Yea I guess it will be too soon for those of us starting next year to significantly affect us. Does make you wonder how it will all play out though. If DO schools keep expanding and popping up, the residencies are definitely going to need to increase.

Any reason why there arent more DO residencies? Funding issue? If so, why so many allo residencies? And I thought residencies were supported by federal funding? Am I wrong there? If so, why the separation at all?

Click to expand...

Residencies do not make money. Schools do.

Nymphicus said:

Residencies do not make money. Schools do.

Click to expand...

On the other side of the coin, residency is big big money making venture for hospitals . but plenty of hospitals have their own identity and do not wanna be labeled as teaching hospitals despite this

user3 said:

FWIW...

In 2016
~18750 US MD grads
~5500 US DO grads
Countless IMG/FMG

In 2011
~23421 ACGME PGY 1 Positions (sf match, military etc excluded)
~2553 AOA PGY 1 Positions

A lot can change in a few years, though.

Click to expand...

Your ACGME total is low and your AOA total is high.

You have failed to include the AUA, SF and out of match spots in your ACGME total. In 2010-2011 there were 26,107 residents entering ACGME programs. Here's the link to the ACGME Data Resource book
http://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdf
See page 76.

Your AOA total includes about 700 traditional rotating year spots. This brings the total AOA spots to about 1,850. Therefore the actual total is just about 28,000.

You also need to factor in med school attrition of approximately 5%. This brings the total domestic DO and MD grads to 24,000.

Obnoxious Dad said:

Your ACGME total is low and your AOA total is high.

You have failed to include the AUA, SF and out of match spots in your ACGME total. In 2010-2011 there were 26,107 residents entering ACGME programs. Here's the link to the ACGME Data Resource book
http://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdf
See page 76.

Your AOA total includes about 700 traditional rotating year spots. This brings the total AOA spots to about 1,850. Therefore the actual total is just about 28,000.

You also need to factor in med school attrition of approximately 5%. This brings the total domestic DO and MD grads to 24,000.

Click to expand...

if we're being really picky like that, then preliminary years shouldnt count for ACGME spots either. Just saying. Those have to number in the high hundreds, low thousand area themself (didnt check cause... well... im lazy today)

Not quite sure why we are arguing about specific numbers, when the fact remains there is obviously not enough DO residencies for the number of students.

Obnoxious Dad said:

Your ACGME total is low and your AOA total is high.

You have failed to include the AUA, SF and out of match spots in your ACGME total. In 2010-2011 there were 26,107 residents entering ACGME programs. Here's the link to the ACGME Data Resource book
http://www.acgme.org/acWebsite/dataBook/2010-2011_ACGME_Data_Resource_Book.pdf
See page 76.

Your AOA total includes about 700 traditional rotating year spots. This brings the total AOA spots to about 1,850. Therefore the actual total is just about 28,000.

You also need to factor in med school attrition of approximately 5%. This brings the total domestic DO and MD grads to 24,000.

Click to expand...

What about military? Does anyone know approximately how many grads match into military residencies each year?

Ibn Alnafis MD said:

What about military? Does anyone know approximately how many grads match into military residencies each year?

Click to expand...

~762 people, between MD and DO combined make up the military match
AUA is dealing with around ~250 people, if i remember correctly.
No clue what the brain surgeons and ophthalmologists number.

DocEspana said:

if we're being really picky like that, then preliminary years shouldnt count for ACGME spots either. Just saying. Those have to number in the high hundreds, low thousand area themself (didnt check cause... well... im lazy today)

Click to expand...

If you look at the page I cited, you will see that my total of ACGME residency spots DOES NOT include transitional or preliminary spots.

Not nearly enough DO spots and definately not enough in the specilaties. It isn't too far off to imgine that the ACGME deciding to not take any resident without and MD title. They just put forth a new rule that to do an ACGME fellowship you must have done an ACGME residency. That cuts off a whole lot of options for people who did a DO residency but want an MD fellowship becuase there are no DO options. It could very well happen. I think the AOA should allow the MDs to apply to DO residencies with the criteria that they complete and pass a 6 week OMM course with a board style exam at the end. Similar to a fellowship. They the ACGME could use the argument that we take you, but you don't take us.

PeepsLove said:

I think the AOA should allow the MDs to apply to DO residencies with the criteria that they complete and pass a 6 week OMM course with a board style exam at the end.

Click to expand...

Does anyone really believe that any MD even remotely competitive for an ACGME slot would apply to an AOA residency? What you will get is a lot of poorly-trained IMG's and Caribbean grads. Regardless of what anyone wants to believe, with the exception of OMM, AOA residencies are EVERYONE's second choice, both for DO's and MD's (were they allowed to apply). Whether that is fair or not is irrelevant. It is what it is.

DO Anes said:

Does anyone really believe that any MD even remotely competitive for an ACGME slot would apply to an AOA residency? What you will get is a lot of poorly-trained IMG's and Caribbean grads. Regardless of what anyone wants to believe, with the exception of OMM, AOA residencies are EVERYONE's second choice, both for DO's and MD's (were they allowed to apply). Whether that is fair or not is irrelevant. It is what it is.

Click to expand...

I'm pretty sure any MD that didnt already match into these fields would love to apply for a DO Urology, Plastics, Derm or Ortho spot. When number of spots is the limiting factor, I can tell you that a dermatologist is a dermatologist no matter where you trained.

DO Anes said:

Does anyone really believe that any MD even remotely competitive for an ACGME slot would apply to an AOA residency? What you will get is a lot of poorly-trained IMG's and Caribbean grads. Regardless of what anyone wants to believe, with the exception of OMM, AOA residencies are EVERYONE's second choice, both for DO's and MD's (were they allowed to apply). Whether that is fair or not is irrelevant. It is what it is.

Click to expand...

It's refreshing to hear a current DO who is sensible and acknowledges reality. After reading all the posts from DO's responding to this article -- page http://www.do-online.org/TheDO/?p=84091 -- I have been seriously depressed about the state of our profession.

I wrote a big long rant, but it doesn't belong in this thread, so I'll put it in a more appropriate place.

Anyways, it is nice to hear people acknowledging the truth.

It is very entertaining reading comments from doctors stating "enough of this intellectual BS" in regards to students questioning the scientific validity of OMT. We've been taught to be scientists in undergrad and to use evidence based medicine, yet somehow this suddenly gets all tossed out the moment OMT is involved.

chickoo said:

Osteopathic manipulative treatment is the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.

LINK TO WEBSITE REMOVED BY MOD

Click to expand...

Ohhh that's what omt is. Thanks for clarifying! Next time I'm in Bellandur ill check it out! Lol wth?

DocEspana said:

I'm pretty sure any MD that didnt already match into these fields would love to apply for a DO Urology, Plastics, Derm or Ortho spot. When number of spots is the limiting factor, I can tell you that a dermatologist is a dermatologist no matter where you trained.

Click to expand...

When the derm residency doesn't even pay you, i'd reapply ACGME as many times as needed. That was the sketchiest thing i've heard about in medicine in a long time

El Dooderino said:

When the derm residency doesn't even pay you, i'd reapply ACGME as many times as needed. That was the sketchiest thing i've heard about in medicine in a long time

Click to expand...

Idk which seem residency is doing that, but the 6 year one over here in NY pays out all 6. (technically any year after the 5th could theoretically only pay half salary abd its up to the hospital to match it for full pay)

DocEspana said:

Idk which seem residency is doing that, but the 6 year one over here in NY pays out all 6. (technically any year after the 5th could theoretically only pay half salary abd its up to the hospital to match it for full pay)

Click to expand...

A few in Florida I know about think the privilege of working for them for 5 years means you don't deserve a paycheck. The problem is people are desperate enough to take that deal. Sets up a dangerous precedent

El Dooderino said:

A few in Florida I know about think the privilege of working for them for 5 years means you don't deserve a paycheck. The problem is people are desperate enough to take that deal. Sets up a dangerous precedent

Click to expand...

Holy crap.

El Dooderino said:

A few in Florida I know about think the privilege of working for them for 5 years means you don't deserve a paycheck. The problem is people are desperate enough to take that deal. Sets up a dangerous precedent

Click to expand...

Could you point them out specifically and if I remember correctly Derm is 4 years total including the TRI year.

yeah i know about that..I actually had to seek my own funding for a dermpath fellowship..but i didn't feel too bad when half the MD fellows also had to pay their own way in the fellowship...that may actually be the standard in the future witht eh feds pulling funding right and left...you want a residency??? better be able to support yourself and pay for your education, just like medical school!

The fact that they will take as many students as they can handle, without thinking ahead and providing these students with residencies, is yet another reason I am against DO. Why do the DO schools think it's ok to take so many students and then to dump them into the MD system? It's not.

Athina said:

Why do the DO schools think it's ok to take so many students and then to dump them into the MD system?

Click to expand...

$$$$$$$$$$$$$$$$$$$$$

DO Anes said:

$$$$$$$$$$$$$$$$$$$$$

Click to expand...

True. Some schools more than others though, particularly newer schools.

Athina said:

The fact that they will take as many students as they can handle, without thinking ahead and providing these students with residencies, is yet another reason I am against DO. Why do the DO schools think it's ok to take so many students and then to dump them into the MD system? It's not.

Click to expand...

Read the new accreditation standards being proposed for COCA in pre-osteo. Don't know what's come out of them yet, though.

dntke1518 said:

Why is this the case and why are some programs sub-par? I am entering c/o 2016 and I just don't get why there aren't adequate DO residency programs.

Click to expand...

Because the body that governs the osteopathic profession, the AOA is ineffectual. Because of the AOA and their inability to effectively manage the osteopathic profession, the field is now in crisis.

bth7 said:

Because the body that governs the osteopathic profession, the AOA is ineffectual. Because of the AOA and their inability to effectively manage the osteopathic profession, the field is now in crisis.

Click to expand...

Crisis? I think that is a poor choice of words.

DoktorB said:

Crisis? I think that is a poor choice of words.

Click to expand...

Absolutely. "Crisis" is overused and overly dramatic. The field is in a period of transition and uncertainty. Crisis is when there are dozens of nuclear missiles being assembled less than a hundred miles from your coast. Crisis is not the restructuring of post-graduate education. Inconvenient? Yes. Concerning? Yes. Crisis? No.

zach175 said:

So does anyone think that ACGME will restrict DO students from residencies for those of us starting med school next Fall? It seems like everyone is concerned it could happen but how likely is that so soon?

From all the posts, if that happened ever, most DOs wouldn't get into residency? What do you do at that point if you have 200k+ in debt from med school? Seems unlikely it'd happen abruptly with the coming physician shortage over the next few decades. Yet so many posts point to it, but where would that leave a graduating DO?

Click to expand...

There will be a lot of talk and ultimately very little will change. Any major change will be gradual. If funding falls short for residencies, hospitals will cut back a few spots, then go crying to their legislators with red in the books and an "emergency" measure will restore funding, although certainly not to the same levels.

A very loose parallel can be seen with the NBA this offseason. Teams were legitimately losing money because of their labor system (Medicare cutbacks). They would have lost less money by not having a season (closing residencies). But they know that would have destroyed their future product, as this is a key time of transition in the NBA, from a period with few superstars to a time with many, young, spectacular talents (the impending "shortage" of providers).

The worst case scenario would involve turning GME into a dental-like system where you do unpaid residencies, or you actually pay your preceptors during your residency.

There is a valuable lesson to be learned from the history of DOs, when the military refused to allow DOs to serve. Because of the resultant shortage of MDs, who went overseas, DOs grabbed up a lot of practices and established a stronger foothold. If the ACGME and AOA can't sort out this residency squabble, and ends up with fewer practicing physicians, NPs, PAs, and other sub-doctorate level providers will fill the gaps and leave us standing with the empty bag.

And if you think that the AOA or AMA or any governing/representative body is going to merge or accede to the other, just remember that NO ONE ever votes himself/herself out of a job.

DO Anes said:

$$$$$$$$$$$$$$$$$$$$$

Click to expand...

Fair enough but ultimately, the students are the victims. My take on this is: Hey, you weren't good enough to get into an MD school? No problem, we have lower standards. Come join us. We'll make you a doctor and then dump you on the people who didn't want you in the first place.

This whole two systems thing is ridiculous. One system should exist and it should be tightly regulated.

Athina said:

Fair enough but ultimately, the students are the victims. My take on this is: Hey, you weren't good enough to get into an MD school? No problem, we have lower standards. Come join us. We'll make you a doctor and then dump you on the people who didn't want you in the first place.

Click to expand...

Wow. Get your Canadian ignorance out of this message board. This is your armchair evaluation from your pre-medical viewpoint of a country that you are not even attending medical school in? Have you set foot in a DO school before? Worked with a DO? Howabout you ask an MD in the United States what their experience has been working with DO's. In the real world, nobody gives a flying **** what letters are behind your name as long as you can take care of your patients. Do you have some more ill-formed preconceived notions of my profession or what poor decisions I have made to become a doctor? You don't know me and you certainly don't know the circumstances of any of my colleagues.

Wrong forum to give us your peanut gallery perspective my Canadian friend.

painmd87 said:

Absolutely. "Crisis" is overused and overly dramatic. The field is in a period of transition and uncertainty. Crisis is when there are dozens of nuclear missiles being assembled less than a hundred miles from your coast. Crisis is not the restructuring of post-graduate education. Inconvenient? Yes. Concerning? Yes. Crisis? No.



There will be a lot of talk and ultimately very little will change. Any major change will be gradual. If funding falls short for residencies, hospitals will cut back a few spots, then go crying to their legislators with red in the books and an "emergency" measure will restore funding, although certainly not to the same levels.

A very loose parallel can be seen with the NBA this offseason. Teams were legitimately losing money because of their labor system (Medicare cutbacks). They would have lost less money by not having a season (closing residencies). But they know that would have destroyed their future product, as this is a key time of transition in the NBA, from a period with few superstars to a time with many, young, spectacular talents (the impending "shortage" of providers).

The worst case scenario would involve turning GME into a dental-like system where you do unpaid residencies, or you actually pay your preceptors during your residency.

There is a valuable lesson to be learned from the history of DOs, when the military refused to allow DOs to serve. Because of the resultant shortage of MDs, who went overseas, DOs grabbed up a lot of practices and established a stronger foothold. If the ACGME and AOA can't sort out this residency squabble, and ends up with fewer practicing physicians, NPs, PAs, and other sub-doctorate level providers will fill the gaps and leave us standing with the empty bag.

And if you think that the AOA or AMA or any governing/representative body is going to merge or accede to the other, just remember that NO ONE ever votes himself/herself out of a job.

Click to expand...

I disagree that this will be a gradual change. I think it will all change with the stroke of a pen/keyboard as we've seen with the ACGME changes for fellowships.

The AAMC has a seat at the ACGME table, while COCA/AOA does not. The AAMC will present its position about how its students are now facing increased competition for residency spots as the increased enrollments are graduating, and the ACGME will have to react.

How they will react is the question. Will they make the first iteration of the match US senior MD only? Will they outright ban certain degrees,FMGs,etc? No one can predict what the change will be, but I think it will be a matchwide policy, taking decisions out of individual programs hands.

DoktorB said:

Wow. Get your Canadian ignorance out of this message board. This is your armchair evaluation from your pre-medical viewpoint of a country that you are not even attending medical school in? Have you set foot in a DO school before? Worked with a DO? Howabout you ask an MD in the United States what their experience has been working with DO's. In the real world, nobody gives a flying **** what letters are behind your name as long as you can take care of your patients. Do you have some more ill-formed preconceived notions of my profession or what poor decisions I have made to become a doctor? You don't know me and you certainly don't know the circumstances of any of my colleagues.

Wrong forum to give us your peanut gallery perspective my Canadian friend.

Click to expand...

painmd87 said:

The worst case scenario would involve turning GME into a dental-like system where you do unpaid residencies, or you actually pay your preceptors during your residency.

Click to expand...

You mean like this?

Hippocrates said:

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, ...

Click to expand...

DrBowtie said:

I disagree that this will be a gradual change. I think it will all change with the stroke of a pen/keyboard as we've seen with the ACGME changes for fellowships.

Click to expand...

That's actually a perfect example of what I described. The ACGME wants to enhance the quality of advanced training (or just limit the competition, however you see it), and instead of just barring all non-LCME grads, they proposed this rule. (Is it a 100% good-to-go thing or still "in the pipeline"?) Ultimately, it will affect less than 10% of DOs. A crisis would be making it senior US MD only. This is an inconvenience, and a troubling one at that.

Athina said:

Fair enough but ultimately, the students are the victims. My take on this is: Hey, you weren't good enough to get into an MD school? No problem, we have lower standards. Come join us. We'll make you a doctor and then dump you on the people who didn't want you in the first place.

This whole two systems thing is ridiculous. One system should exist and it should be tightly regulated.

Click to expand...

Completely agree that ultimately it is the students (and the patients) who suffer because of the incompetence of the AOA.

The other points can't be argued with, as they represent well-established facts: DO schools do in fact have lower educational standards than MD schools.

Teacher student ratio
Overall per student spending
Funding for training equipment, classrooms, materials, libraries
Standards for clinical rotations: length, diversity, assessment,

There is a measurable difference in each category.

DoktorB said:

Wow. Get your Canadian ignorance out of this message board. This is your armchair evaluation from your pre-medical viewpoint of a country that you are not even attending medical school in? Have you set foot in a DO school before? Worked with a DO? Howabout you ask an MD in the United States what their experience has been working with DO's. In the real world, nobody gives a flying **** what letters are behind your name as long as you can take care of your patients. Do you have some more ill-formed preconceived notions of my profession or what poor decisions I have made to become a doctor? You don't know me and you certainly don't know the circumstances of any of my colleagues.

Wrong forum to give us your peanut gallery perspective my Canadian friend.

Click to expand...

Athina said:

Fair enough but ultimately, the students are the victims. My take on this is: Hey, you weren't good enough to get into an MD school? No problem, we have lower standards. Come join us. We'll make you a doctor and then dump you on the people who didn't want you in the first place.

This whole two systems thing is ridiculous. One system should exist and it should be tightly regulated.

Click to expand...

You know, however rare they may be, there are students, like myself, that only applied to one medical school, mine happening to be an Osteopathic institution.

But, hey, whatever makes you sleep at night. DO hate is fine, its sort of motivational.

As far as AOA residencies vs ACGME residencies, the points that the above posters have mentioned seem to make sense logically i.e. More well established programs with stable financial backing and strong affiliations. But then again, how are AOA programs supposed to progress to a similar level if they don't accept the bumps and bruises of starting up new programs and building on it year after year? I'm not too well informed on this though because I have yet to start rotations in August.

People do realize that the number of ACGME and AOA spots is actually increasing, right? ACGME spots have increased at about 500 spots a year over the past few years, and AOA spots about 100 a year (many of them in competitive specialities). The issue is will this rate keep up with the increasing number of med students (apparently, by 2020 it won't). I've said it before, but someone once posted an study with a graph that did a very good job at illustrating the growth rate, and when the number of graduates would exceed spots.

on this residency crunch which is really a jobs issue:
dunno about the future of the new private do schools. but it's gonna be a gigantic - and highly visible - mess if the state do schools can't place their graduates because of their degree - whereas the state md schools can - thus leading to unemployed do's?
we're talking about michigan, oklahoma, texas, ohio, new jersey, west virginia where the do schools are funded by taxpayers to produce doctors - and people have been talking about a doctor shortage ad nauseam
maybe this is what the aoa was thinking when they let all kinds of new schools open and ride on the coattails of the old state do schools!! sigh

johnnydrama said:

I don't really understand the incentive for a hospital to start a new DO residency program.

Unless the requirements are less stringent or they are subsidized by pro-osteopathic organizations, why not just have an ACGME residency and accept the best MDs/DOs who show interest?

All a hospital does by opening a DO residency instead of ACGME is limit their pool of applicants...

Click to expand...

You need a school to basically "affiliate" (this doesnt need explanation, right? Because I honestly never understood the *why* myself, but its just been told to me repeatedly that it must be this way) with you. Lots of the DO schools are finding previously unused hospitals, convincing them to take medical students and then a few years later selling them on residency training as well.

What it ends up being is a bit of 1) loyalty to the students who first trained there prior to the decision to have residency programs and 2) if by that time they have no LCME schools affiliated, then they really don't have much of a choice.