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Ha! You posted this as I was writing the same thing!
So you were there too huh?
Ha! You posted this as I was writing the same thing!
So you were there too huh?
DISCLAIMER: these are my opinions based on my experiences. It doesnt make it right or wrong. It's gathered from rotating at 2 allopathic ortho and 6 osteo ortho. I also asked anesthesiologist/nursing staff/scrub techs etc questions between the two because I felt I had the stats to go either allo or osteo ortho. I wanted to know which one would provide to me the best opportunity. This only applies to ortho (maybe). Please dont post back attacking this post - well you can, but look we all get it, this is a generalization post.Your experiences with discrimination against your degree are certainly disheartening. I think you did a better job keeping your cool than most.
And I have to ask...why do you think a DO makes a better orthopod than an MD. Them's fightin' words.
undergrad at a few colleges because I thought I could play baseball.. I initially started at RICKS.. for those of you who know that school, it shows my antiquity but ended up at BYU.Love Elder Nelson! He came and spoke at a pre-med conference at UVU about 2 yrs ago and it was an awesome experience! Where'd you do your undergrad? Did you find that the Micro major (though 6 years removed) was beneficial in a good amount of classes during school? I'm a Micro major about to graduate from Weber State.
However they could tell you all the osteoprogenitor cells and what factors stimulated osteoclast growth and what's the new trials on bone growth factors, etc, etc I also discovered that MD programs have some huge surgical names to work with - ones who pioneered new procedures/research. cool right... well in most cases do you think these hot shot surgeons with huge reputations are going to hand the knife over to a second or third, maybe even fourth year resident.. It didnt happen and in fact I watched in most cases the residents get grilled/fired and roasted during the procedures with questions that have no bearing on surgery (Like, why is this instrument called the kelly forceps, who was the guy and what did he do- the resident didnt know and was shunned the rest of the operation.. happened at Mayo)
Now compare that do osteopathic programs which tend to be more smaller community based programs. In most instances as an intern there was plenty of OR time, and in fact the 4-5 year residents were expected to be the teachers for them on simple procedures. I saw second years roding femurs/tibias, placing screws, working one on one with an attending. Often third years were open to close. fifth years ran their own room (attending pops head in to start procedure for legal reasons then leaves). So the surgical experience and opportunities to operate were placed in a much higher emphasis. The surgical skills therefore, as a fifth year, were much more developed than in the allopathic programs.
I asked so many anesthesiologist about the difference in skills between allo and ortho residents -- they are the eyes in every OR. they almost always said the osteopathic residents are way more autonomous and have better surgical skills. they stated the third years were 1-2 years behind in surgical skills and in some extreme cases stated that they couldn't believe how little the senior residents operated.
i believe due to this, I would prefer to have a DO surgeon right out of residency operate on me as compared to a new MD surgeon. I'm not sure if this gap disappears after 5-10 years as an attending but its a major factor of why I DID NOT choose to participate in the MD match for ortho. I chose to match into a DO program because from day one I will be handed the knife, per say. Academics can always be learned on your own. I want to have the opportunity to be put in front of a patient, given the knife and guided as much as possible from day one.
by the way - the program I matched into I feel is the best osteo ortho program (Modesto California). just an amazing group of docs, case load and case variability. If you guys make it that far- make sure to come rotate. I'll be a senior resident, just mention this post and I'll make sure you get handed the knife, drill, saw or whatever.
Allopathic programs sacrifice surgical experiences for knowledge/research. Interns rarely see the inside of the OR and when they do, its to hold retractors, prep patients and close. You end up doing the scut work (work that no one wants and really should be left up to the nurses or ancillary staff) Yes you can learn during during the operation by observing but its totally different then when you actually hold the knife (or scope or whatever). I found that in most cases it wasn't until late third year/fourth year that the residents got to do many of the surgeries from close to close. At one program I observed a third year being taught how to do a distal radius, one of the most common operations in ortho. I was shocked because I actually had done a distal radius close to close with a hand surgeon and knew the steps,anatomy,etc better. I watched a third year at a prestigious allopathic ortho program open only once and the rest was just closing in a 4 weeks time.
understandable. No resident, just me and the hand surgeon,Not saying you're misrepresenting, but I would say this is an exaggeration as I checked out 7 DO programs and never did anything skin to skin. In fact most PGY2s didn't do cases skin to skin, even distal radius, attendings/senior residents always took charge.
good questions man! I am impressed. I did my homework as well. I spoke with the hospital administrator and the director of a conglomerate of community programs thats sole goal is to entice physicians to practice in their county. They specifically polled the county and determined that orthopedics was the greatest need - thus why they began an orthopedic residency (in hopes a few residents will stay). So I believe the opportunity, should I choose, will be there whether in private practice or through hospital employment. california's taxes (states personal income tax just jumped to 13%) and environment has made it difficult to entice physicians into the central california area.Orthojoe -
It's been said to do the residency where you wanna practice in the future.
Since you'll be doing your orthopaedic surgery residency at Modesto, CA:
1) How do you think about the job opportunities in Northern & Southern California after residency? Do you have to do your job search in other regions?
2) Does your program promise to help you in your job search efforts in the future?
3) How is the networking of osteopathic surgeons in California?
thanks for the confirmation - even a pre-medical student recognizes the difference.I noticed this as well while I was shadowing in all the surgical specialties. The osteopathic hospital let the brand new residents take part, while the fellows of the prestigious allo heavy hospital ended up holding things and completing less tasks. I wonder though, does it make it harder to complete a fellowship coming from an osteopathic hospital? I am sure it does. I really enjoyed hearing that the osteopathic surgery PDs were still highly biased toward taking osteopathic residents because they felt the same things that you just stated.
understandable. No resident, just me and the hand surgeon,
lets see, after having a 15 minute conversation of the steps,structures, etc before the case we scrubbed in and the scapel was handed to me, i made the skin incision, dissected out nerves/vessels under direct supervision of attending (obviously he was directing me!), protected these structures, reflected PQ to expose fracture site ----- here attending took over to gain provisional fixation and plate placement --- handed drill to me, i placed all screws --- attending took over to close fascial layers -- I closed skin. Of course he was giving me step by step instructions, guided my hand, checked with flouro, etc. It was last case of the day, last week of my 4 week rotation.
This was more than what a PGY-3 at a very reputable allopathic program did in four weeks. I saw him make one skin incision, remove two screws, and close. that was my point. But i guess you were right, I didnt do every step.
In osteopathic programs I saw three PGY2's do skin to skin on multiple cases -- but most commonly femoral neck fractures. I saw quite a few PGY3-4 do some large trauma cases skin to skin (AGAIN attending was there guiding and directing). I saw three PGY-5s run their own room for the whole day doing scopes (knee and shoulders), total knees, distal radius, femur and tibial fractures, femoral neck fractures, AKA. etc. WHILE guiding and directing PGY2-3. Attendings had complete confidence in these seniors. I was impressed with some of these seniors that I felt they were better than some other attendings I rotated with.
Maybe I just happened to luck out on my audition rotations to find programs like this. But I've heard many many of my friends say the same thing.
When you said skin to skin, I thought you did everything with no attending intervention, only supervision. I would say the amount of autonomy you got is a rarity for a medical student in any program.
undergrad at a few colleges because I thought I could play baseball.. I initially started at RICKS.. for those of you who know that school, it shows my antiquity but ended up at BYU.
Micro was fine and helped in a few areas. but I also took a few additional classes that made a huge difference such as biochemistry (I know some med schools are requiring it now as a pre-recc), anatomy, physiology -- those made a bigger differences,huge difference
Haha yeah my brother went to Ricks for a year so I can definitely see the age gap haha. I've taken all the required micro courses but I've taken as electives anatomy, advanced anatomy (teach the anatomy lab and perform dissections), physiology, biochem, genetics and a few others. Hopefully these will allow me to focus on things I'm less familiar with when school starts.
Being a family man, would you have any tips for what worked best for you as far as time management and spending time with the fam. I'm married with a 6 month old. Probably going to start trying for another in the next year or so. A friend of mine always gets up at 4:30am, studies, works out, studies more, eats lunch, studies, etc. comes home at 6pm ever night except the weeks before their block exams. Sounds awesome to me but I don't know if I could do the 4:30 every day haha. What did you do to make sure to give yourself time with your family in the first two years of school?
havent been back to rexburg since 1996. someday maybe -Haha yeah my brother went to Ricks for a year so I can definitely see the age gap haha. I've taken all the required micro courses but I've taken as electives anatomy, advanced anatomy (teach the anatomy lab and perform dissections), physiology, biochem, genetics and a few others. Hopefully these will allow me to focus on things I'm less familiar with when school starts.
Being a family man, would you have any tips for what worked best for you as far as time management and spending time with the fam. I'm married with a 6 month old. Probably going to start trying for another in the next year or so. A friend of mine always gets up at 4:30am, studies, works out, studies more, eats lunch, studies, etc. comes home at 6pm ever night except the weeks before their block exams. Sounds awesome to me but I don't know if I could do the 4:30 every day haha. What did you do to make sure to give yourself time with your family in the first two years of school?
wow thank you for that! I will definitely have my wife read this post this evening. I look forward to the challenge of finding what works best for my family.
Orthojoe -
What's the main reason that the day starts too early for surgeons, like around 4:00am in the morning? Does it have anything to do with catching up with the patient's Circadian rhythm?
starting the day at 4:00am as a surgeon is a legend/myth and not the norm. You only start that early consistently if (1) you are a resident/medical student or (2) you've been on call. I dont know of any attending that starts that early.Orthojoe -
What's the main reason that the day starts too early for surgeons, like around 4:00am in the morning? Does it have anything to do with catching up with the patient's Circadian rhythm?
are you in AZ? if so PM me and lets meet at the school and I will help you go through the selection process.Orthojoe: I'm still a little nervous about picking LA for rotations. How do I find out which location is good? I know you said you're not sure about LA specifically, but do you have any suggestions on how I can find out?
Don't care where I go. Just picked it because familiarity with area.
I called the program two weeks before I was to start the rotation, asking about dress code, white coat, tie, when and where to show up first day. I also made sure I was badged before I started the rotation. That way I hit the ground running and didn't leave in the middle of the first day to get my hospital badge.Orthojoe, at what point during do you learn what is expected of you as a 3rd year med student? Do you just show up being ready for anything? For example, a couple of posts ago you mentioned that you needed to do rounds before rounding with the residents. How did you know what time you needed to be there? How did you know when to show up on your first day? How do you know what to do when you round by yourself? Do you just learn on the go, looking clueless on your first rotations? I'm not trying to sound lazy, and I'm not trying to see how little I can get away with on rotations. It just seems like there is such a huge difference between pre clinicals and clinical years, I'm just wondering how you know where to start when 3rd year begins.
I have noticed that for what I'm interested in (sports medicine orthopedics), PCOM has an orthopedic program where you can be completed with your residency and fellowship (in near by hospitals) within 5 years. How does this compare to a MD's route for sports medicine orhtopedics? I'm a pre med and I don't know much about the process of how residencies/fellowships work. I know however that a DO has the option to apply to MDs if he or she has taken the USMLEs.
You have the option to apply to an MD residency, that is correct. However, this forgoes your ability to match DO ortho.
Most people do not take this gamble, as between 1-6 DOs match ACGME a year. To match as a DO, you'd have to have stellar stats, LOR, research, and often inside connections above that of the majority of MDs matching ortho. Additionally, you will have to overcome the serious anti-DO bias surgical program directors hold. For that reason, most competitive DOs will go the AOA route and not take that gamble, but exceptions happen every year. Unlike the other specialties such as IM, FM, psych, PM&R, peds etc, the ACGME surgery world is not DO friendly in any way. AOA ortho is incredibly competitive as well and is an amazing opportunity if you match.
Are the chances to match AOA ortho for DOs proportional to chances for matching ACGME ortho for MDs?
In 2011 there were 86 AOA orthopedic spots and 4228 graduates. In 2013 there 100 orthopedic spots and 4913 graduates.
Thanks for that - I thought I saw there was an increase in spots. I suppose one has to assume that with an increased number of students, there would be a corresponding increase in the amount of #1 choice ortho applicants as well. At least ortho has been adding spots unlike some of the other surg subspecialties.
Yeah, it's unfortunate that there just aren't enough spots on AOA side for all graduating DOs. Very concerning if ACGME changes it's policies towards DOs. Already DOs are limited to mostly primary care type things on the ACGME side with comlex.