4th Year DO student, ask me anything...

[SLC]

Hello everyone, current 4th year student here. I'm on my second to last rotation, things have slowed way down, and I'd like to offer up answers and advice for anyone who wants it.

A little about me:

- Former underdog applicant (from the original underdogs thread)
- Did quite well in med-school and on boards
- Married with kids
- Applied to FM residency, awaiting match results (two weeks!)

If anyone has any questions for someone who's been through the whole process of DO school I'd be glad to offer up my responses.

Best of luck everyone!

SLC

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[Oo Cipher oO]

Did you enjoy you schools unique 2nd year? I've heard mixed reviews about thew way AT Still AZ does it.

 

[SLC]

Did you enjoy you schools unique 2nd year? I've heard mixed reviews about thew way AT Still AZ does it.

If I'm being completely honest, 2nd year wasn't that unique except for the fact that most of our lectures were delivered via video podcast. We had the same number of lectures per week to deal with, we had the same subjects to learn (all subjects are spread out over M1 and M2), we had 4-8 hours of clinical exposure too.

So I guess I'm saying that it was only unique in the sense that SOMA's curriculum is unique (and therefore M1 is unique too). I loved the curriculum.

 

[DoctorSynthesis]

Hello everyone, current 4th year student here. I'm on my second to last rotation, things have slowed way down, and I'd like to offer up answers and advice for anyone who wants it.

A little about me:

- Former underdog applicant (from the original underdogs thread)
- Did quite well in med-school and on boards
- Married with kids
- Applied to FM residency, awaiting match results (two weeks!)

If anyone has any questions for someone who's been through the whole process of DO school I'd be glad to offer up my responses.

Best of luck everyone!

SLC

Why family med?

 

[DetectiveAlonzo]

I was very interested in applying to ATSU. Did you feel the streaming lectures or CHC hindered your education in anyway? did it still prepare you well for the STEP 1 and COMLEX?

 

[IslandStyle808]

I noticed that most learning at ATSU is through the CHC and that the curriculum allows for a couple months of electives during 3rd year. Did you set up rotations at any of local teaching hospitals which did not have strong affiliations with ATSU during your 3rd year? If so, how hard was it?

 

[NontradCA]

Why family med?

 

[j4pac]

What would you have done differently? Was there anything that surprised you about medical school?

 

[SLC]

Why family med?

It ended up being a late realization, I did originally plan on trying to chase down a career in Oncology, which meant IM followed by a 3 year fellowship.
But I was that guy who loved a little of everything. OB was great, Pediatrics was really fun, liked a bit of surgery, the ER, Derm, etc. I also really liked clinic and chatting with people/getting to know them. Family Med is the only job out there where you get to do it all.
If the match goes my way in two weeks, I'll have the chance to learn some of the smaller surgery procedures (appy's, chole's, tonsils, etc), learn to do endoscopy, learn surgical obstetrics, and learn to be a kick-ass clinic doctor.
The "prestige" is lacking, but I never went into this field to be admired by people. You gotta do what you love.
If I'd known from the get go, I might have skipped USMLE-2 though.

 

[SLC]

I was very interested in applying to ATSU. Did you feel the streaming lectures or CHC hindered your education in anyway? did it still prepare you well for the STEP 1 and COMLEX?

I really don't feel like t hindered me at all. I also won't pretend like it was some huge advantage either. Except for the boards, the examination style at SOMA was very much like the boards, so the format of being tested with 2nd and 3rd order questions that required my knowledge from a few different subject areas was very comfortable for me.

 

[SLC]

I noticed that most learning at ATSU is through the CHC and that the curriculum allows for a couple months of electives during 3rd year. Did you set up rotations at any of local teaching hospitals which did not have strong affiliations with ATSU during your 3rd year? If so, how hard was it?

I did set up rotations at a teaching hospital that my school had no affiliation with. It was a place that has a FM residency and teaches local MD students and a few DO students from other schools. The FM residency is top tier (even though at the time I wasn't interested in FM).

The process wasn't that difficult, the hospital was very receptive and my school was supportive. I had to put some administrative things in motion (getting the hospital's parent company affiliated with my school etc) but it wasn't tough, just required enough lead time so it would be complete by the time I wanted to do my rotations. Which meant mid-2nd year.

 

[Awesome Sauceome]

Sort of going off of something you kind of already answered. How do you go about really settling down on something like family med? I know I have pretty much enjoyed every field that I have shadowed in so far. There are aspects about each one that I like, and then some things I dislike. Its like I could see myself going in pretty much anything at this point. And going off of that, how do you really firmly make that decision that you want breadth over depth in a specialty? Again, I feel like some days I dig the "jack of all trades," rural, town doc kind of thing. Then other days its like I could see myself really going down a specific path and becoming specialized. Was there a time/moment during your clinical years where you just finally definitively knew that you wanted breadth over depth, and that is what helped confirm FM for you?

 

[Awesome Sauceome]

Also, since you are obviously doing the ACGME match, I take it you have no serious intentions of utilizing OMM in your practice on day?

 

[Crookster]

How much time does AT Still allow for board prep was it enough? Did you prepare for USMLE first or COMLEX and which one did you take first? How did you go about preparing for both exams?

 

[DoctorSynthesis]

It ended up being a late realization, I did originally plan on trying to chase down a career in Oncology, which meant IM followed by a 3 year fellowship.
But I was that guy who loved a little of everything. OB was great, Pediatrics was really fun, liked a bit of surgery, the ER, Derm, etc. I also really liked clinic and chatting with people/getting to know them. Family Med is the only job out there where you get to do it all.
If the match goes my way in two weeks, I'll have the chance to learn some of the smaller surgery procedures (appy's, chole's, tonsils, etc), learn to do endoscopy, learn surgical obstetrics, and learn to be a kick-ass clinic doctor.
The "prestige" is lacking, but I never went into this field to be admired by people. You gotta do what you love.
If I'd known from the get go, I might have skipped USMLE-2 though.

Do you think its difficult to do everything versus a specific task?

 

[evooo8]

How many residency programs did you apply to?

 

[SLC]

Do you think its difficult to do everything versus a specific task?

I think it depends on your personality. I won't pretend that I think I'll be as good as a fellowship trained specialist at anything. But I sure plan on being great at what I'll do and I also plan on being very clear about when and where it's time to refer.

I'm the guy who knows and takes pride at knowing something about everything in medicine. And I'm good about looking things up before dispensing information/advice.

That's what it takes to be a good PCP in my mind. That and a willingness to go without being seen as an "expert". I'm cool with that, I like being useful in virtually any situation.

 

[SLC]

What would you have done differently? Was there anything that surprised you about medical school?

I would have paid more attention to my school's clinical years grading policy. It's a bit wonky IMO and I didn't go over it with my preceptors which I think knowing what I now know, I would have.

Basically, preceptors are asked to rate students in a variety of criteria on a scale of 0-5. They are not told what my average score needs to be to land the student with a certain grade. So they circle numbers and leave it up to the school to assign the grade. It's also crazy that a 4 equals "exceeds expectations" and a 5 equals "greatly exceeds expectations". You have to average like a 4.75 I think to get honors.

Basically I've had preceptors tell me that I did a fantastic job, that I had performed at the level of an intern, or even a 2nd year resident on one rotation. They said I'd earned honors in their book. Then their score which was mostly 4's and 5's would inevitably fall .01 pts short of honors by my school's criteria and I'd get a high pass. Honors on the shelf exam won't push a high pass eval to honors in the rotation either, so despite the fact that I honored all shelf exams beating the average by 2+ SD's, I still just got high passes.

It's not a huge deal to me on a personal level. I don't have a personal need for honors grades to feel good about my knowledge or anything. But I'm sure it cost me a few interviews this year to not have honors in FM 3rd year.

 

[SLC]

Sort of going off of something you kind of already answered. How do you go about really settling down on something like family med? I know I have pretty much enjoyed every field that I have shadowed in so far. There are aspects about each one that I like, and then some things I dislike. Its like I could see myself going in pretty much anything at this point. And going off of that, how do you really firmly make that decision that you want breadth over depth in a specialty? Again, I feel like some days I dig the "jack of all trades," rural, town doc kind of thing. Then other days its like I could see myself really going down a specific path and becoming specialized. Was there a time/moment during your clinical years where you just finally definitively knew that you wanted breadth over depth, and that is what helped confirm FM for you?

Also, since you are obviously doing the ACGME match, I take it you have no serious intentions of utilizing OMM in your practice on day?

Basically I sorta always had this nagging feeling in the back of my mind that I'd be best suited as a PCP. I realized by mid-3rd-year that if I did IM and then decided not to go for Onc fellowship that I would rather be a PCP than a hospitalist. And if I was going to be a PCP, I'd much rather do it as a FP than an Internist. I really look forward to doing Obstetrics, and a few other things that internists just don't get involved in.

At the end of the day, I realized that while I love the science of Oncology, I'd probably be content talking to my patients about it and not really getting involved in managing chemo and stuff like that. I wasn't that into doing the Oncology as much as I liked talking to patients about what to expect, etc. Plus there's this awesome field that deals a lot with Oncology called Palliative Medicine and I think that might be better suited for my personality ultimately. Still get to work with cancer patients, which I love. But you get longer, more in-depth visits with them, and you focus on quality of life instead of just killing cancer. And Palliative Care is a growing and high-demand field that you can enter through a 1 year fellowship after FM, so I may think about that at some point.

As for OMM, I won't write it off completely; but I don't enjoy it and I think the few things I learned well in med-school are sufficient for what I plan to potentially offer my patients. Things like CS and muscle energy, but nothing really beyond that.

 

[SLC]

How much time does AT Still allow for board prep was it enough? Did you prepare for USMLE first or COMLEX and which one did you take first? How did you go about preparing for both exams?

I got a little over a month of dedicated time for Step-1, longer if I wanted to use the summer between M1 and M2 but I didn't want to do that. I studied hard the last few months of M2 and the course load lightened up enough to allow for that.

I prepared for USMLE, and did COMBANK OPP questions for two days before COMLEX. I took COMLEX first and treated it like a practice run for USMLE. I was certain I could pass both exams, but wanted to use COMLEX (and a real testing experience) to identify any areas I waffled on under pressure. I realized that there were a few areas of microbiology that I didn't have down pat and I was able to focus on those in the week between COMLEX and USMLE.

 

[SLC]

How many residency programs did you apply to?

I think 28 or 30, don't remember exactly.

I got about 20 invites, went on 9 interviews.

 

[boxer0011]

Thank you for your information. What was your college cGPA, sGPA, MCAT, and USMLE and COMLEX scores? Thank you again.

 

[SLC]

Thank you for your information. What was your college cGPA, sGPA, MCAT, and USMLE and COMLEX scores? Thank you again.

3.2, 2.7, 30 (12B, 11V, 7P)

230's, 570's (step/level 1)
230's, 520's (step/level 2)

 

[UTsksk]

Did you have kids before or during med school? Currently a 1st year and the wife is talking about wanting another. We already have a 6 year old. Also, was your spouse cool about you pursuing a fellowship? My wife has kind of hinted that she wants me to do FM or IM and be done with it so we can settle down and not deal with fellowships.

Also, what kind of family doc do you want to be? Direct primary care (concierge medicine?) seems to be trending, but I kind of envisioned myself mixing up inpatient with outpatient, but not sure if family docs still do that.

 

[Awesome Sauceome]

Basically I sorta always had this nagging feeling in the back of my mind that I'd be best suited as a PCP. I realized by mid-3rd-year that if I did IM and then decided not to go for Onc fellowship that I would rather be a PCP than a hospitalist. And if I was going to be a PCP, I'd much rather do it as a FP than an Internist. I really look forward to doing Obstetrics, and a few other things that internists just don't get involved in.

At the end of the day, I realized that while I love the science of Oncology, I'd probably be content talking to my patients about it and not really getting involved in managing chemo and stuff like that. I wasn't that into doing the Oncology as much as I liked talking to patients about what to expect, etc. Plus there's this awesome field that deals a lot with Oncology called Palliative Medicine and I think that might be better suited for my personality ultimately. Still get to work with cancer patients, which I love. But you get longer, more in-depth visits with them, and you focus on quality of life instead of just killing cancer. And Palliative Care is a growing and high-demand field that you can enter through a 1 year fellowship after FM, so I may think about that at some point.

As for OMM, I won't write it off completely; but I don't enjoy it and I think the few things I learned well in med-school are sufficient for what I plan to potentially offer my patients. Things like CS and muscle energy, but nothing really beyond that.

Gotcha, thanks for the time spent to write this.

I could end up seeing that for me as well. There are some super interesting and flashy specialties out there; but, maybe even the fact that I sort of want a piece of all of them would help direct me to FM as well? Who knows...

Are you really shooting for an unopposed program then, and then practicing rural one day? Word is that around the cities FM docs simply dont get the cases necessary to keep up with OB and then scopes and whatnot get passed off to specialists. Is a little more rural/suburban in the long term plan then?

Cool... Can you still bill for some of the osteopathic stuff even if you are not like AOA/OMM board certified, or would it just be random enough that you would pretty much do it simply to help out and it only takes a couple minutes?

As for the palliative care thing. It is my understanding of things that palliative care has one of the highest job satisfaction ratings of all specialties. I did not quite understand it until a recent loss in the family. It seems like a field that gives you the ability to really help with issues in the end of life and really support entire families which is not dissimilar from FM - I can definitely see the draw.

 

[Awesome Sauceome]

Did you have kids before or during med school? Currently a 1st year and the wife is talking about wanting another. We already have a 6 year old. Also, was your spouse cool about you pursuing a fellowship? My wife has kind of hinted that she wants me to do FM or IM and be done with it so we can settle down and not deal with fellowships.

Also, what kind of family doc do you want to be? Direct primary care (concierge medicine?) seems to be trending, but I kind of envisioned myself mixing up inpatient with outpatient, but not sure if family docs still do that.

DPC seems amazing. Sign me up for PCP right at the start of Med school if thats what my practice is guaranteed to look like.

As a question for either of you guys: how would FM mix inpatient with outpatient? Is this really only found in rural areas? How rural would you have to get for that? Or is it pretty much being phased out altogether? Or conversely is it growing?

 

[SLC]

Did you have kids before or during med school? Currently a 1st year and the wife is talking about wanting another. We already have a 6 year old. Also, was your spouse cool about you pursuing a fellowship? My wife has kind of hinted that she wants me to do FM or IM and be done with it so we can settle down and not deal with fellowships.

Also, what kind of family doc do you want to be? Direct primary care (concierge medicine?) seems to be trending, but I kind of envisioned myself mixing up inpatient with outpatient, but not sure if family docs still do that.

I had a 7 year old and a 4 year old when I started 1st year. Then had a newborn in the second semester of 1st year. It worked out well for us, but I'm married to superwoman so she was able to handle me being very busy and sorta take it in stride.

And you know what they say about wives, once they talk about wanting a kid, all you can do is stall them

My wife was OK with the idea of fellowship. I could tell she wasn't thrilled; but like I said, she's superwoman and she was ready to make it work so I could pursue what I thought was going to make me happy. She's definitely supportive of whatever I want to do.

As for practice type, I'm hoping for semi-rural/suburban where I can do OB, and hopefully a few office type procedures. I'm planning on learning endoscopy and if I can use that skill that would be great. Even if I have to travel to the back-woods on the weekend and do a "scope-clinic" or something.

 

[SLC]

Are you really shooting for an unopposed program then, and then practicing rural one day? Word is that around the cities FM docs simply dont get the cases necessary to keep up with OB and then scopes and whatnot get passed off to specialists. Is a little more rural/suburban in the long term plan then?

Cool... Can you still bill for some of the osteopathic stuff even if you are not like AOA/OMM board certified, or would it just be random enough that you would pretty much do it simply to help out and it only takes a couple minutes?

As for the palliative care thing. It is my understanding of things that palliative care has one of the highest job satisfaction ratings of all specialties. I did not quite understand it until a recent loss in the family. It seems like a field that gives you the ability to really help with issues in the end of life and really support entire families which is not dissimilar from FM - I can definitely see the draw.

I have my ROL in, the top 4 are unnopposed. The 5th program is basically unopposed, with just a small IM program at the same hospital. #6 is very opposed (UTSW) and #7 is unopposed as is #8. #9 (UofA south campus) has a few other programs around and just doesn't have a lot of comprehensive training going on.

My #2 program may be the strongest program in the country for what I'm trying to learn. If it was closer to my home state it would have been #1, but my #1 is 10 mins from my current home and is pretty dang close to #2 program in terms of quality.

As for OMM, I doubt I'll bill for it. It's just something quick to try for the patient IMO.

And Palliative care, you nailed it. You do a lot of great things, you do a lot of education, counseling, family support, and quality of life care. Plus, like you said, the ethos is similar to FM. And I think I could have the training and offer it to patients while still running a Primary Care practice at the same time at the right location.

 

[SLC]

As a question for either of you guys: how would FM mix inpatient with outpatient? Is this really only found in rural areas? How rural would you have to get for that? Or is it pretty much being phased out altogether? Or conversely is it growing?

It's easy to do if you work as faculty at a residency. But some docs are still doing it in urban/suburban settings. I live in a town of about 800,000 and there are FP docs that admit their own patients, do OB with c-sections, etc as private practitioners. Just gotta find the right hospital.

 

[Awesome Sauceome]

I had a 7 year old and a 4 year old when I started 1st year. Then had a newborn in the second semester of 1st year. It worked out well for us, but I'm married to superwoman so she was able to handle me being very busy and sorta take it in stride.

And you know what they say about wives, once they talk about wanting a kid, all you can do is stall them

My wife was OK with the idea of fellowship. I could tell she wasn't thrilled; but like I said, she's superwoman and she was ready to make it work so I could pursue what I thought was going to make me happy. She's definitely supportive of whatever I want to do.

As for practice type, I'm hoping for semi-rural/suburban where I can do OB, and hopefully a few office type procedures. I'm planning on learning endoscopy and if I can use that skill that would be great. Even if I have to travel to the back-woods on the weekend and do a "scope-clinic" or something.

How on God's green earth did you afford this? My wife and I have talked about kids off and on. Its not necessarily the time devotion to school that I am worried about, its the money. If I am a full time student, my wife will be working full time so we can afford to live. How can you financially make that work?

 

[SLC]

How on God's green earth did you afford this? My wife and I have talked about kids off and on. Its not necessarily the time devotion to school that I am worried about, its the money. If I am a full time student, my wife will be working full time so we can afford to live. How can you financially make that work?

Sacrifice I suppose. And a willingness to go into an incredible amount of debt. One thing I feel strongly about (personally not in relation to other people) is that my kids need to be raised by my wife and I. So my wife didn't work while I was in med-school; we didn't want them to spend time in day care (the youngest one mostly because the other two are in elementary).

We look for cheap rent in the best area possible. We kept expenses to a minimum, which means we do without in a lot of ways. Our kids don't get new school clothes for example, instead we replace when things are outgrown or worn out. We look for financial assistance too, most states will not consider loans as income so we qualified for food-stamps and Medicaid which eliminated two huge costs. Still we live on around $35-40k per year, which isn't easy, but doable.

And again, my wife is incredible. She knows how to balance a budget. We have more "living money" available to us now than we did in undergrad so it's been a bit easier.

 

[Awesome Sauceome]

Sacrifice I suppose. And a willingness to go into an incredible amount of debt. One thing I feel strongly about (personally not in relation to other people) is that my kids need to be raised by my wife and I. So my wife didn't work while I was in med-school; we didn't want them to spend time in day care (the youngest one mostly because the other two are in elementary).

We look for cheap rent in the best area possible. We kept expenses to a minimum, which means we do without in a lot of ways. Our kids don't get new school clothes for example, instead we replace when things are outgrown or worn out. Still we live on around $35-40k per year, which isn't easy, but doable.

And again, my wife is incredible. She knows how to balance a budget. We have more "living money" available to us now than we did in undergrad so it's been a bit easier.

But even that much, how do you get that much? I was under the impression you can only get out a max amount with the cost of living thing at schools? Like at my school in the fall I think its like 22-24K or something like that is the max cost of living expense that they will grant. Having been working for a couple years, I know that for my wife and I to not go into the red each month I need to pull in roughly 2.1K a month or like 25-26K after taxes. Where is that extra 10-15K coming from to afford the kids?

I dont mean to pry, I am just legitimately trying to figure out how to do it so that way I could maybe start having kids as well.

 

[SLC]

But even that much, how do you get that much? I was under the impression you can only get out a max amount with the cost of living thing at schools? Like at my school in the fall I think its like 22-24K or something like that is the max cost of living expense that they will grant. Having been working for a couple years, I know that for my wife and I to not go into the red each month I need to pull in roughly 2.1K a month or like 25-26K after taxes. Where is that extra 10-15K coming from to afford the kids?

I dont mean to pry, I am just legitimately trying to figure out how to do it so that way I could maybe start having kids as well.

My school's COA allowed for about $40k for living expenses.

 

[Awesome Sauceome]

My school's COA allowed for about $40k for living expenses.

ohhh gotcha, thanks.

 

[SLC]

ohhh gotcha, thanks.

Depending on where you're going, you can always talk to the financial-aid department about adjusting your COA to allow for more living funds. Some people have success with this...

 

[xBODOMx]

Honestly, that is insane. What are you buying that makes your family live on 40k/year. I have two kids and we live on 20-25k. How much debt are you in currently? How do you plan to pay that off working in FM?

 

[SLC]

Honestly, that is insane. What are you buying that makes your family live on 40k/year. I have two kids and we live on 20-25k. How much debt are you in currently? How do you plan to pay that off working in FM?

Rent on a single family home (we're a family of 5 so it's generally cheaper than renting a 3 bedroom apartment). Portland, OR isn't an inexpensive place. We also have a car payment.

I'm going to do IBR and, hopefully, PSLF.

 

[Roxas]

Honors on the shelf exam won't push a high pass eval to honors in the rotation either, so despite the fact that I honored all shelf exams beating the average by 2+ SD's, I still just got high passes.

It's not a huge deal to me on a personal level. I don't have a personal need for honors grades to feel good about my knowledge or anything. But I'm sure it cost me a few interviews this year to not have honors in FM 3rd year.

Any general advice for studying for COMATs?

 

[SLC]

Any general advice for studying for COMATs?

Pay attention to your rotation, do questions from a step2 bank.

 

[SLC]

The COMAT exams are not difficult, doing qbank questions is good study.

 

[Lawgiver]

top 3 non pre req classes that will be most useful in med school? im talking things like immuno, a&p , micro etc..

 

[boxer0011]

3.2, 2.7, 30 (12B, 11V, 7P)

230's, 570's (step/level 1)
230's, 520's (step/level 2)

Thank you for that information. That GPA is like mine, very encouraging thank you.

 

[chizledfrmstone]

3.2, 2.7, 30 (12B, 11V, 7P)

230's, 570's (step/level 1)
230's, 520's (step/level 2)

You said you were above average in your classes correct?

 

[SLC]

You said you were above average in your classes correct?

Yes, top 10.

 

[SLC]

top 3 non pre req classes that will be most useful in med school? im talking things like immuno, a&p , micro etc..

Anatomy (unless that counts as a pre-requisite these days)
Embryology (even better if you can find a combo anatomy/embryology course)
Microbiology would be a great class if you found a good one.

I even took a basic intro to pharmacology class which took some of the learning curve away from that course. Even knowing general drug classes and a few basic things about them was very handy going in.

 

[RNtoMDDO]

This may seem like a fundamental question, but I have had a difficult time with public speaking. Did you have to do many presentations infront of your whole class and do you feel that you have improved in this skill since MS1 ?

 

[thepoopologist]

This may seem like a fundamental question, but I have had a difficult time with public speaking. Did you have to do many presentations infront of your whole class and do you feel that you have improved in this skill since MS1 ?

I can answer this. There will absolutely be presentations in front of groups of people. They usually start your 3rd year of medical school and while infrequent, will not stop until the end of residency at the very least.

 

[weirdmutt]

What are the pros/cons in getting core 2 for rotations in third year?

 

[SLC]

What are the pros/cons in getting core 2 for rotations in third year?

I don't think I've ever heard that terminology before. Core 2?

 

[SLC]

This may seem like a fundamental question, but I have had a difficult time with public speaking. Did you have to do many presentations infront of your whole class and do you feel that you have improved in this skill since MS1 ?

I had one presentation to give to the entire class, I shared a part with a group of about 10.

I also had to present patients on rounds to groups of up to 10.

That's really it.