All Things ACGME/AOA Merger

[Stagg737]

This will likely never happen honestly and going to a DO school expecting as such is foolish.

I generally agree with the sentiment that if you're at a DO school you should consider yourself an underdog in the match, however this will vary based on PD. I have talked to one or two who have said they don't care about letters at all, and I think many actually feel this way.

The problem, as was already stated, is that opportunities to build a CV are typically harder to come by at DO schools along with the USMLE Vs COMLEX argument. There's a few PD's here who have stated they don't interview students without a USMLE score out of convenience (as a way to narrow down their interview field) and not any actual bias between the two tests. These issues become generalized across the entire degree even when they are completely false for individuals, which is where the overall bias comes from.

Either way, I personally don't foresee the DO bias disappearing anytime soon, even with the completion of the merger becuase of the significant variability in the DO education as a whole.

---

Members don't see this ad.

 

[hallowmann]

only HALF of DO students take Step 1.

The rotations are not the same.

Access to research is not the same.

Home programs do not exist for a majority of specialties for DO schools.

I do agree that only a small minority of PDs will care about MD initials but for a vast majority of them it will be Step Scores, Letters from Home Program Directors, Research and CV in general. There is nothing stopping DO students from getting those CVs built up, but there is nothing helping DO students either. The older more established DO programs are probably going to be fine considering they have been doing this for a while and their entering classes are academically ready to do well. The newer DO schools however are going to have a difficult time. The Match rate for osteopathic students was 80~something percent. Compared to 94~ percent for MDs.

Furthermore you seem to forget that your leadership likes it this way. They want primary care doctors not specialists. So they are unlikely to enforce higher standards to ensure student success into competitive specialties.

I was getting ready to be all defensive about your post, because its been a while and that's what I expect from SDN. But after reading it, I basically agree with everything you said.

To clarify some points:
-Based on last year's data ~54-55% of DOs take the USMLE Step 1 (so technically the majority, but pretty close to half)
-DO senior match rate is 87-89% and MD senior NRMP match rate is like 94%. As for DOs (seniors and grads), the match rate is more like 81% and for MDs (seniors and grads) its more like 90%.
-All DO schools are required to rotate and be affiliated with osteopathic GME programs (i.e. have a connection to an OPTI). So while it certainly isn't as broad as most of the well established MD schools, and student experiences do vary, all DO schools have some programs that can be considered "home programs". There are also a handful of schools with actual home programs, because they also own a hospitals with OGME programs. I have no idea how this will be affected by the merger though.

 

[libertyyne]

I was getting ready to be all defensive about your post, because its been a while and that's what I expect from SDN. But after reading it, I basically agree with everything you said.

To clarify some points:
-Based on last year's data ~54-55% of DOs take the USMLE Step 1 (so technically the majority, but pretty close to half)
-DO senior match rate is 87-89% and MD senior NRMP match rate is like 94%. As for DOs (seniors and grads), the match rate is more like 81% and for MDs (seniors and grads) its more like 90%.
-All DO schools are required to rotate and be affiliated with osteopathic GME programs (i.e. have a connection to an OPTI). So while it certainly isn't as broad as most of the well established MD schools, and student experiences do vary, all DO schools have some programs that can be considered "home programs". There are also a handful of schools with actual home programs, because they also own a hospitals with OGME programs. I have no idea how this will be affected by the merger though.

My point about home programs was mostly about ease of access. Even at lower tier MD schools a home program in IM, Gen Surg, probably some surg subspecialties are a walk or short drive away, If one needs to start putting in face time one can easily and build relationships. It is much more difficult if that ease of access is not available for mentorship, research.

I do have a somewhat contentious point I will make . I dont think the bottom of half of DO schools is taking Step 1. I can only imagine the results that would happen if Step 1 became the defacto requirement. I think the failure rates would be close to 20%. Which would keep DO ACGME match rates in the 80's. It might even enforce standard tightening for admissions if you have a 20% of the class having difficulty matching and no TRI or AOA spots left to accept them.

 

[hallowmann]

My point about home programs was mostly about ease of access. Even at lower tier MD schools a home program in IM, Gen Surg, probably some surg subspecialties are a walk or short drive away, If one needs to start putting in face time one can easily and build relationships. It is much more difficult if that ease of access is not available for mentorship, research.

I do have a somewhat contentious point I will make . I dont think the bottom of half of DO schools is taking Step 1. I can only imagine the results that would happen if Step 1 became the defacto requirement. I think the failure rates would be close to 20%. Which would keep DO ACGME match rates in the 80's. It might even enforce standard tightening for admissions if you have a 20% of the class having difficulty matching and no TRI or AOA spots left to accept them.

For the first part, I'm not sure what the point you're trying to make is. There are some DO schools that have exactly what you describe (GME programs including IM, GenSurg, and Surgical subspecialties within a walk or short drive of campus, because the schools own those hospitals in the same way most MD schools own hospitals). Most schools with affiliated OPTIs also have programs close-by as well, not just the ones that own hospitals.

To the second point, I think that if the requirement for USMLE came into existence, you might see a year or two of classes struggling to adjust, but they will eventually do so. All they would need to really do is adjust the curriculum so they have increased dedicated study time (like 4-8 wks most MD schools have, not like the 1-1.5 wks my school or the two other DO schools whose students I bumped into through 3rd year had) and a bigger focus on USMLE high yield topics. Numerous resources exist for board prep. Given enough time and exposure, most people could pass the USMLE. Now whether or not most people would do well is another issue all together.

 

[Adrenaline Junky]

For the first part, I'm not sure what the point you're trying to make is. There are some DO schools that have exactly what you describe (GME programs including IM, GenSurg, and Surgical subspecialties within a walk or short drive of campus, because the schools own those hospitals in the same way most MD schools own hospitals). Most schools with affiliated OPTIs also have programs close-by as well, not just the ones that own hospitals.

To the second point, I think that if the requirement for USMLE came into existence, you might see a year or two of classes struggling to adjust, but they will eventually do so. All they would need to really do is adjust the curriculum so they have increased dedicated study time (like 4-8 wks most MD schools have, not like the 1-1.5 wks my school or the two other DO schools whose students I bumped into through 3rd year had) and a bigger focus on USMLE high yield topics. Numerous resources exist for board prep. Given enough time and exposure, most people could pass the USMLE. Now whether or not most people would do well is another issue all together.

Would it not make sense to standardize the boards and have an optional section for OMM specifically for DO students who want to take that section, similar to how the New SAT works with optional writing.

 

[sab3156]

Would it not make sense to standardize the boards and have an optional section for OMM specifically for DO students who want to take that section, similar to how the New SAT works with optional writing.

Yes it would male perfect sense. Unfortunately, AOA/COCA/NBOME are not rational. They want $$, so what you are saying won't happen until these organizations are finally shut down.

The AOA president was also delusional enough to come to my school and basically ask us to take the AOA specialty board certification instead of ABMS. No real objective reason given. He seemed to be saying that it would be good for AOA if we did that. It was pretty sad.

 

[Adrenaline Junky]

Yes it would male perfect sense. Unfortunately, AOA/COCA/NBOME are not rational. They want $$, so what you are saying won't happen until these organizations are finally shut down.

The AOA president was also delusional enough to come to my school and basically ask us to take the AOA specialty board certification instead of ABMS. No real objective reason given. He seemed to be saying that it would be good for AOA if we did that. It was pretty sad.

Well haven’t they all lost power with the agreement of the merger? Only a matter of time before they all shut down

 

[AnatomyGrey12]

Well haven’t they all lost power with the agreement of the merger? Only a matter of time before they all shut down

No. The AOA isn't going anywhere now, they sealed their continued existence by snagging ~30% of the voting seats on the ACGME board. COCA will likely not exist but that won't likely happen for a large number of years

 

[Adrenaline Junky]

No. The AOA isn't going anywhere now, they sealed their continued existence by snagging ~30% of the voting seats on the ACGME board. COCA will likely not exist but that won't likely happen for a large number of years

 

[weechdr]

----What Happens when a student matched to a 4 year AOA program in the NMS match and then in April the program received accreditation to become a 3 year program? So it's after a contract has been signed but bore the student matriculates into the residency.

 

[DrMcLovin]

Does anybody know why the programs that received initial ACGME accreditation this past month have an “effective date” listed as 7/1/2017?

The prior programs that received initial accreditation just list the date of the RRC meeting as the “effective date.”

Has there been a policy change allowing programs to backdate the ACGME accreditation to the beginning of the academic year?

 

[Adrenaline Junky]

Does anybody know why the programs that received initial ACGME accreditation this past month have an “effective date” listed as 7/1/2017?

The prior programs that received initial accreditation just list the date of the RRC meeting as the “effective date.”

Has there been a policy change allowing programs to backdate the ACGME accreditation to the beginning of the academic year?

I would check the pinned thread on the DO forum, I believe that question may be answered

 

[DrMcLovin]

I would check the pinned thread on the DO forum, I believe that question may be answered

Thanks, this is the pinned thread in the DO forum and it hasn't been answered yet.

I'm just confused why the orthopedic surgery residencies that were reviewed at January 2018's RRC meeting were given an effective Initial ACGME accreditation date of 1/18/2018, but the dermatology residencies that were reviewed at April 2018 RRC meeting were given an effective initial ACGME accreditation date of 7/1/2017.

Some specialties require all residency years to be completed in an ACGME accredited residency in order to obtain ABMS board certification instead of AOA board certification. If all programs are getting backdated to the start of the academic year it would help the interns who started in a "continued pre-accredited" program that obtained "initial accreditation" in the middle of the year.

It was an interesting trend I've noticed so I was wondering if anyone had any insight into this.

 

[Adrenaline Junky]

Thanks, this is the pinned thread in the DO forum and it hasn't been answered yet.

I'm just confused why the orthopedic surgery residencies that were reviewed at January 2018's RRC meeting were given an effective Initial ACGME accreditation date of 1/18/2018, but the dermatology residencies that were reviewed at April 2018 RRC meeting were given an effective initial ACGME accreditation date of 7/1/2017.

Some specialties require all residency years to be completed in an ACGME accredited residency in order to obtain ABMS board certification instead of AOA board certification. If all programs are getting backdated to the start of the academic year it would help the interns who started in a "continued pre-accredited" program that obtained "initial accreditation" in the middle of the year.

It was an interesting trend I've noticed so I was wondering if anyone had any insight into this.

My mistake, thought this was a secondary thread by accident.

 

[hallowmann]

Thanks, this is the pinned thread in the DO forum and it hasn't been answered yet.

I'm just confused why the orthopedic surgery residencies that were reviewed at January 2018's RRC meeting were given an effective Initial ACGME accreditation date of 1/18/2018, but the dermatology residencies that were reviewed at April 2018 RRC meeting were given an effective initial ACGME accreditation date of 7/1/2017.

Some specialties require all residency years to be completed in an ACGME accredited residency in order to obtain ABMS board certification instead of AOA board certification. If all programs are getting backdated to the start of the academic year it would help the interns who started in a "continued pre-accredited" program that obtained "initial accreditation" in the middle of the year.

It was an interesting trend I've noticed so I was wondering if anyone had any insight into this.

Every RRC has their own rules regarding when they institute accreditation. Some will do it based on the time the application was reviewed, some on when it was submitted, some on site visits, etc. Each RRC makes its own decision. What the Derm RRC does is likely going to be different than what the Ortho RRC does.

I also wouldn't be surprised if some of that decision is on a program-specific basis. You really have to look at the specialty boards to see how it will affect you as a medical student. Some boards require all years to be in the same ACGME accredited program, others require the last x number of years in an accredited program, etc. The truth is it depends on each specialty. Each specialty board has a different rule in this regard.

 

[DrMcLovin]

Every RRC has their own rules regarding when they institute accreditation. Some will do it based on the time the application was reviewed, some on when it was submitted, some on site visits, etc. Each RRC makes its own decision. What the Derm RRC does is likely going to be different than what the Ortho RRC does.

I also wouldn't be surprised if some of that decision is on a program-specific basis. You really have to look at the specialty boards to see how it will affect you as a medical student. Some boards require all years to be in the same ACGME accredited program, others require the last x number of years in an accredited program, etc. The truth is it depends on each specialty. Each specialty board has a different rule in this regard.

Ok cool, it makes sense that its RRC specific. The specialty I start in July requires all 5 in ACGME and it looks like they make the effective date when the meeting ends. I was hoping it was a wider policy change. Thanks!

 

[hallowmann]

Ok cool, it makes sense that its RRC specific. The specialty I start in July requires all 5 in ACGME and it looks like they make the effective date when the meeting ends. I was hoping it was a wider policy change. Thanks!

Worst case scenario, you'll have to take the DO boards. Its not the end of the world. DOs have been practicing just fine with DO board certs. Its also possible that the boards will make exceptions for people from programs that get accredited in their first year of training. There's really no way to know.

Hopefully you won't have to worry about it and your program will get accredited before you start, but if your program ends up getting accreditation during your PGY1 year, I think it would be worth it to contact the specialty board and see what their policy will be in your case. Boards make exceptions all the time, and you'll be paying them thousands to keep certification if they make an exception in your case.

 

[moonwake]

Was talking to my school dean this week and they said that a few years ago the amount of D.O.s that scrambled each year was 30~. Last year it was ~120 and they're expecting it to be 200~ this year. Can anyone confirm the past numbers?

 

[hallowmann]

Was talking to my school dean this week and they said that a few years ago the amount of D.O.s that scrambled each year was 30~. Last year it was ~120 and they're expecting it to be 200~ this year. Can anyone confirm the past numbers?

I don't know if there was ever a time that only 30 DOs scrambled. Way more than that scramble/SOAP. For at least the last 3 yrs (and likely much longer than that), 10-15% of all DOs have been scrambling/SOAPing. I have no idea what your dean was referring to.

In the past, DO NRMP match rates had been even lower than they are now, and the AOA OGME positions could only support ~50% of DOs for at least the last 10-20 yrs, and they never filled and hundreds of positions consistently went to scrambling DOs.

The fact that a dean said this and the fact that in general DO admins give terrible and clueless advice about applying for residency and matching is a huge problem. We really need to work on this, because the NRMP match requires a bit more legwork/research to really be successful in it.

 

[moonwake]

I don't know if there was ever a time that only 30 DOs scrambled. Way more than that scramble/SOAP. For at least the last 3 yrs (and likely much longer than that), 10-15% of all DOs have been scrambling/SOAPing. I have no idea what your dean was referring to.

In the past, DO NRMP match rates had been even lower than they are now, and the AOA OGME positions could only support ~50% of DOs for at least the last 10-20 yrs, and they never filled and hundreds of positions consistently went to scrambling DOs.

The fact that a dean said this and the fact that in general DO admins give terrible and clueless advice about applying for residency and matching is a huge problem. We really need to work on this, because the NRMP match requires a bit more legwork/research to really be successful in it.

Awesome, thanks a ton. I didn't realize it was 10-15%. Sheesh. Hopefully because of just not playing their cards right mostly? Back up plans and such specialty wise?

 

[hallowmann]

Awesome, thanks a ton. I didn't realize it was 10-15%. Sheesh. Hopefully because of just not playing their cards right mostly? Back up plans and such specialty wise?

I mean some people have big redflags and others are just unlucky, but I imagine most people would be OK if they apply/interview broadly enough and have a backup.

 

[TheRealCookieMonster]

So to be clear in total we're netting negative several dozen residencies (how many positions total?) and they are all on the DO side. How can there be any confusion on whether or not the match rates for DOs (med students in general) are going to go down? Increasing med school grads with fewer positions = more people who have no livelihood. Like how can states like Idaho justify a new med school when the US can't even train the med students already in circulation? Seems like DO schools are going to have to accept lower and lower match rates and that sounds a lot like what happened in the Caribbean.
I realize this has been touched on, but reading all these posts and quotes and only understanding half the jargon is leaving me confused.

 

[Thumpar]

Serious, stupid question: are there international residencies that DO graduates could apply to?

 

[Robotfishbrain]

So much misinformation here in this thread. Residency spots don't just stagnate year to year. They grow too. A recent study just showed, even with the growing number of medical school grads, there will be enough spots up till 2026.

Source: Ten Year Projections for US Residency Positions: Will There be Enough Positions to Accommodate the Growing Number of U.S. Medical School Graduates? - PubMed - NCBI

 

[hallowmann]

Serious, stupid question: are there international residencies that DO graduates could apply to?

Canada? But they are few and far between. You'd be better off applying US. The rest will have very little impact in your ability to practice in the US and for most you'll have to repeat training anyways.

 

[TheRealCookieMonster]

So much misinformation here in this thread. Residency spots don't just stagnate year to year. They grow too. A recent study just showed, even with the growing number of medical school grads, there will be enough spots up till 2026.

Source: Ten Year Projections for US Residency Positions: Will There be Enough Positions to Accommodate the Growing Number of U.S. Medical School Graduates? - PubMed - NCBI

Right... but the number of spots will drop after the merge due to program closures (like ~20%), although that may have already happened.

 

[Robotfishbrain]

Right... but the number of spots will drop after the merge due to program closures (like ~20%), although that may have already happened.

While what you're saying is accurate, it is important to remember the programs that are closing are the smaller ones that cannot afford to run with ACGME standards. These are programs that funded 2 or 3 spots. I am not sure if the study I cited has taken this into account, but if growth remains steady I'm not sure any specialty outside of ortho or derm will be affected.

 

[TheRealCookieMonster]

 

[Robotfishbrain]

Also, according to the latest Webinar posted on the AACOM website, the AOA will be granted special accreditation powers post 2020. They will still need to follow the new regulations, but this merger will not be the end all for the AOA creating new spots. Like we've been saying for years, no one knows what's going to end up happening after 2020.

edit: added link to the webinar I'm referring to

July 2018: Single GME Accreditation System Update

 

[TheRealCookieMonster]

interesting thank you for the extra info.

 

[hallowmann]

While what you're saying is accurate, it is important to remember the programs that are closing are the smaller ones that cannot afford to run with ACGME standards. These are programs that funded 2 or 3 spots. I am not sure if the study I cited has taken this into account, but if growth remains steady I'm not sure any specialty outside of ortho or derm will be affected.

This is a very important thing to remember. Also keep in mind that the ACGME residency spot growth has been on the level of 1% per year. Even if we consider the 20% of AOA programs equating to spots (as stated above that's not actually the case), it only constitutes something on the level of 2-3% of ACGME spots, so the period of time of the merger (5 yrs) has already seen overall growth of GME regardless of the 20% loss of AOA programs.

That all said, we are still growing medical school spots faster than residency spots, so this will be an issue eventually, but an estimate I had a few years back had parity of US grads and PGY-1 spots at around 2025-2030, assuming growth of GME and medical school spots persist. It ended up being pretty close to that study I guess.

 

[Robotfishbrain]

Just a quick update -- after doing a little digging, Dr. Brucer (past AOA president) states that half of the AOA programs that are closing don't even have any current residents and were filed to close before the merger. He said this at a press conference this past June.

@hallowmann Actually the ACGME residency growth is as high as 2% some years, and consistently so for many specialties. As far as the residency gap in the future goes, people forget that the ACGME itself stated we need 22,000 grades by 2020. Logic tells us that maybe they have a long term plan. The merger was planned around 2008, seven years before it happened. These guys don't look at the short term as much as SDN users seem to think. I don't think these people are just winging it, but I could be wrong.

 

[TheRealCookieMonster]

I just want hope lol

 

[Robotfishbrain]

I just want hope lol

Unfortunately all the big threads on SDN devolve into projection of inferiority and misery. If you want hope I would follow the actual news sites (ACGME, AOA, Medscape, etc) and follow the NMRP data. SDN takes this stuff into a place of doom and gloom so quickly with absolutely no sources cited.

 

[socalpremed91]

I apologize if this questions is ridiculous but.... What if you match in a pre-accredited program that never gains initial accreditation by the 2020 deadline? I know they let residents finish out the residency program and just recruit no more new residents but what is the impact on those residents long term? will it restrict job opportunities in some way to have graduated from a program that isn't ACGME accredited? or will you take different boards (osteopathic vs ACGME) boards at the end of residency and that would make it obvious that you graduated from a program not ACGME accredited and make it harder for you to get more competitive jobs? I guess my question is what is the actual downside to being accepted to a non-ACGME accredited residency program that never gains accreditation and eventually stops recruiting residents while you are still finishing your training? Besides the obvious increased work load with less residents to work with on your rotations.

 

[gamerEMdoc]

I apologize if this questions is ridiculous but.... What if you match in a pre-accredited program that never gains initial accreditation by the 2020 deadline? I know they let residents finish out the residency program and just recruit no more new residents but what is the impact on those residents long term? will it restrict job opportunities in some way to have graduated from a program that isn't ACGME accredited? or will you take different boards (osteopathic vs ACGME) boards at the end of residency and that would make it obvious that you graduated from a program not ACGME accredited and make it harder for you to get more competitive jobs? I guess my question is what is the actual downside to being accepted to a non-ACGME accredited residency program that never gains accreditation and eventually stops recruiting residents while you are still finishing your training? Besides the obvious increased work load with less residents to work with on your rotations.

I think the big thing is the hospital may just shut down the program. That happened at York Memorial. Couldnt get initial accredidation, and it was decided to just shut down and residents had to find a new program.

Why would a program do this? After all, wouldnt it make sense to just let the residents finish? You have to remember that many of these programs are fairly small. A single class might only be three or four residents. And a small handful of residents may not be worth it to admin when it comes to having to pay faculty academic time, pay a program coordinator, etc. Admin could look at the bottom line and just flat out say we arent paying to keep the residency going for 1-2 more years, just to have the benefit of having 3 or 4 residents finish out their last year or two.

 

[gamerEMdoc]

On a positive note, the group of programs that were the first to get initial accredidation through the merger 3 years ago all should have had their site visit for full continued accredidation (10 years). We had ours and are now in continued (full) accredidation. No more site visits for 10 years!

 

[Dr.Bruh]

AOA President came to our school and showed us days on how many programs closed. He said that even though many programs have closed there will actually be more total spots post merger than preserver. He basically said that they have been able to expand the number of spots that the residencies that could get accredited could take. So technically there’s a net gain of spots post merger in former AOA programs. However they might be mostly primary care so that may be a negative. But I think we are still going to have plenty of Spitsbergen.

 

[gamerEMdoc]

AOA President came to our school and showed us days on how many programs closed. He said that even though many programs have closed there will actually be more total spots post merger than preserver. He basically said that they have been able to expand the number of spots that the residencies that could get accredited could take. So technically there’s a net gain of spots post merger in former AOA programs. However they might be mostly primary care so that may be a negative. But I think we are still going to have plenty of Spitsbergen.

I guess that’s true. Partly. Many of the small programs had to add spots to get accreditted. For example, in EM, programs have to be at least 6 residents / year to get accreditted. So some tiny EM AOA programs would have to expand if they wanted to get ACGME accredidation. So I agree with what they said that there are potentially more spots at those prior AOA places. However, what the AOA President fails to mention is, those spots are no longer guaranteed to go to DOs. Previously, those AOA programs matched 100% DOs. The second they switch over to ACGME, they can take whoever they want. Sure, they’ll still be DO heavy, at least for a while, but they will match MDs in some of those spots, no doubt. So I’m not sure this truly expands the opportunity for DO’s. The one thing it does do is allow then to only apply to one single match and not have to weigh programs accross two separate matches and have to gamble about matching AOA vs risking the ACGME match.

 

[rg2o3]

I guess that’s true. Partly. Many of the small programs had to add spots to get accreditted. For example, in EM, programs have to be at least 6 residents / year to get accreditted. So some tiny EM AOA programs would have to expand if they wanted to get ACGME accredidation. So I agree with what they said that there are potentially more spots at those prior AOA places. However, what the AOA President fails to mention is, those spots are no longer guaranteed to go to DOs. Previously, those AOA programs matched 100% DOs. The second they switch over to ACGME, they can take whoever they want. Sure, they’ll still be DO heavy, at least for a while, but they will match MDs in some of those spots, no doubt. So I’m not sure this truly expands the opportunity for DO’s. The one thing it does do is allow then to only apply to one single match and not have to weigh programs accross two separate matches and have to gamble about matching AOA vs risking the ACGME match.

I am not sure how this affects programs outside of primary care. My schools president spoke to some of us recently and they had to close/lower the number of residents/fellows in many of their programs due to the more strict rules of ACGME. I'm not saying this is a bad thing for medicine overall, but seems to be a bad thing for students, especially DO's trying to match, and even more so, match outside of pc. Also, I see that your post is quite old, but I just figured I would toss that out there since I had the conversation with the schools President the other day.

 

[gamerEMdoc]

I am not sure how this affects programs outside of primary care. My schools president spoke to some of us recently and they had to close/lower the number of residents/fellows in many of their programs due to the more strict rules of ACGME. I'm not saying this is a bad thing for medicine overall, but seems to be a bad thing for students, especially DO's trying to match, and even more so, match outside of pc. Also, I see that your post is quite old, but I just figured I would toss that out there since I had the conversation with the schools President the other day.

I wouldn't be so certain. There weren't a ton of AOA EM programs that closed down. The vast majority of them successfully switched over, and many that did expanded their number of spots. The net number of EM residency spots has gone up, not down, since the merger. At least for EM, the match rate for DO's with a COMLEX < 500 was 60% in 2018. That's a pretty good match rate for a competitive specialty for DO's with lower end board scores. The overall match rate for DO's for EM in 2018 was about 85% or so if I can remember. This year I looked at where the DO students that rotated with my EM program matched, and they predominantly matched at programs that weren't former AOA programs. DO's options just opened up, and they opened up significantly, over the last few years.

 

[rg2o3]

I wouldn't be so certain. There weren't a ton of AOA EM programs that closed down. The vast majority of them successfully switched over, and many that did expanded their number of spots. The net number of EM residency spots has gone up, not down, since the merger. At least for EM, the match rate for DO's with a COMLEX < 500 was 60% in 2018. That's a pretty good match rate for a competitive specialty for DO's with lower end board scores. The overall match rate for DO's for EM in 2018 was about 85% or so if I can remember. This year I looked at where the DO students that rotated with my EM program matched, and they predominantly matched at programs that weren't former AOA programs. DO's options just opened up, and they opened up significantly, over the last few years.

That's awesome to hear! I know that he was specifically talking about their ortho and CC/Pulm fellowship. Thanks for the info.

 

[gamerEMdoc]

That's awesome to hear! I know that he was specifically talking about their ortho and CC/Pulm fellowship. Thanks for the info.

I mean I can only speak for EM. I'd imagine the merger could have made it harder for Ortho, I know the boards requirements for DO's matching into orhto is a pretty high ceiling. All in all though, I still think the merger was a great thing for DO's. Former AOA programs are still very DO heavy, so their spots are still going to DO's. And now DOs can apply to one match with many more possibilities without limiting themselves to only those AOA programs. It's definitely a net positive for DOs.

 

[DrStephenStrange]

I mean I can only speak for EM. I'd imagine the merger could have made it harder for Ortho, I know the boards requirements for DO's matching into orhto is a pretty high ceiling. All in all though, I still think the merger was a great thing for DO's. Former AOA programs are still very DO heavy, so their spots are still going to DO's. And now DOs can apply to one match with many more possibilities without limiting themselves to only those AOA programs. It's definitely a net positive for DOs.

You're one of the first persons on these forums that I've seen saying that the merger is good for DOs overall lol. It's good to not hear about the doom and gloom for once.

 

[eberge3]

You're one of the first persons on these forums that I've seen saying that the merger is good for DOs overall lol. It's good to not hear about the doom and gloom for once.

The real doom/gloom is if they make USMLE pass fail.

 

[hallowmann]

You're one of the first persons on these forums that I've seen saying that the merger is good for DOs overall lol. It's good to not hear about the doom and gloom for once.

To be completely honest that was the overarching consensus prior to a couple years ago. If you look back there was a lot of debate about the merger in 2014 & 2015, but most of us agreed that the pros for most DOs consistently outweighed the cons.

Overall it was the best option given the circumstances and was best overall for the profession.

 

[OwurayawMD]

To be completely honest that was the overarching consensus prior to a couple years ago. If you look back there was a lot of debate about the merger in 2014 & 2015, but most of us agreed that the pros for most DOs consistently outweighed the cons.

Overall it was the best option given the circumstances and was best overall for the profession.

As an incoming DO student that gives me hope.

 

[Deecee2DO]

Unfortunately all the big threads on SDN devolve into projection of inferiority and misery. If you want hope I would follow the actual news sites (ACGME, AOA, Medscape, etc) and follow the NMRP data. SDN takes this stuff into a place of doom and gloom so quickly with absolutely no sources cited.

"The merger will screw us"
"FM is getting competitive"
"You won't get into med school unless you have a 520 MCAT and a 3.9"
-SDN

jk jk i love SDN lol

 

[DO2015CA]

To be completely honest that was the overarching consensus prior to a couple years ago. If you look back there was a lot of debate about the merger in 2014 & 2015, but most of us agreed that the pros for most DOs consistently outweighed the cons.

Overall it was the best option given the circumstances and was best overall for the profession.

Ya but as someone who was extremely optimistic back then, I can’t deny some bad writings on the wall. The whole competitive programs are still going to favor DOs and it’s just the changing of the governing body turned out to be untrue. I still think it’s a great gig but those of us who were here in 14/15 can look back at the posts and see the nativity. You still aren’t doomed to PC but with the continued opening of schools without additional residencies (in anything subspecialized) we will be.

 

[hallowmann]

Ya but as someone who was extremely optimistic back then, I can’t deny some bad writings on the wall. The whole competitive programs are still going to favor DOs and it’s just the changing of the governing body turned out to be untrue. I still think it’s a great gig but those of us who were here in 14/15 can look back at the posts and see the nativity. You still aren’t doomed to PC but with the continued opening of schools without additional residencies (in anything subspecialized) we will be.

Ehh, I never thought that favoring DOs meant having no MDs, and I kind of expected that to become less true over time (5-10 yrs out from the merger even if they historically were DO residencies). I did/still do expect (and its not clear yet whether that is the case) that with more DOs applying to competitive ACGME specialties that more of those programs would take DOs, if only by virtue of getting competitive DO apps that would otherwise only exist in the AOA side of ERAS.

I've made posts in the past where I've said that Ortho would be hit hard by the merger, mainly because we had so many DOs going into Ortho and had a ton of AOA spots. Many other specialties (NSG, ENT, Ophtho, Uro, Neuro, PM&R) all had number of spots in the 20s each per year (some were even single digits) in the NMS match, which compared to the 5000-6000 DOs really is a small number of actual DOs going in to those fields to begin with. Only time will tell if things even out for fields in the mid-range like OB and GS that had 100-150 spots each, but the 2018 numbers were reassuring. For Derm, I think that it hurt us, but a lot of those Derm residencies used to pay residents nothing or make them work for free in clinics. It was a predatory environment and easily half of those programs needed to close anyway.

That said, certain things have made me less optimistic in general, but part of that is issues with COCA. School expansion combined with elimination of the placement requirement for schools basically makes establishing GME pointless for schools. In the past, I expected that the placement requirement would force schools to open up more GME or reduce class sizes, but now they just don't have to. By far a placement requirement is the strongest recommendation I have for COCA at this time.

EDIT: Also, I got bored, so I came up with these numbers. The 2019 data that will come out later this month will give us a better idea, but virtually every specialty has seen a decent rise in the absolute number of DOs going into them, except for a handful of the most competitive surgical subspecialties (ENT, Derm, Ortho, and NSG - most of these were actually stable in 2018 but will likely drop in 2019/2020). Ophtho has stayed relatively stable over the last few years with 20-25 DOs matching annually, including in 2019 despite a huge drop in AOA spots. Uro is impossible to say, because the AUA match data doesn't differentiate between DOs and MDs.

Despite many numbers staying stable though, the percentages of DOs going into those surgical subspecialties have gone down due to the expansion of DOs, but that was going to happen anyways because DO expansion has been out of control, well out of the pace of even OGME specialty expansion.

2014 AOA Spots NRMP/SF Match Total
GAS 30 177 207
EM 270 177 447
FM 880 395 1275
GS 139 44 184
IM 609 444 1053
NSG 16 3 19
NEURO 22 56 78
OBGYN 78 131 209
ORTHO 103 1 104
ENT 19 0 19
PEDS 70 290 360
PSYCH 50 154 204
RADS 34 94 128
OPHTHO 17 ~6(?) ~23? - SF match didn't differentiate between DOs and MDs prior to 2015, but the 2015-2016 numbers were single digits
PM&R 12 111 123
DERM 45 3 48


2018 AOA Spots NRMP/SF Match Total
GAS 20 281 301
EM 172 484 656
FM 807 700 1507
GS 118 83 201
IM 559 875 1434
NSG 10 3 13 (-6)
NEURO 20 91 111
OBGYN 56 156 212
ORTHO 116 5 121
ENT 21 3 24
PEDS 31 403 434
PSYCH 39 251 290
RADS 12 143 155
OPHTHO 9 12 21 (-2?)
PM&R 18 123 141
DERM 41 13 54