Apparently DO's have to do a year of internship before residency. What does this mean?

[baratheonfire]

Confusing to me as I always thought it was med school then residency

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[Mad Jack]

Every physician does a year of internship followed by residency. DOs historically had a traditional rotating internship (as did MDs back in the day) but this has been completely abolished with the merger, and even prior to the merger was a non-issue in all but five states.

 

[baratheonfire]

Every physician does a year of internship followed by residency. DOs historically had a traditional rotating internship (as did MDs back in the day) but this has been completely abolished with the merger, and even prior to the merger was a non-issue in all but five states.

What did this internship consist of, and how was it different from a residency?
Also, I'd graduate from med school no earlier than 2021; does this mean that this issue is now irrelevant to me?

Side question: Do you think DO's will retain their 99% match rate post-merger?

 

[cliquesh]

Here is an example of one http://www.graduatemedicaleducation.org/traditional-rotating-internship-program/

http://www.osteopathic.org/inside-a.../Pages/aoa-recognition-of-acgme-training.aspx

DO schools do not have a 99% match rate, nor do MD schools. DO schools may have a 99% post graduate placement rate, but they probably have around an 80-85% match rate. I know it's sort of semantics, but I think it's worth noting.

 

[Peach Newport]

The internship thing was barely an issue before the merger, and it's an absolute non-issue now. It will not effect you.

As for the merger, no one has any idea what will happen.

As for the General ability of DOs to get residency, I really don't think this is going to change much. There are something like 29,000 ACGME residency positions, and about 3,000 AOA positions. (there are about 18,000 U.S. MD first years and 7,000 DOs now). Some AOA positions will disappear, and all will be available to US MDs, FMGs, and IMGs.

So theoretically, we could get pushed out the AOA positions. US MDs probably won't compete much for the formerly DO spots, but FMGs and IMGs will. I don't think this will be a big deal because 1) at least for the foreseeable immediate future, there are plenty of ACGME spots for ALL US graduates, and 2) residency directors at top ACGME residencies aren't the only ones who can discriminate. Do you guys really think that the residency directors at PCOM and MSU are suddenly going to rank the IMG/FMG applicants over the DOs? Sure, some will get in, but I highly doubt this will make an appreciable difference in March rate.

The bottom of the barrel DOs will still probably get into a community program somewhere.

However, I can totally beleive that this will make competitive specialties more competitive. If you're a DO and you want to do a surgical subspecialty or Derm, odds are you're going AOA. With relatively few spots, every IMG, FMG, and the odd US MD who wants to be a plastic surgeon enough to go former AOA will make an impact. They'll probably still be mostly DOs, but with increasing enrollment, each spot taken by a non-DO makes a big difference. Then again, DOs are slowly getting into competitive ACGME residencies, so who knows?

 

[OrdinaryDO]

I have a slightly different outlook on the whole merger deal. D.O.s have increasingly gained traction and recognition over the years from the fellow MD peers as well as the people from within our communities. I believe that the one of the biggest upsets people had with respect to D.O.s were their ability to obtain basically the same residencies in an AOA match as an MD matching in an ACGME residency program. I say this for a few reasons: AOA or ACGME, a residency is a residency at the end of the day. They may not be equally trained, but they will have the same job title as their counterpart and therefore will be performing the same work within the field they most desired. The fact of the mater is the AOA was restrited to only D.O. students, but the ACGME was open to both MD and DO students. Also, the AOA residency slots were most generally more lax and of lesser quality than their ACGME equivalent.

With this merger coming through, every physician who goes through a residency post-2020 will have the same residency training guidelines as all other residents across the United States. This should place all physicians on the same, level playing field and thus respect will be given to those D.O.s that succeed within the system that has been ever so competitive for the MD students. If anyone is to suffer it will be the FMGs and the IMGs, as well as the American Caribbean medical schools (which will eventually be put out of business).

 

[kelminak]

Every physician does a year of internship followed by residency. DOs historically had a traditional rotating internship (as did MDs back in the day) but this has been completely abolished with the merger, and even prior to the merger was a non-issue in all but five states.

I'm still confused. So students apply for residencies in their fourth year right? Is this intern year integrated in the residency they apply for and synonymous with PGY-1?

 

[Marrowist]

I'm still confused. So students apply for residencies in their fourth year right? Is this intern year integrated in the residency they apply for and synonymous with PGY-1?

You are correct. Sometimes people take transitional years in which case they make do the residency somewhere else. This is my understanding. It used to be required that DO students do a rotating internship I believe. That is no longer the case.

 

[Mad Jack]

I'm still confused. So students apply for residencies in their fourth year right? Is this intern year integrated in the residency they apply for and synonymous with PGY-1?

Some specialties require a separate internship (rads, derm, and neuro, for example) but most integrate it into PGY-1. For those with a separate internship, you match the internship and residency simultaneously, do the internship first (often at a different institution) then start PGY-2 at your advanced program the following year.

 

[kelminak]

Some specialties require a separate internship (rads, derm, and neuro, for example) but most integrate it into PGY-1. For those with a separate internship, you match the internship and residency simultaneously, do the internship first (often at a different institution) then start PGY-2 at your advanced program the following year.

Wow that sounds really annoying. I was hoping that once you made it to the point that you're on residency you could stop moving around, but if you're doing intern year at a different institution that's just another time you have to move to add to the list. :/

 

[Mad Jack]

Wow that sounds really annoying. I was hoping that once you made it to the point that you're on residency you could stop moving around, but if you're doing intern year at a different institution that's just another time you have to move to add to the list. :/

A lot of the time it's actually pretty nice, since you can do a TY or TRI at a chill institution before transitioning to a more rigorous place for the program in the specialty you actually give a damn about.

 

[femmegoblue]

Also, perhaps OP is confused by the fact that every first year resident is technically called an intern, regardless of DO or MD.

 

[cabinbuilder]

I'm still confused. So students apply for residencies in their fourth year right? Is this intern year integrated in the residency they apply for and synonymous with PGY-1?

Intern year is just the first year of residency. It gives you a "big picture view" of all aspects of medicine: OB, FP, PEDs, RAD, SURG, ER, Hospitalist with a few electives. Some residencies historically like Anesthesia, Radiology etc, start residency as a PGY-2 so you would have to do an Intern year first that would not necessarily be connected with that residency.

Most residencies like FP, PEDS, IM, etc equate the Intern year (PGY-1) in the residency program so you would attend one program straight through.

 

[Ho0v-man]

Intern year is just the first year of residency. It gives you a "big picture view" of all aspects of medicine: OB, FP, PEDs, RAD, SURG, ER, Hospitalist with a few electives. Some residencies historically like Anesthesia, Radiology etc, start residency as a PGY-2 so you would have to do an Intern year first that would not necessarily be connected with that residency.

Most residencies like FP, PEDS, IM, etc equate the Intern year (PGY-1) in the residency program so you would attend one program straight through.

Just to be clear:

A field like EM is a 3 year residency, is that 3 years AFTER intern year or is it just 3 years total and you're done?


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[femmegoblue]

Just to be clear:

A field like EM is a 3 year residency, is that 3 years AFTER intern year or is it just 3 years total and you're done?


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Three years total. As a first year you're called an intern.

 

[kelminak]

Thanks for the explanation @cabinbuilder, that really helps makes things clear. So as someone interested in anesthesia, I'd end up going to one place for the intern year then another institution for the remaining three years. Why do residencies prefer this rather than having it all together? Don't the residencies generate money? Or do they lose money training students?

 

[cabinbuilder]

Just to be clear:

A field like EM is a 3 year residency, is that 3 years AFTER intern year or is it just 3 years total and you're done?


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For ER I think it depends on the program. I have seen it go both ways. I had a guy who did Intern year with us then went to ER as a second year. I have seen where ER was just one residency that includes the Intern year. Just depends on how it is set up I suppose.

Intern year is designed to give you a feel of what all the other PCP specialties do. I think it makes you a better doctor and more prepared to answer patient's questions. Also, in many places where hospitals are small, the ER doctor actually writes the admission orders for the admitting doc so they don't have to come in during the night. You need to know those things. every doctor should know. I trained in FP but work urgent care. I answer skin questions and surgery questions all the time when I send them for referral. You need to have a general knowledge of what the other specialties do.

 

[cliquesh]

Thanks for the explanation @cabinbuilder, that really helps makes things clear. So as someone interested in anesthesia, I'd end up going to one place for the intern year then another institution for the remaining three years. Why do residencies prefer this rather than having it all together? Don't the residencies generate money? Or do they lose money training students?

There are categorical anesthesia residencies, like mine, where the intern year is integrated into the residency. My intern year consisted of 9 months of normal intern stuff and the last 3 months were anesthesia.

 

[cabinbuilder]

Just to be clear:

A field like EM is a 3 year residency, is that 3 years AFTER intern year or is it just 3 years total and you're done?


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Some EM programs are 4 years.

 

[cabinbuilder]

Thanks for the explanation @cabinbuilder, that really helps makes things clear. So as someone interested in anesthesia, I'd end up going to one place for the intern year then another institution for the remaining three years. Why do residencies prefer this rather than having it all together? Don't the residencies generate money? Or do they lose money training students?

Depends on the location, I would suppose. You have to understand that you have to have doctors who are willing to train residents for the intern year. That means you would have OB/GYN, FP, IM, Pulm, ICU, Cards, ER, Nephro, etc who are there and WILLING to be trainers. That's a lot to ask if you don't have the program or the personnel. Whereas, in Anesthesia, you are asking ONE specialty to train a single group, same as ER.

 

[kelminak]

Depends on the location, I would suppose. You have to understand that you have to have doctors who are willing to train residents for the intern year. That means you would have OB/GYN, FP, IM, Pulm, ICU, Cards, ER, Nephro, etc who are there and WILLING to be trainers. That's a lot to ask if you don't have the program or the personnel. Whereas, in Anesthesia, you are asking ONE specialty to train a single group, same as ER.

That makes sense. Thank you again for all of the information!

 

[Ho0v-man]

Thanks for the responses. Before this thread, I thought every field had an internship that didn't count toward the residency.

Instead, it's only the ones I'm most interested in...


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[cabinbuilder]

That makes sense. Thank you again for all of the information!

Another thing is that residents pay is funded by medicare, did you know that? You are only allotted so many dollars to be a resident. That's why it's so hard to do a second residency because CMS won't pay a resident to do the same year twice in a different residency. Friends of mine who did a second residency didn't get paid, instead moonlighted on the weekends to pay the bills.

 

[kelminak]

Another thing is that residents pay is funded by medicare, did you know that? You are only allotted so many dollars to be a resident. That's why it's so hard to do a second residency because CMS won't pay a resident to do the same year twice in a different residency. Friends of mine who did a second residency didn't get paid, instead moonlighted on the weekends to pay the bills.

Whoa, I did not know that. That definitely explains why people say that doing a second residency very rarely happens. I imagine people generally know what they want to do after their rotations, right? I've heard of some people dropping out of surgery due to its intensity and doing something else, but other than that, I can't imagine it's common? Are there specific fields that benefit from two residencies?

 

[Wiggly Tuff Da Ruff]

Three years total. As a first year you're called an intern.

This is how I understand it too!

 

[MADD!!!]

The internship thing was barely an issue before the merger, and it's an absolute non-issue now. It will not effect you.

As for the merger, no one has any idea what will happen.

As for the General ability of DOs to get residency, I really don't think this is going to change much. There are something like 29,000 ACGME residency positions, and about 3,000 AOA positions. (there are about 18,000 U.S. MD first years and 7,000 DOs now). Some AOA positions will disappear, and all will be available to US MDs, FMGs, and IMGs.

So theoretically, we could get pushed out the AOA positions. US MDs probably won't compete much for the formerly DO spots, but FMGs and IMGs will. I don't think this will be a big deal because 1) at least for the foreseeable immediate future, there are plenty of ACGME spots for ALL US graduates, and 2) residency directors at top ACGME residencies aren't the only ones who can discriminate. Do you guys really think that the residency directors at PCOM and MSU are suddenly going to rank the IMG/FMG applicants over the DOs? Sure, some will get in, but I highly doubt this will make an appreciable difference in March rate.

The bottom of the barrel DOs will still probably get into a community program somewhere.

However, I can totally beleive that this will make competitive specialties more competitive. If you're a DO and you want to do a surgical subspecialty or Derm, odds are you're going AOA. With relatively few spots, every IMG, FMG, and the odd US MD who wants to be a plastic surgeon enough to go former AOA will make an impact. They'll probably still be mostly DOs, but with increasing enrollment, each spot taken by a non-DO makes a big difference. Then again, DOs are slowly getting into competitive ACGME residencies, so who knows?

Those numbers are skewed. Right now about 4k DO's graduate, but by 2020 it should be around 7k. There's around 3,300 DO residencies, but by then it will be more like 4 to 5k.

 

[Peach Newport]

Those numbers are skewed. Right now about 4k DO's graduate, but by 2020 it should be around 7k. There's around 3,300 DO residencies, but by then it will be more like 4 to 5k.

Yeah, I meant 7000 DOs in the class of 2020, sorry. Why would there be MORE DO residencies in 2020? I would think there would only be slightly fewer as a few would find meeting ACGME criteria more trouble than it's worth.

 

[Rekt]

Yeah, I meant 7000 DOs in the class of 2020, sorry. Why would there be MORE DO residencies in 2020? I would think there would only be slightly fewer as a few would find meeting ACGME criteria more trouble than it's worth.

Because new programs still open all the time. Here's the 2016 approved residencies.
http://www.osteopathic.org/inside-aoa/Education/Pages/new-aoa-approved-ogme-programs.aspx

I'm assuming most of them planned on being both AOA/ACGME accredited due to the merger or are planning to apply, otherwise that would be a lot of work for nothing.

 

[cabinbuilder]

Whoa, I did not know that. That definitely explains why people say that doing a second residency very rarely happens. I imagine people generally know what they want to do after their rotations, right? I've heard of some people dropping out of surgery due to its intensity and doing something else, but other than that, I can't imagine it's common? Are there specific fields that benefit from two residencies?

So a surgeon friend of mine did not match surgery the first time. He really wanted to be a surgeon but didn't want to go unmatched so he did FP residency (3 years) After that he worked in urgent care and saved as much money he could all in the while applying to general surgery. He was accepted but since surgery is 5 years, he didn't get paid for the first 3, only the last 2 since he was already paid as a resident in FP. He got through by working weekends and became a surgeon.

I have another friend who is an orthopedic surgeon who didn't match. He went through Intern year and took step III so he could get his medical license and work. He gambled and also worked urgent care for 3 years while applying to ortho residency. It took that many tries for him to match ortho.

All comes down to how bad do you want it?? Need to have youth on your side too.

 

[Goro]

It will be easier to answer the question "Who will win the 2020 presidential election?"


Side question: Do you think DO's will retain their 99% match rate post-merger?[/QUOTE]