Breaking down DO stigma in residency apps (Possible useful info for DO stakeholders, check out this thread if you are)

[deleted978973]

- Hold the schools to LCME standards for clinical training.

- Require all DO students to take USMLE and replace COMLEX with some sort of smaller osteopathic certification that is pass/fail.

- Eliminate the parts of OMM that are dangerous (cervical HVLA), are founded on very weak research that cannot be replicated or have heavy research disproving their efficacy (myofascial release) or are blatant pseudoscience (cranial, Chapman's points).

That would be a good start.

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[AnatomyGrey12]

Yeah, I definitely get your point, and it is an interesting suggestion. I just think that these issues of prestige are too ingrained into the academic culture. Programs will always try to bolster their reputation, and if that means not taking DOs and IMGs so that they can keep attracting more Harvard and Stanford graduates, they're not going to stop. Lots of people in competitive specialties pay attention to the pedigree of residents, and that won't change, either. It is the same thing in my previous field of finance - my firm would not interview any MBAs from any school below the top 10ish. The COO told me that it was about the prestige of the firm and to make it look excellent, not just to take the brightest. None of those firms have a filter based on school, they just do it themselves and if someone with a low tier MBA has a connection or gets lucky, he might get in (just like what happens with DOs). But it does not change the overwhelmingly prevalent culture of prestige.

To be fair I do think forcing these PD's to actually look at the app and then throw away would help DO's overall. I have seen some pretty eye opening interviews in people I personally know and I have a hunch it's because someone decided to actually read their apps before chucking them. I'm talking elite of the elite programs in surgical subs/derm/etc, without any sort of connections to the said programs. Obviously the majority of the time these apps will still get chucked, and like you say it's something that will likely always happen for a multitude of reasons but at least we would be getting the apps of our best students under the view of an actual pair of eyes instead of just making them disappear with the click of a button where they never even get looked at.

 

[Schwifty]

To be fair I do think forcing these PD's to actually look at the app and then throw away would help DO's overall. I have seen some pretty eye opening interviews in people I personally know and I have a hunch it's because someone decided to actually read their apps before chucking them. I'm talking elite of the elite programs in surgical subs/derm/etc, without any sort of connections to the said programs. Obviously the majority of the time these apps will still get chucked, and like you say it's something that will likely always happen for a multitude of reasons but at least we would be getting the apps of our best students under the view of an actual pair of eyes instead of just making them disappear with the click of a button where they never even get looked at.

What kind of stats did these people have, was it like 270+ step, 20+ pubs, 300+ max bench (for ortho), or like decent stats comparable to USMDs applying to the same programs?

 

[Angus Avagadro]

To be fair I do think forcing these PD's to actually look at the app and then throw away would help DO's overall. I have seen some pretty eye opening interviews in people I personally know and I have a hunch it's because someone decided to actually read their apps before chucking them. I'm talking elite of the elite programs in surgical subs/derm/etc, without any sort of connections to the said programs. Obviously the majority of the time these apps will still get chucked, and like you say it's something that will likely always happen for a multitude of reasons but at least we would be getting the apps of our best students under the view of an actual pair of eyes instead of just making them disappear with the click of a button where they never even get looked at.

I totally agree. I have called PDs for several of my students. They were good candidates for their respective programs, not superstars, but well above avg for the programs, say mid 240s on Step 1 . They had no interviews in early dec, but went on to interview well. I think it was because no one had even looked at their app until I contacted them. I think in the future some open minded PDs will give them a shot. One student went from no interviews to 3 at top 10 programs. There is absolutely no doubt some programs have never taken a DO, and never will. Our local University IM program is like that. So look into whether they have DO faculty or residents. It will get better by bits, but pedigree bigotry is tough to eliminate, because most of the bigots believe their own BS. DO students from new schools who have no inpatient medicine experience are not desirable resident candidates. I have heard PDs on SDN state this very thing. We need to produce a better product. Otherwise, even open minded PDs will lose interest in taking DOs. Opening all these new schools with no clinical sites is thoughtless and ruining our chances to match into good programs

 

[2021Doctor]

- Hold the schools to LCME standards for clinical training.

- Require all DO students to take USMLE and replace COMLEX with some sort of smaller osteopathic certification that is pass/fail.

- Eliminate the parts of OMM that are dangerous (cervical HVLA), are founded on very weak research that cannot be replicated or have heavy research disproving their efficacy (myofascial release) or are blatant pseudoscience (cranial, Chapman's points).

That would be a good start.

There is no significant difference between LCME and COCA standards for clinical training.
LCME:

Standards, Publications, & Notification Forms | LCME

lcme.org

COCA:

https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf

 

[Mass Effect]

The most significant, primary, number 1 reason there is stigma is rotations. Everything else is vanity, but there is definitely a difference in the quality of clinical experiences.

 

[AnatomyGrey12]

Opening all these new schools with no clinical sites is thoughtless and ruining our chances to match into good programs

The fact we have faculty that recognize this is huge. Standing ovation for you.

 

[2021Doctor]

The most significant, primary, number 1 reason there is stigma is rotations. Everything else is vanity, but there is definitely a difference in the quality of clinical experiences.

Clinical experiences suck at a lot of the newer MD schools.
Third-year medical students at Orlando-based University of Central Florida can no longer complete clerkships at the region's two largest health systems, according to the Orlando Sentinel.

Altamonte Springs, Fla.-based AdventHealth and Orlando Health closed their doors to UCF when it chose HCA Healthcare as its partner for a new teaching hospital, which is slated to open next year. AdventHealth and Orlando Health are longtime partners of the university, and their support helped UCF earn approval to open a medical school more than 10 years ago, according to the report.

The split is a major loss for UCF — the two health systems hosted 40 percent of its clerkships, and student feedback on HCA sites has not been overwhelmingly positive, according to the report. For example, one student's end-of-year evaluation said, "HCA facilities are not good places to train. We are treated very poorly at HCA sites and there is very little going on," according to the report. The HCA sites in the area are community hospitals, which tend to have lower patient volumes and less complex cases.

Orlando Health and AdventHealth are continuing to partner with UCF in other ways, including offering training for nursing students.

Florida medical school loses 40% of student training sites after partnering with HCA

Third-year medical students at Orlando-based University of Central Florida can no longer complete clerkships at the region's two largest health systems, according to the Orlando Sentinel.

www.beckershospitalreview.com

 

[AlteredScale]

There is no significant difference between LCME and COCA standards for clinical training.
LCME:
View attachment 288073

Standards, Publications, & Notification Forms | LCME

lcme.org

COCA:
View attachment 288072

https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf

Yep. Even with LCME requirements, the loose definition means that DO schools could get away with what their doing now but maybe not to the same extent. For the most part, MD students will have a base hospital with many established residencies in which undergrad medical education is quite developed within the system. For DO schools such as KCU, there is no base hospital, residencies are sparse and sometimes not even in an applicable location. There are way too may students in comparison to faculty and therefore the clinical experiences get watered down to the point where these requirements are met truly in the most minimal way (aka I can rotate with a surgery preceptor but never write notes, never interact with the residents, go to 1 didactic conference a week, and this would count as me working "with resident physicians" because I was technically around them).

 

[Mass Effect]

Clinical experiences suck at a lot of the newer MD schools.
Third-year medical students at Orlando-based University of Central Florida can no longer complete clerkships at the region's two largest health systems, according to the Orlando Sentinel.

Altamonte Springs, Fla.-based AdventHealth and Orlando Health closed their doors to UCF when it chose HCA Healthcare as its partner for a new teaching hospital, which is slated to open next year. AdventHealth and Orlando Health are longtime partners of the university, and their support helped UCF earn approval to open a medical school more than 10 years ago, according to the report.

The split is a major loss for UCF — the two health systems hosted 40 percent of its clerkships, and student feedback on HCA sites has not been overwhelmingly positive, according to the report. For example, one student's end-of-year evaluation said, "HCA facilities are not good places to train. We are treated very poorly at HCA sites and there is very little going on," according to the report. The HCA sites in the area are community hospitals, which tend to have lower patient volumes and less complex cases.

Orlando Health and AdventHealth are continuing to partner with UCF in other ways, including offering training for nursing students.

Florida medical school loses 40% of student training sites after partnering with HCA

Third-year medical students at Orlando-based University of Central Florida can no longer complete clerkships at the region's two largest health systems, according to the Orlando Sentinel.

www.beckershospitalreview.com

That's the minority for MD schools and yet the norm for DO schools. And I'm sorry, but I have yet to hear about an MD student doing outpatient surgery as part of the core clerkship. There is no defense for the poor clerkships and lack of standardization within the same class.

 

[AlteredScale]

That's the minority for MD schools and yet the norm for DO schools. And I'm sorry, but I have yet to hear about an MD student doing outpatient surgery as part of the core clerkship. There is no defense for the poor clerkships and lack of standardization within the same class.

Yep. I had to purposely go out of my way to get decent IM training during my third year. My second IM core was completely outpatient...I did nothing that whole month (did not see patients on my own, did not write notes, did not examine patient on my own).

I was given a completely outpatient peds rotation. I was given an entirely inpatient child/teen psych rotation. My Ob/Gyn rotation was 90% outpatient and 10% inpatient. These rotations were required and to change them in any way was a very difficult hurdle of appeals.

However my classmate could potentially rotate entirely inpatient pediatrics, have essentially entirely outpatient IM. It was whatever was available.

So it's really not wrong when PD's are worried about clinical training from DO students. And TBH, I think it also stems from maybe also taking DO students in residency and realizing they were overall weaker and less efficient than their MD counterparts who understood their role better as a intern and were more efficient in getting notes done and putting orders in because they were exposed to this early and consistently in their third and fourth year of medical school.

 

[DrStephenStrange]

...And TBH, I think it also stems from maybe also taking DO students in residency and realizing they were overall weaker and less efficient than their MD counterparts who understood their role better as a intern and were more efficient in getting notes done and putting orders in because they were exposed to this early and consistently in their third and fourth year of medical school.

Not generally true from what I've seen at residency programs I've been to and also from talking to residents. Actually, at some MD schools students don't get much clinical education at all during pre-clinicals, while many DO schools introduce students to standardized patients and get exposed to writing notes early, so we usually actually have a leg up by the time we start rotations. The problem stem from variability in our core rotations, but yet if you play the elective rotation game well enough, you can actually set up decent rotations on your own as well (most of us do), and still measure up against our MD counterparts in residency. I've never talked to a DO resident who says they felt inadequate or less prepared than their MD colleagues.

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[Angus Avagadro]

Not generally true from what I've seen at residency programs I've been to and also from talking to residents. Actually, at some MD schools students don't get much clinical education at all during pre-clinicals, while many DO schools introduce students to standardized patients and get exposed to writing notes early, so we usually actually have a leg up by the time we start rotations. The problem stem from variability in our core rotations, but yet if you play the elective rotation game well enough, you can actually set up decent rotations on your own as well (most of us do), and still measure up against our MD counterparts in residency. I've never talked to a DO resident who says they felt inadequate or less prepared than their MD colleagues.

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I used to believe this until i heard a PD on SDN say he wont hire any more DOs as one he hired had never had an inpatient medical rotation. I was incredulous as this was far from my experience. I started investigating, talking to colleagues and current residents at our school and found this to not be unusual for some schools. There is also no way to play the elective rotation game to get this. How many 3rd and4th yrs students dont even realize this is a deficiency?This is not acceptable. Most residents are required to have inpatient responsibilities and should be somewhat comfortable with the emr and patient management.This needs to be corrected.

 

[sab3156]

Not generally true from what I've seen at residency programs I've been to and also from talking to residents. Actually, at some MD schools students don't get much clinical education at all during pre-clinicals, while many DO schools introduce students to standardized patients and get exposed to writing notes early, so we usually actually have a leg up by the time we start rotations. The problem stem from variability in our core rotations, but yet if you play the elective rotation game well enough, you can actually set up decent rotations on your own as well (most of us do), and still measure up against our MD counterparts in residency. I've never talked to a DO resident who says they felt inadequate or less prepared than their MD colleagues.

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I am not sure why you have mentioned preclinical education here. This has nothing to do with clinical education during preclinical years. That does NOT teach you anything about how to operate as an intern in the hierarchy of a full blown residency program.

 

[deleted947265]

- Eliminate the parts of OMM that are dangerous (cervical HVLA), are founded on very weak research that cannot be replicated or have heavy research disproving their efficacy (myofascial release) or are blatant pseudoscience (cranial, Chapman's points).

I haven't heard people complain about cervical HVLA. Is it similar to the chiropractic manipulations that cause cervical artery dissection?

I read through the Chapman Points part of the Atlas of Osteopathic Techniques this past weekend and I fell out of my chair laughing at how ridiculous it is. It's literally reflexology only more ridiculous because it's being taught in medical schools. There is basically no research on them, and of the few papers I have found they're published in the JAOA. In the Osteopathic Textbooks they generally don't cite anything or it leads to a reference circlejerk. I think the only reason there hasn't been a push to take that stuff out is because nobody has really publicly called out how ridiculous it is. The only time somebody has really called it out effectively was Stephen Barrett on Quackwatch, and that was like 7 generations of Pokemon ago. The only other times it's been laypeople that don't really go for the throat.

 

[AnatomyGrey12]

I haven't heard people complain about cervical HVLA. Is it similar to the chiropractic manipulations that cause cervical artery dissection?

It's the same thing.

 

[AlteredScale]

Not generally true from what I've seen at residency programs I've been to and also from talking to residents. Actually, at some MD schools students don't get much clinical education at all during pre-clinicals, while many DO schools introduce students to standardized patients and get exposed to writing notes early, so we usually actually have a leg up by the time we start rotations. The problem stem from variability in our core rotations, but yet if you play the elective rotation game well enough, you can actually set up decent rotations on your own as well (most of us do), and still measure up against our MD counterparts in residency. I've never talked to a DO resident who says they felt inadequate or less prepared than their MD colleagues.

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I’m not aware of any MD school that does not have exposure to SPs during preclinical years and I’m sorry but my monthly experience to SPs did not give me a leg up in rotations at all because 1) SPs are not the same as real patients and 2) the note writing expected for these is not at all close to the progress notes or H&P notes expected in real life.

your 2-3 elective rotations can help, but there’s no guarantee you will still get the same experience as the majority of MD students who for the majority of their third year will be a much more “integral” part of the resident team.

to say “most of us” get decent rotations is way too large of a generalized statement.

why would any DO resident say they felt more unprepared than their MD counterparts? Most would never be that honest with you if they are even aware of the discrepancy if there. It’s really unfair to just blame the “unmotivated” DO student for not getting the best rotations possible as that’s not where the crux of the issue really is set.

 

[slowthai]

I’m not aware of any MD school that does not have exposure to SPs during preclinical years and I’m sorry but my monthly experience to SPs did not give me a leg up in rotations at all because 1) SPs are not the same as real patients and 2) the note writing expected for these is not at all close to the progress notes or H&P notes expected in real life.

your 2-3 elective rotations can help, but there’s no guarantee you will still get the same experience as the majority of MD students who for the majority of their third year will be a much more “integral” part of the resident team.

to say “most of us” get decent rotations is way too large of a generalized statement.

why would any DO resident say they felt more unprepared than their MD counterparts? Most would never be that honest with you if they are even aware of the discrepancy if there. It’s really unfair to just blame the “unmotivated” DO student for not getting the best rotations possible as that’s not where the crux of the issue really is set.

I wish I could like this harder. Here. I unliked it and liked it again. Have another like.

 

[sab3156]

To be fair I do think forcing these PD's to actually look at the app and then throw away would help DO's overall. I have seen some pretty eye opening interviews in people I personally know and I have a hunch it's because someone decided to actually read their apps before chucking them. I'm talking elite of the elite programs in surgical subs/derm/etc, without any sort of connections to the said programs. Obviously the majority of the time these apps will still get chucked, and like you say it's something that will likely always happen for a multitude of reasons but at least we would be getting the apps of our best students under the view of an actual pair of eyes instead of just making them disappear with the click of a button where they never even get looked at.

Who knows. It's probably more likely that these applicants had the research connections that got them great letters or even phone calls from important people that were known to the PDs at those programs. Interviews simply because a letter writer is well known to the programs is a very real thing, and may not lead to a match if the program still wants to preserve their image (I know of interviews like that in Boston that happened at programs that have never taken a DO, and never will - seemed like isolated courtesy invites).

It seems less likely to me that someone read a DO application to a top tier program that has never taken a DO and has always had an anti-DO bias and then said "this DO applicant is very good, we should interview them".

This goes in line with what can be seen as a fact, which is that PDs are looking to preserve their program's future image. They aren't saying "this person is likely pure trash cuz he came from a DO school" (or even if they are, it's a secondary thing), they're mainly saying "this applicant's DO school is trash tier and it's going to hurt me if he matches at this program, and I'll probably be asked about it at conferences and by the board that oversees residency programs at my hospital".

 

[deleted978973]

I know of interviews like that in Boston that happened at programs that have never taken a DO, and never will - seemed like isolated courtesy invites

So name and shame those programs so that the rest of us don't waste our time.

 

[Ho0v-man]

I’m not aware of any MD school that does not have exposure to SPs during preclinical years and I’m sorry but my monthly experience to SPs did not give me a leg up in rotations at all because 1) SPs are not the same as real patients and 2) the note writing expected for these is not at all close to the progress notes or H&P notes expected in real life.

your 2-3 elective rotations can help, but there’s no guarantee you will still get the same experience as the majority of MD students who for the majority of their third year will be a much more “integral” part of the resident team.

to say “most of us” get decent rotations is way too large of a generalized statement.

why would any DO resident say they felt more unprepared than their MD counterparts? Most would never be that honest with you if they are even aware of the discrepancy if there. It’s really unfair to just blame the “unmotivated” DO student for not getting the best rotations possible as that’s not where the crux of the issue really is set.

Hey I’ll call out DO rotations all day. But the majority of MD students would laugh if you asked them if they felt integral to the team.

 

[DrStephenStrange]

I used to believe this until i heard a PD on SDN say he wont hire any more DOs as one he hired had never had an inpatient medical rotation. I was incredulous as this was far from my experience. I started investigating, talking to colleagues and current residents at our school and found this to not be unusual for some schools. There is also no way to play the elective rotation game to get this. How many 3rd and4th yrs students dont even realize this is a deficiency?This is not acceptable. Most residents are required to have inpatient responsibilities and should be somewhat comfortable with the emr and patient management.This needs to be corrected.

I am not sure why you have mentioned preclinical education here. This has nothing to do with clinical education during preclinical years. That does NOT teach you anything about how to operate as an intern in the hierarchy of a full blown residency program.

I’m not aware of any MD school that does not have exposure to SPs during preclinical years and I’m sorry but my monthly experience to SPs did not give me a leg up in rotations at all because 1) SPs are not the same as real patients and 2) the note writing expected for these is not at all close to the progress notes or H&P notes expected in real life.

your 2-3 elective rotations can help, but there’s no guarantee you will still get the same experience as the majority of MD students who for the majority of their third year will be a much more “integral” part of the resident team.

to say “most of us” get decent rotations is way too large of a generalized statement.

why would any DO resident say they felt more unprepared than their MD counterparts? Most would never be that honest with you if they are even aware of the discrepancy if there. It’s really unfair to just blame the “unmotivated” DO student for not getting the best rotations possible as that’s not where the crux of the issue really is set.

Well, what can I say? Maybe I'm still a bit naive as a mere M2. Thanks for opening my eyes.

Recently, we were deciding on ranking our sites for rotations next year, and it's funny to me reading stuff here because of how many students in my class didn't rank sites with residency programs high on their lists because they were scared of being pimped out a lot, or not getting to do many procedures at these places because they'll be second to a resident. I scoff on the inside at these remarks, but at the same time relieved because that increase my odds of getting those sites.

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[EMDoc22]

We just got our clinical site assignments and I was lucky to end up at one of the larger sites with a residency in almost every specialty that have become ACGME accredited. However, this is not the case at all of the sites associated with my school as some of them are smaller hospitals in small towns with no residencies and I can see why this variability in clinical education is concerning to PD's.

 

[AlteredScale]

Hey I’ll call out DO rotations all day. But the majority of MD students would laugh if you asked them if they felt integral to the team.

Ha I guess I was somewhat metaphorical which is why I put it in quotations. Idk what I was thinking.

 

[Dr.Bruh]

So name and shame those programs so that the rest of us don't waste our time.

Ding ding. Please. Blows my mind programs that are apparently filled with smart people running them have such stupid and counterproductive mindsets. There’s is no objective way taking a DO of superior quality over a lesser quality MD (from a high tier school) affects the program negatively. Total BS. If you think competitive applicants are going to stop applying you’re just wrong plain and simple. These top programs have more competitive applicants than they know what to do with (which is a much better argument to not take a DO). If someone over seeing the residency asks question the answer is “the DO was a better candidate/fit for he program”.

 

[Mass Effect]

Not generally true from what I've seen at residency programs I've been to and also from talking to residents. Actually, at some MD schools students don't get much clinical education at all during pre-clinicals, while many DO schools introduce students to standardized patients and get exposed to writing notes early, so we usually actually have a leg up by the time we start rotations. The problem stem from variability in our core rotations, but yet if you play the elective rotation game well enough, you can actually set up decent rotations on your own as well (most of us do), and still measure up against our MD counterparts in residency. I've never talked to a DO resident who says they felt inadequate or less prepared than their MD colleagues.

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No. Just no. The more we defend this BS, the less the chances that it will ever change. It should not be up to me to schedule electives at academic centers in order to prepare myself for intern year. That's literally what I am paying the school to do for me. So no. Don't take my money, then send me to an outpatient surgery clinic and expect that I will shell out more money to travel all over the country just to learn to suture.

People really need to stop defending the DO community and call it what it is.

 

[Ho0v-man]

No. Just no. The more we defend this BS, the less the chances that it will ever change. It should not be up to me to schedule electives at academic centers in order to prepare myself for intern year. That's literally what I am paying the school to do for me. So no. Don't take my money, then send me to an outpatient surgery clinic and expect that I will shell out more money to travel all over the country just to learn to suture.

People really need to stop defending the DO community and call it what it is.

I love this so much...

 

[Giovanotto]

No. Just no. The more we defend this BS, the less the chances that it will ever change. It should not be up to me to schedule electives at academic centers in order to prepare myself for intern year. That's literally what I am paying the school to do for me. So no. Don't take my money, then send me to an outpatient surgery clinic and expect that I will shell out more money to travel all over the country just to learn to suture.

People really need to stop defending the DO community and call it what it is.

Wait, hold up. You mean our tuition is too high?
I've spent the better part of the last year being an email jockey, corresponding with sites all over the state to set up rotations, never mind housing, transportation, etc. Why is our own program paying it's administrators? For 3/4's of a years worth of work? And that costs us 60k? Math isn't my strong suit, but still...

 

[Kardio]

It seems less likely to me that someone read a DO application to a top tier program that has never taken a DO and has always had an anti-DO bias and then said "this DO applicant is very good, we should interview them".

I'm assuming that the best DO matches of 2015-2019 are better than the best of 1995-1999.

 

[sab3156]

Ding ding. Please. Blows my mind programs that are apparently filled with smart people running them have such stupid and counterproductive mindsets. There’s is no objective way taking a DO of superior quality over a lesser quality MD (from a high tier school) affects the program negatively. Total BS. If you think competitive applicants are going to stop applying you’re just wrong plain and simple. These top programs have more competitive applicants than they know what to do with (which is a much better argument to not take a DO).

I think it blows your mind because you just haven't been around top programs in a competitive specialty to understand things properly. Maybe you haven't worked in finance or held a job in a competitive industry prior to joining medical school. You're just an outside observer coming up with your own theories about how the world should run... How much more do you need us to tell you before you begin to understand? Yes, taking DOs and IMGs negatively affects a program. I've been doing research in ophthalmology for years now, including at a top ophthalmology hospital, and I know tons of rotating students and current residents from top 10 schools. For someone like me or others in this thread who have been interacting with people in these places every single day for years, it's such an obvious truth that pedigree of the residents is something that people pay a great deal of attention to, especially if they come from a top tier school themselves. It is seen as one of the indicators for the health of the program and an indicator that the program is constantly receiving applications from the cream of the crop aspiring ophthalmologists. It is crystal clear that people who go to schools like Harvard and Stanford would rather have Harvard and Stanford graduates as their co-residents than DOs or IMGs. PDs and Chiefs of departments know this (and have told me this), and it's likely they were also in the same mind-set when applying for residency. It's well known that medical school of the applicant is one of the MOST important factors in ophthalmology resident selection - fourth most important (after step 1, letters, and clinical grades, if I remember correctly), and is probably more important in the upper tier. This is similar to other highly competitive specialties.

I was just at a meeting last month, and faculty were casually discussing residency stuff over some food, and a chief of a department said that "students from Harvard might get nervous and apply to every program but they're going to end up ranking places where students of their quality are residents"... I even know the PD of a mid tier program in a major city that took a DO a long time ago, and will not do it again because of the problems it caused. Completely understandable and justified. Welcome to reality.

Graduates of top schools are getting invites from all the top program in their specialty of choice - when it comes down to ranking two similar tier programs, but one has a history of taking IMGs and DOs, chances are they may get ranked lower by graduates of top schools. Why risk that when you can easily ignore the IMGs and DOs and interview only graduates of top schools? It's a no-brainer. Finance and business world - same thing. There are real world implications to everything you do. Wow, shocking...

If someone over seeing the residency asks question the answer is “the DO was a better candidate/fit for he program”.

Yeah, try that over here. The hospital I am currently at right now as we speak has a policy of "do not take IMGs and DOs whatsoever at the flagship centers because it will tarnish our reputation and make us seem less competitive"... If you're a PD and you take a DO, and the hospital board that oversees residency programs has a meeting with you and asks you why you took a DO over the qualified MDs from top schools and therefore risk the reputation of the hospital, you better have a more reasonable explanation than "the DO was a better fit, he was cool and had a great SOAP note, man!", as the policy has nothing to do with fit and qualifications.


From your post, it sounds like you're really angry, but it's much better to just accept that this is how the world works. Emotional claims and personal attacks against the experienced faculty of these prestigious programs isn't going to change anything. Calling it unfair or whatever is not going to change anything. It is what it is. They're preserving their program's reputation, and you can either keep being angry about it or you can accept the world for the way it is.

 

[deleted978973]

I think it blows your mind because you just haven't been around top programs in a competitive specialty to understand things properly. Maybe you haven't worked in finance or held a job in a competitive industry prior to joining medical school. You're just an outside observer coming up with your own theories about how the world should run... How much more do you need us to tell you before you begin to understand? Yes, taking DOs and IMGs negatively affects a program. I've been doing research in ophthalmology for years now, including at a top ophthalmology hospital, and I know tons of rotating students and current residents from top 10 schools. For someone like me or others in this thread who have been interacting with people in these places every single day for years, it's such an obvious truth that pedigree of the residents is something that people pay a great deal of attention to, especially if they come from a top tier school themselves. It is seen as one of the indicators for the health of the program and an indicator that the program is constantly receiving applications from the cream of the crop aspiring ophthalmologists. It is crystal clear that people who go to schools like Harvard and Stanford would rather have Harvard and Stanford graduates as their co-residents than DOs or IMGs. PDs and Chiefs of departments know this (and have told me this), and it's likely they were also in the same mind-set when applying for residency. It's well known that medical school of the applicant is one of the MOST important factors in ophthalmology resident selection - fourth most important (after step 1, letters, and clinical grades, if I remember correctly), and is probably more important in the upper tier. This is similar to other highly competitive specialties.

I was just at a meeting last month, and faculty were casually discussing residency stuff over some food, and a chief of a department said that "students from Harvard might get nervous and apply to every program but they're going to end up ranking places where students of their quality are residents"... I even know the PD of a mid tier program in a major city that took a DO a long time ago, and will not do it again because of the problems it caused. Completely understandable and justified. Welcome to reality.

Graduates of top schools are getting invites from all the top program in their specialty of choice - when it comes down to ranking two similar tier programs, but one has a history of taking IMGs and DOs, chances are they may get ranked lower by graduates of top schools. Why risk that when you can easily ignore the IMGs and DOs and interview only graduates of top schools? It's a no-brainer. Finance and business world - same thing. There are real world implications to everything you do. Wow, shocking...



Yeah, try that over here. The hospital I am currently at right now as we speak has a policy of "do not take IMGs and DOs whatsoever at the flagship centers because it will tarnish our reputation and make us seem less competitive"... If you're a PD and you take a DO, and the hospital board that oversees residency programs has a meeting with you and asks you why you took a DO over the qualified MDs from top schools and therefore risk the reputation of the hospital, you better have a more reasonable explanation than "the DO was a better fit, he was cool and had a great SOAP note, man!", as the policy has nothing to do with fit and qualifications.


From your post, it sounds like you're really angry, but it's much better to just accept that this is how the world works. Emotional claims and personal attacks against the experienced faculty of these prestigious programs isn't going to change anything. Calling it unfair or whatever is not going to change anything. It is what it is. They're preserving their program's reputation, and you can either keep being angry about it or you can accept the world for the way it is.

It is what it is, I guess. But who wants to be around a bunch of insufferable, narcissistic *ssholes like that at a top program anyway? Prestige is the absolute dumbest thing that one can pursue in this life. I'd much rather go to a community program with nice people.

 

[sab3156]

It is what it is, I guess. But who wants to be around a bunch of insufferable, narcissistic *ssholes like that at a top program anyway? Prestige is the absolute dumbest thing that one can pursue in this life. I'd much rather go to a community program with nice people.

The vast majority of the people I work with are incredible people who have done incredible things for the medical world, and are fun to be around. Don't let the stereotypes make you believe they're all a bunch of @$$holes. @$$holes also exist all over the place in the community setting, as some of my classmates will tell you.

 

[Dr.Bruh]

I think it blows your mind because you just haven't been around top programs in a competitive specialty to understand things properly. Maybe you haven't worked in finance or held a job in a competitive industry prior to joining medical school. You're just an outside observer coming up with your own theories about how the world should run... How much more do you need us to tell you before you begin to understand? Yes, taking DOs and IMGs negatively affects a program. I've been doing research in ophthalmology for years now, including at a top ophthalmology hospital, and I know tons of rotating students and current residents from top 10 schools. For someone like me or others in this thread who have been interacting with people in these places every single day for years, it's such an obvious truth that pedigree of the residents is something that people pay a great deal of attention to, especially if they come from a top tier school themselves. It is seen as one of the indicators for the health of the program and an indicator that the program is constantly receiving applications from the cream of the crop aspiring ophthalmologists. It is crystal clear that people who go to schools like Harvard and Stanford would rather have Harvard and Stanford graduates as their co-residents than DOs or IMGs. PDs and Chiefs of departments know this (and have told me this), and it's likely they were also in the same mind-set when applying for residency. It's well known that medical school of the applicant is one of the MOST important factors in ophthalmology resident selection - fourth most important (after step 1, letters, and clinical grades, if I remember correctly), and is probably more important in the upper tier. This is similar to other highly competitive specialties.

I was just at a meeting last month, and faculty were casually discussing residency stuff over some food, and a chief of a department said that "students from Harvard might get nervous and apply to every program but they're going to end up ranking places where students of their quality are residents"... I even know the PD of a mid tier program in a major city that took a DO a long time ago, and will not do it again because of the problems it caused. Completely understandable and justified. Welcome to reality.

Graduates of top schools are getting invites from all the top program in their specialty of choice - when it comes down to ranking two similar tier programs, but one has a history of taking IMGs and DOs, chances are they may get ranked lower by graduates of top schools. Why risk that when you can easily ignore the IMGs and DOs and interview only graduates of top schools? It's a no-brainer. Finance and business world - same thing. There are real world implications to everything you do. Wow, shocking...



Yeah, try that over here. The hospital I am currently at right now as we speak has a policy of "do not take IMGs and DOs whatsoever at the flagship centers because it will tarnish our reputation and make us seem less competitive"... If you're a PD and you take a DO, and the hospital board that oversees residency programs has a meeting with you and asks you why you took a DO over the qualified MDs from top schools and therefore risk the reputation of the hospital, you better have a more reasonable explanation than "the DO was a better fit, he was cool and had a great SOAP note, man!", as the policy has nothing to do with fit and qualifications.


From your post, it sounds like you're really angry, but it's much better to just accept that this is how the world works. Emotional claims and personal attacks against the experienced faculty of these prestigious programs isn't going to change anything. Calling it unfair or whatever is not going to change anything. It is what it is. They're preserving their program's reputation, and you can either keep being angry about it or you can accept the world for the way it is.

I think you're missing part of my point. I agree that the mindset you described is totally a thing and is heavily important in top specialties at top programs. No question about it. But I'm allowed to say that it's dumb, likely doesn't effect applicant pool at all, and surrounding yourself by people like that and a program like that would be absolutely miserable. Why would anybody want to work with people that petty?

It doesn't affect me in the slightest. In the specialty I'm applying (EM) the top 3 factors for ranking literally are "better fit" type stuff. According to the 2018 PD survey the top factors for ranking are "Interactions with faculty during interview and visit, Interpersonal skills, Interactions with housestaff during interview and visit, Feedback from current residents". School is bottom 5 (out of like 20 factors).

 

[sab3156]

surrounding yourself by people like that and a program like that would be absolutely miserable. Why would anybody want to work with people that petty?

Keep your baseless personal attacks to a minimum. These are some of the best people I've ever had the privilege to be around. The fact that you haven't ever worked with people like that means that you have absolutely zero idea about what you're talking about.

 

[DNC127]

What kind of stats did these people have, was it like 270+ step, 20+ pubs, 300+ max bench (for ortho), or like decent stats comparable to USMDs applying to the same programs?

Comparable to USMDs getting interviews at these places.

 

[Goro]

If they do not have at least one core rotation with residents in the 3rd year, then your school is not meeting COCA accreditation requirements.

Ok, what did you do to get on the Bad Boy list???

 

[Chibucks15]

Keep your baseless personal attacks to a minimum. These are some of the best people I've ever had the privilege to be around. The fact that you haven't ever worked with people like that means that you have absolutely zero idea about what you're talking about.

I mean nobody attacked you at all but okay. Certain people (myself included) don’t really care about the “prestige” factor and all the extraneous nonsense that comes with it. We have every right to state that fact just as you have every right to disagree. But just saying blanket statements like we don’t know what we’re talking about and dismissing everyone isn’t very productive either.
Some people care about prestige, some people don’t. Everything always has to be so black and white on here damn

 

[AlteredScale]

Just wanted to point out (as we all can learn something from this) that in general and across all specialties the "fit" of an applicant becomes some of the most important factors in ranking. In terms of importance of school, both EM and IM have pretty similar rankings to this particular factor.

It's exceptionally hard to know which programs are going to say "we aren't looking to take DO's into our roster" outright, you have to infer it (which I know is frustrating). But with a little digging you can sort of tell (are there any DO's in the current roster, any alumni who are DO's?). Some programs may change, some programs may hide the fact that there was a DO in the program, you will really never know unless again you do a little digging.

What kind of stats did these people have, was it like 270+ step, 20+ pubs, 300+ max bench (for ortho), or like decent stats comparable to USMDs applying to the same programs?

Stats need to be on par if not better than USMDs. Additionally, many of these people have garnered exceptionally strong letters.

 

[Sephirakra]

I think it blows your mind because you just haven't been around top programs in a competitive specialty to understand things properly. Maybe you haven't worked in finance or held a job in a competitive industry prior to joining medical school. You're just an outside observer coming up with your own theories about how the world should run...

From your post, it sounds like you're really angry

Keep your baseless personal attacks to a minimum. These are some of the best people I've ever had the privilege to be around. The fact that you haven't ever worked with people like that means that you have absolutely zero idea about what you're talking about.

Pot, kettle.

 

[sab3156]

I mean nobody attacked you at all but okay.

Here you go, I'll simplify it for you:

He attacked faculty at competitive programs for being "petty" and calling the atmosphere in those programs "miserable"... I was replying to that. Not once did anyone mention an attack on me, and not once did I mention anyone's attack on me.

 

[sab3156]

I understand your thoughts - they are all reasonable. I'm also sure that you have more experience in dealing with this than I have. Threads talking about programs like Cleveland Clinic neurology demonstrate your point clearly.

Do you have a link to the CCF neurology discussions in which this happened? Thanks in advance.

 

[DNC127]

Just wanted to point out (as we all can learn something from this) that in general and across all specialties the "fit" of an applicant becomes some of the most important factors in ranking. In terms of importance of school, both EM and IM have pretty similar rankings to this particular factor.

It's exceptionally hard to know which programs are going to say "we aren't looking to take DO's into our roster" outright, you have to infer it (which I know is frustrating). But with a little digging you can sort of tell (are there any DO's in the current roster, any alumni who are DO's?). Some programs may change, some programs may hide the fact that there was a DO in the program, you will really never know unless again you do a little digging.



Stats need to be on par if not better than USMDs. Additionally, many of these people have garnered exceptionally strong letters.

Bolded is most important.

DO's for competitive places / specialties are NOT up to par with the MD applicants even IF they scored 260+.

That is just one aspect of your app.

You need respectable boards, great letters from chairs/important people, research, and everything else

Letters and research will be DOs achilles heel forever. No resources = no research = no prominent faculty = sub-par applicants (for competitive things / places)

 

[gyngyn]

This seems like a good time to remind everyone that civil disagreement is expected.
If this is not possible, a closure of the thread will be necessary.

 

[Ho0v-man]

It is what it is, I guess. But who wants to be around a bunch of insufferable, narcissistic *ssholes like that at a top program anyway? Prestige is the absolute dumbest thing that one can pursue in this life. I'd much rather go to a community program with nice people.

They’re not narcissistic or whatever else for not taking DOs. They can literally have their pick among top applicants.

If you were adcom for a med school and had the exact same app betweena Harvard grad and an alum of natty lite U, who do you pick? The answers obvious.

 

[Neopolymath]

Bolded is most important.

DO's for competitive places / specialties are NOT up to par with the MD applicants even IF they scored 260+.

That is just one aspect of your app.

You need respectable boards, great letters from chairs/important people, research, and everything else

Letters and research will be DOs achilles heel forever. No resources = no research = no prominent faculty = sub-par applicants (for competitive things / places)

Most importantly: no home program and no one who will make calls on your behalf. It's like DO schools exist to spite students unlike MD schools.

 

[Chibucks15]

Here you go, I'll simplify it for you:

He attacked faculty at competitive programs for being "petty" and calling the atmosphere in those programs "miserable"... I was replying to that. Not once did anyone mention an attack on me, and not once did I mention anyone's attack on me.

Honestly for some people those are exactly what they experience? I don’t understand why you’re upset. Not everyone is about prestige and the must-get-ahead culture is miserable for people. It isn’t that the people are terrible (all the time) but it’s just the nature of prestige driven people. And some view it as “petty” to put so much emphasis on which school you came from.

Idk none of this actually matters haha apply to whatever your goals are and don’t **** on people for not agreeing

 

[Angus Avagadro]

Most importantly: no home program and no one who will make calls on your behalf. It's like DO schools exist to spite students unlike MD schools.

I have made phone calls for my students and was faculty at a top 10 program. You should not make broad comments like that without any means to back them up.

 

[Tozanzibarbymotorcar]

We can get rid of the AOA, NBOME, and COCA so we can become LCME accredited schools.

You do know that if we did this we would essentially become MD schools and I could tell you for a fact that most people on this forum would not gain acceptance into these schools lol.

 

[Tozanzibarbymotorcar]

Personally I think it's clinical rotations- DO schools have to send out a lot of students for clinical rotations to remote locations and private hospitals that are not teaching institutions. It's often reliant on docs who are more concerned with production than teaching, but out of the goodness of their hearts will volunteer to take on students. You get some teaching for sure, but it's just not the same; COCA knew this and at least made one rotation mandatory at a hospital with residents- which is about the only good thing they've done for a while.

The result is clinically weaker DO residents, at least for the first 6 months or so of residency. It all comes to a wash for sure, but at first im sure its a pretty big pain in the ass to deal with.

AnatomyGrey I agree that some of it may have to do with pseudoscience on board exams, but I would question how much that actually influences it. I really think its more the quality, or lack thereof of our clinical rotations.

Edit- I guess im now the third person to echo this about clinical rotations...I know that there will be additional discussion but I hope we can largely agree that thats the main differentiation here.

Personally I think it's clinical rotations- DO schools have to send out a lot of students for clinical rotations to remote locations and private hospitals that are not teaching institutions. It's often reliant on docs who are more concerned with production than teaching, but out of the goodness of their hearts will volunteer to take on students. You get some teaching for sure, but it's just not the same; COCA knew this and at least made one rotation mandatory at a hospital with residents- which is about the only good thing they've done for a while.

The result is clinically weaker DO residents, at least for the first 6 months or so of residency. It all comes to a wash for sure, but at first im sure its a pretty big pain in the ass to deal with.

AnatomyGrey I agree that some of it may have to do with pseudoscience on board exams, but I would question how much that actually influences it. I really think its more the quality, or lack thereof of our clinical rotations.

Edit- I guess im now the third person to echo this about clinical rotations...I know that there will be additional discussion but I hope we can largely agree that thats the main differentiation here.

Do we have evidence for this?

 

[AnatomyGrey12]

You do know that if we did this we would essentially become MD schools and I could tell you for a fact that most people on this forum would not gain acceptance into these schools lol.

Your point?