D.O. Residency Limitations?

[jimjones]

How competitive are DO grads for "MD" residencies? I know there is no such thing as MD residencies but you know what I mean I'm sure. Specificaly, how much (if at all) higher would one have to place in the USMLE to be competetive for say gen surg or ENT, at a community based program.
Also, same question as above but for a big university based peds or IM residency.
thanks

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[drusso]

Go get the September 5 issue of JAMA and turn to page 1056 and read the article titled, "US Graduate Medical Education, 2000-2001. On page 1057, you'll see a table showing the number of US MDs US DOs and IMGs in US GME to date. You'll notice that the US DO column has been trending upward since 1995. There is also an appendix at the back of the issue that breaks US MD US DO and IMG match rates by specialty. All your questions will be answered.

 

[jimjones]

Wow awesome thanks drusso.

 

[MRF1366]

Wow, this is a good JAMA. Lot's of interesting data. As to the question asked initially, I think you might find the following info helpful. These are the total number of residents in each specialty nationwide in "MD" programs (ACGME). They broke the data down into groups based on MD, DO, IMG, Female, and Canadian. Here's the info for a few specialties:

Specialty---------DO's/Total Residents
______________________________________
Derm----------------6/858
Neurosurg-----------4/785
Optho---------------29/1265
Orthopedics---------13/2915
ENT-----------------8/1077
Plastics-------------2/474
General Surg--------109/7548
Thoracic surg-------0/299
Urology-------------6/1017

REMINDER: These are totals for all the different resident years combined!

However, these specialties have a better DO representation:
_________________________________
Family Practice------1057/10,127
IM------------------910/21,173
EM------------------254/3619
Ob/Gyn--------------210/4679
Peds----------------334/7629
PM&R----------------134/1110
Psych---------------197/4521
Rads----------------147/3641

 

[jimjones]

thanks mrf, my university only has august 29th's issue on the shelf.

 

[daveshnave]

It might not be necessarily that it's much tougher for DO grads to get into some specialties. Generally DO schools emphasize treating the whole patient, and this obviously has a primary care slant to it. For that reason I think many DO grads go into primary care and don't specialize/subspecialize as frequently. This could account for some of the low numbers that were shown. My gut feeling is that it's not much more difficult for a DO grad to get into a residency program associated with an allopathic school, although I've heard that depending on the state the DO must do a year of DO internship, BEFORE starting as an allopathic intern...does anyone know if this is true? (I heard it applies here in Pennsylvania, but they might not require it anymore).

 

[fisgig]

If MD's don't treat the whole person, then we got a real problem!

 

[Leotigers]

Originally posted by daveshnave:
•It might not be necessarily that it's much tougher for DO grads to get into some specialties. Generally DO schools emphasize treating the whole patient, and this obviously has a primary care slant to it. For that reason I think many DO grads go into primary care and don't specialize/subspecialize as frequently. This could account for some of the low numbers that were shown. My gut feeling is that it's not much more difficult for a DO grad to get into a residency program associated with an allopathic school, although I've heard that depending on the state the DO must do a year of DO internship, BEFORE starting as an allopathic intern...does anyone know if this is true? (I heard it applies here in Pennsylvania, but they might not require it anymore).•

Dave is absolutely right. Realize that there are very few DOs who even apply to the extremely competitive allopathic residencies. For instance, in 2001, there were only 36 DOs who applied for allopathic Orthopedic Surgery Residencies. For comparison, there were 882 AMGs that applied and 217 IMGs. Also, DOs have far fewer applications per applicant which could also be a factor as well.

1. Applicant Count
2. Application Count
3. Avg. # Applications


U.S. (Public)

1. 480 2. 19,682 3. 41.0

U.S. (Private)

1. 402 2. 17,333 3. 43.1

Canadian

1. 4 2. 136 3. 34

Osteo.

1. 36 2. 535 3. 14.9

IMG

1. 217 2. 5,342 3. 24.6

Total

1. 1,139 2. 43,028 3. 37.8


http://www.aamc.org/about/progemph/eras/01stats.htm

Additionally, many of the top DO students enter osteopathic Neurosurgery, Plastics, ENT, Derm, Orthopedics, etc. residencies. Since the osteopathic match occurs before the allopathic match, many will not risk not getting an Orthopedic residency at all (which is a risk for US MDs and US DOs). With regards to doing an osteopathic internship in PA, this is true. However, allopathic residencies that require a separate internship (like Derm, Rads, PM&R, 4 year EM programs, and Anesthesia) will take the osteopathic internship year. For fields like Peds, FP, etc., they can apply to get residency approved and it is usually approved nowadays.

 

[jimjones]

Yes, those are interesting stats.
It is hard to tell though how competetive a DO applicant is, compared to say a US MD grad and an IMG.
My guess is that for pretty much any senario a US DO will be more comptetetive than IMG's, all other factors (eg USMLE) being equal.
I'm sure though that some foriegn grads are rated fairly highly (eg a US citizen coming from an Irish or Australian school).
Can anyone else add to this?

 

[platinumdoc]

I have an allopathic background however I have practiced with many D.O.'s that are very competent and excellent clinicians. If I were a residency director, with the quality of DO's out there, it would make my job very difficult. I have observed that many of my friends did both DO Boards and USMLE boards....

 

[drusso]

With regard to the more competitive specialties such as derm, ENT, optho, ortho, and neurosurgery (although neurosurgery is not as competitive as you might think---many neurosurg slots go unfilled believe it or not!) many DO's elect to do AOA-approved residencies. If you're a DO and you know that you want to do a specialty or subspecialty, it is arguably to your advantage to apply only to AOA programs since 1) you won't be competing against MD students; 2) most DO's want to do primary care related specialties, thus a smaller applicant pool; 3) since there are fewer programs, it's easier to rotate at a larger percentage of them and get your face seen by residency directors. The Journal of the American Osteopathic Association (JAOA) puts out a similar issue either this month or next detailing the number of DO's in osteopathic GME programs. Look for it.

 

[daveshnave]

Originally posted by fisgig:
•If MD's don't treat the whole person, then we got a real problem!•

Fisgig, that wasn't what I was saying at all... you totally took that statement out of context. Please don't start a petty DO vs MD argument, because they are ridiculous, and I really have to discount ANYONE who thinks DO's are inferior... I can't see any rational basis why someone would think this.

 

[drusso]

Originally posted by MRF1366:
•This looks like a self-perpetuating problem to me.•

Are you sure it's a problem. DO students tend to be more primary care oriented. That's where the focus of the osteopathic profession has been historically. I'm all for DO's specializing--in fact I think it's important--but I also think that the difference between DO and MD representation in specialties has more to do with attitudes and training than it does with competitiveness. Some of the brightest people in my class did either Family Medicine, Pediatrics, or Internal Medicine.

 

[JS-UNMC]

Just thought I'd add my two-cents worth! I am pretty sure (about 95%) that I want to specialize in something like cardiothoracic surg or Plastics. Many of the MD programs that I have contacted regarding their general surg residency, have flat out told me that as a DO, I must: be at least in the top quartile (or better), TAKE the USMLE (top 10%), and do roatations with them before the match. As far as general surg residency goes, you must also be aware of the difference between a catagorical and a preliminary position. VERY few DO's get categorical positions at MD hospitals. Many DO's get prelim positions at these same programs. Just realize that MD surgery residencies are one of the last areas to take DO's. This is for many reasons: they get a lot of qualified MD app's, and generally, many DO students elect not to take the USMLE which automatically takes you out of running.

 

[MRF1366]

Originally posted by drusso:
•Are you sure it's a problem?•

It is if you're a DO student who wants to become a specialist! Especially if you want to train at a university-based program (which tend to be ACGME).

 

[Leotigers]

Originally posted by MRF1366:
•I guess my personal feelings are that many DO students don't waste their time applying for positions that they most likely won't get. They therefore have lower numbers in those fields due in part to the decreased applicant numbers to those specific specialties. This looks like a self-perpetuating problem to me.•

I'm not sure that I necessarily agree with this. If this were true then why is that very few DO students apply to Psychiatry or Pathology? Only 23 DO students applied to Path and 79 for Psych vs. 36 applying for ACGME Ortho spots. If you look at the numbers, I think you could make the argument that this would be the case with FMGs (2782 for Psych and 1530 for Path, but only 217 for Ortho). Like drusso said, many DO students go into primary care fields because that is the focus of many osteopathic medical schools. Many of the top students in my class also went into primary care and some of them scored 240+ on the USMLE. The ones who matched into Ortho, GenSurg, EM, etc... or those who went to prestigious university-based programs were not the top students in our class.

 

[Leotigers]

MRF1366:

I don't think it's a problem at all. You have to realize that not all the top DO students apply for ACGME specialties. I think the reason that very few DOs apply to the competitive ACGME specialites is because of the existence of AOA (osteopathic) specialty residencies. The AOA residency match occurs prior to the ACGME one and you are automatically withdrawn from the ACGME match once you've matched through the AOA. If your dream is to do Derm, ENT, or Ortho, not many people will take the chance that they won't match. Also, it's not just DOs who have a difficult time matching into competitive specialities. What percentage of students get Junior or Senoir AOA? Which percentage score higher than 236 on the USMLE? The average USMLE for ENT last year was 236. What are the chances of matching for non-AOA and a 222 USMLE scorers in ENT? Not every US MD student is from Harvard, Stanford, etc. with AOA status and 99 percentile on the boards. With the fact that US MD students who apply for the ACGME match outnumbering US DOs by 800-1000 in each specialty, you will obviously find more US MD students filling these spots.

My classmates did well in the match through ERAS. Over 50% got their first choice and about 80% got their top three choices. Taken into consideration that my school, TUCOM, just graduated their first class. We matched into very competitive residencies with 63 students in our class. I've noticed that several other DO schools that list their match online also did very well in the match (COMP & AZCOM). The Bay Area is one of the toughest places to obtain residency, yet all the west coast schools did very well in placement into California programs. I think a factor in this was due to the location of the schools. Despite the competitiveness of the CA programs, I've met two DOs in the Cardiology Dept. at Stanford (The top Cardiac Dept. in the West according to US News & World Report), the chief resident of Neurosurgery at UC Davis (Jeff Mimbs, D.O.) and an Ortho Trauma fellow at UC Davis too. I also know of a D.O. doing a Derm fellowship at UCSF. This has just been my personal experience while I was a medical student. At USC's Doheny Eye Institute, one of the ophthos that I worked with was a DO too. A friend of mine matched at Yale (Dr. Penner, D.O.) for ER, my classmate matched at USC, and so on. My point is that very DO students apply exclusively for the allopathic match in competitive specialites. Those that do have done well in the match. Also, realize that when you are talking about Plastics, ENT, Derm, etc., many students have difficulty in matching into University based programs. You really need to do well on the USMLE, be AOA, research, connections, etc.. What percentage of US MD students have all that on their CV? I'm sure that their might be some bias in some programs in certain states, but I haven't experienced that at all. Unless one is a residency director for a competitive ACGME specialty, I don't see how one can make that type of statement. DOs need to do the exact same things as MD students to get into a competitive specialty. Somehow going by this board, it seems that getting an ENT spot for any US MD student is a cakewalk. Obviously, by sheer numbers alone and with schools such as Harvard, UCSF, Hopkins, etc. there will be better qualified US MD students. However, these types of stellar students do not comprise the majority of students applying. Not every US MD student gets AOA and 240+ on the USMLE.

This really shouldn't be about MD vs. DO. Residency directors do not separate applications from US MDs from US DOs. Matching into a competitve residency requires a number of things that apply to both MD and DO students. There is a wide range of quality of US MD students just as their is a wide range of quality of US DO students as well. Residency directors take a look at your whole package and do not separate MDs from DOs. If they did, then why is it that 4th year DO students who do apply for competitive specialities seem to match despite the fact that they are told that they won't by certain pre-meds and medical students?

 

[drusso]

My experience pretty much mirrors Leotigers. Another thing to keep in mind when looking at the match rates in JAMA for DO's is the fact that those numbers do not consider those DO's who do AOA-approved internships prior to going into a PGY-2 slot. Again, I think the majority of the discrepancies you see between DOs and MDs matching into competitive specialities can be accounted by two factors: 1)Primary care specialty preference for DO's; 2) DO's matching into AOA-approved specialty residencies. Time and time again I've been told by residency directors that DO's with USMLE scores, good letters of rec, and rotation experience at the program they are applying to are evaluated on par with their US-MD colleagues.

 

[JS-UNMC]

I heard that the rules changed this last year regarding doing both the AOA and ACGME matches... I heard that now, even if you match through the AOA, that you can now decline it and take the ACGME program that you matched with. Has anyone else heard this? Am I way off on this?

 

[jimjones]

Thanks for all the responses.

I'm looking at the numbers posted and wondering why there are such low numbers of DO's in ortho vs optho. Both are very competetive, but you'd think ortho would be more DO oriented due to the emphasis on the muskuloskeletal system.

 

[MRF1366]

Originally posted by drusso:
•Another thing to keep in mind when looking at the match rates in JAMA for DO's is the fact that those numbers do not consider those DO's who do AOA-approved internships prior to going into a PGY-2 slot.•

Actually, they do. Those weren't match rates, they were the TOTALS for all years of all programs nationwide. So any DO in a PGY 2, 3, 4, etc. spot, would have been counted.

As far as the primary care bent in DO schools; I understand that you all are steered in that direction. But I imagine there is usually another group that ends up there not by their own choosing. And I know this happens at MD schools as well. Is the DO group larger? I guess there's no way to tell for sure.

I guess the point of my posting all this was that I too thought that DO's received equal footing in residency placements when all other factors were equal. But it seems (to me) that this is not the case. I do not beleive that the numbers are so low because most DO students prefer AOA programs over large, University based programs. These will almost always provide better training, especially if one is interested in specialization. You just can't expect to see the volume or bredth of cases at a small community hospital.

These are just my thoughts. I considered attending a DO school, and chose an MD school over it for a variety of reasons; not the least of which was my fear of the situation that these numbers are telling me does in fact exist.

It seems to me that having the AOA match before the ACGME match prevents many students from applying to the MD programs along with the DO ones. If I were a DO student, that would piss me off.

 

[drusso]

Originally posted by MRF1366:
•

I guess the point of my posting all this was that I too thought that DO's received equal footing in residency placements when all other factors were equal. But it seems (to me) that this is not the case. You can't tell me that every DO student prefers to go to AOA programs rather than large, University based programs. These will almost always provide better training, especially if one is interested in specialization. You just can't expect to see the volume or bredth of cases at a small community hospital.

It seems to me that having the AOA match before the ACGME match prevents many students from applying to the MD programs. If I were a DO student, that would piss me off.•

I think there are a variety of reasons why some students choose primary care specialties and others do not. I do know that DO admissions committees try to maximize prematriculation factors that predict primary care specialty choice (biopsychosocial orientation, rural background, female gender, etc).

Just a FYI: Virtually every AOA-approved specialty program (while usually based out of a community hospital) sends their residents on out-rotations to large medical centers for tertiary care experience. PCOM's ENT residents go to Albert Einstein; NYCOM's Neurosurgery Residents go to Long Island Jewish Hospital and a variety of other NYC hospitals; New Jersey's Cardiothoracic surgery residents go to Deborah Heart and Lung; I think that Oklahoma's Optho residents rotate both at Mayo and the University of Arkansas.

 

[Pitt Panther]

Here's a question (I think), and be brutally honest...Do you think that by going into osteopathic medicine that we are "limiting" ourselves in terms of available residencies? I feel that MDs and DOs are equal however, the individuals who will be evaluating our credentials for residency may not.

Here's my situation... When I compare allopathic vs. osteopathic medicine, I strongly prefer the osteopathic, "treat the patient, not the disease" ideology. On the flipside of that, I would like to go into neurosurgery, which is somewhat rare for DOs. I also feel that OMM therapy has much to offer this specialty.

Personally, I have the stats and extracurricular experiences which make me competitive at most allopathic and osteopathic medical schools and I'm not going to give up my end goal of becoming a neurosurgeon just because I prefer osteopathic over allopathic medicine. Am I the only one who feels this way or are there others?

All comments are welcome except by those who wish to turn this into a DO/MD superiority flame war (that's a different thread, and I don't want to get involved with that as I may end up smashing my monitor into pieces.) just like this

Thanks

 

[Dr JPH]

Honest enough question.

First of all, you already know that a DO can, theoretically, enter any specialty field.

Now, it is indeed not so common to see DOs in areas such as neurosurgery. There are few DO neurosurgery residencies (maybe one 1) and the MD programs are very competitive.

In order to balance things out, you may consider taking the USMLEs in order to provide "proof" that you can do as well as an MD can.

You may also want to do a rotation at the hospital that offers the program you are interested in. Exposure to the program and the director, as long as it is positive exposure, will help.

And, do well in school. No one can look poorly upon amazing grades, even if it is "only a DO school."

Will you definately get to become a neurosurgeon? Nothing is definite, even grads from the top MD schools have uncertainty. But there are things you can do to help your chances.

One more thing...remember that most people who go into medical school with a particular specialty in mind do not actually end up entering that specialty. One poll I saw showed only about 20-25% were certain prior to school. Either way, best of luck to you.

 

[WishUponAStar]

Hello,

Neurosurgery may be the most difficult of all the residency specialties to get into. There are a very small number of residency spots. I forget the exact number, but it is around 116 in the entire U.S. In many cases, those spots go to the best of the best from ivy league institutions, MSTP grads, and other superhuman graduates. So getting into neurosurgery from an MD school is going to be amazingly difficult and unlikely from most schools, and getting in from a DO school may be impossible, unless you get that one DO residency spot.

I am a huge osteopathic medicine supporter, but I have no interest in the most difficult of residency positions. I'm just trying to give the most accurate opinion I can. You've chosen a field that few ever attain.

 

[lady bug]

I know two DO cardiothoracic sugeons, and I've heard CT surgery is pretty hard to get a residency for too....so its certainly doable. This is kinda sidetrack, but does anyone know if there are ophthalmology programs out there that cater to DO?

 

[FutureM.D.]

This is probably very obvious, but there are a lot more MD's out there then DO's.

 

[Cranialpressure]

There is maybe 9 or 10 DO neurosurgery residency programs available. Listen, as Drusso stated, DO philosophy has a primary care oriented slant; that is one of the main thrusts of the profession. Therefore, DO schools do select for students with an inclination for primary care. However, DOs do specialize, although they may have a harder time matching at some allopathic institutions in competative specialties. Remember, MDs have it hard matching in competative specialities also. Bottom line, follow your heart and try your best, but keep in mind the basis of the DO profession when applying to DO schools. Is there bias??? I suspect there is in ultra competative fields but I do not think it is as bad as boards such as these make it out to be. If I were interested in a competative speciality I would first look at programs in the DO world. If my heart was set on a competative allopathic program I would do the best; take the USMLE and do well, do a rotation in the hospital, maybe do some research, and get good letters of rec. Furthermore, if one is interested in the military, specialty residencies are on even ground for DOs and MDs. Some people are overly pessimistic, others are overly optimistic, but the truth is usually somewhere in the middle.

 

[Cranialpressure]

Information on DO surgical specialty residency training programs can be found at the web site for the American College of Osteopathic Surgeons; Go to "graduate education" and then to "training sites"

There are actually 11 neurosurgery training programs in the DO world. They are, according to the American College of Osteopathic Surgeons web site, the following:

Bro Menn Regional Center, IL
Garden City Hospital, MI
Horizon/Henry Ford, MI
Long Island Jewish, NY
St. Barnabas, NY
Doctors Hospital, OH
Grand View Hospital, OH
PCOM program, PA
Pontiac Osteopathic hospital, MI
Tulsa Regional Medical Center, OK
Arrowhead Regional Medical Center, CA

There is hope for all of you future DO specialists out there! Keep the Faith and do the best you can.

 

[DOnut]

Hey let me tell you that Long Island Jewish, NY and
St. Barnabas, Bronx NY are 2 great hospitals. Both very large very good teaching hospitals. I don't know much about the other hospitals on that list, but I'm sure that at these two, your training would match or surpass almost any of the allopathic neurosurg residencies. Maybe with the exception of Johns Hopkins.......Dr. Ben Carson still amazes me....read his book.

 

[Pitt Panther]

Cranial Pressure a.k.a. ICP (Intracranial pressure),

Thanks for that post..that was very helpful and informative.

That goes for you too DOnut. Thanks.