D.O's after Graduation

[donkeykong1]

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I took this from the U.S dept of labor site on physician occupations.

"Following medical school, almost all M.D.s enter a residency—graduate medical education in a specialty that takes the form of paid on-the-job training, usually in a hospital. Most D.O.s serve a 12-month rotating internship after graduation and before entering a residency, which may last 2 to 6 years."

can someone explain the last part. i heard of there being d.o restrictions in some states, but i'm not so clear on that. also is this a year of paid internship?

 

[donkeykong1]

anyone?

 

[medhacker]

Yes internship is paid.

At this time, most DO residencies start at the year of internship, that is internship year is physician graduate year 1 PGY1.






_______________________________________________
Medhacker an FP doing cosmetic surgery, pissing off the plastics and the derms...and loving every single minute of it!

 

[medhacker]

you mean post-graduate year.

No, I meant what I said, Physician graduate year - PGY

Widely varying Physician Graduate Year, or PGY status, also demonstrates the
difficulties of downsizing given that many specialty programs have lengthy training periods.


http://www.cms.hhs.gov/reports/downloads/cromwell2.pdf

 

[donkeykong1]

why is this internship necessary? wouldn't this only add to the residency period for DO's compared to MD's.

 

[donkeykong1]

also is this what is meant by a traditional rotation. i only ask this because i see this all over match lists.

 

[spicedmanna]

Just to clarify further, yes, there are a handful of states where the licensing body requires an osteopathic physician to have completed a traditonal rotating internship. If you are doing an AOA residency, this is taken care of for you, as in many cases the requirement is included. The time where its more of a concern is if you are doing an allopathic, or ACGME, residency. Then you either have to get your PGY-1 yr approved by the AOA to fulfill the requirement, or you have to complete an already approved traditional internship. All provided you actually want to practice in one of those states, that is.

 

[medhacker]

why is this internship necessary? wouldn't this only add to the residency period for DO's compared to MD's.

No. As I said, for most AOA residencies, the internship year is PGY1.


The traditional rotating internship, usually has the same core rotations but it is completed apart from a residency program. Most people who do it, do it with the intention to jump from it to a residency they wish to match into.

 

[donkeykong1]

absolutely for aoa residencies i presume the internship year mentioned in the quote is pgy1. yet if one were to take an allopathic residency, the 12 month rotation would be apart from the residency with no pay, would it not? please correct me if i'm wrong

 

[Longshanks]

absolutely for aoa residencies i presume the internship year mentioned in the quote is pgy1. yet if one were to take an allopathic residency, the 12 month rotation would be apart from the residency with no pay, would it not? please correct me if i'm wrong

You get paid for internship, its pgy-1.

 

[medhacker]

absolutely for aoa residencies i presume the internship year mentioned in the quote is pgy1. yet if one were to take an allopathic residency, the 12 month rotation would be apart from the residency with no pay, would it not? please correct me if i'm wrong

If you do an allo residency in one of the 10 states that require you to have the traditional internship, then you will need to file a resolution 42? I think it's called, to have that state osteopathic board recognize your first allo PGY1 as your traditional internship. Of course the same applies if you went allo to any of the other states but wish to practice in one of the 10.

And you get paid for your first year regardless.


Things get messy with funding when you jump from one specialty to another, but that's of course a whole other subject... 😀

 

[tkim]

No, I meant what I said, Physician graduate year - PGY

I've always known it as post-graduate year.

 

[TexasTriathlete]

I've always known it as post-graduate year.

that's because that's what it is

 

[medhacker]

can someone explain the last part. i heard of there being d.o restrictions in some states

Also, just to keep things clear, they're not restrictions per se
They're different requirements in some cases.
Physician graduates year 2-6 (PGY 2-6) and DOs can practice unrestricted, for all practical purposes, in all states of the union, in most cases*.

Cheers 😉


* Some states issue unrestricted license after completion of Physician graduate year 2 - PGY2.

 

[tkim]

If you do an allo residency in one of the 10 states that require you to have the traditional internship, then you will need to file a resolution 42? I think it's called, to have that state osteopathic board recognize your first allo PGY1 as your traditional internship. Of course the same applies if you went allo to any of the other states but wish to practice in one of the 10.

And you get paid for your first year regardless.


Things get messy with funding when you jump from one specialty to another, but that's of course a whole other subject... 😀

I'm not sure where you are getting your information, but it's five states that require an osteopathic traditional rotating internship. Not ten. Resolution 42 is for people who enter an allopathic residency in the other 45 states and want to get a waiver of that internship requirement.

Get your info straight.

 

[donkeykong1]

so, if i were to choose an allopathic residency after graduating from an osteopathic institution and i wanted to play it safe[see resolution 42] and enter into the traditional rotating internship which i've seen many people do from match lists all over sdn, would i be prolonging residency by 12 months?

sorry if this is redundant, but this is very important in terms of planning out things in the future.

 

[medhacker]

so, if i were to choose an allopathic residency after graduating from an osteopathic institution and i wanted to play it safe[see resolution 42] and enter into the traditional rotating internship which i've seen many people do from match lists all over sdn, would i be prolonging residency by 12 months?

sorry if this is redundant, but this is very important in terms of planning out things in the future.

Yes, it would represent an extra year and in most cases could lead you into the running out of funds for a paid residency issue, that I alluded to before.

 

[donkeykong1]

Yes, it would represent an extra year and in most cases could lead you into the running out of funds for a paid residency issue, that I alluded to before.

wow,that's scary

 

[DO2Be2013]

I can use google too. Another CMS publication:

...because he/she is still in post-graduate year (PGY) 1.

www.cms.hhs.gov/Transmittals/Downloads/R218PI.pdf

Also, it's only 5 states that have the AOA intern year requirement, not 10: West Virginia, Florida, Pennsylvania, Michigan and Oklahoma.

 

[donkeykong1]

what happens if you go through residency w/o the 1 yr requirement and later on in life decide to practice in say the state of Pennsylvania?

 

[beckhunter116]

You apply for the resolution 42. The safest thing to do if to make sure that if you do an ACGME residency that you compare your 1st year to what the AOA requires and then plan your electives in 1st yr to fill those requirements if you don't already meet them.

The point here is to plan ahead.

 

[medhacker]

wow,that's scary

You'll be surprised to know there's a good number of residents out-there who do extra years of residency to get to a desired specialty, or even those who take a pay cut on salary (I've seen anywere from $0 a year to 14,000).

 

[MedStudentWanna]

Yes, it would represent an extra year and in most cases could lead you into the running out of funds for a paid residency issue, that I alluded to before.

You're the first person I've ever heard say that. OP, what I've seen from residents and attendings is that if you plan to practice in one of those five states and you want to do an allo residency, just go through Res. 42 and have it approved. The paperwork sucks, but most people get it approved and they're set to practice wherever they want, even with their allo residency.

If you choose not to do that, then do your TRI and then have it count toward an intern year in an allo residency. I'm sure this varies according to specialty, but from what's posted in the residency forum, only a handful of allo residencies won't count a TRI as an intern year.

The point is there are many ways around this without having to tack on an extra year of training.

 

[donkeykong1]

this is what i thought originally, hope you're right. just got veered off course by the quote i took from the U.S Dept of Labor.

 

[medhacker]

You're the first person I've ever heard say that.

You can find another one here:

http://forums.studentdoctor.net/showthread.php?t=628158

 

[TrumpsMom]

The other thing to remember is that many residencies now are dually accredited for both osteopathic and allopathic credit.

 

[donkeykong1]

The other thing to remember is that many residencies now are dually accredited for both osteopathic and allopathic credit.

do you have any details on this dual accreditation

 

[medhacker]

do you have any details on this dual accreditation

If you go to http://opportunities.osteopathic.org/search/search.cfm

And choose "Advanced search", towards the bottom you'll see an option for dual accredited programs.

 

[donkeykong1]

does anyone have any data on what the majority of the 60-70% of D.O grads who choose the allopathic route actually end up doing in terms of 1)rotational year
2)straight to residency
3)dual accreditation
it seems like the majority ends up with the rotational yr. and only a handful get into what seem like competitive dual accredited programs.---just a guess, please correct me if i'm wrong

 

[tkim]

Also, just to keep things clear, they're not restrictions per se
They're different requirements in some cases.
Physician graduates year 2-6 (PGY 2-6) and DOs can practice unrestricted, for all practical purposes, in all states of the union, in most cases*.

Cheers 😉


* Some states issue unrestricted license after completion of Physician graduate year 2 - PGY2.

Again, your information is wrong. Most states will issue an unrestricted license after completing just the intern year. There are some states that require 2 or more years, and some that will not issue licences until completion of residency:

http://www.fsmb.org/usmle_eliinitial.html

Once more, don't spread false information.

 

[tkim]

Yes, it would represent an extra year and in most cases could lead you into the running out of funds for a paid residency issue, that I alluded to before.

http://www.uth.tmc.edu/med/administration/gme/pdf_files/medicare_payments_gme.pdf

This explains how Medicare fund ACGME residency programs. Make note that stand-alone prelim med or surg or transitional years are not counted in your final 'clock' of funding. By clock I mean that whatever specialty you match in, your clock is set and starts when you enter that residency. Say you match into general surgery, that's five years in length. Five years is the length of your clock. If you decide after the second year of training, that you'd rather do internal medicine, you are still fully funded, because IM is three years long, you've done only two years of surgery, and your clock is set for five years.

The problem is when you try to switch to something with a longer training period after matching into a specialty with a shorter training period. Say you were doing IM, and matched into gen surgery. Depending on when you switched, one or more of those gen surg residency years may only be funded by half.

Again, preliminary medicine and surgery and transitional years do not count towards this clock. While this publication only covers ACGME internship and residency, I see no reason why AOA internships aren't counted as the same, since they are also funded by Medicare.

Then again, this publication makes no specific mention of AOA internships.

 

[donkeykong1]

http://www.uth.tmc.edu/med/administration/gme/pdf_files/medicare_payments_gme.pdf

This explains how Medicare fund ACGME residency programs. Make note that stand-alone prelim med or surg or transitional years are not counted in your final 'clock' of funding. By clock I mean that whatever specialty you match in, your clock is set and starts when you enter that residency. Say you match into general surgery, that's five years in length. Five years is the length of your clock. If you decide after the second year of training, that you'd rather do internal medicine, you are still fully funded, because IM is three years long, you've done only two years of surgery, and your clock is set for five years.

The problem is when you try to switch to something with a longer training period after matching into a specialty with a shorter training period. Say you were doing IM, and matched into gen surgery. Depending on when you switched, one or more of those gen surg residency years may only be funded by half.

Again, preliminary medicine and surgery and transitional years do not count towards this clock. While this publication only covers ACGME internship and residency, I see no reason why AOA internships aren't counted as the same, since they are also funded by Medicare.

Then again, this publication makes no specific mention of AOA internships.

why doesn't the AOA straighten this out?

i mean the D.O and MD curricula are almost identical, aren't they?

 

[medhacker]

why doesn't the AOA straighten this out?

i mean the D.O and MD curricula are almost identical, aren't they?

As I mentioned, when one starts swithcing from one residency program to another, things can get messy in terms of funding...

What part do you feel the AOA should straighten out?

 

[donkeykong1]

As I mentioned, when one starts swithcing from one residency program to another, things can get messy in terms of funding...

What part do you feel the AOA should straighten out?

the whole idea behind resolution 42 is a mess. D.O's and MD's are equally qualified knowledge after graduation. there should no longer be any extra 12 month rotation to practice in these 5 states, if one chooses an allopathic residency.

lets face it, there are some specialties that can be reached only by applying to an allopathic residency. why should a D.O be at a disadvantage and take a 12 month rotation while an MD cruises on w/o doing so. i'm not sure if the statement made by MedStudentWanna is correct, but it seems logical.

anyways, my point here is that as DO's become larger in numbers in the next few years, and more prominent in urban areas the transitional period just has to be reformed.

jut my 2 cents-as a pre-med ofcourse

 

[MedStudentWanna]

You can find another one here:

http://forums.studentdoctor.net/showthread.php?t=628158

Ah, from Dr. Midlife, another pre-med. When you see a resident or attending spout such nonsense, let me know.

 

[medhacker]

Ah, from Dr. Midlife, another pre-med. When you see a resident or attending spout such nonsense, let me know.

Does Lee, the founder and administrator of SDN count as someone who does not spout nonsense?

http://forums.studentdoctor.net/showthread.php?t=27375

 

[MedStudentWanna]

Does Lee, the founder and administrator of SDN count as someone who does not spout nonsense?

http://forums.studentdoctor.net/showthread.php?t=27375

Yes and let's take a look at what Lee said:

I did an osteopathic internship, and now am completing my family practice residency at a large allopathic institution. There was no problem with that, especially because I transferred into the ACGME program as a second year (PGY-II).

Now let's take a look at what you had originally said:

Yes, it would represent an extra year and in most cases could lead you into the running out of funds for a paid residency issue, that I alluded to before.

So thank you for proving that you were wrong. For further reflection, let's revisit what I wrote:

If you choose not to do that, then do your TRI and then have it count toward an intern year in an allo residency. I'm sure this varies according to specialty, but from what's posted in the residency forum, only a handful of allo residencies won't count a TRI as an intern year.

Which is similar to what Lee did, so his post backs up my point, not yours. Again, thank you.

 

[group_theory]

There are a lot of misunderstandings in this thread. Hopefully I can help.

Traditional Rotating Internship (TRI) - is a PGY1 year which doesn't lead specifically to any residency. It's equivalent to the ACGME transition year (also PGY1). Doing a TRI does not start the medicare funding clock so it will not affect future funding for your residency. Why do some DOs do TRI? Some want more time to decide what field they want to go into. Others want to get that AOA approved year so that they won't have to worry about licensure issues in 5 states when they pursue ACGME residency. Some want residencies that require TRI (ie AOA dermatology). Others want another shot at the AOA match.


There are other types of AOA intern year besides Traditional Rotating. There are internships which links directly into a residency. If you do a AOA intern year in Internal Medicine, once you complete it you go directly into PGY2. Once you complete your AOA intern year in surgery, you go into PGY2 year. This is no different than in the ACGME world, where most interns are links to their residency program (unless they are doing a transitional year OR prelim year). Doing this type of intern year will start the medicare funding clock.


Now if you do an AOA intern year and go into an ACGME residency, will you get credit for that intern year? That depends on which specialty you go into. The major hurdle is that the board in your specialty (American Board of Pediatrics, American Board of Internal Medicine, American Board of Surgery, etc) must recoginze your AOA intern year for it to count. If the board does not, then you will have to repeat intern year. Some boards will recognize it, others will not. Hence why some people can go from TRI to PGY2 in an ACGME program without any issues, while others cannot.


About Resolution 42 and the 5 states. There are 5 states where the licensing boards require an AOA-approved Intern year (or with some exception, have the state licensing board persoanlly review your intern year and grant you a waiver). These 5 states are: Florida, West Virginia, Pennsylvania, Michigan, Oklahoma.
If you do an AOA TRI or an AOA Intern year as part of a residency, you have nothing to worry about. For those who did an ACGME PGY1 year, Resolution 42 is a process in which you get your ACGME PGY1 year AOA Approved. Once your ACGME PGY1 year is AOA approved, in the eyes of those 5 states, you completed an AOA-approved intern year and are able to get an unrestricted license to practice. Some states will allow you to practice as a resident without an AOA approved intern year, others will not.

 

[medhacker]

The major hurdle is that the board in your specialty (American Board of Pediatrics, American Board of Internal Medicine, American Board of Surgery, etc) must recoginze your AOA intern year for it to count. If the board does not, then you will have to repeat intern year.

It's not only an issue only for a DO going into an allo residency, I've seen an MD resident who did physician graduate year 1 (PGY-1) in general surgery and then decided to quit G. surg and go to family medicine.

He had to repeat physician graduate year 1 (PGY-1) in family medicine, albeit, he didn't have to do general surgery for his family medicine PGY-1. But still, he had to repeat that year.

 

[tkim]

It's not only an issue only for a DO going into an allo residency, I've seen an MD resident who did physician graduate year 1 (PGY-1) in general surgery and then decided to quit G. surg and go to family medicine.

He had to repeat physician graduate year 1 (PGY-1) in family medicine, albeit, he didn't have to do general surgery for his family medicine PGY-1. But still, he had to repeat that year.

Listen, the AOA calls it OGME - osteopathic graduate medical education, or postdoctoral year:

http://www.do-online.org/index.cfm?PageID=edu_main&au=D&SubPageID=sir_postdoc

The Journal of the American Osteopathic Association calls it 'post graduate year':

http://www.jaoa.org/cgi/reprint/103/8/367.pdf

"Recent changes instituted by the ACOFP integrate the postgraduate year (PGY) 1 curriculum as part of the family
practice residency training."

The ACGME calls it 'post graduate year':

http://www.acgme.org/acwebsite/about/ab_acgmeglossary.pdf

"Graduate-Year Level: Refers to a resident's current year of accredited GME. This designation may or may not correspond to the resident's particular year in a program. For example, a resident in pediatric cardiology could be in the first program year of the pediatric cardiology program but in his/her fourth graduate year of GME (including the 3 prior years of pediatrics.) Also referred to as ‘post graduate year' or ‘PGY".

If neither the AOA or the ACGME refer to it as 'physician graduate year', why do you persist in calling it that? Are you even a resident? Your sig mentions you being an FP doing derm. Is any of it true? If it is, why are you posting about taking Step I?