DO or MD in terms of rotations and residencies

[markboonya]

i'm sitting on an acceptance at touro CA (osteopathic) and nymc. my gut feeling is that i will be more comfortable and happy at touro.

however, i am concerned about residencies. although i am sure i will change my mind several times in the next 4 years, right now i assume that i will go into internal medicine. from there, i want to keep the option open of going into a competitive fellowship like cardiology. from what people have been telling me, fellowships tend to take doctors from their own residency programs. i've been looking around, but so far i have not found an osteopathic residency in internal medicine IN CALIFORNIA that has a cardiology fellowship (maybe i am mistaken, but do all internal medicine residencies have all the possible fellowships at their hospital?) this means that i will probably have to do an allopathic residency to keep my options for fellowships open.

so, lets say i want to do an allopathic internal medicine residency at UCLA (i want to end up in cali). i hear that it is optimal to rotate through the program where u eventually want to do ur residency. however, it seems that there are a set number of rotations that u are required to do at your medical school's affiliated hospital. am i correct on this issue? so if i am required to do my internal med rotation at touro or nymc, how do people not from stanford med school ever end up at a prestigious internal med residency at stanford? is rotating through an internal medicine program not as important as it is for the more competive surgical specialties?


sorry for the rambling questions, but if anyone has any insight to the italicized questions, i would be much obliged to hear your answers, especially if u can relate it back to the while DO vs MD issue.

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[Creightonite]

I am curious on this as well

 

[Taty]

i'm sitting on an acceptance at touro CA (osteopathic) and nymc. my gut feeling is that i will be more comfortable and happy at touro.

however, i am concerned about residencies. although i am sure i will change my mind several times in the next 4 years, right now i assume that i will go into internal medicine. from there, i want to keep the option open of going into a competitive fellowship like cardiology. from what people have been telling me, fellowships tend to take doctors from their own residency programs. i've been looking around, but so far i have not found an osteopathic residency in internal medicine IN CALIFORNIA that has a cardiology fellowship (maybe i am mistaken, but do all internal medicine residencies have all the possible fellowships at their hospital?) this means that i will probably have to do an allopathic residency to keep my options for fellowships open.

so, lets say i want to do an allopathic internal medicine residency at UCLA (i want to end up in cali). i hear that it is optimal to rotate through the program where u eventually want to do ur residency. however, it seems that there are a set number of rotations that u are required to do at your medical school's affiliated hospital. am i correct on this issue? so if i am required to do my internal med rotation at touro or nymc, how do people not from stanford med school ever end up at a prestigious internal med residency at stanford? is rotating through an internal medicine program not as important as it is for the more competive surgical specialties?


sorry for the rambling questions, but if anyone has any insight to the italicized questions, i would be much obliged to hear your answers, especially if u can relate it back to the while DO vs MD issue.

I had MD vs DO choice too...I figure I would rather spend my 4 years in the place where I feel happy. Plus, my family is in NY,so I went with NYCOM

 

[olliemctuffy]

Yes, you typically have to do your 3rd year rotations at your affiliated hospital(s). However, 4th year is available for you to do rotations at sites of your choice, usually with requirements as to x months in im, surg, etc. Hope this helps..

 

[Winged Scapula]

i'm sitting on an acceptance at touro CA (osteopathic) and nymc. my gut feeling is that i will be more comfortable and happy at touro.

Then that's where you should go.

... from what people have been telling me, fellowships tend to take doctors from their own residency programs.

Well, you are a known entity and that is attractive to *some* programs, others want "new blood" and have a tendency to prefer outsiders.

i've been looking around, but so far i have not found an osteopathic residency in internal medicine IN CALIFORNIA that has a cardiology fellowship (maybe i am mistaken, but do all internal medicine residencies have all the possible fellowships at their hospital?)

You are mistaken. Most hospitals, even the largest, do not have even a fraction of all the possible IM fellowships. Therefore, it is not at all unusual to find an IM residency that does not have a Cards fellowship.

...this means that i will probably have to do an allopathic residency to keep my options for fellowships open.

Only if you absolutely must stay in California for fellowship; there are many osteopathic options outside of the state. You do not need to train in California to find a post-fellowship job there.

so, lets say i want to do an allopathic internal medicine residency at UCLA (i want to end up in cali). i hear that it is optimal to rotate through the program where u eventually want to do ur residency.

Away or audition rotations are a double-edged sword. If you are the type of student who looks better on paper than in person, it can potentially hurt you...then again, if you are a real people person but don't have the numbers to match, especially at a competitive place like UCLA, an audition rotation may help you. But it can be very difficult - its 4+ weeks of interviews essentially, with you on your toes all the time. At any rate, at many competitive programs it may be worth it to audition there (who knows, you may end up hating it there) and let them see you beyond the application (but bear in mind that at the most competitive places, a great personality doesn't make up for a rotten academic record).

...however, it seems that there are a set number of rotations that u are required to do at your medical school's affiliated hospital. am i correct on this issue?

Generally yes. Most students are somewhat limited in the number of outside rotations they can do - it may be as little as one or two months.

...so if i am required to do my internal med rotation at touro or nymc, how do people not from stanford med school ever end up at a prestigious internal med residency at stanford?

Is IM at Stanford prestigious? Connections, good USMLE scores, LORs, etc. are the general routes to matching in a more prestigious residency than your medical school...same as everything else.

...is rotating through an internal medicine program not as important as it is for the more competive surgical specialties?

Generally, IM is not as competitive as other specialties, but there are particular IM programs that are more competitive than others (and I have no idea whether or not Stanford is one of those...Stanford Med is not as prestigious as its undergrad programs or some of the other CA programs). In general, an audition rotation is a chance for you to learn about a program as much as it is for them to learn about you - whether or not that's important is up to you.

Now that California has more osteopathic schools, there may be less a bias against DOs in allopathic residency programs...but you would be advised to ask some of the DO denizens here about the feasibility of matching into the programs you list as a DO. But unless you have a significant reason to only look at California residency programs, I see no reason to limit yourself there...it is entirely possible to get a job post-fellowship without having trained there.

 

[bth7]

i'm sitting on an acceptance at touro CA (osteopathic) and nymc. my gut feeling is that i will be more comfortable and happy at touro.

however, i am concerned about residencies. although i am sure i will change my mind several times in the next 4 years, right now i assume that i will go into internal medicine. from there, i want to keep the option open of going into a competitive fellowship like cardiology. from what people have been telling me, fellowships tend to take doctors from their own residency programs. i've been looking around, but so far i have not found an osteopathic residency in internal medicine IN CALIFORNIA that has a cardiology fellowship (maybe i am mistaken, but do all internal medicine residencies have all the possible fellowships at their hospital?) this means that i will probably have to do an allopathic residency to keep my options for fellowships open.

so, lets say i want to do an allopathic internal medicine residency at UCLA (i want to end up in cali). i hear that it is optimal to rotate through the program where u eventually want to do ur residency. however, it seems that there are a set number of rotations that u are required to do at your medical school's affiliated hospital. am i correct on this issue? so if i am required to do my internal med rotation at touro or nymc, how do people not from stanford med school ever end up at a prestigious internal med residency at stanford? is rotating through an internal medicine program not as important as it is for the more competive surgical specialties?


sorry for the rambling questions, but if anyone has any insight to the italicized questions, i would be much obliged to hear your answers, especially if u can relate it back to the while DO vs MD issue.

Hi. Touro student here.

At any med school, 4th year is all about doing "audition rotations" at the residency programs you're interested in.

If cardiology is your thing, you will almost certainly do an allopathic residency in IM. Then go on from there. There are Osteopathic residencies in IM, but you generally want to avoid them. Long, convoluted story. Trust me.

Doing allopathic residency is not a problem from Touro, nor is doing rotations at California allopathic programs. If fact, Standford just publicly announced that DO students are welcome to come do forth year auditions at their school. They've been taking Touro students for a while, but they just formally put it on their website. How nice!

Here's some info for ya: http://med.stanford.edu/md/clerkships/
This is all very customary, nothing to worry about. Everyone does auditions at lots of places.

These places generally don't care where you went to school. That's why they have a month long audition. They want to check you out for a whole month before they commit to you for four years of residency. It's about personality and work ethic matching. I don't care if you have perfect board scores, if you're annoying or a jerk, they are not going to want to work with you every day, all day for four years.

Just some thoughts to consider.

Bryan

 

[Tired]

But it can be very difficult - its 4+ weeks of interviews essentially, with you on your toes all the time.

I love that you made this point. I've known more than one MS4 who went to an away rotation thinking that just "doing a good job" would get them in. You really have to make an effort to go above and beyond on these rotations for them to be truly effective, IMHO.

 

[PeepshowJohnny]

"my gut feeling is that i will be more comfortable and happy at touro"

That's all you need to say right there. All you can plan for is where you'll be the most happy during your years of medical school. You've obviously put a lot of effort into thinking about where you eventually want to go into, and you may be right, but it's far from a sure thing. The best thing you can do to prepare for any future is make yourself happy in med school, because happy students are succesful students. Once you've got some experience under your belt and some grades and test scores, you can figure our your future from there. The smart decision now is to go where you're most happy.

 

[markboonya]

thanks everyone for such detailed responses. now that i know that 3rd year rotations are ususally done at your med schools affiliated hospitals, i am wondering about the time line of residency applications/interviews and how that matches up to 4th year audition rotations.

what is the latest date i can do an away rotation and have letters and such from that program be considered for my residency application?

and if someone could educate me a little more about IM rotations, that would be awesome. am i correct to assume that IM is one of the core rotations u do during ur third year at your school's affiliated hospital? is an IM rotation similar to a surgical rotation where u rotate through most of the different specialties during that block?

so hypothetically, if i do my IM rotation at my schools affiliated hospital during third year(since i am required to do so), but want to attend ucla's IM program for residency with the hopes of later landing a fellowhip in card at ucla, what should be my strategy for my 4th year audtion rotations? do i have to do a whole IM rotation at ucla again or is there something more specific like a "cardiology rotation." as for logistics, is it difficult to obtain audition rotations at the more competitive places? how should i go about maximizing my chances to land such audition rotations.

thanks again everyone. i really do appreciate the help. although my heart is for DO schools, i defintely dont want to kick myself in the ass later if its too steep of an uphill battle to obtain an allo residency/fellowship in cali. but then it seems being in NY at allo school wont really boost my chances at a residency in cali either.

and this may seem like a stupid question, but when people talk about good vs mediocre residencies, what makes a residency good or bad besides location. is it more related to research opprtunites and fundings in that arena?

 

[Syranope2]

what is the latest date i can do an away rotation and have letters and such from that program be considered for my residency application?

and if someone could educate me a little more about IM rotations, that would be awesome. am i correct to assume that IM is one of the core rotations u do during ur third year at your school's affiliated hospital? is an IM rotation similar to a surgical rotation where u rotate through most of the different specialties during that block?

I definitely can't help with all your questions, but I can try with some of them at least. For allopathic residencies, the earliest you can submit your application is September 1. At my school, they recommend that you do the rotations from which you want letters of recommendation before September. You could probably do your rotation in September if your letter-writer was really fast on the turn around and could get your letter to you quickly so it could go out to schools quickly.

In third year, at my school at least, most people do two months on a general IM service. A few people do a specialized cardiology service, but not many. This is different from surgery, where most people do a month in two different specialities, such as hepatobiliary, cardiothoracic, or transplant, for example.

The dean at my school who is responsible for writing our Dean's letters recommends to anyone doing away rotations to try to get a rotation in a subspecialty, such as cardiology or endocrinology or ID or whatever, in order to narrow down the things you need to know really well. It's a lot easier to impress an attending with your knowledge of cardiology than to impress an attending with your knowledge of all of internal medicine. It allows you to focus your reading and look better in rounds. I'm sure you could do a general IM rotation for your away rotation if you wanted to, but it'd be harder to impress.

As far as applying for these away rotations, the same dean told us that it mostly depends on when you get your application in, that they typically choose students based on a first come, first serve principle. I'm not sure if this is actually true, and I definitely don't know how Stanford works, but this is what I've heard. As in most things in applications, earlier is better.

 

[Winged Scapula]

what is the latest date i can do an away rotation and have letters and such from that program be considered for my residency application?

As noted above, the earliest you can apply is September 1 in the year before you plan on starting internship and in general, most IM programs stop taking applications by January, some earlier. If you check out the 30 allopathic IM programs listed on FREIDA, most have application deadlines.

Therefore, lets say that most programs interview between November and January. You should give your letter writer a month to get your letter out to ERAS. Thus, you would probably want to, and this is conventional wisdom, YMMV, do your audition rotations no later than October of your final year. Those with experience in applying in IM can better say than I if it is reasonable to do one later and apply later in the interview cycle.

and if someone could educate me a little more about IM rotations, that would be awesome. am i correct to assume that IM is one of the core rotations u do during ur third year at your school's affiliated hospital?

IM, along with Surgery, Ob-Gyn, Peds are considered the Core clinical rotations in which most medical students rotate during their 3rd year. Schedules will vary from school to school, but this is the typical plan. IM is generally done at your school's hospital but they may farm you out to other places - ie, VAs, or other locations - to accomodate all the students that need placement.

is an IM rotation similar to a surgical rotation where u rotate through most of the different specialties during that block?

First, of all - a surgery core rotation does not rotate through MOST of the different specialties. Most students do 8-12 weeks of surgery, and about half of that (or generally 1 month) is devoted to "general surgery" which may be at at VA, or it may even be Peds Surgery (which is general surgery, but of a different sort than adult general surgery) and the other month devoted to at least 1 or other subspecialties. For example, the med students at my hospital did 1 month general surgery which was either at the VA (generally for those not interested in surgery since it was the easier rotation), on Surg Onc/general surgery or Peds Surgery. Then they got 1 more month which they divided up into two week rotations - usually in Vascular, Plastics, Ortho, Uro, ENT, etc. It was a lottery system, so not everyone got the rotations they wanted. Anyway, point is that you may or may not get exposure to certain subspecialties.

Typically your IM core will consist of two months of inpatient adult medicine. You don't usually rotate on IM subspecialties unless you are doing a 4th year elective. You admit and take care of whatever medical problems come your way.

so hypothetically, if i do my IM rotation at my schools affiliated hospital during third year(since i am required to do so), but want to attend ucla's IM program for residency with the hopes of later landing a fellowhip in card at ucla, what should be my strategy for my 4th year audtion rotations? do i have to do a whole IM rotation at ucla again or is there something more specific like a "cardiology rotation."

You can do either - you can do an IM sub-I (sub-internship) or you can choose a subspecialty like Cards. Do not choose cards because you think that doing a rotation there as a medical student will increase your chances of getting into a Cards fellowship there down the road but rather because you are interested in it. Or maybe you want to choose a medicine specialty you don't know much about. The purpose of the audition rotation (be it a sub-I or an elective) is to allow the program to learn more about YOU and for you to learn more about THEM. Hopefully, if you do well it will increase your chances of matching there for residency.

Not to beat a dead horse, but your goal now is to get into residency. You should not be thinking about fellowship at this point because in most cases, you start from square one with residency when it comes to fellowship matches. That means, choose a Cards rotation at UCLA (or wherever) because it interests you and you hope that it gives you some connections when it comes time for residency matching, not for fellowship 4 or more years from now.

as for logistics, is it difficult to obtain audition rotations at the more competitive places? how should i go about maximizing my chances to land such audition rotations.

They can be. Most schools allow their own students to register for 4th year rotations before they give spots to visiting clerks. The way to maximize your chances is to get your application materials in early, follow all their rules about how to apply and be flexible. Audition rotations are at a premium during the fall of 4th year, so you need to consider several places in case UCLA (or wherever) doesn't offer you a spot.

thanks again everyone. i really do appreciate the help. although my heart is for DO schools, i defintely dont want to kick myself in the ass later if its too steep of an uphill battle to obtain an allo residency/fellowship in cali. but then it seems being in NY at allo school wont really boost my chances at a residency in cali either.

I am not sure where you are getting that information. California medical schools prefer in-state applicants and California residencies may prefer those with local connections but there is no reason you cannot get into a California residency just because you went to medical school out of state. Obviously many of the residencies are competitive, but there are some that are not, but many people don't match into California programs simply because of numbers - there are many more applicants than there are positions. The "bias" against out of state medical students really only exists for people without any "real" reason to come to California (ie, family) and even then, is not likely a significant factor in the decision.

and this may seem like a stupid question, but when people talk about good vs mediocre residencies, what makes a residency good or bad besides location. is it more related to research opprtunites and fundings in that arena?

What makes one program better than another can be subjective. Most residents are not significantly involved in research so that is not typically a reason given for preferring a certain program. Besides location, people are concerned with opportunties for fellowship matches, "personality" of a program (do you like the residents), opportunities for certain rotations and experiences, employment opportunities for spouse, schools (which are location based) etc. But I'll bet most residents chose their programs with location as the most important factor.