DO state licensing question (especially for NSUCOMERs)

[robinhudster]

I recently heard someone very senior from the admissions office at NYCOM speak and he said something which I found strange and I want to know if this is true. He said that in some states (he specifically mentioned FLORIDA and PENN.) they have a seperate osteopathic licensing board (whereas NY licenses MDs and DOs regardless of degree) and that if you do an allopathic residency, say in NY, FL and PA will not grant you a license b/c they require that you do an osteopathic internship and residency. Is this true?!?! He even mentioned a case about a NYCOM grad who did an allotpathic residency in NY and then wanted to work in PA but couldn't for this reason. Has anyone heard about this? Does this mean someone from NSU or PCOM MUST do an osteopathic residency in order to practice medicine in those states? Please clarify this for me if you can. Thanks!!

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[Dr JPH]

DO graduates, in order to practice in Florida and Pennsylvania, as well as a few other states (OK, MI and WV) must complete an AOA approved osteopathic internship in order to gain licensure there.

There ARE ways around this...by attending a residency program that is accredited by both the ACGME and AOA and therefore your first year is counted as the internship year...or by petitioning the AOA to be exempt from the internship year if your program matches their requirements. From what I hear, though, petitioning them is getting a little sticky lately as the AOA is trying to promote Osteopathic internships and residencies.

This website should help clear up some info:

http://www.aoa-net.org/PostDoc/ogme1.htm

Here too: http://www.aoa-net.org/PostDoc/ogmefaq.htm

 

[DrQuinn]

JPHazel is correct, atleast partially...

but it is not as "sticky" as the AOA or DO-residency advocates would argue. One of my psychiatry attendings told me that he "knew off the top of his head 5 people who got the AOA internship waived." On the rumor mill amongst my colleagues, the AOA has decreased its requirements of what constitutes a similar AOA-internship, is two months of IM, one month of EM, and one of OB/GYN. Most traditional internships as well as IM/FP/EM (of which I am doing an MD residency) meet those requirements.

Q

 

[robinhudster]

Thanks for the information folks. QuinnNSU, it's comforting to know that they may be easing up on those requirements. I find it shocking that some states won't license a DO who did an allopathic residency!! But if I understand you correctly if you do an EM residency the very fact that rotating through IM & OB/GYN would suffice. I'm very glad to hear that as I will be in the procees of applying to schools and was a little disuaded from applying to DO schools once I heard that. Thanks again for the clarification.

 

[group_theory]

According to AOA Resolution 42,

to get AOA internship approval for a ACGME residency,

1.) The applicant maintains intern/resident membership status in the AOA.

2.) The D.O. documents limitations to entering an AOA-approved internship because of one or more of the following reasons:

a. Physical or mental disability or handicap which precludes the satisfactory completion of an AOA-approved internship.

b. Legal restrictions which require the D.O.?s physical presence in a state or local area where AOA-approved programs are not located.

c. Acceptance of a non-AOA accredited primary care training position based on a federally designated health profession shortage area (HPSA) where no AOA-approved programs exist.

d. Participation in a medical specialty or subspecialty in which no available AOA-approved programs or positions exist.

e. Unusual or exceptional circumstances, not included in a-through-d above, which limit AOA-approved training opportunities.

For those currently enrolled in an ACGME-approved program, the applicant should apply to the AOA for special consideration within ninety (90) days after the start of the ACGME training, with notice to the appropriate AOA-recognized specialty college, and complete parts A and B.

Part A. Complete all AOA-approved traditional internship requirements within the ACGME program.

Part B. Participate in at least one of the following osteopathic medical education activities during the ACGME training:

a. Attend the AOA Annual Convention and Scientific Seminar.

b. Attend the annual meeting of the relevant osteopathic specialty college or AOA-affiliated divisional society.

c. Participate in an osteopathic training program offered by the regional OPTI, to include OPP/OMT training via clinical elective rotations, or clinical/OMM-OPP training modules.

d. Prepare and conduct an osteopathic clinical presentation to their ACGME residency program, or to the relevant osteopathic specialty college, and/or submit a manuscript from this presentation for possible publication.

http://www.aoa-net.org/PostDoc/res42.htm

Basically for QuinnNSU to receive the waiver, she must maintain her AOA membership, tell the osteopathic EM college that she wants a waiver, and comply with Part A and B. However, I don't know if your request for a waiver is automatically approved if you meet all their requirements OR if it also depends on politics.

 

[oceandocDO]

As far as the internship goes, doing an allopathic residency in those states will not prevent you from licensure, only failing to complete an osteopathic rotating internship will prevent you from licensure. You can start an allopathic program after completing the internship and become licensed.

It is true that the AOA is loosening some of their internship requirements, but because of that, petitioning for approval of an allopathic program to suffice and count toward an internship is becoming more difficult. Basically, if an internship position is available in the same geographic vicinity as your allopathic program, you're out of luck without a really good excuse.

That being said, there are many MD programs which encourage you to do the rotating internship. A friend of mine who's going to Harvard anesthesiology from NYCOM was urged by Harvard to complete the internship in NY before starting in Boston. MDs were actually the ones who created the idea of the rotating internship, but then abandoned it as the medical profession overall became less patient in one's training.

Also of note, the internship is a state issue, not an AOA issue. These states are not going to change anytime soon, nor should they I feel. Why? Because the states that do require it, PA, FL, MI, WV, and OK are some of the strongest states in terms of quality and quantity of D.O.s. They must be doing something right. Anyone who's ever completed the internship has never regreted it. Besides the training in OMM, it's really the only thing left that truly defines what is unique about osteopathic medicine as it affords a young physician the opportunity to see a greater diversity of pathology and hence have a better, overall, well-rounded training which facilitates the "body as a unit" ideology. Allopathic students who graduate and immediately enter their specialty are robbed of this opportunity.

 

[luckystar]

What's the timeline like for those who want to do the osteopathic rotating internship with an allopathic residency? Do you go through the match with everybody else during your 4th year and apply separately for an internship at the same time?

 

[shindog]

Originally posted by oceandocDO
Also of note, the internship is a state issue, not an AOA issue. These states are not going to change anytime soon, nor should they I feel. Why? Because the states that do require it, PA, FL, MI, WV, and OK are some of the strongest states in terms of quality and quantity of D.O.s. They must be doing something right. Anyone who's ever completed the internship has never regreted it. Besides the training in OMM, it's really the only thing left that truly defines what is unique about osteopathic medicine as it affords a young physician the opportunity to see a greater diversity of pathology and hence have a better, overall, well-rounded training which facilitates the "body as a unit" ideology. Allopathic students who graduate and immediately enter their specialty are robbed of this opportunity.

Reading this post makes me laugh. What a load of crap. The allopathic world dropped rotating internships because they are useless and a waste of time. Every D.O. I know that has done a rotating internship has regretted it and realizes that it is a year of their life they will never get back. This whole "body as a unit" crap is crap. The only reason those states have the requirement is to blackmail D.O.s into doing a rotating internship. No one would do one if they didn't require it. The training at most of these places is awful. Some of the D.O.'s I talked to thought they got dumber as a result of it.

 

[DrQuinn]

Originally posted by oceandocDO

Also of note, the internship is a state issue, not an AOA issue. These states are not going to change anytime soon, nor should they I feel. Why? Because the states that do require it, PA, FL, MI, WV, and OK are some of the strongest states in terms of quality and quantity of D.O.s. They must be doing something right. Anyone who's ever completed the internship has never regreted it. Besides the training in OMM, it's really the only thing left that truly defines what is unique about osteopathic medicine as it affords a young physician the opportunity to see a greater diversity of pathology and hence have a better, overall, well-rounded training which facilitates the "body as a unit" ideology. Allopathic students who graduate and immediately enter their specialty are robbed of this opportunity.

Funny funny. Most of your posts I agree with, but this last paragraph I wholeheartedly disagree with. A, the Florida Osteopathic Board has been debating whether or not to lift the AOA sanctioned internship because there are so many DOs leaving the state of FL (due to the malpractice crisis)... one way to keep the DOs in the state is to not limit any DOs from practicing in the state of FL...

I did my cores at a hospital that has 20 spots for AOA internship. No OMM training (unless you pick a FP month with a doctor who does OMM), and basically the whole month is scut work. The only thing I think worth the whole year is the two months of House Officer, which I think should be in everyone's residency but is pretty hard to manage at a huge 800 bed hospital (this hospital is about 120 beds or so).

Most, if not all, of the interns said their internship there was a waste of time, and like Shindog said, they wished they could have that year back.

And getting the AOA-internship waived is getting easier, not more difficult. From the attendings who are a few years out, they have said it was a bit harder to get it waived, but I know many many residents who are getting it waived, and they said they did not have any trouble (example, OB/GYN resident in FL only has to go to the state Osteopathic Medicine Association meetings to meet her requirement).

The Internship idea is nothing new and nothing unique to Osteopathic Medicine. Like Shindog said, it was an MD idea a long time ago, but it was dropped becuase many felt it was unnecessary.

I will not argue that an extra year of ANY training will be of some benefit. To say it is COMPLETELY useless is incorrect. There is something to be learned by every patient adn every admission and every order you write. But that doesn't mean that the internship is necessary.
Q

 

[MOZ D.O.]

i go to nova and i plan on doing the rotating internship. i've been told by several DO's who did residencies at top-notch allopathic hospitals, such as johns hopkins, that doing their internship made them more desirable to attendings and actually helped them stand out among their colleagues. don't forget that their are several different types of internships, such as tracked internships which are basically combined with residencies so that once you finish your internship you can move uninterrupted into desired field. also, we were told directly by people in the know that the florida board of osteopathic medicine has plans on changing the internship requirement.

 

[T.A.M]

Two questions:

How does the AOA regard military residencies? Does this fall under the "legal restriction" clause? HPSP scholarship students are required to apply for a military residencies first , and enter the residency if accepted. I ask because once I finish my military requirement, I would prefer to practice in PA.

Next, MOZ DO mentioned that the FL board is reconsidering the requirement, due to the malpractice crisis in the state. PA presently suffers from the same awful state of affairs. Does anyone "in the know" have any information that the PA board might consider similar actions?

 

[DrQuinn]

Originally posted by MOZ D.O.
i go to nova and i plan on doing the rotating internship. i've been told by several DO's who did residencies at top-notch allopathic hospitals, such as johns hopkins, that doing their internship made them more desirable to attendings and actually helped them stand out among their colleagues. .

Let's see here. If doing a DO internship makes you more desirable, but you can still match into the residency without doing it, why would you do it? If you want to do a 3 year IM residency at such "top-notch hospitals" such as Hopkins, and can get in without the residency, why would you?

Like I said in my previous post, of course a year of extra training will make anyone a little bit sharper and more knowledgable. Would you rather have a 4th year medical student or a person who graduated and did a one year rotating internship?

BUT! You forget that the majority of residencies accept people right out of fourth year. I, for example, matched into a *relatively* competitive specialty (EM) at an MD institution, without doing the DO internship. I COULD have done it, but why? That's a year out of my life that the MD world does not think is necessary (most EM programs are 3 yrs). I'm sure I would know a little bit more or be a little quicker with the answers if I did a year internship, but its not necessary. So I'm not going to waste a year of my life.

Q

 

[oceandocDO]

Reading this post makes me laugh. What a load of crap. The allopathic world dropped rotating internships because they are useless and a waste of time. Every D.O. I know that has done a rotating internship has regretted it and realizes that it is a year of their life they will never get back. This whole "body as a unit" crap is crap. The only reason those states have the requirement is to blackmail D.O.s into doing a rotating internship. No one would do one if they didn't require it. The training at most of these places is awful. Some of the D.O.'s I talked to thought they got dumber as a result of it.

The opinion on what constitutes a worthwhile experience is very much a subjective one. The docs I've interacted with in NY have very much enjoyed their internships and encourage students to do it, and this is in a state where it's not required. These arent dumb folks either, as they continued on to pretty established programs. You mention blackmail, but I'm not sure how the internship requirement help the states, certainly not in recruiting. So what is the gain for FL in needing to "blackmail" young D.O.s? All the reqs are is a throwback to the old timers who believe a D.O. degree should be different than MD+OMM and the internship can offer this. More liberal, younger grads feel differently because they see allopathic colleagues practicing very similar medicine, earlier, and honestly are a bit inpatient in wanting to get to their specialty too. I can understand that, but also understand the need to maintain a bit of uniqueness, for the profession must do that if it's to survive. Having OMM in an internship is not the most important requirement. It's the varied and diverse clinical exposure as a physician, not the use of OMM, which classifies it as "osteopathic".

I'm not aware of the politics of the Florida Board, but knowing a bit about PA and Michigan, they're not changing anytime soon from what I've hear. These states are saturated with D.O.s, so my point was that it must not be the limiting factor in attracting D.O.s to a state. D.O.s may be leaving Florida, but all docs are leaving Florida. The AOA is aware of D.O.s leaving the profession overall however and hence have lightened the requirements in order to keep D.O.s in house. It's a shift to the middle. They're also starting a major joint taskforce with the ACGME to offer dual accredidation to allopathic programs. Another shift to the middle. Evolution of the profession.... a good thing, but maintaing the separate need for the profession is now the challenge.

MD's did drop the internship because, yes, in their eyes it was a waste of time, but that was because what constituted a "waste of time" was any time spent in a department that wasnt their own. I, for one, see a bit of value in spending 6 months as a young doctor experiencing other specialties with more responsibility. QuinnNSU, I also usually agree with you on this site, but if you personally are going into EM, I honestly dont see how this could hurt you minus the time to a real paycheck granted you found a strong internship. You must have a shorter timeline in your head anyway as you chose a 3 year EM program, whereas the 4 year EM programs will catapult you more often to the prestigious teaching gigs at the big Unis as an attending. Yes, some of the internship may be scutwork, but your first year of residency anywhere will consist of alot of scutwork, especially if there's not alot of students around.

It's funny, many fourth year students are dying to be attendings tomorrow, but then they become residents and often like to slow down the process because they dont feel like they know enough to be an attending yet and have all the answers all the time, with all the added responsibility. Hence they do a fellowship, a Chief year, etc. For some an internship is a great way to get your feet wet slowly, for others it's not. Different strokes for different folks I guess.

I'll shutup now

 

[DrQuinn]

Originally posted by oceandocDO

MD's did drop the internship because, yes, in their eyes it was a waste of time, but that was because what constituted a "waste of time" was any time spent in a department that wasnt their own. I, for one, see a bit of value in spending 6 months as a young doctor experiencing other specialties with more responsibility. QuinnNSU, I also usually agree with you on this site, but if you personally are going into EM, I honestly dont see how this could hurt you minus the time to a real paycheck granted you found a strong internship. You must have a shorter timeline in your head anyway as you chose a 3 year EM program, whereas the 4 year EM programs will catapult you more often to the prestigious teaching gigs at the big Unis as an attending. Yes, some of the internship may be scutwork, but your first year of residency anywhere will consist of alot of scutwork, especially if there's not alot of students around.

It's funny, many fourth year students are dying to be attendings tomorrow, but then they become residents and often like to slow down the process because they dont feel like they know enough to be an attending yet and have all the answers all the time, with all the added responsibility. Hence they do a fellowship, a Chief year, etc. For some an internship is a great way to get your feet wet slowly, for others it's not. Different strokes for different folks I guess.

I'll shutup now

Hm. I have stated several times that a year of internship would be good for anybody. Even a year of scutwork will make anyone a bit sharper and, yes, "get their feet wet." But it is not necessary to make a 100% board certified just-as-good doctor, MD or DO. That's why the ACGME doesn't require it for many specialties.

EM is probably the golden child of "spending time in other people's specialties." You have to know a lot about a lot. But yet, for some reason, there are 80+ MD EM residencies that are only three years... but they keep churning out ABEM certified EPs... who practice good medicine and are not a liability to their patients. Why should I be any different?

I admit that if I did a year of internship, I would be far ahead of any fourth year who did not do one once I got into residency. But the learning curve is steep, and after a while it wouldn't make much of a difference.

And in regards to "4th years wishing they were attendings..." When I did an EM elective at a "prestigious teaching gig" University in the mid-east, all the third year residents told me "I can't wait to get out of here, I'm very comfortable with patients on my own." A lot of times they even got in debates about standard of care issues with attendings, and often they both would be correct. And they had only done 2.5 years of residency. How can they be so good if they didn't do a year of internship? Maybe just lucky, I guess. Yeah, those 20 residents I met were all lucky. Oh wait, that's how medical education works.

And there are plenty of residents out of third year residencies that get academic spots. Many of the three year residencies are a bit older and have a better reputation of churning out excellent graduates...
in three years.
Q