This is my opinion on applying to ACGME general surgery residencies. I am currently a fourth year DO student applying for general surgery for the upcoming match. I have extensively research this thought of applying to ACGME residencies and have talked with many program directors about my chances of matching into an allopathic world and I have concluded that being a DO the chances are slim to none. First off you have to be better than 90% of the MD applicants. You have to have taken the USMLE and done very well. Don't bother sending your COMLEX scores because they will mean about as much as sending your ACT/SAT scores, program directors could care less. You need a great GPA/Class rank (Top 5-10%) remember the idea is that DO schools are much easier than any MD school so you better be in the top 10% of the "inferior" group of medical students. Score great letters of recommendation as do most applicants. Plan on doing an audition rotation at a county program and know your stuff cold. Forget about academic instiutions because the guys at Mayo, Duke, Hopkins, etc could care less about cranial osteopathy or a L-5 RlSr. Now can you apply to allopathic places and get interviews...Sure, you can show up, spend "X" amount of dollars flying all over the county to find out that in the end there still exists a major barrier for DO's when it comes to getting into MD surgery residencies. Granted the barrier has fallen in nearly all fields of medicine with the exception of surgery. It is a "good old boys club" and DOs are not allowed to play. A great first hand example of this is at Good Samaritan Hospital in Phoenix, AZ. Nearly all programs there are a 50/50 ratio of DO/MD with the exception of surgery. I got to know one of the IM residents, a DO, and he told me that there has never nor will there ever be a DO go through the program as long as the program director is still calling the shots. In his mind DO's make great family doctors and internists, but have no business in the OR.
Looking around you will find some DOs here and there in various programs throughout the country which may seem that there is a place for us, but the fact of the matter is that these guys got in while the competetion for general surgery was low. Over the past couple of years the numbers of applicants has jumped back up for what ever reason. The only thought is maybe due to the so called 80 work week, so the in the minds of some, surgery has become a cake residency so it is attractive once again. Another thing to keep in mind that some of the DOs that might fill surgery positions at ACGME programs may be only preliminary positions. "Sure Mr. or Mrs. DO we will take you, so that you can become our scut monkey for a year and you will work your ass off while never complaining in hopes that a PGY-2 position will open at the end of the year and we dont give it to someone else." Getting a prelim. position does not mean you got a surgery residency it only means you have to show up to the hospital before anyone else, leave after everyone else and never show signs of tiring for 365 days in hopes of getting that one position that might open.
Needless to say I didn't want to have to jump through all that B.S. so instead of spending countless hours researching what MD programs I would have a slim shot at, I spent that time and research all 37 AOA programs. I looked at every program very closely and in my mind tried to decide what 4-5 were the best and then set up audition rotations there. Now I am the first to admit there are some horrible AOA programs but I do honestly believe there are some solid programs as well. The 5 I was most interested in were: Doctors, Grandview, Plaza, Mercy (Des Moines), and Botsford. I rotated at Doctors, Grandview and Plaza and knew a lot about Mercy being a DMU student. Mercy in my opinion could easily be an ACGME program. There is very little differnce between Mercy and Methodist which is an ACGME program across town. The size of the hospital, didactics, # of cases, traumas, etc is on par with nearly any MD county program. Doctors has now merged with Grant which is the major Level 1 center in Columbus so now 50% of your time is spent over at Grant. Grant has three fellowship that the resident is exposed to on a daily basis: Trauma, Breast, and Colo-rectal. Grandview offers a vascular fellowship and Plaza is trying to get a CT fellowship going by 2006. The downside to Plaza is the time you spend in Houston. Granted you get great rotations at Hermann, MD Anderson, and Childrens, but if you have a family you spend a considerable amount of time away during years 3-4. Of the five Botsford I know the least about being that I didnt rotate there.
I personally have an interest in CT. CT like many of the other GS fellowship, tend not to be all that competetive right now with the exception of Plastics and Colo-rectal. CT didnt fill 17 of the 94 programs last year, trauma and vascular go unfilled at many places each year. All one has to do is go onto the apds.org website and look at all the available positions. 75% of them are Trauma or Vascular. So being a DO will most likely not hurt your chances if you wish to subspecialize since more positions go unfilled each year. The idea of doing a 2-3 year fellowship after general surgery seems like an unbearable idea to many If your interest is Colo-rectal go to Doctors/Grant and express interest from day one. The cheif this year is doing his breast fellowship there next year. If you have an interest in Plastics however this may be a little different. Again the odds of getting into an ACGME plastics fellowship as a DO are slim to none. There are not enough spots for all the MDs that want to pursue plastics let alone a DO or two. My advice would be to go to one of the 2 possibly 4 AOA programs and work your butt of during those five years gunning for that position. I say four because rumor has it that Doctors and Grandview are in the works of getting plastics in the future. I rotated at both places and my understanding was that things are in the works. Grandview told us during the interview that the funding is there, they are just waiting for the final approval and there is an attending at Doctors that wants to get a fellowship and a fourth year has interest in getting the program going. Of the two Doctors is a little more up in the air, but sounds promising.
With all this being said, I am sure that people will disagree with all that I have posted and can point of a few people here and there that got into MD programs. Going to back to what I said in the beginning it is possible but unlikely. My advice to all DOs who wish to pursue General Surgery, is to take a look at your stats. Did you kick a$$ on the USMLE, are you toward the top of your class, do you have great letters, do you have any type of connection internally at a program, do you have many publications? If you answered yes to all those, then maybe you will be one of the few that gets into an ACGME program, but otherwise consider the amount of time, effort, and potential money during interview time you may waste applying for something that never really was there. I hate the fact more than anyone that the allopathic surgery world is still closed to DO's but have decided to make the best out of the situation and find the best AOA program out there and I encourage you to consider the same.
