DO: the underdog

[SpecterGT260]

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i appreciate your sensitive sentiment but...Correction. They are preferential to MDs from top 20 schools.You hardly find low tier MD grads at those IM spots we talked about earlier. The fact that there are only what 26-30 DO schools and 130+ MD schools, and DOs are still found at the top of the grapevine in terms of ACGME residencies at some places tells you a lot. that is all.

You are also forgetting self-selection where the top DO students choose to simply apply AOA and forgo ACGME since it takes place first, if they are interested in ortho, neurosurg, ENT, optha...

well fine. we can say that school rank plays role regardless of MD/DO. But not many DO schools are ranked above MD schools in general. A few DOs in top programs means it is possible, but nothing more. If a program has fewer than 1/5 DO make-up then it is not unreasonable to say that it is preferential to MD. Sure a DO may be at least as competitive as an MD from meharry or (hopefully) more so than an MD from the caribbean. So what?

but the presence of the odd DO in a top program is not informative beyond dispelling any claims of impossibility. That is ALL it CAN mean... not trying to be a downer, but this is that thinking that doesnt really track well. The self selection hinders both arguments equally. and IIRC I dont think including AOA match or not will skew the results too greatly.... is it fair to say that the most qualified and competitive DO applicants choose AOA over ACGME? I thought it was the other way around...... but I honestly dont know for sure.

 

[dntke1518]

I don't understand why this is an argument. It's common sense that ACGME will be preferential to MD students. I also find it ridiculous that DO students feel perhaps, "entitled" to an ACGME residency when (granted, maybe there isn't a high demand ) the AOA has a more stringent bias to allopathic students pursuing AOA residencies or AOA PD spots. Splinter in their eye, log in our own much? Lastly, the argument that extremely competitive residencies like NYU/MGH etc don't have a lot of DOs is self-evident, it's almost just as impossible for low-tier MD students to match there.

Again, who cares if someone waits to go to an MD school, or decides to go to a DO school. People choose things for a lot of reasons. I chose a DO school in my hometown, over an MD school for a multitude of different reasons. Assuming that it's always a black and white decision is ignorant.

 

[donkeykong1]

well fine. we can say that school rank plays role regardless of MD/DO. But not many DO schools are ranked above MD schools in general. A few DOs in top programs means it is possible, but nothing more. If a program has fewer than 1/5 DO make-up then it is not unreasonable to say that it is preferential to MD. Sure a DO may be at least as competitive as an MD from meharry or (hopefully) more so than an MD from the caribbean. So what?

but the presence of the odd DO in a top program is not informative beyond dispelling any claims of impossibility. That is ALL it CAN mean... not trying to be a downer, but this is that thinking that doesnt really track well. The self selection hinders both arguments equally. and IIRC I dont think including AOA match or not will skew the results too greatly.... is it fair to say that the most qualified and competitive DO applicants choose AOA over ACGME? I thought it was the other way around...... but I honestly dont know for sure.

First off lets not even bring up MDcarib into the mix. Its no secret that those students really have it bad when it comes to getting any sort of residency in the U.S. But awesome, I am glad that you agree that a DO may be at least as competitive as an MD from a low tier school (i.e Meharry). Furthermore I would even argue that DO grads from some of the more established DO schools have an easier road for ACGME than MD grads from some of the brand new MD schools which lack the alumni connections, and rotation networks.

Secondly why does it have to be labeled an "odd DO in a top program". Its not like there are thousands of DOs applying for those top ACGME positions. You have to understand the risk involved even for a DO that gets a 240+ on the USMLE who lets say is gunning for Ortho at Hopkins. He/She has to forgo the AOA match, and rank those top places as #1,#2 and then settle for something less, in case they don't get in. Not everyone will take that risk.

 

[SpecterGT260]

First off lets not even bring up MDcarib into the mix. Its no secret that those students really have it bad when it comes to getting any sort of residency in the U.S. But awesome, I am glad that you agree that a DO may be at least as competitive as an MD from a low tier school (i.e Meharry). Furthermore I would even argue that DO grads from some of the more established DO schools have an easier road for ACGME than MD grads from some of the brand new MD schools which lack the alumni connections, and rotation networks.

Secondly why does it have to be labeled an "odd DO in a top program". Its not like there are thousands of DOs applying for those top ACGME positions. You have to understand the risk involved even for a DO that gets a 240+ on the USMLE who lets say is gunning for Ortho at Hopkins. He/She has to forgo the AOA match, and rank those top places as #1,#2 and then settle for something less, in case they don't get in. Not everyone will take that risk.

you are going to have to cite something to back this up. I understand that you would argue it (... you have been...) but the point is moot unless you can show preferential treatment to DO vs a new MD school (which schools are you referring to? I am not aware of too many US MD schools that are "new") on an otherwise level playing field. I feel like this has been demonstrated in match statistics quite clearly and citing the AOA match (I was under the impression you could attempt this first and then enter the ACGME match if it doesnt work out.... so I am not understanding your argument of "risk"), and everything else is beside the point.

MOST med students regardless of title do not match #1. So to say there is excessive selection bias because a high-scoring DO will not list highly ranked programs is a little silly. This is assuming they were offered an interview to begin with. There is no risk to ranking a program highly if you have others to rank as well except that if you rank something too highly and you don't feel that strongly you may get stuck there. if I were to rank hopkins highly and they rank my low, the list effectively is everything I ranked - hopkins (unless nobody wants them....). since the alternative to having a list that functionally does not rank them is to just not rank them, there is no risk.

to make this all further beside the point - saying that there is self selection does NOT bolster your point. You cannot predict the outcome with that sort of bias. You cannot assume that if more were applying more would get in. The stats out there are complete enough - and I believe it does give a break down of # of applicants by degree and # offered positions so again, the self selection point is entirely moot.

 

[necronomicon]

Look, MD will make your path easier as compared to a DO. DO can still realistically match into most specialties, but you typically won't have as much geographical choice as a MD student with similar scores...

This is probably the most comprehensive explanation. The road is easier for MD's, but not impossible for DO's. If you want a top spot at a top hospital, it is irrefutable that you are MUCH better off being an MD.

Also, even a DO with the same (or marginally better) scores than an MD can have a difficult time matching into those top spots. It's just the way things are. Should that stop someone from going DO? Not in my eyes.

 

[SpecterGT260]

http://www.nrmp.org/data/resultsanddata2011.pdf

here is the data.

for all comparisons, DOs match at a lower PERCENT than MDs. It doesnt matter how many are applying, because this only considers those who tried. It doesnt matter those who pussed out due to any perceived "risk" because that is obviously intangible and there are plenty of MD applicants that will also not rank certain programs due to whatever criteria as well (your argument on this is every MD student ranks the top program for their respective field.... this doesn't happen).

this just says that for ACGME residencies, MDs match more often more of the time. Do you think it is appropriate to attempt to subdivide the data to the point that nobody really has any evidence? this is why "some odd DO" can match a top program without validating the point. It is all an odds game with sample sizes like this. It is still entirely possible for the programs to strongly favor MDs and still accept a DO - the fact that they are in with ANY number of technicality type arguments does NOTHING to counter the argument that the program favors MDs.

so get over it.... nobody is saying you or anyone else is dumb... it is just saying that these programs favor one institution over another. go re-read the post by the guy explaining that it is obvious for an MD-based program to favor MDs. This is really very simple

 

[SLC]

http://www.nrmp.org/data/resultsanddata2011.pdf

here is the data.

for all comparisons, DOs match at a lower PERCENT than MDs. It doesnt matter how many are applying, because this only considers those who tried. It doesnt matter those who pussed out due to any perceived "risk" because that is obviously intangible and there are plenty of MD applicants that will also not rank certain programs due to whatever criteria as well (your argument on this is every MD student ranks the top program for their respective field.... this doesn't happen).

this just says that for ACGME residencies, MDs match more often more of the time. Do you think it is appropriate to attempt to subdivide the data to the point that nobody really has any evidence? this is why "some odd DO" can match a top program without validating the point. It is all an odds game with sample sizes like this. It is still entirely possible for the programs to strongly favor MDs and still accept a DO - the fact that they are in with ANY number of technicality type arguments does NOTHING to counter the argument that the program favors MDs.

so get over it.... nobody is saying you or anyone else is dumb... it is just saying that these programs favor one institution over another. go re-read the post by the guy explaining that it is obvious for an MD-based program to favor MDs. This is really very simple

Dude…why do you waste so much time arguing in these crap threads? Don't you have some board prep or something to do?

 

[donkeykong1]

you are going to have to cite something to back this up. I understand that you would argue it (... you have been...) but the point is moot unless you can show preferential treatment to DO vs a new MD school (which schools are you referring to? I am not aware of too many US MD schools that are "new") on an otherwise level playing field. I feel like this has been demonstrated in match statistics quite clearly and citing the AOA match (I was under the impression you could attempt this first and then enter the ACGME match if it doesnt work out.... so I am not understanding your argument of "risk"), and everything else is beside the point.

MOST med students regardless of title do not match #1. So to say there is excessive selection bias because a high-scoring DO will not list highly ranked programs is a little silly. This is assuming they were offered an interview to begin with. There is no risk to ranking a program highly if you have others to rank as well except that if you rank something too highly and you don't feel that strongly you may get stuck there. if I were to rank hopkins highly and they rank my low, the list effectively is everything I ranked - hopkins (unless nobody wants them....). since the alternative to having a list that functionally does not rank them is to just not rank them, there is no risk.

to make this all further beside the point - saying that there is self selection does NOT bolster your point. You cannot predict the outcome with that sort of bias. You cannot assume that if more were applying more would get in. The stats out there are complete enough - and I believe it does give a break down of # of applicants by degree and # offered positions so again, the self selection point is entirely moot.

The new MD schools that I was referring to were TCMC, Cooper..I think it is impossible to show how preferential the desire to select a DO from an established school over a new school based on matchlists alone. Its also quite difficult to show that within the MD tier as well. Basically, it is an uphill climb from both sides. The AOA match coming before further complicates things. Gunning for Derm ACGME even with a 240+ USMLE, as a DO seems irrational since the applicant could simply go AOA derm---this would withdraw the DO from the ACGME match.

 

[donkeykong1]

http://www.nrmp.org/data/resultsanddata2011.pdf

here is the data.

for all comparisons, DOs match at a lower PERCENT than MDs. It doesnt matter how many are applying, because this only considers those who tried. It doesnt matter those who pussed out due to any perceived "risk" because that is obviously intangible and there are plenty of MD applicants that will also not rank certain programs due to whatever criteria as well (your argument on this is every MD student ranks the top program for their respective field.... this doesn't happen).

this just says that for ACGME residencies, MDs match more often more of the time. Do you think it is appropriate to attempt to subdivide the data to the point that nobody really has any evidence? this is why "some odd DO" can match a top program without validating the point. It is all an odds game with sample sizes like this. It is still entirely possible for the programs to strongly favor MDs and still accept a DO - the fact that they are in with ANY number of technicality type arguments does NOTHING to counter the argument that the program favors MDs.

so get over it.... nobody is saying you or anyone else is dumb... it is just saying that these programs favor one institution over another. go re-read the post by the guy explaining that it is obvious for an MD-based program to favor MDs. This is really very simple

Thanks for that pdf. Walk me through how you're viewing it though if you can. So on page 8, right you can clearly see that the percent of US MD getting in ACGME is like greater 90%, while US DO is 70% (with AOA, the overall match for DO was something was calculated on SDN to be like 90% too). Then on page 20 and 21 you can compare the percentages of MD/DO matched by specialty. Suprisingly in some specilaties a higher percentage of DOs matched ACGME than MDs (anes, OBGYN, EM, rads was equal...) while others like Ortho, Derm showed a discrepancy for obvious reasons. And again matching AOA can resolve this issue.

So I guess we can say that matching into top tier residencies is not really what distinguishes the opportunities an MD has over an DO. The difference in opportunity emerges within the heavily sought-after specialties, where a DO is better off going AOA.

 

[cabinbuilder]

I think if funny that the arguments on this thread are beyone ridulous. It's seems silly to have a pre-medical student spout "facts" like they know more than the medical student and there is not one attending among you refereeing. Reality check folks, none of you really know anything about the reality of matching, residencies, and working as a doctor in the real world. Need to move on and start studying. In 8 years you will totally be laughing at this thread like me. 😴

 

[HYFR]

Dude…why do you waste so much time arguing in these crap threads? Don't you have some board prep or something to do?

By far the best response here. I agree. If you're a med student, go study and prepare for your responsibilities. If you're pre-med, tone it down, do what you can to get into a program that is good for you, and move on. In fact, everyone move on.

 

[SpecterGT260]

Thanks for that pdf. Walk me through how you're viewing it though if you can. So on page 8, right you can clearly see that the percent of US MD getting in ACGME is like greater 90%, while US DO is 70% (with AOA, the overall match for DO was something was calculated on SDN to be like 90% too). Then on page 20 and 21 you can compare the percentages of MD/DO matched by specialty. Suprisingly in some specilaties a higher percentage of DOs matched ACGME than MDs (anes, OBGYN, EM, rads was equal...) while others like Ortho, Derm showed a discrepancy for obvious reasons. And again matching AOA can resolve this issue.

So I guess we can say that matching into top tier residencies is not really what distinguishes the opportunities an MD has over an DO. The difference in opportunity emerges within the heavily sought-after specialties, where a DO is better off going AOA.

I think that is fair. Some (like FM) show a heavy skew towards DO (18%). Anesthesia is a more sought-after specialty, but there are a butt-load of positions. Otherwise the reality of the situation is that programs that have more difficulty filling positions are kinder to DO applicants. Although I feel like it is safe to apply the same forces within specialties as well. The trend seems to be for ACGME matching, that the more US MD applicants that want it, the harder it is for other applicant types to match.


bringing the AOA into this doesnt really add anything. The topic is whether or not the ACGME match is skewed towards MD applicants - it is. Yes, the AOA can offset this. cool 👍 but does not stand as valid reasoning to say that a DO applicant will not have additional burden placed on him/her in order to match competitively with ACGME - it just says you can match AOA. Matching ortho in general isn't THAT much different than matching a highly competitive IM program. Each program is somewhat autonomous and sets the bar where they see fit and selects the applicants they deem most worthy. If a particular FM program only wants applicants with 260+ that is their perogative (hypothetically speaking...).

The comparison becomes much more difficult beyond that..... and there are as many negative ways to look at the numbers as there are positive. For example, FM has one of the lowerest average board scores, and DOs have a high presence there. This could mean either DO's self select, that the programs actually prefer DOs, or that DOs tend to score lower on USMLE compared to MDs. All 3 of these are equally valid without further information - so I am just saying lets not get too carried away with the number crunching.

 

[SpecterGT260]

Dude…why do you waste so much time arguing in these crap threads? Don't you have some board prep or something to do?

I get things done between posts 👍
number analysis is interesting and things like this not only keep me on my toes but also give me greater insight into the DO world. you would be surprised how much I have actually learned in these too. The only issue is too many people take the numbers as personal attacks so it seems like DO-bashing when it is not.

 

[SpecterGT260]

http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf

this survey lists the criteria used by specialty to determine ranking and interview invite.

I am about to go for a run because my phys studying is making me crosseyed lol so I am still making sure I completely understand the #s presentation, but it looks like qualities are listed via a % of how important.... although it is way over 100 so maybe just a relative importance based on how many respondants listed it according to a given number value? not sure....

but if you look for the total breakdown, being a US allopathic graduate is considered higher than alpha omega alpha membership. also higher than bbeing from a top tier school. (feel free to correct me i I am reading these wrong. this was hasty and I took a pre-workout drink so I am too amped to sit still here any more lol)

individual specialties may surprise any one of us.... this paper is new to me.

 

[HYFR]

http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf

this survey lists the criteria used by specialty to determine ranking and interview invite.

I am about to go for a run because my phys studying is making me crosseyed lol so I am still making sure I completely understand the #s presentation, but it looks like qualities are listed via a % of how important.... although it is way over 100 so maybe just a relative importance based on how many respondants listed it according to a given number value? not sure....

but if you look for the total breakdown, being a US allopathic graduate is considered higher than alpha omega alpha membership. also higher than bbeing from a top tier school. (feel free to correct me i I am reading these wrong. this was hasty and I took a pre-workout drink so I am too amped to sit still here any more lol)

individual specialties may surprise any one of us.... this paper is new to me.

I'm sure you are brilliant to have achieved what you have. But seriously, act like a physician and stop engaging in these fruitless tit-for-tat discussions. This behavior is not becoming of someone who should be a role model, a leader, and who will be depended upon to help humanity.

 

[Instatewaiter]

So I guess we can say that matching into top tier residencies is not really what distinguishes the opportunities an MD has over an DO. The difference in opportunity emerges within the heavily sought-after specialties, where a DO is better off going AOA.

Actually, I would that the difference in residency opportunities are most pronounced in the middle of the class, rather than the top (where people are gunning for heavily saught after specialties).

The top of the any class will do pretty well (most will go to decent academic centers) regardless of school. However the middle of the class is where the difference is really seen. This is also seen when you look at Harvard vs Low-tier MD (to a lesser extent) as well as MD to DO. It is hard to tease out which part is prestige of the school and which part is board scores as you would assume those who were able to get into a stronger school would also be able to score higher on standardized tests.

This arguement is really only applicable to those choosing between schools. If you have the option to go to a stronger school (where you'd probably be happy) take it. It will open doors no matter which side of the tracks you fall onto. If you are already at a specific school the point is moot and all you can do is try your hardest to get where you want to go.

In the end, shoot for the strongest school you can get into and be happy with wherever you end up.

 

[SpecterGT260]

I'm sure you are brilliant to have achieved what you have. But seriously, act like a physician and stop engaging in these fruitless tit-for-tat discussions. This behavior is not becoming of someone who should be a role model, a leader, and who will be depended upon to help humanity.

gotta figure out how to respond and make it seem like I give a rat's ass about what some noob on the other end of the web says....


to hell with it. There are some WAY better posts you could have quoted other than the one that links the paper of what program directors THEMSELVES cite as being determining factors for interviews and rankings. The topic of this discussion is whether or not being a DO really is a disadvantage when applying to the ACGME match. in all cases more than 50% of PDs responded that they do look at whether or not you graduated from a US allopathic school, and this is substantially more than those who cited looking at top-tier schools.

you, sir, are one of the people who seems to be unable to separate the ridiculous emotional responses from this discussion. i did not say they are worse. I did not say they will not make good doctors. I said PDs WILL take this into account. anyone following this topic could stand to benefit from this information. I do not see how it is a tit-for-tat discussion, and even if it is, I do not see how that is just so egregiously unbecoming. It is also quite difficult for MD's to match AOA, but since that is not a hot topic of confusion there is little benefit to discussing it.

so slow your roll there chieftain... nobody is saying not to go DO. The only thing I am saying is do not expect your ability to match to be wholly unaffected if you do. It will be. the statistics and surveys are quite clear on this. So take the information accordingly and stop acting like someone is picking on you just for highlighting the sources which answer the question.



EDIT: I also really really disagree with you on the point that role models in the medical field should not be using objectivity to approach a problem and interpret results.... That is all that is happening here. good day sir! 🙂

 

[donkeykong1]

I think that is fair. Some (like FM) show a heavy skew towards DO (18%). Anesthesia is a more sought-after specialty, but there are a butt-load of positions. Otherwise the reality of the situation is that programs that have more difficulty filling positions are kinder to DO applicants. Although I feel like it is safe to apply the same forces within specialties as well. The trend seems to be for ACGME matching, that the more US MD applicants that want it, the harder it is for other applicant types to match.


bringing the AOA into this doesnt really add anything. The topic is whether or not the ACGME match is skewed towards MD applicants - it is. Yes, the AOA can offset this. cool 👍 but does not stand as valid reasoning to say that a DO applicant will not have additional burden placed on him/her in order to match competitively with ACGME - it just says you can match AOA. Matching ortho in general isn't THAT much different than matching a highly competitive IM program. Each program is somewhat autonomous and sets the bar where they see fit and selects the applicants they deem most worthy. If a particular FM program only wants applicants with 260+ that is their perogative (hypothetically speaking...).

The comparison becomes much more difficult beyond that..... and there are as many negative ways to look at the numbers as there are positive. For example, FM has one of the lowerest average board scores, and DOs have a high presence there. This could mean either DO's self select, that the programs actually prefer DOs, or that DOs tend to score lower on USMLE compared to MDs. All 3 of these are equally valid without further information - so I am just saying lets not get too carried away with the number crunching.

This i could agree with 👍

 

[crmellon]

gotta figure out how to respond and make it seem like I give a rat's ass about what some noob on the other end of the web says....


to hell with it. There are some WAY better posts you could have quoted other than the one that links the paper of what program directors THEMSELVES cite as being determining factors for interviews and rankings. The topic of this discussion is whether or not being a DO really is a disadvantage when applying to the ACGME match. in all cases more than 50% of PDs responded that they do look at whether or not you graduated from a US allopathic school, and this is substantially more than those who cited looking at top-tier schools.

you, sir, are one of the people who seems to be unable to separate the ridiculous emotional responses from this discussion. i did not say they are worse. I did not say they will not make good doctors. I said PDs WILL take this into account. anyone following this topic could stand to benefit from this information. I do not see how it is a tit-for-tat discussion, and even if it is, I do not see how that is just so egregiously unbecoming. It is also quite difficult for MD's to match AOA, but since that is not a hot topic of confusion there is little benefit to discussing it.

so slow your roll there chieftain... nobody is saying not to go DO. The only thing I am saying is do not expect your ability to match to be wholly unaffected if you do. It will be. the statistics and surveys are quite clear on this. So take the information accordingly and stop acting like someone is picking on you just for highlighting the sources which answer the question.

I'm actually really greatful you posted that PD survey. It was extremely informative.

 

[SpecterGT260]

I'm actually really greatful you posted that PD survey. It was extremely informative.

hell, I'm glad I found it. It is not only useful for pre-meds who are on the MD/DO fence, but any and all current med students who are considering what type of programs to apply to.

there are other resources out there as well.... I will talk to some upper classmen next time I get a chance. there was a guy that was using some online school to crunch numbers and get ballpark match odds for specific programs (I think?) or something like that. The PD survey does not tell you too much about the ultra elite programs within a specialty.

 

[rad0nc]

I'm sure you are brilliant to have achieved what you have. But seriously, act like a physician and stop engaging in these fruitless tit-for-tat discussions. This behavior is not becoming of someone who should be a role model, a leader, and who will be depended upon to help humanity.

He posted an excellent resource that gives us insight into how program directors judge candidates. Why is this a bad thing?

 

[Nymphicus]

First off lets not even bring up MDcarib into the mix. Its no secret that those students really have it bad when it comes to getting any sort of residency in the U.S. But awesome, I am glad that you agree that a DO may be at least as competitive as an MD from a low tier school (i.e Meharry). Furthermore I would even argue that DO grads from some of the more established DO schools have an easier road for ACGME than MD grads from some of the brand new MD schools which lack the alumni connections, and rotation networks.

Secondly why does it have to be labeled an "odd DO in a top program". Its not like there are thousands of DOs applying for those top ACGME positions. You have to understand the risk involved even for a DO that gets a 240+ on the USMLE who lets say is gunning for Ortho at Hopkins. He/She has to forgo the AOA match, and rank those top places as #1,#2 and then settle for something less, in case they don't get in. Not everyone will take that risk.

Is this not another disadvantage of going DO? MD students don't have to deal with the double matching dilemma, or going through both the COMLEX and USMLE.

Also, the new DO schools popping up everywhere at XYZ random school and the AOA/ACGME/CME drama is a little ridiculous.

 

[donkeykong1]

Is this not another disadvantage of going DO? MD students don't have to deal with the double matching dilemma, or going through both the COMLEX and USMLE.

Also, the new DO schools popping up everywhere at XYZ random school and the AOA/ACGME/CME drama is a little ridiculous.

1. Its actually quite advantageous to have 2 matches. Some students gun for super competitive specialties in the AOA match and are able to have another shot in ACGME w/o the need to scramble. Its disadvantageous for the DO who is gunning for a specific highly competitive specialty (derm, ortho..which is super competitiveness even for MDs ) in the ACGME match and doesn't want AOA maybe for location or some other reason. Taking the USMLE and COMLEX as a DO is pretty routine now. COMLEX is also accepted at many ACGME programs.

2. New MD schools are opening as well bud. Cuts to Medicare affects AOA and ACGME residencies. Both sides will feel the pinch.
============================
Also so according to the survey something like 58% of 48.7% of all ACGME residency programs prefer U.S allopathic grads. (48.7% responded)......100% of AOA programs obviously require (not just prefer) US osteopathic, I'd like to see the COMLEX opened up to allopaths though.

 

[SpecterGT260]

1. Its actually quite advantageous to have 2 matches. Some students gun for super competitive specialties in the AOA match and are able to have another shot in ACGME w/o the need to scramble. Its disadvantageous for the DO who is gunning for a specific highly competitive specialty (derm, ortho..which is super competitiveness even for MDs ) in the ACGME match and doesn't want AOA maybe for location or some other reason. Taking the USMLE and COMLEX as a DO is pretty routine now. COMLEX is also accepted at many ACGME programs.

2. New MD schools are opening as well bud. Cuts to Medicare affects AOA and ACGME residencies. Both sides will feel the pinch.

maybe I missed it, but I asked where all these MD schools were opening. I am not aware of new ones, at least not at the rate of new DO schools

 

[Drrrrrr. Celty]

maybe I missed it, but I asked where all these MD schools were opening. I am not aware of new ones, at least not at the rate of new DO schools

http://en.wikipedia.org/wiki/Medical_Schools_in_the_United_States

Scroll to the bottom.

 

[donkeykong1]

http://en.wikipedia.org/wiki/Medical_Schools_in_the_United_States

Scroll to the bottom.

lets just do an epic copy/paste for our SDN friends:

Developing medical schools

These medical schools are still in the process of undergoing accreditation and are not yet accepting student applications.
State School City Degree Anticipated Inaugural Class
Alabama Alabama College of Osteopathic Medicine[49] Dothan DO 2013
Arizona Mayo Medical School-Arizona[50] Scottsdale MD 2014
California University of California, Merced School of Medicine[51] Merced MD 2013
California University of California, Riverside School of Medicine[52] Riverside MD 2013
California The Scripps Research Institute School of Medicine La Jolla MD 2013[53]
California California Northstate University College of Medicine[54] Elk Grove MD 2012
Connecticut Quinnipiac University[55] North Haven MD 2013 or 2014
Florida Palm Beach Medical College Palm Beach MD Under Discussion
Indiana Marian University[56] Indianapolis DO Under Discussion
Michigan Central Michigan University College of Medicine[57] Mount Pleasant MD 2013
Michigan Western Michigan University[58] Kalamazoo MD Under Discussion
Missouri Missouri Southern State University KCUMB Partnership Joplin DO 2012
New Jersey Cooper Medical School of Rowan University[59] Camden MD 2012
New Mexico Bataan Medical School of University of New Mexico Las Cruces MD Under Discussion
Oklahoma OU - TU School of Community Medicine[60] Tulsa MD 2014
Pennsylvania Lake Erie College of Osteopathic Medicine at Seton Hill University[61] Greensburg DO 2009
Pennsylvania Temple University School of Medicine at West Penn Allegheny Health System[62] Pittsburgh MD 2013
Virginia King College, School of Medicine[63] Abingdon MD 2013 or 2014
Texas University of Houston[citation needed] Houston MD Under Discussion
Wisconsin Wisconsin College of Osteopathic Medicine[citation needed] Wausau DO 2013 or 2014, Under Discussion

New School ratio if i counted correctly: 5 DOs to 15 MDs

 

[SpecterGT260]

interesting. any of the newer MD schools old enough to have match lists yet?

 

[donkeykong1]

interesting. any of the newer MD schools old enough to have match lists yet?

The commonwealth medical college opened up in 2008 i believe, and should have its first matchlist out. keep in mind they are also on probation (along with SUNY Upstate)

 

[Poisson]

ive been reading this closed thread below, and how an individual keeps on trolling/belittling osteopathy and its doctors.

http://forums.studentdoctor.net/showthread.php?t=901303

most of the threads on md vs do always seems to have a reoccurring theme of osteopathic doctors being underdogs. – “MANY” in osteopathic medicine are underdogs, the GPAs are lower and course retakes are allowed, MCATs are lower

i feel this is true among people who don't have a clue about osteopathy or feel that DO's aren't cut out of the same cloth as MDs. – DOs are cut out for the same path, they just prove that you don’t need the highest GPA on the planet to be a great doctor, not saying that their aren’t 3.9s in DO programs by choice or impatience with trying to get into a school of their choice

I'm in no way starting a md vs do thread as ive read and know the differences but i'll like to chime in my thoughts (if i came off as doing so by the end of my post...then shut this down! sorry!). Ive been an underdog my entire life who has been proving people wrong with hard work and determination... and I am pursuing a career in medicine. – that’s great, I know how you feel with this, but it doesn’t make you any more attractive to rub it in peoples’ faces, I do acclaim you though, because going against what people say is an annoying process

This stigma that's prevalent in these threads and how these trolls keep on degrading DOs, makes me more inclined to pursue the DO letters after my name. – this is probably the only thing you have said that I consider a red flag, getting a DO should not be a reason to prove somebody something, some people in general like to do something just to get attention, I’m not sure what kind of personality disorder this is, but it shouldn’t be done in medicine, DO is basically the same as MD, and a defensiveness is only going to bring down the degree

Is it wrong for me to say that I want to become a DO just to prove people wrong that it doesn't matter what letters come after my name...and all i want to do is to get into a program and become the best doctor i can be and heal patients and even save their lives!? – I think it is completely wrong, this is my opinion, you may have another one, yes you will be a great MD or DO but Its my opinion that it looks bad to try to act like you need to defend the degree, when it needs no defense, it is respected, period

Although I know where you do your residency factors in a lot of how much you get to experience and learn from those varying situations, it depends on the individual to become a really good/dedicated doctor and the best one can be. If one is passionate enough about his/her patients...then all the more power to the patients and that doctor. – yeah totally true

that is my response to these trolls and anyone can feel free to chime in on my views, whether you agree or not...or whether I made a complete fool out of myself lolz!

to all the "underdogs" and MD/DO doctors....let's be the best physicians we can be!!!

Just my opinion – don’t do DO just because, and don’t be a DO just to make a lot of unnecessary statements, do you care about patients or just trying to make points to colleagues and others?

 

[Nymphicus]

1. Its actually quite advantageous to have 2 matches. Some students gun for super competitive specialties in the AOA match and are able to have another shot in ACGME w/o the need to scramble. Its disadvantageous for the DO who is gunning for a specific highly competitive specialty (derm, ortho..which is super competitiveness even for MDs ) in the ACGME match and doesn't want AOA maybe for location or some other reason. Taking the USMLE and COMLEX as a DO is pretty routine now. COMLEX is also accepted at many ACGME programs.

2. New MD schools are opening as well bud. Cuts to Medicare affects AOA and ACGME residencies. Both sides will feel the pinch.
============================

1.) I think you are making it out to sound a little nicer than it is in reality.

2.) ACGME residencies outnumber AOA residencies by a very large amount. There are currently not enough AOA residencies to hold all US DO graduates.

 

[Nymphicus]

lets just do an epic copy/paste for our SDN friends:

Developing medical schools

These medical schools are still in the process of undergoing accreditation and are not yet accepting student applications.
State School City Degree Anticipated Inaugural Class
Alabama Alabama College of Osteopathic Medicine[49] Dothan DO 2013
Arizona Mayo Medical School-Arizona[50] Scottsdale MD 2014
California University of California, Merced School of Medicine[51] Merced MD 2013
California University of California, Riverside School of Medicine[52] Riverside MD 2013
California The Scripps Research Institute School of Medicine La Jolla MD 2013[53]
California California Northstate University College of Medicine[54] Elk Grove MD 2012
Connecticut Quinnipiac University[55] North Haven MD 2013 or 2014
Florida Palm Beach Medical College Palm Beach MD Under Discussion
Indiana Marian University[56] Indianapolis DO Under Discussion
Michigan Central Michigan University College of Medicine[57] Mount Pleasant MD 2013
Michigan Western Michigan University[58] Kalamazoo MD Under Discussion
Missouri Missouri Southern State University KCUMB Partnership Joplin DO 2012
New Jersey Cooper Medical School of Rowan University[59] Camden MD 2012
New Mexico Bataan Medical School of University of New Mexico Las Cruces MD Under Discussion
Oklahoma OU - TU School of Community Medicine[60] Tulsa MD 2014
Pennsylvania Lake Erie College of Osteopathic Medicine at Seton Hill University[61] Greensburg DO 2009
Pennsylvania Temple University School of Medicine at West Penn Allegheny Health System[62] Pittsburgh MD 2013
Virginia King College, School of Medicine[63] Abingdon MD 2013 or 2014
Texas University of Houston[citation needed] Houston MD Under Discussion
Wisconsin Wisconsin College of Osteopathic Medicine[citation needed] Wausau DO 2013 or 2014, Under Discussion

New School ratio if i counted correctly: 5 DOs to 15 MDs

That is some creative counting. "New School" =/= "under discussion". You do realize how much more difficult it is to open a MD school than a DO school, correct?

Another thing to note is the number of DO schools at graduate health farm conglomerates that have PA, dental, nursing, pharmacy, and a DO school, but no undergraduate or basic science departments and very limited research.

 

[donkeykong1]

1.) I think you are making it out to sound a little nicer than it is in reality.

2.) ACGME residencies outnumber AOA residencies by a very large amount. There are currently not enough AOA residencies to hold all US DO graduates.

1) what exactly is that supposed to mean?

2) this is true. its also true that ACGME residencies can not be completely filled by US MD even at the current rate of expansion.

 

[donkeykong1]

That is some creative counting. "New School" =/= "under discussion". You do realize how much more difficult it is to open a MD school than a DO school, correct?

Another thing to note is the number of DO schools at graduate health farm conglomerates that have PA, dental, nursing, pharmacy, and a DO school, but no undergraduate or basic science departments and very limited research.

The point was to show that there are new MD schools opening soon. The COCA (for DO) and LCME (MD) have almost exactly the same requirements for opening up new schools.Their charters are literally sometimes word for word. MD schools are also following te precedent set forth by some DO schools to open at ugrad/grad schools with limited research. See that list as well as schools like TCMC, Cooper Rowan...

 

[River Rat]

1) what exactly is that supposed to mean?

2) this is true. its also true that ACGME residencies can not be completely filled by US MD even at the current rate of expansion.

Having 2 matches isn't actually that advantageous. The DO Match occurs before the MD Match. Meaning if you have any desire whatsoever to test the waters in the MD world, you'd be shooting yourself in the foot by ranking the DO programs if they end up ranking you to match. I know beggars can't be choosers, and you should be happy with what you get, but there's a certain degree of strategy involved with this, and issues that arise should you decide to go the MD route, such as:

a) planning 4th year away electives. It's a known fact that AOA programs tend to select residents who have done an away elective at their institution, moreso than board scores. Away electives are also very important as a D.O. trying to break into the M.D. world, but not so much as an "interview" at the site, but as a part of a process into gathering valuable LORs from people that actually matter, not Dr. John Smith, family doctor, from a small community hospital in the middle of nowhere. You only get so much space to fit in all the rotations you want, after a certain point, most graduates need to weigh whether its worth it to spread themselves so thin. The answer is: no, it is not. Because you are taking away from valuable face time from doing D.O. rotations (or vice versa) where you could be doing M.D. rotations (or vice versa). In the end, graduates go all-in, one way or another, if they're aiming for a moderately competitive field.

b) Thinking that the 2nd match (ACGME) is a back up is kind of misguided. If you're going AOA ROAD and do not get a spot, chances are you won't get an ACGME ROAD spot. I don't have the evidence to back this up, but it just doesn't make sense to me that someone uncompetitive for an AOA spot would suddenly be competitive and match into an ACGME spot in the same specialty.

c) also looking at the future, if anyone is interested in fellowships at all, they need to realize that fellowships don't really exist in the DO world. It's way too small. With the proposed ACGME changes (which will come up again, I'm sure,) it's best to be safe and go M.D. just for that PGY-1 internship year that will allow you to have access to all the fellowships you want.

d) there was some other point i wanted to make...but I forgot.

Also many other things involved. Just wanted to say that it's misleading to say "ACGME residencies take COMLEX now." It really depends on the specialty. The most friendly specialties towards COMLEX tend to be things like Fam, Psych, PM&R (PM&R loves D.O.s, apparently, since we practically do all that crap already...for the most part...) Any moderately competitive specialty "requires" the USMLE to be on even ground with your MD counterparts. I say requires in quotations because even if the residency program SAYS they take COMLEX, the reality is that most programs don't even look at you unless you take the USMLE. And as DO's to be, especially DO's with high hopes of matching into an ACGME residency, we NEED to constantly look at putting our best foot forward, day in and day out, and not give anyone any reason to doubt that we're capable and equal. The USMLE can and will be your best friend. It is a crime to paint anything other than a bleak picture of the future, it's good to be optimistic, but you (or anyone) need to remember what the reality is. That for every DO at Cornell, UPenn, Harvard, etc, there are hundreds more left....elsewhere. If you got the fear of god working for you, you should have a pretty industrious 4 years at medical school.

 

[donkeykong1]

Having 2 matches isn't actually that advantageous. The DO Match occurs before the MD Match. Meaning if you have any desire whatsoever to test the waters in the MD world, you'd be shooting yourself in the foot by ranking the DO programs if they end up ranking you to match. I know beggars can't be choosers, and you should be happy with what you get, but there's a certain degree of strategy involved with this, and issues that arise should you decide to go the MD route, such as:

a) planning 4th year away electives. It's a known fact that AOA programs tend to select residents who have done an away elective at their institution, moreso than board scores. Away electives are also very important as a D.O. trying to break into the M.D. world, but not so much as an "interview" at the site, but as a part of a process into gathering valuable LORs from people that actually matter, not Dr. John Smith, family doctor, from a small community hospital in the middle of nowhere. You only get so much space to fit in all the rotations you want, after a certain point, most graduates need to weigh whether its worth it to spread themselves so thin. The answer is: no, it is not. Because you are taking away from valuable face time from doing D.O. rotations (or vice versa) where you could be doing M.D. rotations (or vice versa). In the end, graduates go all-in, one way or another, if they're aiming for a moderately competitive field. Agree

b) Thinking that the 2nd match (ACGME) is a back up is kind of misguided. If you're going AOA ROAD and do not get a spot, chances are you won't get an ACGME ROAD spot. I don't have the evidence to back this up, but it just doesn't make sense to me that someone uncompetitive for an AOA spot would suddenly be competitive and match into an ACGME spot in the same specialty. Actually in some specialties like optha where there are literally only something like 20 spots in the AOA, a DO might have a better shot in the ACGME where there are hundreds of positions. Also, shooting for AOA ROAD and settling for EM, IM...in ACGME is also a pretty reasonable advantage.

c) also looking at the future, if anyone is interested in fellowships at all, they need to realize that fellowships don't really exist in the DO world. It's way too small. With the proposed ACGME changes (which will come up again, I'm sure,) it's best to be safe and go M.D. just for that PGY-1 internship year that will allow you to have access to all the fellowships you want. We'll know for sure in June, whether or not the addendum to include one who completes an AOA residency is eligible for ACGME fellowship passes. Word around SDN (whatever that means) is that they will make that addition.

d) there was some other point i wanted to make...but I forgot. Ok man, i forgive you lol

Also many other things involved. Just wanted to say that it's misleading to say "ACGME residencies take COMLEX now." It really depends on the specialty. The most friendly specialties towards COMLEX tend to be things like Fam, Psych, PM&R (PM&R loves D.O.s, apparently, since we practically do all that crap already...for the most part...) Any moderately competitive specialty "requires" the USMLE to be on even ground with your MD counterparts. I say requires in quotations because even if the residency program SAYS they take COMLEX, the reality is that most programs don't even look at you unless you take the USMLE. And as DO's to be, especially DO's with high hopes of matching into an ACGME residency, we NEED to constantly look at putting our best foot forward, day in and day out, and not give anyone any reason to doubt that we're capable and equal. The USMLE can and will be your best friend.Yes

It is a crime to paint anything other than a bleak picture of the future-I wish your patients much luck my friend---just kidding it's good to be optimistic, but you (or anyone) need to remember what the reality is. That for every DO at Cornell, UPenn, Harvard, etc, there are hundreds more left--US DO is only 20% of the physician population

....elsewhere. If you got the fear of god working for you, you should have a pretty industrious 4 years at medical school-amen.

if you carefully read my post, you will find that I mentioned both an advantage as well as a disadvantage to the 2 matches. i think that is pretty rational and up par with reality----its not as optimistic as you are making it seem. secondly saying "COMLEX is also accepted at many ACGME programs" DOES NOT MEAN the same thing as "ACGME residencies take COMLEX now."

 

[crmellon]

Having 2 matches isn't actually that advantageous. The DO Match occurs before the MD Match. Meaning if you have any desire whatsoever to test the waters in the MD world, you'd be shooting yourself in the foot by ranking the DO programs if they end up ranking you to match. I know beggars can't be choosers, and you should be happy with what you get, but there's a certain degree of strategy involved with this, and issues that arise should you decide to go the MD route, such as:

a) planning 4th year away electives. It's a known fact that AOA programs tend to select residents who have done an away elective at their institution, moreso than board scores. Away electives are also very important as a D.O. trying to break into the M.D. world, but not so much as an "interview" at the site, but as a part of a process into gathering valuable LORs from people that actually matter, not Dr. John Smith, family doctor, from a small community hospital in the middle of nowhere. You only get so much space to fit in all the rotations you want, after a certain point, most graduates need to weigh whether its worth it to spread themselves so thin. The answer is: no, it is not. Because you are taking away from valuable face time from doing D.O. rotations (or vice versa) where you could be doing M.D. rotations (or vice versa). In the end, graduates go all-in, one way or another, if they're aiming for a moderately competitive field.

b) Thinking that the 2nd match (ACGME) is a back up is kind of misguided. If you're going AOA ROAD and do not get a spot, chances are you won't get an ACGME ROAD spot. I don't have the evidence to back this up, but it just doesn't make sense to me that someone uncompetitive for an AOA spot would suddenly be competitive and match into an ACGME spot in the same specialty.

c) also looking at the future, if anyone is interested in fellowships at all, they need to realize that fellowships don't really exist in the DO world. It's way too small. With the proposed ACGME changes (which will come up again, I'm sure,) it's best to be safe and go M.D. just for that PGY-1 internship year that will allow you to have access to all the fellowships you want.

d) there was some other point i wanted to make...but I forgot.

Also many other things involved. Just wanted to say that it's misleading to say "ACGME residencies take COMLEX now." It really depends on the specialty. The most friendly specialties towards COMLEX tend to be things like Fam, Psych, PM&R (PM&R loves D.O.s, apparently, since we practically do all that crap already...for the most part...) Any moderately competitive specialty "requires" the USMLE to be on even ground with your MD counterparts. I say requires in quotations because even if the residency program SAYS they take COMLEX, the reality is that most programs don't even look at you unless you take the USMLE. And as DO's to be, especially DO's with high hopes of matching into an ACGME residency, we NEED to constantly look at putting our best foot forward, day in and day out, and not give anyone any reason to doubt that we're capable and equal. The USMLE can and will be your best friend. It is a crime to paint anything other than a bleak picture of the future, it's good to be optimistic, but you (or anyone) need to remember what the reality is. That for every DO at Cornell, UPenn, Harvard, etc, there are hundreds more left....elsewhere. If you got the fear of god working for you, you should have a pretty industrious 4 years at medical school.

👍

/endthread

 

[SpecterGT260]

👍

/endthread

 

[donkeykong1]

why the mustache?

 

[River Rat]

if you carefully read my post, you will find that I mentioned both an advantage as well as a disadvantage to the 2 matches. i think that is pretty rational and up par with reality----its not as optimistic as you are making it seem. secondly saying "COMLEX is also accepted at many ACGME programs" DOES NOT MEAN the same thing as "ACGME residencies take COMLEX now."

I know what you meant by that. And you're misinterpreting my response. I was pointing out the flaw in even acknowledging that some ACGME residencies claim to take the COMLEX, because it shouldn't change the fact that you NEED to take the USMLE anyways, which is something that a lot of D.O. students either are not told or do not want to make the effort to do.

also: 20% is the DO population doesn't mean anything. There are doctors in places like Wyoming, the Dakotas, Montana, etc. right? Why does saying that it's rare to see a D.O. in a big time, big name program automatically invoke such stubborn responses? Anecdotal evidence in this case is silly because it obviously is the exception, not the rule. Pull up any match list at a D.O. school, sure you will see students that match into MD programs, and sometimes you'll see the occasional "holy crap, he matched into [insert big name program here]" but compare that to the rest of the class that are herded into the D.O. capitals of the country; Ohio, Michigan, etc. in AOA programs. Look, I'm a D.O. student too, and I will tell you that it's not impossible, but it's not good to react to this obvious shortcoming of getting a D.O. education with defensiveness. Knowing and understanding how these things work will help you get your ass in gear when you start school.

 

[SpecterGT260]

http://knowyourmeme.com/memes/i-lied

 

[donkeykong1]

I know what you meant by that. And you're misinterpreting my response. I was pointing out the flaw in even acknowledging that some ACGME residencies claim to take the COMLEX, because it shouldn't change the fact that you NEED to take the USMLE anyways, which is something that a lot of D.O. students either are not told or do not want to make the effort to do.

also: 20% of the DO population doesn't mean anything. There are doctors in places like Wyoming, the Dakotas, Montana, etc. right? Why does saying that it's rare to see a D.O. in a big time, big name program automatically invoke such stubborn responses? Anecdotal evidence in this case is silly because it obviously is the exception, not the rule. Pull up any match list at a D.O. school, sure you will see students that match into MD programs, and sometimes you'll see the occasional "holy crap, he matched into [insert big name program here]" but compare that to the rest of the class that are herded into the D.O. capitals of the country; Ohio, Michigan, etc. in AOA programs. Look, I'm a D.O. student too, and I will tell you that it's not impossible, but it's not good to react to this obvious shortcoming of getting a D.O. education with defensiveness. Knowing and understanding how these things work will help you get your ass in gear when you start school.

I agree taking the USMLE is the smartest investment a DO can make when it comes to applying for residency.

Regarding the 20% thing.I wasn't really being "defensive" either. And I know you're a DO student, and thanks for the advice at the end there. But really, doesn't the mere fact that DOs are such a small sample size of the physician population play at least some role in the reality that they have a small representation at the big time academic centers for residency and beyond? (I'm not denying other biases which are present for some MDs as well.)

 

[donkeykong1]

http://knowyourmeme.com/memes/i-lied

 

[River Rat]

I agree taking the USMLE is the smartest investment a DO can make when it comes to applying for residency.

Regarding the 20% thing.I wasn't really being "defensive" either. And I know you're a DO student, and thanks for the advice at the end there. But really, doesn't the mere fact that DOs are such a small sample size of the physician population play at least some role in the reality that they have a small representation at the big time academic centers for residency and beyond? (I'm not denying other biases which are present for some MDs as well.)

possibly, but i tend to take things for face value. 20% isn't exactly that small of a proportion. Obeying the path of least resistance, it's easy to see why most DO students end up where they end up, in whatever specialties they end up in. We go where our opportunities are....and it's harder to go where there are more limited opportunities. It takes a special person to look at the hand they're given and feel like there's more out there. It takes a special person to look at a program that historically hasn't taken DO's and have the drive to be that first DO at that program. I don't know if I have an accurate figure for how many people I feel are capable of that (MD or DO.)

I'm not sure how it works for most DO schools, but there isn't a lot of directed opportunities for exploring your interests at mine. Research, getting experience with more competitive specialties (even during my third year.) We get bombarded with 6 months of primary care (family medicine, geriatrics, pediatrics, underserved care (family medicine again), internal medicine for two months.) That's 6 months! out of 9 months! Don't get me wrong, I'm not bitter, that is the whole DO mission statement, to provide a source of primary care physicians in underserved areas, so I knew what I was getting myself into. This wisdom I hope to impart is that for anyone that wants more, you're going to have to do a lot of work on your own to get the clinical experience you want to help you make the decisions you want. The lesson here is that whatever you're given, you always have the ability to make more opportunities for yourself (down time on a boring rotation? go hang out with the interventional radiologist, why not.) Extra work, but it is well worth it.

 

[AlabamaPop]

Problem solved.

 

[SpecterGT260]

cant tell if you are comparing DO matching to the civil rights movement.....

 

[AlabamaPop]

cant tell if you are comparing DO matching to the civil rights movement.....

Well in fact I am, because at the end of the day, we're going to the bare bones of the same concept: beating the stigmas and bias.

 

[Drrrrrr. Celty]

You're unconsciously trolling.

 

[River Rat]

cant tell if you are comparing DO matching to the civil rights movement.....

yeah, wasn't exactly the response i was hoping to invoke...haha. geez why did i venture in to this section.

 

[SpecterGT260]

Well in fact I am, because at the end of the day, we're going to the bare bones of the same concept: beating the stigmas and bias.

well there is irony... I cannot help but read this in an overly peppy sorority girl voice... must be the avatar

 

[PhiPhenomenon]

Well in fact I am, because at the end of the day, we're going to the bare bones of the same concept: beating the stigmas and bias.

... Should that qualify for applicants from lower tiered allopathic schools, Caribbean Schools (including the scary ones that don't require an MCAT score) and those who don't score >200 on Step 1?