DO's ability to match into general surgery after the merger?

[Goro]

While I always tell my students who are in the top 2/3rds of the class to take both USMLE and COMLEX, there are plenty of PDs in these fields are happy with COMLEX as the board exams. The more competitive the specialty, the less likely they're accept COMLEX I. Oddly, they're more willing to take COMLEX II.

It seems ridiculous to those of us in the SDN bubble, but I asked about Usmle prep at every one of my interviews and always got the same answer: "We just take the comlex. No need to take both." And these were people shooting for academic IM, ACGME EM and rads. We all know that's suicide, but it would seem that most DO students don't. Out of 5 interviews, I only met one person that intended to take step 1.


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[Ho0v-man]

While I always tell my students who are in the top 2/3rds of the class to take both USMLE and COMLEX, there are plenty of PDs in these fields are happy with COMLEX as the board exams. The more competitive the specialty, the less likely they're accept COMLEX I. Oddly, they're more willing to take COMLEX II.

Yes. My post was geared specifically toward competitive specialties.


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[JB50]

If I hear "I heard from this surgeon/that surgeon/my friend/my cousin/my friends dad who's head of trauma surgery at Hopkins/on SDN that (insert own opinion here)" I will strangle them...

 

[Espressso]

You can apply to other specialties as a back up but just know that your letters and personal statement when applying will be geared to gen surg. So if FM programs will know you really don't want to do it and are using them as a backup.

If you don't match initially you will go through the NRMP SOAP process (Google nrmp soap), then you will scramble probably looking for leftover gen surg programs or leftover TRI/prelim spots.


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Follow-up question regarding this... can these applicants simply get more letters that are tailored to the specific residency type (a set of letters geared for gen surg, another few letters geared for IM...), or is that just not how it works? totally understand that your letters will be tailored to the specific type of residency that you plan to apply and match into, but if you are applying to multiple types, is it possible to just have more letters ranging in specificity?

 

[AlteredScale]

Follow-up question regarding this... can these applicants simply get more letters that are tailored to the specific residency type (a set of letters geared for gen surg, another few letters geared for IM...), or is that just not how it works? totally understand that your letters will be tailored to the specific type of residency that you plan to apply and match into, but if you are applying to multiple types, is it possible to just have more letters ranging in specificity?

I guess that would be okay but I really don't know the specifics. @aProgDirector is this something that applicants do (have multiple LOR's if applying say to surgery and another specialty as a backup)?

 

[Dustbowl12]

merger won't negatively affect DOs. Will enhance training. SDN has been wrong by consensus multiple times before. DO pds will not reject their own and with rising averages DO student quality is much stronger and that is why they continue to match in better places every year

 

[NotAProgDirector]

I guess that would be okay but I really don't know the specifics. @aProgDirector is this something that applicants do (have multiple LOR's if applying say to surgery and another specialty as a backup)?

Technically, yes. Practically maybe.

ERAS absolutely allows you to apply to multiple fields. When you create LOR requests, you can specifically state what field the LOR is designed for. That means that a single LOR writer could write you two letters - one for IM and one for GS -- and then you could assign the IM letters to IM programs and vice versa. You can also create multiple PS's, and assign them to programs as you will. So, technically, you can do this.

But reality makes it difficult:

1. You only have one transcript, one application, and one MSPE. So if you apply to my IM program but you have 3 surgical SubI's on your transcript, and a surgical research project, but then tell me in your PS about how much you love IM, I'm probably going to toss your application in the trash. I can see you're probably using me as a backup, and I don't want to waste my interview slots on people like that. Will some programs perhaps not notice / care? It's possible. What if you did all that surgical work and then really, really changed your mind and now want IM? In that case, your best weapon is an LOR from your surgical mentor, or an MPSE, specifically stating that you are not applying to surgical programs. Your surgical mentor is unlikely to write that if untrue, and you only have one MSPE so if it's in there, any surgical program would see it.

2. Double LOR's (one for each field from the same person) is somewhat dangerous. Every year, some secretary uploads the wrong letter into the wrong slot. Then all the IM programs get the GS LOR, and vice versa. Total catastrophe. Remember that you can't see your letters -- you only see which one is labeled "GS" and "IM", but that assumes that the person uploading them got it right.

3. You'll want to interview at 10-12 programs per field. That won't be easy if you're applying to 2 fields.

4. Interviewing for both programs at the same institution can be dangerous. If you're seen by someone from the other program, you're doomed at both.

 

[DNC127]

Anyone have any insight to research and gen surg and how much it matters to be field specific? I had a 3rd year tell me that a surgery PD told him "if your research isn't in surgery don't include it on your app". I didn't think this sounded right because all research seems relevant for a CV, I am a 1st year and will have 3 projects submitted for publication this semester, and 8 by the end of the year (ranging from OB and Psych to ortho and neurosurgery). Basically, is it a waste of time to do research outside of surgery if you want to go into surgery (obviously if I could do all surgery I would but some projects aren't as feasible in surgery fields). Even though surgery is at the top of my list, I am interested in almost everything procedure based so I don't want to pigeon hole myself now by only doing research in one field and find out I like another field 3rd year.

 

[Espressso]

Technically, yes. Practically maybe.

ERAS absolutely allows you to apply to multiple fields. When you create LOR requests, you can specifically state what field the LOR is designed for. That means that a single LOR writer could write you two letters - one for IM and one for GS -- and then you could assign the IM letters to IM programs and vice versa. You can also create multiple PS's, and assign them to programs as you will. So, technically, you can do this.

But reality makes it difficult:

1. You only have one transcript, one application, and one MSPE. So if you apply to my IM program but you have 3 surgical SubI's on your transcript, and a surgical research project, but then tell me in your PS about how much you love IM, I'm probably going to toss your application in the trash. I can see you're probably using me as a backup, and I don't want to waste my interview slots on people like that. Will some programs perhaps not notice / care? It's possible. What if you did all that surgical work and then really, really changed your mind and now want IM? In that case, your best weapon is an LOR from your surgical mentor, or an MPSE, specifically stating that you are not applying to surgical programs. Your surgical mentor is unlikely to write that if untrue, and you only have one MSPE so if it's in there, any surgical program would see it.

2. Double LOR's (one for each field from the same person) is somewhat dangerous. Every year, some secretary uploads the wrong letter into the wrong slot. Then all the IM programs get the GS LOR, and vice versa. Total catastrophe. Remember that you can't see your letters -- you only see which one is labeled "GS" and "IM", but that assumes that the person uploading them got it right.

3. You'll want to interview at 10-12 programs per field. That won't be easy if you're applying to 2 fields.

4. Interviewing for both programs at the same institution can be dangerous. If you're seen by someone from the other program, you're doomed at both.

Amazing, thank you for all of this! So theoretically possibly but practicality speaking.. not likely. Seems like a lot of hoops to jump through with a lot of potential downside. I guess I have never really heard of anyone applying to multiple fields. Which, seems like a good sign because all these residency applicants are set on which field they would like to go into.

 

[Ioannes Paulus]

Anyone that doesn't tells you marching into surgert or the surgical sub specialties will be nearly impossible after the merger for a DO is lying to you. Simple as that.

 

[AnatomyGrey12]

Anyone that doesn't tells you marching into surgert or the surgical sub specialties will be nearly impossible after the merger for a DO is lying to you. Simple as that.

This. If you want it then get the app for it, it's honestly that simple. I don't know why people are so I up in arms about it either. Especially gen surg if a good number of the AOA programs make the merger.

 

[Ioannes Paulus]

I was in Chicago a year ago for a medical conference. Students from Northwestern and UChicago were already talking about the merger an salivating over the idea that there were more options for them. Last year the CCOM Surgery programs interviewed US MDs, although only DOs matched (probably because the MD students didn't rank the programs high enough). I suspect it will be the same this year with an eventually shutting out of DOs. If you look at programs in the past that went AOA to ACGME, few of them take DOs anymore. Face it. It's over. It is going to be nearly impossible in the future. You know, signing up, that DO schools have an emphasis in training primary care physicians. It's nice to have the attitude "Oh, I will be THAT students to break from the pack and match plastics." These are fantasy thoughts and have no basis in reality. It can happen but it is extremely rare and it will be even rarer in the future.
Also, the USMLE is becoming more and more important in matching (see NRMP trends) and until more DO schools enforce policies like RVU that teach at a higher thinking level and enforce policies to also take the USMLE, we will see no change.
Again, many people have the thought that "Oh, I will self study for the USMLE. It is the same as the COMLEX right?" Again, these are not based on reality. The USMLE and the COMLEX are two different tests with a completely different approach.

 

[SurgDoc95]

I was in Chicago a year ago for a medical conference. Students from Northwestern and UChicago were already talking about the merger an salivating over the idea that there were more options for them. Last year the CCOM Surgery programs interviewed US MDs, although only DOs matched (probably because the MD students didn't rank the programs high enough). I suspect it will be the same this year with an eventually shutting out of DOs. If you look at programs in the past that went AOA to ACGME, few of them take DOs anymore. Face it. It's over. It is going to be nearly impossible in the future. You know, signing up, that DO schools have an emphasis in training primary care physicians. It's nice to have the attitude "Oh, I will be THAT students to break from the pack and match plastics." These are fantasy thoughts and have no basis in reality. It can happen but it is extremely rare and it will be even rarer in the future.
Also, the USMLE is becoming more and more important in matching (see NRMP trends) and until more DO schools enforce policies like RVU that teach at a higher thinking level and enforce policies to also take the USMLE, we will see no change.
Again, many people have the thought that "Oh, I will self study for the USMLE. It is the same as the COMLEX right?" Again, these are not based on reality. The USMLE and the COMLEX are two different tests with a completely different approach.

So would you say that matching Gen Surg is going to be nearly impossible moving forward for DOs or is your statement more about matching ortho/vascular/plastics?

 

[AlteredScale]

So would you say that matching Gen Surg is going to be nearly impossible moving forward for DOs or is your statement more about matching ortho/vascular/plastics?

Gen surg is possible. It will become harder since a fair amount of AOA gen surg will close and newly ACGME accred programs will have the ability and option to interview MD students now. Cannot say whether the PDs of these programs will protect their own kind and only interview DOs or not. Time will tell.

Vascular and plastic surgery are extremely extremely hard to get into as a DO, there are not too many AOA programs as is and of the ACGME many are at strong hospitals that prefer MDs on the basis of the perception that having a DO in your programs means it's a weaker program and also the fact that MD applicants have exceptional CVs due to close mentorship and research that is much more accessible at an MD school with actual clinical departments (many DO schools do not have this because they have loose affiliations with community hospitals).


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[SurgDoc95]

Gen surg is possible. It will become harder since a fair amount of AOA gen surg will close and newly ACGME accred programs will have the ability and option to interview MD students now. Cannot say whether the PDs of these programs will protect their own kind and only interview DOs or not. Time will tell.

Vascular and plastic surgery are extremely extremely hard to get into as a DO, there are not too many AOA programs as is and of the ACGME many are at strong hospitals that prefer MDs on the basis of the perception that having a DO in your programs means it's a weaker program and also the fact that MD applicants have exceptional CVs due to close mentorship and research that is much more accessible at an MD school with actual clinical departments (many DO schools do not have this because they have loose affiliations with community hospitals).


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Good thing gen surg is the only surgery field that I find appealing at this point then! How hard is it to go IM to cardiology or oncology as a DO? Is that more where you do your IM residency than anything else?

 

[Ioannes Paulus]

Good thing gen surg is the only surgery field that I find appealing at this point then! How hard is it to go IM to cardiology or oncology as a DO? Is that more where you do your IM residency than anything else?

Good thing gen surg is the only surgery field that I find appealing at this point then! How hard is it to go IM to cardiology or oncology as a DO? Is that more where you do your IM residency than anything else?

Cardiology is an inflated field right now. Not easy but not impossible. GI and Pulm will be the new Cardiology in 5-10 years as demand will increase but there hasn't been a significant increase in programs like Cardiology.

 

[AlteredScale]

Good thing gen surg is the only surgery field that I find appealing at this point then! How hard is it to go IM to cardiology or oncology as a DO? Is that more where you do your IM residency than anything else?

A good residency program is IMO the most important part of going from IM to a subspecialty. It's getting into a good IM residency program that's a big hurdle for DOs. If you look at multiple years of a match lists for IM at multiple schools, the minority of them will be at university hospitals.


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[SurgDoc95]

A good residency program is IMO the most important part of going from IM to a subspecialty. It's getting into a good IM residency program that's a big hurdle for DOs. If you look at multiple years of a match lists for IM at multiple schools, the minority of them will be at university hospitals.


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I hate seeming naive, but which sub specialties are decently achievable from IM for DOs? IM to a sub specialty or gen surg seem to be where I'm leaning atm though I'm sure I'll change my mind 1000 times during rotations.

 

[Mad Jack]

Not only that if you look at the number of rank positions I think that is telling. The students I have talked to have said that a 235+ (The average for GS) step 1 has gottten them multiple interviews, enough to match. I wonder if this means that a lot of those students with only one or two rank positions (and interviews I would assume) are applying with less than GS average step scores, or are limiting the amount ignore programs they apply to. Really only the people with 1-3 rank positions are the ones playing roulette with their matching


With the AOA match the percentage is much higher. It all depends on how many AOA programs survive the merger whether or not these statistics will hold strong IMO.

You can currently count the number of surgery programs that have acquired initial accreditation on one hand and still have a few fingers left over. I don't think the odds are good that most will survive, and even those that do might end up like that ortho program in Michigan that went 100% MD its first year out.

 

[Mad Jack]

I hate seeming naive, but which sub specialties are decently achievable from IM for DOs? IM to a sub specialty or gen surg seem to be where I'm leaning atm though I'm sure I'll change my mind 1000 times during rotations.

All of them are doable if you match a university program.

 

[Ho0v-man]

You can currently count the number of surgery programs that have acquired initial accreditation on one hand and still have a few fingers left over. I don't think the odds are good that most will survive, and even those that do might end up like that ortho program in Michigan that went 100% MD its first year out.

I haven't really kept up bc I don't care about surgery, but isn't the deadline for them to apply fast approaching? Like January?


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[Mad Jack]

I was in Chicago a year ago for a medical conference. Students from Northwestern and UChicago were already talking about the merger an salivating over the idea that there were more options for them. Last year the CCOM Surgery programs interviewed US MDs, although only DOs matched (probably because the MD students didn't rank the programs high enough). I suspect it will be the same this year with an eventually shutting out of DOs. If you look at programs in the past that went AOA to ACGME, few of them take DOs anymore. Face it. It's over. It is going to be nearly impossible in the future. You know, signing up, that DO schools have an emphasis in training primary care physicians. It's nice to have the attitude "Oh, I will be THAT students to break from the pack and match plastics." These are fantasy thoughts and have no basis in reality. It can happen but it is extremely rare and it will be even rarer in the future.
Also, the USMLE is becoming more and more important in matching (see NRMP trends) and until more DO schools enforce policies like RVU that teach at a higher thinking level and enforce policies to also take the USMLE, we will see no change.
Again, many people have the thought that "Oh, I will self study for the USMLE. It is the same as the COMLEX right?" Again, these are not based on reality. The USMLE and the COMLEX are two different tests with a completely different approach.

Pretty much everyone in my class self-studied for the USMLE. It really isn't that hard to find the right resources, and many of my friends had scores well over 235. You should study for the USMLE, period, then throw in a week of OMM tops for the COMLEX.

 

[Mad Jack]

I haven't really kept up bc I don't care about surgery, but isn't the deadline for them to apply fast approaching? Like January?


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The deadline is over a year past- all surgical programs have applied, most are in pre-accred or cont-accred status and might not become accredited.

 

[AlteredScale]

I hate seeming naive, but which sub specialties are decently achievable from IM for DOs? IM to a sub specialty or gen surg seem to be where I'm leaning atm though I'm sure I'll change my mind 1000 times during rotations.

Depends on the residency programs. Some hospitals have inhouse fellowship programs that can make it easier to match since 1) you can match there and 2) having those programs allows you to build your cv and work with them to make your app as competitive as possible.


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[Dustbowl12]

Anyone that doesn't tells you marching into surgert or the surgical sub specialties will be nearly impossible after the merger for a DO is lying to you. Simple as that.

Absolute crap speculation based on absolutely nothing

 

[AlteredScale]

Absolute crap speculation based on absolutely nothing

And your assumption is based on what data or statistics? The fact of the matter is that is absolutely harder for DOs to get into surgical subspecialties as is NOW.

How woudld the merger which is making so that certian aoa surgical subspecialties have to shut down decreasing to spots for do grads to apply to. No amount sympathy in the world is going to change a PD at ucla's vascular surgry program to start considering DO applicants after the merger and that goes for most acgme surgical subspecialties that rarely take or dont take DOs.


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[Ho0v-man]

Quick question:

All of these programs that have "continued pre-accreditation ", what does that mean? Were those programs visited, told to make some changes, and are going to be reviewed again later?


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[Ioannes Paulus]

Absolute crap speculation based on absolutely nothing

"based on absolutely nothing"

uhhh... I cited 3 specific cases where MDs were actively being recruited more by programs that flipped from AOA to ACGME (even after retaining DO PDs)
(1) Chicago surgery programs interviewed MD students even though they weren't even pre-accredited yet last year
(2) Michigan orthopedic surgery filed their paperwork early, got ACGME accreditation, and they recruited a full US MD PGY-1 class this year (even though they still have a DO PD)
(3) Historic AOA surgery programs that flipped to ACGME pre-2015 (like Iowa's gen-surg, NY's neurosurgery, etc.) recruit MDs now.

 

[AnatomyGrey12]

Quick question:

All of these programs that have "continued pre-accreditation ", what does that mean? Were those programs visited, told to make some changes, and are going to be reviewed again later?


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From my understanding that's exactly what it means. People need to remember that the ACGME rarely shuts programs down without giving them every opportunity to correct the issues they find.

Until the merger is 100% complete and the numbers show that surgery is impossible as a DO I will maintain my position that if you want something and have the app for it, you will match it. The "end of surgery, period" for DOs rhetoric is absurd.

Edit: lol, apparently I hit the I on my phone instead of the U when I typed shuts....

 

[Ho0v-man]

From my understanding that's exactly what it means. People need to remember that the ACGME rarely shuts programs down without giving them every opportunity to correct the issues they find.

Until the merger is 100% complete and the numbers show that surgery is impossible as a DO I will maintain my position that if you want something and have the app for it, you will match it. The "end of surgery, period" for DOs rhetoric is absurd.

Edit: lol, apparently I hit the I on my phone instead of the U when I typed shuts....

Well most general surgery programs are falling under that status. That kind of makes sense, doesn't it? It seems a little pre-emptive to say these programs are going to shut down just because the initial review wasn't perfect. It apparently takes 4-9 months from submission of the application for the initial review and the same amount of time to follow up if they don't qualify for initial accreditation. So most if not all of those programs haven't even had a follow up.

5-6 of them got initial accreditation right away. Unless I've miscounted, it looks like 9 programs haven't even been evaluated by the acgme so it seems pretty early in the game to say that all of these programs are innately doomed because most of them weren't perfect right away. That should have been expected.

The more justifiable fear seems to be increased competition for these spots from MDs and not necessarily that these spots are going away.

Please someone with more knowledge on the subject feel free to correct me on the matter.


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[Moose A Moose]

Cardiology is an inflated field right now. Not easy but not impossible. GI and Pulm will be the new Cardiology in 5-10 years as demand will increase but there hasn't been a significant increase in programs like Cardiology.

Betchya ENT is gonna spike as well when you see everyone in the younger generations going in with damage from their earbuds within the next few decades. Lol.

 

[Ioannes Paulus]

Betchya ENT is gonna spike as well when you see everyone in the younger generations going in with damage from their earbuds within the next few decades. Lol.

Yeah ENT is fascinating. I think HEENT pathology is the coolest.

 

[JB50]

Yeah ENT is fascinating. I think HEENT pathology is the coolest.

I actually prefer neonatal oncological anatomical pathology myself.

lol

Just playin

 

[Mh0311]

I'm more interested in surgical specialties, would it be dumb to forgo a D.O acceptance (AZCOM, KCU) if I don't get in the MD school I interviewed at and instead try applying again next cycle for the MD again?

 

[AlteredScale]

I'm more interested in surgical specialties, would it be dumb to forgo a D.O acceptance (AZCOM, KCU) if I don't get in the MD school I interviewed at and instead try applying again next cycle for the MD again?

If you have an acceptance you should take what you have. However, if you have trouble with the idea of primary care or doing residency at a not so prestigious place then by all means you should reapply MD.

It is possible to do surgical subspecialties at DO schools especially Kcu and AZCOM. It will be an uphill battle.


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[68PGunner]

What's up with every premeds and first and second year students wanting to do surgery nowadays?

Is this a new thing or has it always been like this until 3rd yr surgical rotation?

 

[pseud0]

What's up with every premeds and first and second year students wanting to do surgery nowadays?

Is this a new thing or has it always been like this until 3rd yr surgical rotation?

Grey's Anatomy.