DO's in an allopathic EM residency

[sddoc]

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If you decide to go into an allopathic residency, do you need to do a separate internship at an osteopathic hospital? In other words, do you have to complete a total of 4 years even if the residency program is only 3 years?

I can't seem to find any information that clearly states the policy. Thanks for your help!

 

[DocWagner]

Nope...
While it is widely stated that you cannot practice in the "5 states" without the DO internship year, you can get around that law. In other words, no it is not necessary to do an Osteopathic internship prior to residency in 45 states, and the remaining 5 would take some work, but it can be done (besides florida, why go to the other 4 anyway?!)

 

[sddoc]

Thanks for the info. I was starting to get a bit worried!

 

[Dr JPH]

Dr. Wagner is 100% correct.

However, just because it CAN be done...getting around the internship requirement...does not mean that it is by any means easy.

Also, there is the consideration that the year of internship can make you more competitive for a residency position...not to mention the fact that it can make you a better doctor...more patients, more experience.

Also, don't be so critical of doing 4 years post-doc. There are a considerable portion of EM residencies that are 4 years in duration...and some believe that this will be the trend in the future. I seem to think it will be.

So, even though you CAN get out of the internship year, make sure you are clear on your options should you decide to bypass the step.

Good luck.

 

[DrQuinn]

Originally posted by JPHazelton
Also, don't be so critical of doing 4 years post-doc. There are a considerable portion of EM residencies that are 4 years in duration...and some believe that this will be the trend in the future. I seem to think it will be.

So, even though you CAN get out of the internship year, make sure you are clear on your options should you decide to bypass the step.

Good luck.

I have to disagree. The trend is actually more towards a 3 year EM program. Look at all the new EM programs that have popped up around the nation. The majority (if not all) are three year programs. I off the top of my head, am thinking of Duke, USF, Maimoinides. They are all three year EM programs.

And having been through a week of orientation, and talked to three different people who did three different DO traditional internships, they all agree that it was a complete waste of time.

And in regards to the internship year being waived, this was at one point a consideratino for me... having to do the DO internship... but a DO psychiatrist I knew who did his training at a large MD university hospital, said he "knew of 5 people off the top of his head who got it waived EASILY."

Q, DO

 

[doc1]

I just finished my traditional osteopathic internship and am starting my first year at an allopathic EM residency. My past year of experience has been very valuable. I think that an "extra" year of supervised training and experience in a field as broad as emergency medicine is very benificial. I know that the majority of residencies are three years, but I know that having this year experience over the other allopathic residents in my program is definatley advantagous. I may be singing a different tune in 2 years, but I honestly don't think so. The more I can see during a residency when I still have attendings to back me up, the better. Plus, by finishing the internship there are no hurdles to go through for state liscence in the "five states". Just my experiences.

doc1

 

[jonwilli]

hey quinn,

i know you are at USF. i am a LECOM student over in St. Pete. Does anyone over there know the exact rules about overriding the DO internship stuff. I know for a fact that some 3 year programs would rather not have a resident that has had an internship--straight from a ER residency administrator. i want to stay in the SE--either USF, UF, MCG, or Palmetto.....anybody got any input???

 

[DrQuinn]

One new perspective that was brought up to be about doing an extra year (be it a year of DO internship or a four year program), is that you need to think of it as being your last year before retirement. Do you want to retire when you're 59 or 60? And that one year at THAT point will likely be 300-350k difference. A lot of people put the year difference as a startign salary, but you can also think of it as a year less that you'll have to work before you retire. After 20 years of being an attending, that's close to 300-350 (around here anyways).

Q, DO

 

[Freeeedom!]

Another way of looking at it, was that by NOT doing my "traditional internship year" and doing a 3 year EM residency, I feel that I have an "additional year"...of which I will be doing a 1 year sports med fellowship. So, I will have my entire residency plus a fellowship completed at the same time most DO's have completed the 3+1 residency.
And as a second year EM resident, that just sounds like the best move for my career and for my wife!

 

[doc1]

I think it's interesting how little support there is from people on this site for the traditional osteopathic internship. It seems like this year of training is such a huge burden. When I first started osteopathic med school, I thought the internship was a very good tradition. That Osteopathic physicians truly were subscribing to the philosophy of generalists first. Most doctors twenty years ago did a rotating intern year and then went on to specialize. I thought it was a great experience to revisit all of the specialties that you rotated through as third year. I guess it was just "wasted" if you read a lot of what is posted around here.

doc1

 

[edinOH]

doc1,

I'm not a DO but perhaps some of the posters here don't see it as being as valuable to an EM resident as it would be to an ophthalmology resident or the like. After all, EM is about as "generalist" as they come. My intern year looks suspiciously like my third year of medical school. (The only difference is that I've forgotten everything I knew in third year!)😱

 

[DrQuinn]

I will admit that any one who did a one year DO internship would smoke/rape/demolish/word-of-choice/ me in patient care right now. Simply because of the experience.

But from what PD's, DO attendings, MD attnedings, and the like, those right out of medical school quickly catch up.

Your'e right, 20 years ago most people did a rotating internship. But the MD profession quickly moved away from deeming it necessary. Not because they wanted to specialize so quickly, but perhaps it was NOT necessary.

Q, DO

 

[Freeeedom!]

Quinn,


OUt of curiosity...how do you feel about the AAEM position regarding the Team Health association with your new residency in Tampa??

I knew you were interested in an AAEM position, correct...so does their opinion affect your involvement in the AAEM or your residency?

 

[DrQuinn]

Originally posted by Freeeedom!
Quinn,


OUt of curiosity...how do you feel about the AAEM position regarding the Team Health association with your new residency in Tampa??

I knew you were interested in an AAEM position, correct...so does their opinion affect your involvement in the AAEM or your residency?

Freeeeeeeeee-
Did a search on AAEM's website, but didn't find anything about their position on TeamHealth. I'd be pretty interested if you could tell me where to get it or what-not. I thought I read all my newsletters and stuff but something must have passed me by.

Having been about two and a half weeks into residency, I can say that Team Health's association with USF's EM residency is minimal at best. Even though the attendings are employees of TH (and I think are now connected to USF), their loyalties lie in the residency and the residents themselves. Believe it or not, some of the attendings here have taught me more stuff in one shift than some of the academic attendings did on my elective/audition rotations.

One thing that Team Health's association does effect is one of our "Emergency Medicine Administration" months (elective in third year I believe). We are invited to spend one week at any of Team Health's regional offices to see how administration of contracts/departments work.

I do not regret my decision one bit about going to USF, and can honestly say that Team Health has less than a 2% infleunce on the residency or the training.

I will say that TGH has some phenomenal pathology. Unlike my audition rotations (which were in Philadelphia and Baltimore), the patient pathology is quite varied! It is indeed a cornucopia of patients. You'll get your IVDU/Cocaine addicts, your alcoholics, your homeless, and most definately your trauma, but you also see a suburban/yuppie side of Tampa as well (as the hospital is right next to the nicest part of Tampa, $1,000,000+ homes). And we are getting a new ED which will be completed when I am a third year, so it definately is an up and coming residency.

I also REALLY enjoy the fact that no one is above me... that ANYTHING that goes on in the ED is potentially mine (or a fellow interns). And the one on one with the attendings is great.

I can see how some people would worry that the attendings are employees of Team Health... but in reality, what is the difference between those attendings and the 30 attendings at the University of X who are employees of a conglomerate/corporate body such as the "University of X Clinical Associates Group" or "Universtiy of X Emergency Associates." Same thing, 'cept TH is a bit bigger.

Q, DO

 

[Freeeedom!]

Here is what I read from the June 2003 AAEM UPDATE (a little 4 page mailer) sent to the Residency Review Committee for EM by the AAEM executive committee.

"ON behalf of the American Acadamy of Emergency Medicine, I (Joseph Wood, MD pres of AAEM, Robert McNamara MD past pres of AAEM etc) am writing to you with great concern regarding the Tampa General Hospital Emergency Medicine Residency Program and its sponsorship by TeamHealth as detailed in the April 2003 issue of Emergency Physicians Monthly. As you are aware the operating methods of corporate contract management groups such as Team Health are a concern in our specialty. The representatives from TeamHealth quoted in the mentioned article go to great lengths to poin out that they will not profit form this venture. Even if there was no direct proftit from this , the economic benefits to Team Health in the terms of the marketplace are enormous. The ligitimacy obtained by the blessing of this arrangement by the RRC-EM will aid this company in securing other ED contracts and enhance their status amoung physicians seeking EM opportunities. We at the AAEM have serious conerns about this arrangement. It is imperative than y corporation allowed to do business with the RRC-EM remain beyond reproach in order to preserve the integrity of the RRC-EM and the ACGME in their important roles of overseers of resident education. Dr. Sanders, you especially as an appointee to the RRC-EM from the AMA need to be aware of potential conflict with the AMA policies posed by this arrangement..."
(goes on to point out specifics such as loss of Due Process by corporate EM, some conflict with AMA policiy H-190-971, etc)

It goes on to say " The AAEM has definitive evidence in the form of physician contracts that Team Health does not follow AMA policy in the matters of due process and restrictive covenants."

wow.

 

[Blue_guitar9]

Ok this might be alittle of topic, but as a DO student trying to get a decent EM residency do I need to take the USMLE as well as the COMLEX or would the one test do just fine. Thanks.

 

[DrQuinn]

Originally posted by Blue_guitar9
Ok this might be alittle of topic, but as a DO student trying to get a decent EM residency do I need to take the USMLE as well as the COMLEX or would the one test do just fine. Thanks.

First off, I will say that i believe the SAEM.ORG website has a good essay on "to take the USMLE or not" for DO students. I don't knwo if its still on there but I would read it...

I did NOT take the USMLE, and did in fact match at my #1 choice (and had several post-interview contacts from the PD personally). So I can somewhat gleam from that information that i was atleast on par with my fellow MD applicants for EM spots...

However, I did very well on the COMLEX 1 (93%ile).

Here's where I think it may make a difference. If you scored subpar or average on the COMLEX, I think you shoudl go ahead and take the USMLE... maybe you'll do much better on it, and that's what you can send in to the residencies.

If you scored well on your COMLEX, there's no need to take the USMLE because you're in the 75%ile+.

I got about half of my ERAS applications back with interview offers. Maybe if I had taken the USMLE I mgiht have got 75% back. But I ended up only interviewing at 9 or so (and turned down 10 or so)... and it only takes one residency to match.

Q, DO

 

[DrQuinn]

Originally posted by Freeeedom!
Here is what I read from the June 2003 AAEM UPDATE (a little 4 page mailer) sent to the Residency Review Committee for EM by the AAEM executive committee.

"ON behalf of the American Acadamy of Emergency Medicine, I (Joseph Wood, MD pres of AAEM, Robert McNamara MD past pres of AAEM etc) am writing to you with great concern regarding the Tampa General Hospital Emergency Medicine Residency Program and its sponsorship by TeamHealth as detailed in the April 2003 issue of Emergency Physicians Monthly. As you are aware the operating methods of corporate contract management groups such as Team Health are a concern in our specialty. The representatives from TeamHealth quoted in the mentioned article go to great lengths to poin out that they will not profit form this venture. Even if there was no direct proftit from this , the economic benefits to Team Health in the terms of the marketplace are enormous. The ligitimacy obtained by the blessing of this arrangement by the RRC-EM will aid this company in securing other ED contracts and enhance their status amoung physicians seeking EM opportunities. We at the AAEM have serious conerns about this arrangement. It is imperative than y corporation allowed to do business with the RRC-EM remain beyond reproach in order to preserve the integrity of the RRC-EM and the ACGME in their important roles of overseers of resident education. Dr. Sanders, you especially as an appointee to the RRC-EM from the AMA need to be aware of potential conflict with the AMA policies posed by this arrangement..."
(goes on to point out specifics such as loss of Due Process by corporate EM, some conflict with AMA policiy H-190-971, etc)

It goes on to say " The AAEM has definitive evidence in the form of physician contracts that Team Health does not follow AMA policy in the matters of due process and restrictive covenants."

wow.

It indeed is a potent statement that AAEM sent out.

As an AAEM resident member myself, I know that one of their big missions is "anti-corporate EM," which is really what AAEM was founded on.

I really don't have a problem with it. You'll find corporate medicine in everything, FP, IM, Surgery, EM, Anesthesia, blah blah blah. My feeling about my residency is...

I do'nt care who pays my attendings, be it Team Health, USF, Tampa general Hospital, the county of Hillsborough, or Bill Gates... as long as they are ABEM certified, and can teach me what i need to know, AND I become ABEM certified, that's all I need. I am not a political creature, so who the domain the administration's second email address is from doesn't mean much to me...

🙂
Q, DO

 

[ryanpj]

WIth florida being one of the 5 states that you must have done a DO internship in order to practice, how do you and other D.O's get around that rule in your residency?