EM is a Four-Year DO Residency - Why?

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thomasfx10

thomasfx10

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Why is the AOA residency for an EM 4 years and a MD EM residency is 3 years?

Does that mean you are stuck working 60-70 hours a week, getting paid 40-50K a year longer than your MD peers?

It would seem logical to try for a MD residency, and avoid the AOA. How hard is it to get a MD residency if you score well on the Steps?

Thanks!
 
thomasfx10 said:
Why is the AOA residency for an EM 4 years and a MD EM residency is 3 years?

Does that mean you are stuck working 60-70 hours a week, getting paid 40-50K a year longer than your MD peers?

It would seem logical to try for a MD residency, and avoid the AOA. How hard is it to get a MD residency if you score well on the Steps?

Thanks!
Click to expand...

There are 4 year ACGME (MD) residencies as well.

The AOA programs are 4 years mostly due to the required rotating internship, followed by 3 years of EM.
 
thomasfx10 said:
Why is the AOA residency for an EM 4 years and a MD EM residency is 3 years?

Does that mean you are stuck working 60-70 hours a week, getting paid 40-50K a year longer than your MD peers?

It would seem logical to try for a MD residency, and avoid the AOA. How hard is it to get a MD residency if you score well on the Steps?

Thanks!
Click to expand...

I think ~68% of those applying for ACGME EM in 2009 matched.
 
christina30 said:
There are 4 year ACGME (MD) residencies as well.

The AOA programs are 4 years mostly due to the required rotating internship, followed by 3 years of EM.
Click to expand...

This is the big point right here. There are 3 and 4 year options in the ACGME world. My understanding is most are 4 years.

I saw a EM residency director be asked about the difference between the two programs. He basically said that if you want to do EM or an EM-specific sub-specialty you should be doing the 4 year program because it shows more dedication to the field and, in his mind, gives your priority over 3 year programs when applying for sub-specialties.

He said that the 3 years programs are for people who are either 100% sure they just want to do vanilla EM, or people who know that they want to go into something that utilizes an EM skillset, but will likely seek a fellowship somewhat outside of the "straight EM" fellowships and subspecialites... at which point finishing residency alone is enough qualification, the extra year of EM wont help you as its not a directly EM-related field your considering a fellowship in.
 
LastPolarBear said:
Interesting. Were numbers higher in the past?
Click to expand...

I'm not sure. I doubt it, however. The overall ACGME match rate for DOs has been around 70% for the last few years. By the way, since MD and DO schools are expanding and ACGME residencies are not expanding at the same rate, I expect the DO match rate to decline in upcoming years.

The overall ACGME match rate for DOs was 70.6% in 2010, 69.9% in 2009, 71.6% in 2008, 68.8% in 2007 and 67.9% in 2006.
 
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Sinfest said:
Is that including those that also applied AOA, therefore withdrawing from ACGME if they matched AOA?
Click to expand...


I don't think so. I could be wrong, though. I think it is only those who are considered "active applicants"; aka those truely trying to match ACGME EM.
 
cliquesh said:
I'm not sure. I doubt it, however. The overall ACGME match rate for DOs has been around 70% for the last few years. By the way, since MD and DO schools are expanding and ACGME residencies are not expanding at the same rate, I expect the DO match rate to decline in upcoming years.

The overall ACGME match rate for DOs was 70.6% in 2010, 69.9% in 2009, 71.6% in 2008, 68.8% in 2007 and 67.9% in 2006.
Click to expand...

This comment was created by combining multiple isolated and unrelated facts to try to make a cohesive argument. If it turns out to not be true, i apologize, but i think it should hold up fine.

Your argument has a flaw in that there is a very large excess of ACGME spots. Very, very, very large. And for that matter the percentage of DO students who go into the AOA match increases every year. (at 51% in 2010, up from 48 and 49% recently). The giant excess of ACGME spots are in 'less desirable' residencies though. But, coinicidentally, EM is one of those 'less desirable' residencies. Despite it actually be a good residency for a bunch of reasons, its among those residencies where there are a lot of extra spots to be had across the country.

So with all of this, my only assumption is that 70% is either the pre-scramble match rate for all resident applicants to EM (MD and DO). At which point this is a non-story. Or it could be that 30% of DOs have no clue what they are qualified for, as they are applying to only overly-competitive spots when plenty of spots within their same field go unfilled. And those spots are likely available in *somewhat* local areas to wherever they applied.

and a point of information, all of these facts are pre-scramble. As neither the ACGME nor the AOA collects post-scramble data for these statistics. The only post-scramble data available comes from the federal government, which makes no differentiation between MD and DO students, so the specifics cant be extrapolated from that data.
 
Thanks everyone for your posts. It looks like the rotating internship is a State rule with the below states, am I correct?

The 5 states that require a DO internship are Florida, Oklahoma, West Virginia, Michigan, and Pennsylvania.

So, if you do a MD residency (3 years) as a DO in EM, then you can still practice in these states or are all DO's tied to the rotating internship in these 5 states no matter if AOA or MD resident. Thanks
 
DocEspana said:
This comment was created by combining multiple isolated and unrelated facts to try to make a cohesive argument. If it turns out to not be true, i apologize, but i think it should hold up fine.

Your argument has a flaw in that there is a very large excess of ACGME spots. Very, very, very large. And for that matter the percentage of DO students who go into the AOA match increases every year. (at 51% in 2010, up from 48 and 49% recently). The giant excess of ACGME spots are in 'less desirable' residencies though. But, coinicidentally, EM is one of those 'less desirable' residencies. Despite it actually be a good residency for a bunch of reasons, its among those residencies where there are a lot of extra spots to be had across the country.

So with all of this, my only assumption is that 70% is either the pre-scramble match rate for all resident applicants to EM (MD and DO). At which point this is a non-story. Or it could be that 30% of DOs have no clue what they are qualified for, as they are applying to only overly-competitive spots when plenty of spots within their same field go unfilled. And those spots are likely available in *somewhat* local areas to wherever they applied.

and a point of information, all of these facts are pre-scramble. As neither the ACGME nor the AOA collects post-scramble data for these statistics. The only post-scramble data available comes from the federal government, which makes no differentiation between MD and DO students, so the specifics cant be extrapolated from that data.
Click to expand...

I'm sorry, I don't really understand what you have a problem with. Yeah, 68% is a pre-scramble figure, but it applies only to DOs. The match rate for MDs is close to 92% for EM. Additionally, in 2009, 1459 of 1472 ACGME EM spots were filled pre-scramble, so there are not many people matching post scramble.

There were 25,520 PGY1 and PGY2 ACGME spots offered last year and there were 37k applicants. 24,378 of those 25,520 spots were filled pre-scramble. Moreover, by 2013, the MD class is going to be 12.5% larger than it was in 2010, the DO class will be 20% larger, and who knows how many more IMGs there will be. And since our economy is so crappy, do you really think the federal government is going to expand residencies at the same rate? I doubt it. People, MDs and DOs alike, will be "forced" into primary care. Maybe not by 2013, but in the near future. That is just my opinion, however.

Where did you get 51% DOs matching AOA in 2010? Natmatch says 41.2% of all DOs matched AOA in 2010.
 
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cliquesh said:
I'm not sure. I doubt it, however. The overall ACGME match rate for DOs has been around 70% for the last few years. By the way, since MD and DO schools are expanding and ACGME residencies are not expanding at the same rate, I expect the DO match rate to decline in upcoming years.

The overall ACGME match rate for DOs was 70.6% in 2010, 69.9% in 2009, 71.6% in 2008, 68.8% in 2007 and 67.9% in 2006.
Click to expand...

To be honest, these numbers are actually a little bit disheartening. Nothing to really do about it though, just have to work even harder later on.
 
LastPolarBear said:
To be honest, these numbers are actually a little bit disheartening. Nothing to really do about it though, just have to work even harder later on.
Click to expand...

Take the USMLE and don't suck during your first two years, and you will be fine.
 
thomasfx10 said:
Thanks everyone for your posts. It looks like the rotating internship is a State rule with the below states, am I correct?

The 5 states that require a DO internship are Florida, Oklahoma, West Virginia, Michigan, and Pennsylvania.

So, if you do a MD residency (3 years) as a DO in EM, then you can still practice in these states or are all DO's tied to the rotating internship in these 5 states no matter if AOA or MD resident. Thanks
Click to expand...

If you do any AOA residency you can practice anywhere. The rule only applies to DOs who did not do an AOA residency. They must do a residency year if they chose an ACGME residency and wish to practice in those 5 states. PA may have modified their version of the law recently, but i only skimmed that topic on the forums so i dont really remember if they did or not.
 
thomasfx10 said:
Thanks everyone for your posts. It looks like the rotating internship is a State rule with the below states, am I correct?

The 5 states that require a DO internship are Florida, Oklahoma, West Virginia, Michigan, and Pennsylvania.

So, if you do a MD residency (3 years) as a DO in EM, then you can still practice in these states or are all DO's tied to the rotating internship in these 5 states no matter if AOA or MD resident. Thanks
Click to expand...

There is a thing called Resolution 42, which allows you to petition to the AOA to allow your ACGME PGY-1 to count as a rotating internship.

http://www.osteopathic.org/inside-aoa/Education/postdoctoral-training/Pages/resolution-42.aspx
 
DocEspana said:
If you do any AOA residency you can practice anywhere. The rule only applies to DOs who did not do an AOA residency. They must do a residency year if they chose an ACGME residency and wish to practice in those 5 states. PA may have modified their version of the law recently, but i only skimmed that topic on the forums so i dont really remember if they did or not.
Click to expand...

PA no longer accepts applications for Resolution 42. The change occured in July, I believe. For osteopathic neophytes, the law requiring DOs to complete a rotating internship is a self-imposed law created by the AOA. The state doesn't actually require you to do it; the AOA does.
 
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Plenty of DO students match into MD EM residencies. Allopathic EM s a very DO "friendly" specialty.

I take issue with some of the points brought up by DocEspana. My experience has been very different than what the EM Director he spoke to said.

Most allopathic EM residencies are 3 years. Those that are 4 yrs tend to be a bit more academic or research oriented. A 4 yr program offers more time for electives and research.

If you chose to do an EM fellowship there is usually no issue with having done a 3 yr program. The main exception is applying for fellowship at a program which has a 4 yr residency. Some programs frown on having PGY4 fellows supervising and working with PGY4 residents. This is by no means an absolute. I know several 3yr EM residency grads currently doing fellowships at programs with 4 yr residencies.

In addition EM is not an undesirable specialty and is becoming more competitive each year. The last few years there have been very few scramble spots available. That being said EM as a specialty is not just all about board scores and grades. Your EM LORs and EM rotation grades as well as your interview play very heavy in the selection process.

Good luck to those of you considering the field. You don't need to be a superstar! A solid academic background and great EM rotations will take you far.
 
So are DO FM and IM residencies four years as well? Or does their first year count as the internship? If so, why doesn't this apply to EM? Why aren't all DO residencies longer than their MD counterparts?

Also, I think it would be pretty epic if every thread started with "x is this but z is _____ - Why?" interrogative kind of stuff.

Imagine:
"You didn't search before starting a new thread- WHY!?"
"You took time out of your resident schedule just to call an admissions office just to flame them on SDN- WHY!?
"LECOM is cheaper than WVSOM- WHY!?"
"You think Carib is better than DO- WHY!?"
etc. etc.
 
NurWollen said:
So are DO FM and IM residencies four years as well? Or does their first year count as the internship? If so, why doesn't this apply to EM? Why aren't all DO residencies longer than their MD counterparts?

Also, I think it would be pretty epic if every thread started with "x is this but z is _____ - Why?" interrogative kind of stuff.

Imagine:
"You didn't search before starting a new thread- WHY!?"
"You took time out of your resident schedule just to call an admissions office just to flame them on SDN- WHY!?
"LECOM is cheaper than WVSOM- WHY!?"
"You think Carib is better than DO- WHY!?"
etc. etc.
Click to expand...

FM is 3, IM is 4.
 
DocEspana said:
This is the big point right here. There are 3 and 4 year options in the ACGME world. My understanding is most are 4 years.

I saw a EM residency director be asked about the difference between the two programs. He basically said that if you want to do EM or an EM-specific sub-specialty you should be doing the 4 year program because it shows more dedication to the field and, in his mind, gives your priority over 3 year programs when applying for sub-specialties.

He said that the 3 years programs are for people who are either 100% sure they just want to do vanilla EM, or people who know that they want to go into something that utilizes an EM skillset, but will likely seek a fellowship somewhat outside of the "straight EM" fellowships and subspecialites... at which point finishing residency alone is enough qualification, the extra year of EM wont help you as its not a directly EM-related field your considering a fellowship in.
Click to expand...

Most EM residencies are 3 years chief, and you know what they call a 4 year residency? A $250,000 mistake. The only reason to do a 4 year residency is if you want to work in academics, that too at 4 year programs, because they can't have you bossing around their pgy4s.
 
Sam212 said:
Most EM residencies are 3 years chief, and you know what they call a 4 year residency? A $250,000 mistake. The only reason to do a 4 year residency is if you want to work in academics, that too at 4 year programs, because they can't have you bossing around their pgy4s.
Click to expand...

👍
 
beanbean said:
I take issue with some of the points brought up by DocEspana. My experience has been very different than what the EM Director he spoke to said.

Most allopathic EM residencies are 3 years. Those that are 4 yrs tend to be a bit more academic or research oriented. A 4 yr program offers more time for electives and research.

If you chose to do an EM fellowship there is usually no issue with having done a 3 yr program. The main exception is applying for fellowship at a program which has a 4 yr residency. Some programs frown on having PGY4 fellows supervising and working with PGY4 residents. This is by no means an absolute. I know several 3yr EM residency grads currently doing fellowships at programs with 4 yr residencies.
Click to expand...
You took the words out of my mouth....agree with everything you posted. 👍
 
Sam212 said:
Not true, IM is 3 years as well
Click to expand...
Correct.
Sam212 said:
Most EM residencies are 3 years chief, and you know what they call a 4 year residency? A $250,000 mistake. The only reason to do a 4 year residency is if you want to work in academics, that too at 4 year programs, because they can't have you bossing around their pgy4s.
Click to expand...
Correct again. :laugh:
 
Just to throw in m 2 cents:

I have heard from several sources that many allopathic EM residencies are shifting to the 4 year format. It is true that traditionally allo EM residencies have been primarily 3 years, but it seems that there is a trend leading many to become 4 year.

This may or may not be true, but again, I have heard several people discuss this matter.
 
theone1979 said:
Just to throw in m 2 cents:

I have heard from several sources that many allopathic EM residencies are shifting to the 4 year format. It is true that traditionally allo EM residencies have been primarily 3 years, but it seems that there is a trend leading many to become 4 year.

This may or may not be true, but again, I have heard several people discuss this matter.
Click to expand...

No such trend. Stop repeating crap.
 
I went to the link http://opportunities.osteopathic.org, looking at AOA EM residencies in states other than the five (Florida, Oklahoma, West Virginia, Michigan, and Pennsylvania) that require the DO internship, it appears (if I am reading this correct) that they are four years as well (see AZ).

Salary and Vacation
Salary​
Vacation​
OGME 1
48901​
15​
OGME 2
51187​
20​
OGME 3
53417​
20​
OGME 4
54780​
20​
OGME 5
0​
0​


So my question is, has the other states just decided to go with the AOA four-year program for their EM positions as well?

If that is not correct, then how would it work out if you did a three-year EM AOA residency in a state other than the five states and then came back to say to Florida after your residency. Would you be required to still do an internship?

It looks like the best thing to do if you want EM in one of the five states is to try to land a MD residency and apply for Resolution 42.

I am just trying to figure out this confusion. Thanks!
 
All DO EM programs are 4 years, it has nothing to do with the state that the residency is in. That is the length that the certifying board (ABOEM) has decided to require for training in an osteopathic EM residency. It used to be that it was a separate intern year followed by a 3 year residency, but it has been a linked 4 year program for a while now.

Any DO residency qualifies for the states that require a "DO internship." I put that in quotes because that really isn't an accurate statement. For example, Oklahoma is included on that list, but a DO internship is not required for licensure. Certain rotations are required and a DO internship meets those, but so do other intern years.

Please search the forums for resolution 42 and osteopathic internship as there are a ton of threads that address this topic and what to do if you want to get licensed in certain states.
 
So what's the deal if a DO applies to an MD residency for EM? Is the residency 3 years or is there something I'm missing?

Are all DO's required to do an additional year of internship regardless of specialty? Or is this a state by state thing?
 
Residency length isn't a state by state issue and it doesn't depend on the degree the Dr has (other than the fact that MDs cannot enter DO residencies).

All DO EM programs are 4 years. Some MD programs are 3 years, a few are 4. If a DO matches to a 3 year program it still is a 3 year program.

There are a few states that have more specific licensure requirements. If you want to get a license to practice in those states, then you will have to meet their requirements.
 
As of 2010, West Virginia no longer requires the AOA internship either, so it's down to PA, MI, OK, and FL. Those 4 states' osteopathic medical boards still require the "traditional 1-year osteopathic rotating internship" to gain an unrestricted medical license that would let you work as an attending, so far as I know--I haven't heard anything different about Oklahoma, could someone elaborate on their requirements? Anyway, you could still go through an ACGME residency in these states, but you might not be able to get an unrestricted license to practice once you finished, irrespective of board certification or whatever else... at least, not without Resolution 42 approval.

You can get Resolution 42 approval from the AOA for your 1st year in an ACGME residency in most circumstances, allowing you to skip the AOA internship requirements. PA is indeed proposing that Res 42 not be allowed, there's something in the DO student forums about it:
http://forums.studentdoctor.net/showthread.php?t=783875
 
Oklahoma does not require an osteopathic internship and it isn't a recent change (and I'm not sure they ever required a DO internship). They do require certain rotations during the intern year, but it can be an MD program.
 
Okay, thanks for clearing it up DrMom...

Altruist, so are PA, MI, OK, and FL require the "DO internship" for ALL residencies, including anethesiology, FM, etc...I actually live in Illinois and hope to do my residency here, is there an internship that I'd have to do for these specialties?

Thanks in advance.
 
What I was told from a resident at a 4-year allo EM program - "3 years is too short, 4 years is too long, so I guess we went with 4"
 
Honestly, 3 1/2 years would be perfect. At the beginning of my 3rd year I was glad to have a little more time under someone else's wings. After December I was desperately wanting to be done and on my own.

Now that I've been out for a little while I'd say I was personally more ready and more confident with that 4th year (and a bunch of moonlighting).
 
sorry to bump this, but if a DO student opted to do a 3-year MD residency outside of the states listed above (PA, MI, OK, FL) without a DO internship then would that mean that they would NOT be licensed to practice in those states.

The way I understand it is that if you were for example, to do MD residency in Michigan then depending on the program they would allow you to tweak their 3 year curriculum, you lose out on your electives but then you would be fully licensed to practice in all states including Michigan

but how about if you were to do a 3 year MD residency, say in New York, and no tweaking option was available to you, does that mean that you would not be licensed to practice in the above states?

Can someone clear this up for me?
 
If you want to practice in those 4 states as a DO you must either do an AOA residency, an AOA traditional rotating internship, or get resolution 42 approval for your acgme residency. What you are describing in your Michigan example is resolution 42, which is a process that allows your acgme residency to fulfill the AOA training requirements in those 4 states. Its basically paper work, plus some OMM classes, plus a few more primary care rotations.

If you do your residency at an acgme program in new york, or any other state, and you get resolution 42 approval you can practice PA, MI, OK, and FL. If you do not get approval, you will not be able to practice in those 4 states.

Almost everyone who applies for resolution 42 approval gets it.

I think i read they are planning on getting rid of this requirement because of the upcoming acgme/aoa merger, but I dont know if this is true or not.
 
Thanks for the reply, So do all ACGME programs comply with resolution 42 requirements in terms of tweaking the curriculum once you get approval or is it program dependent?
and omm classes? I hadn't read about that, where and how time consuming would these OMM classes be
 
cliquesh said:
I'm not sure. I doubt it, however. The overall ACGME match rate for DOs has been around 70% for the last few years. By the way, since MD and DO schools are expanding and ACGME residencies are not expanding at the same rate, I expect the DO match rate to decline in upcoming years.

The overall ACGME match rate for DOs was 70.6% in 2010, 69.9% in 2009, 71.6% in 2008, 68.8% in 2007 and 67.9% in 2006.
Click to expand...
That the DO match rates have remained fairly static despite a substantial increase in DO applicants between 2006 and 2014 is a pretty good sign IMO.
 
Mad Jack said:
That the DO match rates have remained fairly static despite a substantial increase in DO applicants between 2006 and 2014 is a pretty good sign IMO.
Click to expand...

Yep, my predictions were wrong. I think SDN is filled with cynical people, including myself, and everything negative on here should probably be taken with a grain of salt.
 
cliquesh said:
Yep, my predictions were wrong. I think SDN is filled with cynical people, including myself, and everything negative on here should probably be taken with a grain of salt.
Click to expand...
I think you've said this before. But do you think the consistent increase in match rates is due to schools better preparing their students for the USMLE, the students themselves taking it more seriously or programs being more accepting of DOs or all three?
 
I think the average DO student today is a stronger test taker than a DO 5 or 10 years ago. Also, I think once a program takes a DO and the DO makes a good resident that program is more incline to take DOs in the future.
 
cliquesh said:
I think the average DO student today is a stronger test taker than a DO 5 or 10 years ago. Also, I think once a program takes a DO and the DO makes a good resident that program is more incline to take DOs in the future.
Click to expand...
It will be interesting to see what changes happen as the merger unfolds
 
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