Future of AOBA residencies with Merger

[Mehd School]

Hi everyone,

4th year Osteopathic student here applying anesthesia. I wanted to come here and gain insight on the current state of AOBA residencies, especially in regards to residency merger. I have an audition month scheduled at Oklahoma state, and another two at ACGME programs. I'm taking Step 1 in two weeks (had to cancel last year due to death of family member two days before test date) and practice tests are in the 240's so hopefully I can score in that ballpark.

I am couple's matching and of course am anxious that I'll go through this process and apply to 30 programs and have 2 interviews. Because of this I intend to apply to a select few AOA programs as well. I've looked around at jobs in my preferred area of the country where I'd like to live and work and >50% of the jobs specifically state that they *require* ACGME training.

Well, by the time I finish residency there won't be anything other than ACGME training. Other places mention ABA boards, which I understand to be the gold standard. I've asked around with what will happen to previous AOA programs and who will board them and I am constantly met with "That's a good question...".

I called an AOA program that I will not be applying to and inquired about it, and was met with passive aggressive hostility. "Our training is just as good if not better than anywhere else and you'll be able to get a job anywhere you throw a dart on the map" blah blah.

My intentions are to score 240's on Step 1 and get some great ACGME interviews, but if it doesn't go that way and I like OK state I want to know if I'm going to make my career harder than need by ranking/matching there.

Thanks for reading.

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[AdmiralChz]

My friends that I've met along the way that are DOs in anesthesia are almost all united in their belief that if you can't get into an ACGME residency you should look at another field. You mentioned it, but >50% of jobs out there will not recognize AOA-based training and I think almost all fellowships require ACGME training as well.

As for the merger, if a program can't give you a straight answer that they intend to transition to ACGME by the time you'd graduate then move on. There are tons of new residency spots opening up, although it is tougher for a DO to break into the field it's still very doable with >50% on steps. Like I tell everyone who posts on here coming from DO programs - target DO-friendly programs specifically, if you don't see any in their residency profiles than think before applying.

You need a solid score on Step 1, assuming your COMLEX is up to snuff. I'd take Step 2 CK quickly as well, since all ACGME programs will want it anyway.

 

[Pharmado]

I'm a DO and unfortunately I agree with Admiral. From the research I did when applying to residency, the DO programs are simply not viewed with anything short of a dismissive wave if not outright contempt. Right or wrong, that is simply the way things are. You are doing yourself a HUGE disservice by going to a DO program in anesthesia. Anesthesia may be the only discipline where this is true. That may change in the future, but you shouldn't go into it thinking differently. If you score >220 on the STEP exams you should be able to match to an MD program somewhere if you apply broadly. 240 should get you plenty of interviews and land you a very solid program. I recommend ACGME or bust, but it is up to you.

Before considering a DO program I'd find someone who graduated from one and hit them up for all the details. That may be hard to do though, because there are WAY more ACGME spots than there are DO spots.

 

[Mehd School]

You need a solid score on Step 1, assuming your COMLEX is up to snuff.

Thanks for your insight. That's too bad that the discrimination for DO gas programs is basically a blanket statement of them being bad. I'm aware of what the critiques are and there is for sure merit for many of those programs. But places like OSU and MSU shouldn't be lumped in with those other places IMO. Ah well, that's life. I've worked with at least three anesthesiologists from Ok state as well as some from Wash U, Penn and Tulane. You wouldn't know who went where.

And my comlex level 1 score is not good. It is firmly below average. The solid step 1 score I'm about to achieve will likely erase that mark.

Maybe I'll look into cancelling this audition rotation at OSU considering it will significantly injure my career prospects.

Thanks again everyone, sincerely.

 

[nimbus]

I've worked with at least three anesthesiologists from Ok state as well as some from Wash U, Penn and Tulane. You wouldn't know who went where.

Where did you work with the OK State anesthesiologists? If you think you would be happy spending your career there, it wouldn't hurt to apply.

On a side note, I spent today with a fantastic DO electrophysiologist, ACGME trained however.

 

[Mehd School]

Where did you work with the OK State anesthesiologists? If you think you would be happy spending your career there, it wouldn't hurt to apply.

I did an anesthesiology rotation for a month about 2 hours away from Tulsa because I had an elective month and I had some family to stay with. I don't want to spend my career there, the city/state I want to work in isn't very DO friendly.

 

[Mehd School]

if you can't get into an ACGME residency you should look at another field. You mentioned it, but >50% of jobs out there will not recognize AOA-based training and I think almost all fellowships require ACGME training as well.

Forgot to mention earlier, but this is kind of the issue. When I graduate residency there will be no such thing as an AOA residency. They will all be ACGME, and I'm wondering if that changes things on the job front. I mean, if they meet all of the ACGME requirements and transition over (which almost all of them appear to be doing) I don't see how they could be discriminated against ... right?

 

[partydoc]

I think you might run into the problem of people not recognizing the name, unless you choose to work regionally

 

[nimbus]

Forgot to mention earlier, but this is kind of the issue. When I graduate residency there will be no such thing as an AOA residency. They will all be ACGME, and I'm wondering if that changes things on the job front. I mean, if they meet all of the ACGME requirements and transition over (which almost all of them appear to be doing) I don't see how they could be discriminated against ... right?

People discriminate between Brigham and MGH. They will certainly discriminate against a no name program.

 

[anbuitachi]

Go to ACGME program. Do decent on step 1. Done!. Anesthesiology is very uncompetitive these days and it's realy not hard to get into it. i wouldn't worry much about it unless you bomb step 1.

 

[Mehd School]

Go to ACGME program. Do decent on step 1. Done!. Anesthesiology is very uncompetitive these days and it's realy not hard to get into it. i wouldn't worry much about it unless you bomb step 1.

These are my intentions. Most of my worries are from the couple's match, and while I should be a very competitive applicant I'm still pretty anxious.

And also kind of the point of this post. By the time I graduate, Oklahoma state *will* be ACGME. Also - has no one really heard of OK state?

 

[el mero mero]

the answer to this is to only go to a program that has received initial accreditation by the acgme. do not risk your career on a program that may shut down after 2020.

 

[Chip N Sawbones]

I don't have numbers for DOs, but in the last match, 786 U.S. MD seniors ranked anesthesiology as their only specialty choice. 779 of them matched. As for the unlucky seven who didn't match, I'm guessing that they only ranked a handful of programs or had severe personality problems. Some of them probably found anesthesiology spots in the SOAP, or are going to end up matching to categorical programs after intern year, and everything worked all right for them as well. Whenever I start to get excessively worried about my chances in the match I just look at the statistics. Anesthesiology has gone through some wild swings in competitiveness, but at the moment it's definitely on the down cycle.

 

[DrfluffyMD]

Also - has no one really heard of OK state?

Depends. If you are going to work in OK then it's OK. If you are going to work at San Jose, CA, then the hiring partner may not be familiar with your training between all the MGH, BWH, Stanford and UCSF people he works with.

 

[BLADEMDA]

Depends. If you are going to work in OK then it's OK. If you are going to work at San Jose, CA, then the hiring partner may not be familiar with your training between all the MGH, BWH, Stanford and UCSF people he works with.

I doubt the profit motivated AMC will really care what program you went to. You will need Board Certification from the ABA or Osteopathic version (less likely going forward) but other than that the AMC just wants a warm body.

 

[DrfluffyMD]

I doubt the profit motivated AMC will really care what program you went to. You will need Board Certification from the ABA or Osteopathic version (less likely going forward) but other than that the AMC just wants a warm body.

In my experience, the big pedigree really helps if you have to be in three different areas in my field (Rads)
- NYC
- SF bay
- Socal

I was told that it's similar in almost all other nonprimary care fields.

 

[AdmiralChz]

I doubt the profit motivated AMC will really care what program you went to. You will need Board Certification from the ABA or Osteopathic version (less likely going forward) but other than that the AMC just wants a warm body.

Agree with this. As long as you aren't a total turnoff during an interview and are board eligible, a lot of places are going to give you a solid look. Of course the more desirable the location/job the more selective they can be, but from what I understand the most desirable places rely on word of mouth/local connections and do not use recruiters (and avoid their high fees) unless they need a large number of people due to retirements.

Of course "desirable" is very subjective from person to person depending on what they are looking for. There's a lot of options out there. Also, unsurprisingly, sometimes the more desirable the location the worse the jobs are given the high and steady supply of applicants. The Tampa market is an example of this.

 

[Pharmado]

My understanding about the DO programs was that they were viewed poorly because they were felt to fall into one or more of the following:
A) Poor case mix
B) Too few cases
C) Less strict case minimum standards (compared to ACGME standards)
D) Lower trauma designations

In looking at Oklahoma State, they only take 2 residents per year. This is likely because they only have the case volume to support 2 residents. This limits the scope, type and breadth of cases that you will see. Also, I looked at the hospitals that they rotate at. The Oklahoma State med center is a level 3 trauma center. It doesn't appear that the residents do trauma cases at all. Perhaps I'm biased, but I think you really need to see the knife and gun club type patients in residency to prepare yourself for the future. I will likely not work at a level 1 trauma center in the future as a matter of choice, but I can't explain how valuable it has been in my training. There are likely a significant number of things that you miss out on going to a residency without trauma exposure, and one where there are only 2 residents per class. You may get first choice of the cases, but first choice of a very limited case selection means little. I seriously urge you to avoid the DO programs, they just aren't up to the same standards.

 

[Mehd School]

Wow.

Thanks for that info Pharmado. I'm going to cancel that away rotation. I was under the impression that between OK state med center and Hillcrest there would be solid opportunities in all areas (including trauma). I'm also entering residency with the expectations of doing a fellowship, so that likely rules that program in particular out.

Thanks guys.