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So you think the extra 250k of debt to go to a certain MD is worth it over a reputable DO? (not sarcastic, just asking)
Going MD instead of DO for top specialities?
- Thread starter mariposas905
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So you think the extra 250k of debt to go to a certain MD is worth it over a reputable DO? (not sarcastic, just asking)
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Yep.
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I think that you're fine with DO as long as you're not boning for the uber-specialties, and you can avoid attending the newer schools (plus the three I distrust).
Should you try an MD cycle first? Yes, because more doors are open. But this is different than "more doors are closed". See this:
http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf
If your stats are middling, well, like average, then I suggest a mix of MD and DO.
If you've had to reinvent yourself, DO schools will be more forgiving.
I also don't think that tuition should concern you...from all the gestalt I get from med students and residents here, debt is not as onerous as you might think, especially if you're in a specialty. Now, =if you really like Primary Care, then the lesser debt of a DO school compared to an MD school might be a factor in deciding. And yes, I know that people's interest change a LOT in med school, but a lot of people proclaiming this in these fora are also doing a lot of projecting.
Do DO's have a harder time getting into ACMGE specialties? Yes. Do you have to work harder? Yes, but you're not afraid of hard work, are you? Are some doors shut? Absolutely. But what also gets unmentioned is that the same elitism applied to DOs by the "Top Residencies" (whatever they are) is also applied to MDs from non-Top 20 schools (whatever they are). And again, "more doors are open" is different than "more doors are closed".
So in reality, just because one has an MD, it doesn't mean that one can simply waltz into an uber residency. They're competitive for a reason.
Cue the self-hating DO students, angry that they couldn't get into an MD school.
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AnatomyGrey12
Not to mention the issue is going to be compounded by the massive influx of nedical school graduates that is going to happen in the next 10 years, both MD and DO. That will inflate competitiveness all on its own.
Since you’ve decided to be a little nasty with me the last few days Goro I’m not holding back anymore. You live in your adcom bubble and need to wake up and smell the roses when it comes to the merger. Go ask 4th years applying to competitive specialties right now, or the ones who just went through the NMS match. Better yet go find the ones who didn’t and ask them how competitive the merger has made things. Go ask OrthoJoe what is happening with ortho programs that have already achieved accreditation, they are literally saving spots for MDs at a lot of these places. Fewer spots simply means higher competition for DOs, it’s just a numbers game. A number of AOA General Surgery programs across the country are going to close down because their programs are simply garbage with zero research output, low caseloads, and they farmed their residents all over the country for a good number of their rotations. Former urology programs have already taken MDs. Neurosurgery programs same thing. Competitive specialties across the board are simply going to get more competitive for DO students. You will need to look increasingly more like an MD applicant if you want to compete with them, it can definitely be done, but DO schools largely lack the resources that most MD schools inherently have. This is made even more difficult by the fact that even if you put together a stellar application there will still be a lot of programs that won’t even look at it simply because you are a DO.
We don’t have to wait until 2020 to see the outcome of the merger. For the competitive specialties the merger has already happened and the outcome isn’t super pretty.
All of this is also affected by the fact that the match gets more competitive every single year in essentially every specialty. Applicants are having to be better and better than previous applicants just to get the same opportunities. Why choose the route that places more obstacles in your path?
The merger is not all doom and gloom. It has real benefits that will be good for DOs in the long run, but it has some serious downsides that need to be considered for someone who has the opportunity available to avoid them.
Why would we suggest that someone deal with all of this extra burden when they have an MD acceptance already in hand? To save some money that is easily made up over the course of a 30 year career?
Yes and I don’t even hesitate in saying that. 250k may seem like a lot to someone who is completely broke (ie us applying or currently in medical school) but 250k is easily made up over the course of a 30 year medical career.
No, but an average MD can waltz into a number of spots that a DO needs to be above average for. This is can be most easily seen in the fields like IM where your program has a huge impact on your fellowship opportunities.
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deleted600623
If the merger is so terrible for DO students, why the hell did the AOA agree to the merger?
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I don't necessarily agree that it's always a cut and dry situation. I had a similar situation (not just the money, other factors as well), chose to go DO, and have no regrets thus far. Between tuition/COA difference and the difference in my SO's salary, we're coming out of med school about $230k ahead of if I'd gone MD.
That being said, it's a different ball game for those entering now than when I entered. The AOA match will be gone, so you'll be competing with everyone for the more competitive fields. Which will make things significantly more difficult if you one chose the DO route. If you're 100% sure you don't want a competitive field, it's an alright move. It will certainly make a minimal difference for psychiatry (at least for now). However, I think you should do what you can to keep every door open possible in case you decide to change your mind, which means unless you've got a unique set of circumstances you'd be better off going MD over DO.
Because if the AOA declined the merger, the ACGME was going to cut any individual who graduated from a DO school off from ACGME fellowships, which would have been disastrous for DO students and schools alike. It was essentially a power play by the ACGME because the AOA wasn't playing nice with them in other areas. Personally, I'd like to see a merge in terms of the NBOME and NBME so there's only one set of boards and would even like to see a complete merge of the AOA and ACGME, but I don't think either of those will happen anytime soon as there's far too much money involved.
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Iirc, your situation was focused more on personal factors/SO's job requirements etc. That complicates things but I don't know of any other factor that has a similar impact.
Also, I support an LCME-COCA merger with DO schools being converted into MD, but politics will sadly prevent this from happening.
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The factors for me were money, fit of school, and career opportunities of my spouse. So far I've been very thankful I didn't go MD in my situation, though I'll have my definitive answer as to whether or not it was the correct decision in 2 weeks...
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AnatomyGrey12
They didn’t really have a choice. Any DO who graduated from an AOA residency would not have been eligible for ACGME fellowships. They were stiff armed.
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deleted600623
Anyone see the potential for reversal? The AOA has the ability to back out of the agreement until 2020 I believe.
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Where did this $250,000 number come from? $23,000 extra ($37k vs $60k) per year over 4 years is $92,000, and about $109,000 at graduation with interest.
It's worth it. The bar is lower, often significantly so, for a USMD at virtually every residency program in the country. It may also be somewhat more difficult for similarly-trained DOs to get attending jobs vs MDs. Bias is real, at all levels. On top of that, awareness of DOs is really quite low among non-medical people in the US, and it's kind of a struggle to explain to skeptical people "I'm just like an MD." That may or may not matter to you, but it's something to consider.
It's also worth looking at the differences in the curriculum. Few DO schools are attached directly to major academic medical centers, meaning many of your core clinicals will be offsite and/or marginal. It also means that, as far as I understand (and correct me if I'm wrong) you often don't have the benefit of training alongside residents in your rotations. I'm not familiar with the details of accreditation, but it seems to me that the LCME is far more strict with regards to medical school accreditation than COCA.
In my opinion, it's only worth going DO over MD if there are highly unusual circumstances, such as the DO program being closer to wife/kids, the particular DO program has specific and important advantages over the particular MD program, or you get a full scholarship to the DO school and are absolutely sure you want to do primary care. But in general, $100,000 to go from generic DO to generic MD is a no-brainer to me. Only go DO in the absence of an MD acceptance.
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They don't have that option. The AOA doesn't allow MDs into AOA residency programs. If the AOA backs out of the merger, DOs won't be eligible for ACGME residencies. DOs would be excluded from the all the good residencies in the country, and most DO students would go unmatched. There are less than 2,500 AOA residency positions, and almost 7,000 DO students graduating this year (with over 8,000 starting DO school this year). It would be suicide. Imagine 60% of graduating DOs failing to get a residency spot. Students would burn down AOA HQ.
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Instate OSUCOM versus Harvard is about a $250k difference lol.
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and schools like Georgetown and GWU with estimated COAs of over 90k.
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Two things.
1) The question was specifically about a $37,000 DO school vs $60,000 MD school: "The DO school would be 37000/year and the MD would be 60000/year"
2) Choosing OSUCOM over Harvard Medical School, at any price difference and any circumstance, would be shockingly poor judgment.
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Hence the “lol.”
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deleted600623
It seems as though DO students are screwed either way since some of the AOA residencies will not meet accreditation and thus be shut down which just creates more competition. There needs to be some serious increase in funding for GME overall with how many damn Medical schools keep opening up and no increase in residency spots.
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AnatomyGrey12
No
Eh we have a ton of residency programs and all the residents aren’t having any issues getting jobs in competitive markets if that’s what they want. I’m sure there will be a few practices here or there that don’t want a DO but that is pretty rare honestly. The only struggle is seen in trying to get faculty positions at ACGME residency programs, but even then that can be overcome by doing an ACGME residency.
The bias coming out of residency is extremely minimal when compared to what is seen in residency selection
For stuff like research yes it is, also I believe LCME requires that the majority of funding cannot come from tuition. Ironically everyone likes to bash DO clinical rotations but COCA has the exact same accreditation standards as LCME in that regard.
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deleted600623
So I’m definitely not one that expects to be gunning for the uber competitive specialties. But will the merger affect DOs trying to get into IM, IM subspecialties, anesthesia, PM&R, EM etc?
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Yes. If you get DO and not MD, roll with it. But go MD if you can.
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I should revise my earlier comments to say that the merger will benefit DO students in the long term, as DO admissions standards and overall student quality improve to increase residency matching success rates.
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AnatomyGrey12
For fields like that simply the overall influx of new graduates is more terrifying than the merger honestly.
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This is true, but MD schools, for the most part, have better resources for a lower cost than DO schools. This is coming from a fourth year who matched into my desired specialty in the top program of those I interviewed at (did AOA match). I really like my school and would not trade my experience in med school for just about anything, but interview season and board prep would likely have been easier and with less debt if I’d have been accepted into an MD.
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As someone who knows 2 friends who "should" have matched surgery, and 1 into neurosurgery, I can affirm pretty much all of this. The DO proposition had huge benefits with DO only residencies before the merger, but why would a program choose DO's when they can choose MD's? If a program had 4 spots for DO's, they might reserve 2 for DO and 2 for MD...shift it around as they see fit.
Ultimately I am for the merger, but that's only because I despise the low standards of education and the only way we improve is a severe kick in the pants.
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It's not just two letters behind your name. Your potential in terms of specialty and programs within a specialty will be diminished. Yes there are exceptions but don't bank on the fact that you will be 1 of 10 DOs who matched ACGME ophthalmology this year.
Going DO, you have to learn OMT on top of learning everything else. If you want to be competitive, you'll have to take USMLE exams. That means you'll need to take USMLE Step 1, Comlex Level I, USMLE Step 2 CK, Comlex Level II, USMLE Step 2 CS, Comlex PE. You will have to perform on USMLE exams usually in spite of your DO school and curriculum, because USMLE is not a priority.
Just my style, I personally would take 2-3 years (hell, I'd get my PhD) before I decided to go DO. But I'm also a crazy person, ymmv.
I go to an MD school, and have a few DO friends. We've chatted about this, and they share their woes.
If you want data, it is available. Check out this underused program director survey:
http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf
Again, the premise was competitive specialty.
EDIT: please don't read this as DO hate. DO = MD. Some of my favorite preceptors are DOs, and I think there's a reason for that.
Going DO, you have to learn OMT on top of learning everything else. If you want to be competitive, you'll have to take USMLE exams. That means you'll need to take USMLE Step 1, Comlex Level I, USMLE Step 2 CK, Comlex Level II, USMLE Step 2 CS, Comlex PE. You will have to perform on USMLE exams usually in spite of your DO school and curriculum, because USMLE is not a priority.
Just my style, I personally would take 2-3 years (hell, I'd get my PhD) before I decided to go DO. But I'm also a crazy person, ymmv.
I go to an MD school, and have a few DO friends. We've chatted about this, and they share their woes.
If you want data, it is available. Check out this underused program director survey:
http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf
Again, the premise was competitive specialty.
EDIT: please don't read this as DO hate. DO = MD. Some of my favorite preceptors are DOs, and I think there's a reason for that.
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Just a small correction to decrease even a modicum any anxiety this sentence may cause: Step 2 CS is not necessary for a DO. One or the other of the physical exam tests is good enough for PDs that accept DOs. The rest, though: spot on.
