Hi all, I've been thinking DO (Emergency Medicine)

[Rishikish]

Hello all, I am currently at a crossroads here. I plan to go into emergency medicine (still need to shadow) and I just researched how most DO docs have a good time matching into emergency medicine like MD. Should I apply DO or stick to MD? A part of this decision is my low MCAT score (500).

I currently have a 3.7 cGPA, 3.67 sGPA (average MCAT score but I am retaking this Friday). I also understand I have to shadow a DO and get a LOR, which shouldn't be problematic considering I have 3-4 months free (beside school) to find and shadow an EM DO doc (they're all over in Atlanta).

I also have 2 years (~250-300 hours) of volunteering at a hospital (discharges, basic patient needs, and errands), cofounded my own medical NGO in Kenya (gives monthly woman sanitation products to a local village in Nakuru), taught English in Kenya for 4 months, Lab TA for a semester (gen chem), and currently working on a research poster presentation to give at a local school science conference.

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[Howlin_Radio]

Hello all, I am currently at a crossroads here. I plan to go into emergency medicine (still need to shadow) and I just researched how most DO docs have a good time matching into emergency medicine like MD. Should I apply DO or stick to MD? A part of this decision is my low MCAT score (500).

I currently have a 3.7 cGPA, 3.67 sGPA (average MCAT score but I am retaking this Friday). I also understand I have to shadow a DO and get a LOR, which shouldn't be problematic considering I have 3-4 months free (beside school) to find and shadow an EM DO doc (they're all over in Atlanta).

I also have 2 years (~250-300 hours) of volunteering at a hospital (discharges, basic patient needs, and errands), cofounded my own medical NGO in Kenya (gives monthly woman sanitation products to a local village in Nakuru), taught English in Kenya for 4 months, Lab TA for a semester (gen chem), and currently working on a research poster presentation to give at a local school science conference.

Hey Rishikish:

You should go ahead and move on with your career and apply DO. Let me offer you some advice as an individual who was in a similar situation last year. I have a 3.7c,3.7s and 25 MCAT and retook for a 504/27 (verbal :/). Go ahead and start sending typed letters to DOs in the area asking to shadow with all of your qualifications tied to the letter. I did this, and even though I was never able to shadow a DO, I was able to score a LOR through my full time job as an EMT.

Apply to PCOM-GA (and 10+ other schools so you'll have options). As an NC resident I was accepted to a few schools (one being PCOM-GA) but I also turned down a lot of interviews. You'll likely get in somewhere but apply very broadly. improve your MCAT or you'll be shooting yourself in the foot. You won't have your pick of DO schools. I luckily got into a DO school that I'm happy about but didn't hear or have been rejected from a decent amount of programs.

Most of the established program averages are 3.4-3.6GPA + 27-28 MCAT (a few even have 30 MCAT averages). My school has a 3.6, 27 MCAT avg. Goodluck!

 

[TheBoneDoctah]

Hello all, I am currently at a crossroads here. I plan to go into emergency medicine (still need to shadow) and I just researched how most DO docs have a good time matching into emergency medicine like MD. Should I apply DO or stick to MD? A part of this decision is my low MCAT score (500).

I currently have a 3.7 cGPA, 3.67 sGPA (average MCAT score but I am retaking this Friday). I also understand I have to shadow a DO and get a LOR, which shouldn't be problematic considering I have 3-4 months free (beside school) to find and shadow an EM DO doc (they're all over in Atlanta).

I also have 2 years (~250-300 hours) of volunteering at a hospital (discharges, basic patient needs, and errands), cofounded my own medical NGO in Kenya (gives monthly woman sanitation products to a local village in Nakuru), taught English in Kenya for 4 months, Lab TA for a semester (gen chem), and currently working on a research poster presentation to give at a local school science conference.

If you are retaking the MCAT already, I would find out what you score before you make the decision to apply MD or DO. Your GPA is totally within MD range, so if you score higher on the second MCAT attempt, apply broadly to MD (and then apply to a few DO schools as well). If you get into an MD school, GO MD.

Yes, emergency medicine seems to be DO friendly according to match stats for DO schools, but it's going to be tougher as a DO.

 

[Howlin_Radio]

If you are retaking the MCAT already, I would find out what you score before you make the decision to apply MD or DO. Your GPA is totally within MD range, so if you score higher on the second MCAT attempt, apply broadly to MD (and then apply to a few DO schools as well). If you get into an MD school, GO MD.

Yes, emergency medicine seems to be DO friendly according to match stats for DO schools, but it's going to be tougher as a DO.

either way just apply to a good amount of DO schools regardless. and just apply strategically for MD (+DO) if your retake is okay.

 

[cliquesh]

Hello all, I am currently at a crossroads here. I plan to go into emergency medicine (still need to shadow) and I just researched how most DO docs have a good time matching into emergency medicine like MD. Should I apply DO or stick to MD? A part of this decision is my low MCAT score (500).

I currently have a 3.7 cGPA, 3.67 sGPA (average MCAT score but I am retaking this Friday). I also understand I have to shadow a DO and get a LOR, which shouldn't be problematic considering I have 3-4 months free (beside school) to find and shadow an EM DO doc (they're all over in Atlanta).

I also have 2 years (~250-300 hours) of volunteering at a hospital (discharges, basic patient needs, and errands), cofounded my own medical NGO in Kenya (gives monthly woman sanitation products to a local village in Nakuru), taught English in Kenya for 4 months, Lab TA for a semester (gen chem), and currently working on a research poster presentation to give at a local school science conference.

Apply MD. If you fail to get in on your first try, improve your application and apply MD and DO the second time around. If you get into an MD and DO school go to the MD school. If you only get into a DO school go to the DO. You'll be fine for EM as an osteopathic applicant. If you do slightly above average you'll be able to match EM from a DO school.

 

[Howlin_Radio]

Apply MD. If you fail to get in on your first try, improve your application and apply MD and DO the second time around. If you get into an MD and DO school go to the MD school. If you only get into a DO school go to the DO. You'll be fine for EM as an osteopathic applicant. If you do slightly above average you'll be able to match EM from a DO school.

All this advice just depends on how your retake goes. If you only do slightly above what you just scored on the MCAT, your really doing yourself a disservice by wasting another year in limbo when your shots at going MD rely (at this point) almost entirely how the MCAT goes. Retake at most 2 times and make your move from there. You can take the MCAT one more time before you apply in June. No point in waiting until 2017 to apply DO in your case IMO

 

[cliquesh]

All this advice just depends on how your retake goes. If you only do slightly above what you just scored on the MCAT, your really doing yourself a disservice by wasting another year in limbo when your shots at going MD rely (at this point) almost entirely how the MCAT goes. Retake at most 2 times and make your move from there. You can take the MCAT one more time before you apply in June. No point in waiting until 2017 to apply DO in your case IMO

I agree with you. I didn't read that the OP had a 500 mcat and was retaking.

 

[user121]

You'll be fine. Maybe boost MCAT.

EM is done for.

http://newsroom.acep.org/2015-12-01...airly-for-Emergency-Care-Under-New-Regulation
also EMTALA..

 

[ortnakas]

1) Change your profile pic for privacy purposes.

2) Yes, DOs can do emergency medicine. Apply both MD and DO and see what happens.

 

[Rishikish]

I've also looked up the AOA and ACGME merger that should be completely implemented by 2020-2021, what does this mean for future DOs and MDs when it comes to residency: that there will be less DO bias due to change in DO education and training standards?

 

[deleted407021]

I've also looked up the AOA and ACGME merger that should be completely implemented by 2020-2021, what does this mean for future DOs and MDs when it comes to residency: that there will be less DO bias due to change in DO education and training standards?

No one knows for sure, though you could certainly browse every kind of speculation you like, on the forums.

 

[Mad Jack]

Go MD if you can. If not, DOs have a decent shot at EM.

 

[TheBoneDoctah]

I've also looked up the AOA and ACGME merger that should be completely implemented by 2020-2021, what does this mean for future DOs and MDs when it comes to residency: that there will be less DO bias due to change in DO education and training standards?

You should browse the emergency medicine forum. The common theme I have gathered from that forum is that EM is going downhill. I posted a "Why EM" thread over there and have been getting some responses on it that you should check out. Just something to think about.

By the time you are ready to choose a specialty, medicine will be different than it is today. That being said, I would go to the medical school that will give you the best chance to match into ANY specialty since your mind will probably change ten times by then. You may end up wanting to become a neurosurgeon for all you know.

The order of schools that will give you the best shot at competitive residencies is any M.D. school > established D.O. schools > newer D.O. schools > Caribbean (DONT EVEN THINK ABOUT IT).

 

[HooliganSnail]

Hello all, I am currently at a crossroads here. I plan to go into emergency medicine (still need to shadow) and I just researched how most DO docs have a good time matching into emergency medicine like MD. Should I apply DO or stick to MD? A part of this decision is my low MCAT score (500).

I currently have a 3.7 cGPA, 3.67 sGPA (average MCAT score but I am retaking this Friday). I also understand I have to shadow a DO and get a LOR, which shouldn't be problematic considering I have 3-4 months free (beside school) to find and shadow an EM DO doc (they're all over in Atlanta).

I also have 2 years (~250-300 hours) of volunteering at a hospital (discharges, basic patient needs, and errands), cofounded my own medical NGO in Kenya (gives monthly woman sanitation products to a local village in Nakuru), taught English in Kenya for 4 months, Lab TA for a semester (gen chem), and currently working on a research poster presentation to give at a local school science conference.

I am a D.O. and it's awesome. I remember the anxiety of it when I was deciding, but let me tell you 8 years later, it was a great decision.

1. The whole DO vs MD thing is really just a thing of the internet. If you go on these forums you will note that pre-meds talk about it A LOT, med students only a little bit, and the residents and specialties NEVER. In fact, some of my attendings are MD's and some DO's and I honestly don't know half the time. I truly never think of myself "as a DO" so much as a doctor, which is what I am. In truth, once you become a doctor its more about the different specialties ( like IM are a bunch of nerds, and Ortho are bunch of meatheads, that kind of thing). Looking back, I laugh at myself that I ever felt self conscious about only getting into a DO school. It truly doesn't matter in the long run.

2. EM is an awesome field, and the DO's are well represented. We have a great track record of matching into EM.

3. Getting into medical school is the hardest part of the journey, it's the great choke point. DO school may have lower MCATs, but don't assume they have lower standards. Just as Osteopathy strives to be well rounded, they are looking for well rounded applicants. Competition is fierce. When you get in, you will be amazed at how intelligent and cultured your fellow students are. They are the cream of the crop. We play second fiddle to no one.

Good Luck. Make the Plunge.

 

[HooliganSnail]

You should browse the emergency medicine forum. The common theme I have gathered from that forum is that EM is going downhill. I posted a "Why EM" thread over there and have been getting some responses on it that you should check out. Just something to think about.

By the time you are ready to choose a specialty, medicine will be different than it is today. That being said, I would go to the medical school that will give you the best chance to match into ANY specialty since your mind will probably change ten times by then. You may end up wanting to become a neurosurgeon for all you know.

The order of schools that will give you the best shot at competitive residencies is any M.D. school > established D.O. schools > newer D.O. schools > Caribbean (DONT EVEN THINK ABOUT IT).

Dude,

EM is thriving.

Compensation is up 50% from 3 years ago. The average EM doc makes 320K now, and that is working 12x 12hr shifts = 144hrs a month = less than full time!

Everyone has insurance now, no one wants to do primary care, no one can get into their PCP, so they come to the ED. In groves. There is no more in demand position in all of medicine than a Board Certified Bona Fide Emergency Medicine Physician

Believe That.

 

[HooliganSnail]

You'll be fine. Maybe boost MCAT.

EM is done for.

http://newsroom.acep.org/2015-12-01...airly-for-Emergency-Care-Under-New-Regulation
also EMTALA..

If by done for you mean never been more secure than it is right now

People keep coming to the ER, by the millions.

Compensation for EM docs is way way up, it demand has never been higher.

 

[TheBoneDoctah]

Dude,

EM is thriving.

Compensation is up 50% from 3 years ago. The average EM doc makes 320K now, and that is working 12x 12hr shifts = 144hrs a month = less than full time!

Everyone has insurance now, no one wants to do primary care, no one can get into their PCP, so they come to the ED. In groves. There is no more in demand position in all of medicine than a Board Certified Bona Fide Emergency Medicine Physician

Believe That.

That's awesome and great to hear! I was just going off what was said in the forum.


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[asdf123g]

That's awesome and great to hear! I was just going off what was said in the forum.


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A pessimistic outlook is much more common over there, that's for sure, especially with that new legislation.

 

[zero0]

EM is a great specialty OP and you can certainly match as a DO, but you should know that all AOA EM programs are 4 years. They aren't going to switch to 3 years either post-merger so it's something to keep in mind.

As for 3 year ACGME programs, they're still DO friendly but it's harder to match, especially now that EM seems to be getting more popular.

 

[TheBoneDoctah]

EM is a great specialty OP and you can certainly match as a DO, but you should know that all AOA EM programs are 4 years. They aren't going to switch to 3 years either post-merger so it's something to keep in mind.

As for 3 year ACGME programs, they're still DO friendly but it's harder to match, especially now that EM seems to be getting more popular.

Good to know. Thank you. Gotta keep my grades up and score well on USMLE so I increase my chances at a ACGME program!

 

[kenjixshadow]

Compensation for EM docs is way way up, it demand has never been higher.

How are you sure of increasing compensation with the new EMTALA laws have been enforced? I'm not challenging your statement. I just want some more insights. EPs are speaking of the opposite from your words.

 

[HooliganSnail]

How are you sure of increasing compensation with the new EMTALA laws have been enforced? I'm not challenging your statement. I just want some more insights. EPs are speaking of the opposite from your words.

The EMTALA laws are not new. Technically

The article quoted described the concept of balance billing. Which is where the hospital bills you for the difference between the bill and what your insurance will cover, or the "balance". Some states have laws making balance billing illegal.

Previously, there were laws requiring the payment of a "reasonable" amount for services rendered, and now the plans in the healthcare exchange are no longer held to that standard. So in essence, if you have a crappy Obamacare plan, they could pay $25 dollars for an ER visit, and the hospital may not be allowed to bill the patient for the balance.

Keep in mind, before this many people who showed up to the ED had no insurance, but we were still required to see them anyway.

 

[HooliganSnail]

EM is a great specialty OP and you can certainly match as a DO, but you should know that all AOA EM programs are 4 years. They aren't going to switch to 3 years either post-merger so it's something to keep in mind.

As for 3 year ACGME programs, they're still DO friendly but it's harder to match, especially now that EM seems to be getting more popular.

Not true, many AOA programs intend to switch to three years.

 

[HooliganSnail]

That's awesome and great to hear! I was just going off what was said in the forum.


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Honestly, there is some serious burn out on that forum

Now burn out...........that is a problem, and one that is not isolated to EM in the least

 

[asdf123g]

Honestly, there is some serious burn out on that forum

Now burn out...........that is a problem, and one that is not isolated to EM in the least

isn't EM the specialty most commonly linked to burnout? I'm not sure how many long shifts, overnight shifts, or sporadic work schedules I'd be able to put up with in my 40's or 50's with a family. Not to mention years of lost income from retiring early/cutting way back on the hours early.

 

[zero0]

Not true, many AOA programs intend to switch to three years.

Interesting if true. Have any AOA programs said they'd do this? Up until now I've been hearing that it's unlikely since no program wants less residents around.

isn't EM the specialty most commonly linked to burnout? I'm not sure how many long shifts, overnight shifts, or sporadic work schedules I'd be able to put up with in my 40's or 50's with a family. Not to mention years of lost income from retiring early/cutting way back on the hours early.

EM does have the highest burnout but it's only about 10% higher than the least burnt out specialty. If you go into medicine period, it seems like you have a pretty high chance of getting burnt out. Even more than a 3rd of dermatologists are burnt out.

 

[asdf123g]

Interesting if true. Have any AOA programs said they'd do this? Up until now I've been hearing that it's unlikely since no program wants less residents around.

EM does have the highest burnout but it's only about 10% higher than the least burnt out specialty. If you go into medicine period, it seems like you have a pretty high chance of getting burnt out. Even more than a 3rd of dermatologists are burnt out.

that's if you cut your own hours though right? It seems like people lose their sanity when they start working more than 12 shifts a month. Because when you're working, you're really working, non-stop in an intense environment.

 

[kenjixshadow]

The EMTALA laws are not new. Technically
The article quoted described the concept of balance billing. Which is where the hospital bills you for the difference between the bill and what your insurance will cover, or the "balance". Some states have laws making balance billing illegal.
Previously, there were laws requiring the payment of a "reasonable" amount for services rendered, and now the plans in the healthcare exchange are no longer held to that standard. So in essence, if you have a crappy Obamacare plan, they could pay $25 dollars for an ER visit, and the hospital may not be allowed to bill the patient for the balance.
Keep in mind, before this many people who showed up to the ED had no insurance, but we were still required to see them anyway.

So if an out-of-network patient walks into your shop, you have to see them because of EMTALA and you have to see them for free. If they pay nothing and insurance pays nothing (okay I doubt any insurance company will attempt to reimburse less than CMS), how are you making money? Unless you are planning to work at private FSEDs, since they can be since they can refuse to bill (accept) Medicare and be excluded from EMTALA, I fail to see how the compensation will increase, if not down, in near future.

Not true, many AOA programs intend to switch to three years.

Intend to do it is one thing, but do they actually have the number to do that? Some 4 year programs can't do it, such as Doctors in Ohio , because they don't get to see enough trauma/acuity there even with seeing 85k visits per year.

 

[HooliganSnail]

Interesting if true. Have any AOA programs said they'd do this? Up until now I've been hearing that it's unlikely since no program wants less residents around.

EM does have the highest burnout but it's only about 10% higher than the least burnt out specialty. If you go into medicine period, it seems like you have a pretty high chance of getting burnt out. Even more than a 3rd of dermatologists are burnt out.

So the ACGME lists ER as a three year program. If you want to have four years then you need to demonstrate that they are getting some level of education beyond just EM to warrant that 4th year. Some DO programs are thinking about adding addition tracks, like ultrasound, critical care, etc. Many are just going to three years. I know several in my area that are doing three years for a fact.

The programs won't necessarily lose any workforce, because you still need to do 24 months in the ER, they still have any given resident for 24 months of ER work. Losing the 4th year means there are just less electives and stuff

Truly, EM is a 3 year program, the AOA just has a lot of requirements for intern year to be "well rounded", and there is no way to complete the required ER stuff and the AOA intern stuff in just 3 years, but it could be done in like 3.5 years. The result is that the 4th year is full of fluff like "Admin month", "Research month", "Quality Improvement month", and blah blah blah.

 

[HooliganSnail]

So if an out-of-network patient walks into your shop, you have to see them because of EMTALA and you have to see them for free. If they pay nothing and insurance pays nothing (okay I doubt any insurance company will attempt to reimburse less than CMS), how are you making money? Unless you are planning to work at private FSEDs, since they can be since they can refuse to bill (accept) Medicare and be excluded from EMTALA, I fail to see how the compensation will increase, if not down, in near future.


Intend to do it is one thing, but do they actually have the number to do that? Some 4 year programs can't do it, such as Doctors in Ohio , because they don't get to see enough trauma/acuity there even with seeing 85k visits per year.

The hospital has a lot of negotiating power. Insurance's need to be accepted at local hospitals, otherwise no one will stay with their insurance. So they may not want to pay the ED, but they do need to be accepted for inpatient and outpatient stuff.

The result is that there will be a happy medium

Some insurance companies will try to low-ball the hospital and refuse to negotiate, but then the hospital will not take their insurance. We have a couple of insurances in our area that are like that, and if they walk in they can not be admitted, they have to be transferred. If they low-ball the ER bill, then the hospital just has to eat it. That is generally rare though, most companies negotiate in good faith, because you just can't stay in business if your network is only 1 or 2 hospitals.

In general though, most people have insurance that walk into the ER, and if they don't, we have registration people that immediately sign them up for the hospital plan. A lot of uninsured people used to come to the ED, and they never paid their bills, and the hospital just had to eat the costs. Now that never happens. Even with the crappy insurance, there is some reimbursement. The net result is that business is up, and it reflects itself in ED physician compensation.

As far as the AOA programs, currently every one of them is applying for ACGME accreditation. Some programs will not make the cut. If Doctor's does not see enough trauma patients, they will need to set up outside trauma rotations, or they will not be ACGME accredited, and will thus cease to exist. This is important for med students who are applying. Currently any program can certify its current residents, but AOA will not be certifying anyone past 2020, which means class of 2017, which will graduate from ER in 2021, needs to know that the program they are applying to will get ACGME accreditation, or they could be in serous trouble. That is why all of the programs are applying now, because they need to be able to tell the applicants in 9 months that they are going to be accredited. So it may seem like they have 4 years to get the accreditation, but really they have to do it now.

The total number of ER months is the same for a 3yr and 4yr program = 24 ER months. The difference is the other rotations.

 

[zero0]

that's if you cut your own hours though right? It seems like people lose their sanity when they start working more than 12 shifts a month. Because when you're working, you're really working, non-stop in an intense environment.

I was going by the Medscape 2015 report. I'm honestly not sure what their parameters are. Honestly, I don't pay much attention to all this burnout talk. Jobs suck, we get it. Not everybody's still skipping into work after 20 years... not sure why we have to study this

 

[asdf123g]

@HooliganSnail : you should battle it out in the ER forum. Although I bet you'll get torn apart from the more experienced EP's.

 

[Ligamentumarteriosum]

I want to do EM and overwhelmingly would rather do it as a DO. I feel that due to the philosophy of the practice, it just happens that many of the people who pursue DO residencies pursue internal medicine type roles. This has been slightly compounded because some of the biggest residencies do not seem to be interested in DO applicants. I doubt we have a shortage of DO EM residencies though, although people don't expect it as much and so you really do need to be competitive.

I also think that will probably be a null issue for you if you aren't going to apply for school until class of 2020 or later. I believe somewhere in there residencies were going to start merging between MD and DO since we've really come to an intersection in the scope of what we can accomplish out of respective schools, albeit, each has their own flourish.

 

[Ligamentumarteriosum]

Even more than a 3rd of dermatologists are burnt out.

How much time are they spending in the burn ward?

Bazinga.

 

[K31]

Interesting if true. Have any AOA programs said they'd do this? Up until now I've been hearing that it's unlikely since no program wants less residents around.

They wouldn't have to have fewer residents around. Programs are approved for a total number of residents, not a number per year. So a program with eg 6 residents x 4 years would go to 8 residents x 3 years.

 

[zero0]

They wouldn't have to have fewer residents around. Programs are approved for a total number of residents, not a number per year. So a program with eg 6 residents x 4 years would go to 8 residents x 3 years.

The issue is finding enough work for those extra residents each year to satisfy GME requirements. It's possible, but a serious obstacle for many programs out there. They just don't have enough patients to go around.

 

[AlteredScale]

I want to do EM and overwhelmingly would rather do it as a DO. I feel that due to the philosophy of the practice, it just happens that many of the people who pursue DO residencies pursue internal medicine type roles. This has been slightly compounded because some of the biggest residencies do not seem to be interested in DO applicants. I doubt we have a shortage of DO EM residencies though, although people don't expect it as much and so you really do need to be competitive.

I also think that will probably be a null issue for you if you aren't going to apply for school until class of 2020 or later. I believe somewhere in there residencies were going to start merging between MD and DO since we've really come to an intersection in the scope of what we can accomplish out of respective schools, albeit, each has their own flourish.

Just FYI: AOA (DO) residences are being mandated to apply for ACGME accred. This is because ACGME threatened to bar anyone who wasn't a graduate from an ACGME grad (So DO's who went through an AOA residency) from being able to apply to any ACGME fellowships. I would describe it more as DO residency programs being funneled into the MD residency system and not really a "MD and DO residences coming together".

But, it's def possible to EM as a DO. West coast wise I do not believe UCSF (not UCSF-Fresno) or Stanford has or ever had DO's. UCSD has taken their first few DOs two years ago. UCLA has one in their program right now from RVU, the last time they had a DO was 2011, 1983, and 1982. USC/LAC (LA County) has one DO on their program right now and has graduated two DO's previously, one from KCU, another from WesternCOMP.

 

[HooliganSnail]

@HooliganSnail : you should battle it out in the ER forum. Although I bet you'll get torn apart from the more experienced EP's.

I spend most of my time in that forum......

 

[asdf123g]

I spend most of my time in that forum......

I've perused the relevant threads on the future of EM a week or two ago when this thread was big and I dont remember seeing you (you have a very distinctive red picture). I'm just saying I haven't seen you post in threads relevant to this discussion. Maybe you post in other EM threads.

 

[Giovanotto]

Just FYI: AOA (DO) residences are being mandated to apply for ACGME accred. This is because ACGME threatened to bar anyone who wasn't a graduate from an ACGME grad (So DO's who went through an AOA residency) from being able to apply to any ACGME fellowships. I would describe it more as DO residency programs being funneled into the MD residency system and not really a "MD and DO residences coming together".

But, it's def possible to EM as a DO. West coast wise I do not believe UCSF (not UCSF-Fresno) or Stanford has or ever had DO's. UCSD has taken their first few DOs two years ago. UCLA has one in their program right now from RVU, the last time they had a DO was 2011, 1983, and 1982. USC/LAC (LA County) has one DO on their program right now and has graduated two DO's previously, one from KCU, another from WesternCOMP.

I had the pleasure of shadowing the one from WesternCOMP.

 

[Jewels86]

May I ask...

Why have you decided on Emergency Medicine at this time when you haven't done your rotations through there?

I'm an ER nurse and let me be the first to tell you, it is NOTHING like the TV shows. The physician spends 30 seconds at most with the patient because their load is huge. I spend the most time with the patient's and I have a 4:1 ratio. I'm doing all of the leg work and update the doc's on vitals, when the patient wants to leave, status updates, "Hey doc, you need to get in here now! I need to slam adenosine now!" or my favorite, "I need an order for violent restraints!"

I'd focus on getting into med school first and then figuring it out. When I went through nursing school, I always wanted to do L&D. Then I did; fainted in the OR during my first c-section. Threw up on the 2nd and knew on the 3rd, I'm done.

I'd like you to take your eyes off of EM residency because so much rides on even getting into one.

Enjoy the process, my friend!

 

[dreee]

You should browse the emergency medicine forum. The common theme I have gathered from that forum is that EM is going downhill. I posted a "Why EM" thread over there and have been getting some responses on it that you should check out. Just something to think about.

By the time you are ready to choose a specialty, medicine will be different than it is today. That being said, I would go to the medical school that will give you the best chance to match into ANY specialty since your mind will probably change ten times by then. You may end up wanting to become a neurosurgeon for all you know.

The order of schools that will give you the best shot at competitive residencies is any M.D. school > established D.O. schools > newer D.O. schools > Caribbean (DONT EVEN THINK ABOUT IT).

What would you consider an "established" DO school? What time frames are we lookin at for how long the school has been around?

 

[Drrrrrr. Celty]

What would you consider an "established" DO school? What time frames are we lookin at for how long the school has been around?

Generally the rule is state schools + the old 5 ( DMU,CCOM,PCOM, KCU, KCOM). However schools like NSU, NYCOM, AZCOM, Western, and UNECOM are established for example. Issues are with schools that are less than 10 years or have not graduated a class yet. They are untested and generally their outcomes are much poorer than establishes schools. Schools like WCU and LUCOM for example are new schools I cannot recommend attending for example.

 

[AlteredScale]

What would you consider an "established" DO school? What time frames are we lookin at for how long the school has been around?

The first five are supposedly the best. IMO the best DO schools are RowanSOM, OSU, OU-HCOM, MSUCOM, and TCOM because they all have solid rotation sites, opportunities to to see REAL patients as supposed to simulated ones in your first two years, solid research opps, and actual medical departments (you'll come to find that most DO programs have no dept of cardiology/derm/psych or any specialty for that manner outside of family med or OMM, making the task of obtaining solid LORs a bit harder).


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[jordansetron]

Hello all, I am currently at a crossroads here. I plan to go into emergency medicine (still need to shadow) and I just researched how most DO docs have a good time matching into emergency medicine like MD. Should I apply DO or stick to MD? A part of this decision is my low MCAT score (500).

I currently have a 3.7 cGPA, 3.67 sGPA (average MCAT score but I am retaking this Friday). I also understand I have to shadow a DO and get a LOR, which shouldn't be problematic considering I have 3-4 months free (beside school) to find and shadow an EM DO doc (they're all over in Atlanta).

I also have 2 years (~250-300 hours) of volunteering at a hospital (discharges, basic patient needs, and errands), cofounded my own medical NGO in Kenya (gives monthly woman sanitation products to a local village in Nakuru), taught English in Kenya for 4 months, Lab TA for a semester (gen chem), and currently working on a research poster presentation to give at a local school science conference.

The gap in admission statistics between MD and DO is exaggerated by the extremes in each category and I think you have a chance with either depending on what part of the country you're applying to but retaking your MCAT is REALLY good idea if you have the time/resources. You and everyone else should always apply to both DO and MD programs your first time assuming you dont have set-in-stone aspirations of ultra competitive residencies or a fetish for academic prestige. The applications are pretty similar so after some copy/paste action and some extra $$$ and BOOM you've significantly increased your chances of admission. Ask yourself if an improved chance at matching competitive residencies is worth the year of lost salary/year of life in your prime just for the opportunity to reapply.

 

[dreee]

Generally the rule is state schools + the old 5 ( DMU,CCOM,PCOM, KCU, KCOM). However schools like NSU, NYCOM, AZCOM, Western, and UNECOM are established for example. Issues are with schools that are less than 10 years or have not graduated a class yet. They are untested and generally their outcomes are much poorer than establishes schools. Schools like WCU and LUCOM for example are new schools I cannot recommend attending for example.

Thanks for that. I'm keeping my eye on NSU and wanted to make sure I made the best choice for me. I really fell in love with them.

 

[Drrrrrr. Celty]

The first five are supposedly the best. IMO the best DO schools are RowanSOM, OSU, OU-HCOM, MSUCOM, and TCOM because they all have solid rotation sites, opportunities to to see REAL patients as supposed to simulated ones in your first two years, solid research opps, and actual medical departments (you'll come to find that most DO programs have no dept of cardiology/derm/psych or any specialty for that manner outside of family med or OMM, making the task of obtaining solid LORs a bit harder).


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Realistically the only PCOM and CCOM are strong schools in the big 5. DMU and KCU are good schools, but have lacking things and honestly are still majorly unknown even in their cities compared to their MD schools. KCOM I don't even know about. Truth is that it's schools that are tied to big universities or state schools that make for strong medical school programs. That's why TCOM and NSU, etc are doing so well.

As a whole education at osteopathic schools is going to feel lacking in some dimensions, especially clinical. Another one is fundamentally the lack of mentorship for students who do want to match into competitive fields or do academics does contribute and play a role in why DO students match more poorly than MD students.

I feel like for what it is worth, osteopathic education is a lot of you doing your own work to make it work. Which for many people, including me isn't going to be a big deal. But for others it's going to essentially set their career off on the wrong start.

On the topic of early clinical exposure. I think at least at KCU had we not had such a enormous class we could have probably found ways of allowing students to intern for a weekend or so with physicians in the area like MUCOM does. But I guess grand rounds is our substitute there....

 

[docycle]

Yes, emergency medicine seems to be DO friendly according to match stats for DO schools, but it's going to be tougher as a DO.

Depends on the program. But the idea is just do good on boards and you'll match. /discussion.

Getting into medical school is the hardest part of the journey, it's the great choke point.

Haven't gone through the rest of the process, but this is basically what I imagined. After getting in, you're on the path, and you know it. Not knowing how you're going to end up was the worst part of being a pre-med.

How are you sure of increasing compensation with the new EMTALA laws have been enforced? I'm not challenging your statement. I just want some more insights. EPs are speaking of the opposite from your words.

Some group of people from every specialty is always throwing a tantrum when you bring up the future of their compensation. Often times it's simply half-cocked musings of overworked pessimists with a total lack of relevant information at their disposal.

Also, what new laws, specifically, are you talking about here? EMTALA has been around for ~30 years. The fact you have to admit someone with an emergent medical condition has always and will be (for the foreseeable future) the case in ERs everywhere in the US. So that fact remains constant between the present and the future; therefore, I don't see how that will affect the future of reimbursements in the ER and consequently physician compensation. Unless I've missed something crucial.

Not true, many AOA programs intend to switch to three years.

Trying to find a list. All I can come up with is compilations from years ago. You know any good resources for this or if there's a list somewhere? If not I'll just go through all the osteos later and see what's up. When would the switches to 3yrs occur? I gotta say, didn't know about this but it would be totally awesome to not have to bother with USMLE.

So if an out-of-network patient walks into your shop, you have to see them because of EMTALA and you have to see them for free. If they pay nothing and insurance pays nothing (okay I doubt any insurance company will attempt to reimburse less than CMS), how are you making money?

Isn't the answer simple? Not all patients are walking in with no insurance.

Plus Obamacare may make it even more profitable than it ever was seeing what were previously uninsured patients that fell under EMTALA. So if anything revenues go up, no?

 

[asdf123g]

Also, what new laws, specifically, are you talking about here? EMTALA has been around for ~30 years. The fact you have to admit someone with an emergent medical condition has always and will be (for the foreseeable future) the case in ERs everywhere in the US. So that fact remains constant between the present and the future; therefore, I don't see how that will affect the future of reimbursements in the ER and consequently physician compensation. Unless I've missed something crucial.

Isn't the answer simple? Not all patients are walking in with no insurance.

Plus Obamacare may make it even more profitable than it ever was seeing what were previously uninsured patients that fell under EMTALA. So if anything revenues go up, no?

post #8's link from EM forum

 

[docycle]

post #8's link from EM forum

I don't know where they're getting from the EM section of that referenced document that insurance companies will end up paying "whatever they want."

Direct from the source material:

Therefore, as provided in the interim final regulations and these final regulations, a plan or issuer must pay a reasonable amount for emergency services by some objective standard. Specifically, a plan or issuer satisfies the copayment or coinsurance limitations in the statute if it provides benefits for out-of-network emergency services (prior to imposing in-network cost sharing) in an amount at least equal the greatest of: (1) The median amount negotiated with in-network providers for the emergency service; (2) the amount for the emergency service calculated using the same method the plan generally uses to determine payments for out-of-network services (such as the usual, customary, and reasonable amount); or (3) the amount that would be paid under Medicare for the emergency service (minimum payment standards).

Maybe they were concerned about #2 here? But if you actually read it, the doc says they need to provide "...the greatest of" those three items. So if #2 is a low-ball, it ain't gonna happen. They're either gonna owe the basic Medicare reimbursement or the median amount negotiated with their providers. With the former, you'll only get screwed when congress really starts cutting EM reimbursements (which I don't think has really seriously happened yet, like with other specialties), and with the latter -- I imagine providers want the most for their services, so why would that be a low-ball? Oh yeah, it wouldn't. If anything, #1 here is your saving grace.

So what I'm getting from this is yet another instance of a journalist who can't interpret laws talking to a doc that can't interpret laws but is quick to come to the conclusion that the sky is falling.

Anyone actually have a substantive opinion on this? Again please tell me if I am missing something.

I mean come on. They even explicitly say:

The interim final regulations under PHS Act section 2719 clarified that the cost-sharing requirements create a minimum payment requirement.

It isn't "whatever the insurance companies want."

But idk. Maybe mixed in with all that heavy dose of fear-mongering they're actually trying to make a relevant point and I just didn't catch it? Lemme know.

Tl;dr

REIMBURSEMENTS MUST BE THE GREATEST OF:
1. median of the amount for services negotiated with in-network providers
2. calculated amount plan uses to determine payment for out of network services
3. Medicare