IM Subspecialties as a DO

[DubbiDoctor]

Hello, I am a medical school applicant who just yesterday interviewed at an established DO school, which I really enjoyed. The interview went well and I could see myself thriving there, but it is my dream to subspecialize in IM. I'm not too interested in Cards/GI, but I am deeply interested in applying to Rheum, Onco, Endocrine, or Pulm/CC Fellowships. I am a strong test taker, and the boards should not be a problem. How competitive are these fellowships for DOs? Are DOs at a disadvantage relative to MDs?

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[WedgeDawg]

Moving to pre-DO

 

[bears1992]

If your goal is to specialize, you should probably go MD. Before the merger, there weren't that many opportunities for DOs to level up after an IM residency. With the merger, who knows. I think if anything, specializing will become easier as the stigma against DOs will fade a bit. If you are set on specializing, I'd take a year to get your stats up to MD caliber. You don't want to go through 4 years of medical school and 3 years of residency just to find out that you can't specialize because you went DO over MD.

Edit: This is the answer I got when I asked this question a while back before my career switch. Everyone below me knows much more about the process than I do so I would take their advice over mine.

 

[MADD!!!]

Pg. 16 on the PDF has your answer:

http://www.nrmp.org/wp-content/uploads/2017/02/Results-and-Data-SMS-2017.pdf

It's this + those who match into the AOA (DO) fellowships for IM.

I just want you (and everyone else) to take a look at how many fellowship positions there are as well as how many US MD's there are that go into these fellowships. In the vast majority of cases, there are much more spots than US MD students. So yes, spots get filled by every applicant type. The number (or percentage) of excess spots there are in a fellowship to the number of US MD students applying/matching into them, the easier it is for you as a DO to get into as a general rule of thumb.

 

[statlin98]

If your goal is to specialize, you should probably go MD. Before the merger, there weren't that many opportunities for DOs to level up after an IM residency. With the merger, who knows. I think if anything, specializing will become easier as the stigma against DOs will fade a bit. If you are set on specializing, I'd take a year to get your stats up to MD caliber. You don't want to go through 4 years of medical school and 3 years of residency just to find out that you can't specialize because you went DO over MD.

Where are you getting this info? Nearly everything in this thread contradicts what you are saying:

How easy is it for a DO to get a fellowship after an Internal Medicine residency?

 

[group_theory]

If your goal is to specialize, you should probably go MD. Before the merger, there weren't that many opportunities for DOs to level up after an IM residency. With the merger, who knows. I think if anything, specializing will become easier as the stigma against DOs will fade a bit. If you are set on specializing, I'd take a year to get your stats up to MD caliber. You don't want to go through 4 years of medical school and 3 years of residency just to find out that you can't specialize because you went DO over MD.

Where did you get this belief/perception?

It was harder to get into cards, and GI - but definitely not insanely hard. Having gone through the process myself (and later on, personally involved in selecting and interviewing candidates) - your residency plays a much bigger role than medical school, along with board scores, LORs (who wrote it, was it glowing or luke warm), as well as research (posters at regional or national, peer-reviewed publications, etc)

Being a DO at a small community hospital AOA program would make it harder to match Cards/GI/HemeOnc/PCCM ... than if that same DO were at a university-affiliated hospital, or a university hospital. Part of it is name recognition, part of it is resources (faculty that does research, is known within the field, knows faculty at fellowship programs, etc) ... I've seen the same bias against MDs as well who are from small community hospital (US IMG, FMG, and US MDs) ... I think there is a stronger bias against small community programs than against DOs

Now is this universal for every program? No. There may be a few staunchly anti-DO program, but for the most part ... the further away from med school you are, the less important it becomes

Now is the field completely level - NO. You will still have trouble trying to get Cleveland Clinic Cards, UCSF Pulm/CCM, MD Anderson Heme/Onc - but not sure if it's just DO bias, or the competition (MDs attending top IM programs with very impressive CV/resumes)

 

[deleted831695]

Knowing people having gone through this, if you're not gunning for something super competitive (which are still attinable), or for the top hospitals in that subspecialty, then you'll be fine. Your residency matters more.

 

[AnatomyGrey12]

I am a strong test taker, and the boards should not be a problem

So is everyone else in medical school. Welcome to the big leagues.

Where did you get this belief/perception?

It was harder to get into cards, and GI - but definitely not insanely hard. Having gone through the process myself (and later on, personally involved in selecting and interviewing candidates) - your residency plays a much bigger role than medical school, along with board scores, LORs (who wrote it, was it glowing or luke warm), as well as research (posters at regional or national, peer-reviewed publications, etc)

Being a DO at a small community hospital AOA program would make it harder to match Cards/GI/HemeOnc/PCCM ... than if that same DO were at a university-affiliated hospital, or a university hospital. Part of it is name recognition, part of it is resources (faculty that does research, is known within the field, knows faculty at fellowship programs, etc) ... I've seen the same bias against MDs as well who are from small community hospital (US IMG, FMG, and US MDs) ... I think there is a stronger bias against small community programs than against DOs

Now is this universal for every program? No. There may be a few staunchly anti-DO program, but for the most part ... the further away from med school you are, the less important it becomes

Now is the field completely level - NO. You will still have trouble trying to get Cleveland Clinic Cards, UCSF Pulm/CCM, MD Anderson Heme/Onc - but not sure if it's just DO bias, or the competition (MDs attending top IM programs with very impressive CV/resumes)

This.

 

[AnatomyGrey12]

I didn't want to brag, but I scored a 518 (97th percentile) on the MCATs, with a perfect score on biology/biochemistry. The DO school I was referring to happens to be very local and established, and I really liked it

I also scored very well on the MCAT. That doesn't mean jack when it comes to boards. If you think a high MCAT = high boards you will be heavily surprised.

 

[kubyx]

I didn't want to brag, but I scored a 518 (97th percentile) on the MCATs, with a perfect score on biology/biochemistry. The DO school I was referring to happens to be very local and established, and I really liked it

That was nice for getting into medical school. After that, no one cares, and you will come off like a tool if you tell people that IMO.

I did a lot of research into this topic as I could definitely see myself going IM -> sub specialty someday. The reality it seems is that the uber competitive ones like cards and GI will be difficult, but not impossible, and don't seem to be particularly biased against DO students. Things like allergy, rheum, etc. shouldn't be an issue.

 

[AnatomyGrey12]

The reality it seems is that the uber competitive ones like cards and GI will be difficult, but not impossible, and don't seem to be particularly biased against DO students

Yeah it's interesting but from the research I have done it is heavily based on the residency you go to rather than your degree. I'm sure some programs are still "no DOs" but if you go to a solid residency there isn't a reason you shouldn't get a shot. Another interesting thing is that Cards seems to be very doable because of the number of spots and people get there even from community programs if they build the right type of connections. GI is by far the most difficult and my hunch is that it's because it is a very academic field (with many fewer spots that cards) and it is definitely harder for DOs to break into those types of academic residencies that would place someone in the position to match GI.

I would love for a resident or fellow to chime in and give their 2 cents

 

[DPTinthemaking15]

OP in real life.

 

[MADD!!!]

Yeah it's interesting but from the research I have done it is heavily based on the residency you go to rather than your degree. I'm sure some programs are still "no DOs" but if you go to a solid residency there isn't a reason you shouldn't get a shot. Another interesting thing is that Cards seems to be very doable because of the number of spots and people get there even from community programs if they build the right type of connections. GI is by far the most difficult and my hunch is that it's because it is a very academic field (with many fewer spots that cards) and it is definitely harder for DOs to break into those types of academic residencies that would place someone in the position to match GI.

I would love for a resident or fellow to chime in and give their 2 cents

It's the $$ in my opinion. Cards is getting saturated in many markets and insurances are reimbursing much less now to GI docs... which leads me to predict in the next 4-5 years competition will drop for it as well. But only time will tell, the rest is speculation.

Also OP, realize things change. 10-15 years ago the competitive specialties were known as ROAD(E). Radiology and Anesthesia went way downhill in terms of competitiveness, EM wasn't even on there and it's been added now because it's basically becoming one, and Optho and Derm are the same.

 

[DubbiDoctor]

It's the $$ in my opinion. Cards is getting saturated in many markets and insurances are reimbursing much less now to GI docs... which leads me to predict in the next 4-5 years competition will drop for it as well. But only time will tell, the rest is speculation.

I guess you really can't predict 7 years before I'd apply. And I just learned how great the market is for hospitalists. They out-earn rhem, endo and ID doctors without having to do a fellowship. What's the point of subspecializing then? Only interest?

 

[ortnakas]

I didn't want to brag, but I scored a 518 (97th percentile) on the MCATs, with a perfect score on biology/biochemistry. The DO school I was referring to happens to be very local and established, and I really liked it

I'm happy to be in a DO program so this isn't a "grass is greener" thing or a "hindsight is 20/20" thing, but with that MCAT and being deadset on a competitive subspecialty and/or specialty-- go MD.

 

[workaholic181]

DOs can and do specialize all the time. With that said, having an MD puts you at an advantage in medicine. You still can absolutely achieve your goal as a DO.

 

[MADD!!!]

I guess you really can't predict 7 years before I'd apply. And I just learned how great the market is for hospitalists. They out-earn rhem, endo and ID doctors without having to do a fellowship. What's the point of subspecializing then? Only interest?

The market is changing... more IM docs are just doing what specialists do b/c they're technically allowed to and they are outperforming specialists b/c they have the patient base and are providing more specialist services. Right now many IM specialists are struggling in the sense that since they're specialists, they don't have the patient flow like Primary care docs do.

And no, those specialists did the fellowships to be specialized and bill more for the procedures they can do in their fields. GI is still untouched in that sense since a Primary care doc doesn't have an endoscope to perform those examinations and bill for them. So if those ppl specialized for that reason, they're getting screwed over today.

 

[Limvostov]

I didn't want to brag, but I scored a 518 (97th percentile) on the MCATs, with a perfect score on biology/biochemistry. The DO school I was referring to happens to be very local and established, and I really liked it

So, this may not translate to a great board score. My class had its best board scores come from those that actually scored mid range and even kinda low on MCAT.

Also boards do not = sub-specialty match, there is more that goes into the selection process. Where you trained (likely the most important factor because each location comes with a reputation for quality ... or lack of quality training), your letters, how you interview, how the other fellow's feel about your interactions at the interview dinner, ties to the location... The people who select you have to work in close quarters with you for 2-4 years. There is no way you're getting in at a location if someone strongly disliked you for some reason. It has nothing to do with you being a good candidate and more about being a good fit. I would say work hard and if you really want something you'll likely get it. If you have a location desire that may not be practical, but a specialty should not be unattainable for any good applicant.

 

[AlteredScale]

As it has said, a big hurdle for DO's is getting into a strong IM residency. For the sake of matching into a fellowship, university IM for the most part has the resources to help one get into a fellowship program (such as having in-house fellowships within in medicine like cards, GI, PCC, A/I which means faculty to gain mentorship and research experience from).

From what I have seen so far (again just my perspective) is that there is most definitely a ceiling in IM residency placement for DOs with great board scores, decent research, decent letters. My speculation is that with regards to research and letters, MD students have an upper-hand because of the bigger "academic" focus than most DO schools which rely a lot on community-based preceptor vs. formalized faculty within an appointed teaching hospital.

Now, that's not to say there aren't IM programs at larger community hospitals that can get one into sub-specialty.

The best advice I can give is to do as well as you can academically (pre-clinical, boards, clinical), try to do research early on and get something out of it, and make friends along the way whilst rotating and/or performing research with a specific department/division of interest.

 

[DubbiDoctor]

As it has said, a big hurdle for DO's is getting into a strong IM residency. For the sake of matching into a fellowship, university IM for the most part has the resources to help one get into a fellowship program (such as having in-house fellowships within in medicine like cards, GI, PCC, A/I which means faculty to gain mentorship and research experience from).

From what I have seen so far (again just my perspective) is that there is most definitely a ceiling in IM residency placement for DOs with great board scores, decent research, decent letters. My speculation is that with regards to research and letters, MD students have an upper-hand because of the bigger "academic" focus than most DO schools which rely a lot on community-based preceptor vs. formalized faculty within an appointed teaching hospital.

Now, that's not to say there aren't IM programs at larger community hospitals that can get one into sub-specialty.

The best advice I can give is to do as well as you can academically (pre-clinical, boards, clinical), try to do research early on and get something out of it, and make friends along the way whilst rotating and/or performing research with a specific department/division of interest.

Thanks for the information, but after doing a fair amount of research, I'm pretty sure I'm going to aim for emergency medicine. Better pay than IM subspecialites (excluding cards and gastro) with no fellowship requirement, it offers a far better schedule than a hospitalist, (M, W, F, with some weekends, rather than 7 on/7 off, which seems hellish, especially when older), and it's exciting, intense work. Not having to worry about being accepted to a fellowship would seem to relieve a lot of stress, particularly when I'm not keen on working 84 hour weeks every other week as a hospitalist if I don't match. I do find IM more interesting, and based on the boards outline, would rather study for IM, which is a bit of shame -- but trade-offs are a part of life.

 

[AnatomyGrey12]

and it's exciting, intense work

Lol, maybe you should focus on actually starting med school before you make uninformed opinions of specialties and start making "trade-offs"....

 

[DubbiDoctor]

Lol, maybe you should focus on actually starting med school before you make uninformed opinions of specialties and start making "trade-offs"....

Are you implying that ER physicians do not do exciting, intense work? I thought that would be a pretty non-controversial statement.

 

[AnatomyGrey12]

Are you implying that ER physicians do not do exciting, intense work? I thought that would be a pretty non-controversial statement.

It has its moments of very exciting, intense work (as do a lot of specialties), but it is also a lot of drug seekers, complaints that should be seen by a PC, and patients complaining of the ever nebulous abdominal pain (which can definitely turn exciting but is often not). Most fields of medicine are not really that close to the perceptions that they get from pre-meds or the lay public.

 

[DNC127]

Are you implying that ER physicians do not do exciting, intense work? I thought that would be a pretty non-controversial statement.

LOL, ER is boring most the time, exciting some of the time, and over rated all of the time IMO.

 

[MADD!!!]

Are you implying that ER physicians do not do exciting, intense work? I thought that would be a pretty non-controversial statement.

You will change your mind hundreds of times throughout the next few years.... almost everyone does

Also, You don't know squat about these residencies and what the work life of each actually entails. You figure it out predominantly in 3rd year when you do rotations and get to step in their shoes for 4-6 weeks.