Importance of Post Graduate Medical Education

[redPastel]

What tangible difference does it make by going to a mid-tier to top-tier residency program instead of a low-tier?

When said and done, if you don't want to set a foot in the world of academia, your employer only cares if you are board certified or not correct? Granted, I'm sure you will earn a lot more working as a hospitalist at MGH compared to some place like Kaiser... (is it?) I'm sure you'll obviously get better training experience also...

So in the end, as a person trying to become a M-F hospitalist working at some local (mid-sized) hospital, will it impact me much by going DO? By not getting residency at a university hospital?

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[cliquesh]

What tangible difference does it make by going to a mid-tier to top-tier residency program instead of a low-tier?

When said and done, if you don't want to set a foot in the world of academia, your employer only cares if you are board certified or not correct? Granted, I'm sure you will earn a lot more working as a hospitalist at MGH compared to some place like Kaiser... (is it?) I'm sure you'll obviously get better training experience also...

So in the end, as a person trying to become a M-F hospitalist working at some local (mid-sized) hospital, will it impact me much by going DO? By not getting residency at a university hospital?

For one, you get paid less in academia, about 1/4 to 1/2 less than private work. Moreover, in general, the pay is inversely related to the prestige of the instituition, so Ivy league hospitals tend to pay like crap, like 120k/year for a hospialist.

Going to a mid/upper tier program will provide you with, in all likelihood, a better education, more fellowship opportunities and increased employment opportunities. The most important thing, at least for someone who is only interested in becoming a hospitialist, is probably education. Some "low tier" community programs are completely fine in regards to education. Christiana in Delaware, for example, is a 900 bed hospital with numerous fellowship opportunities. I'd imagine that the training there is more than sufficient. On the other hand, there are other community internal medicine residencies at hospitals with only 150 beds and no in house fellowships, which makes me suspicious of the residents' education.

Being a DO will not matter for most jobs. Some elite private groups and academic hospitals will not hire you solely because of your degree. These exclusionary groups are a small minority, however. Other institutions may potentially not hire you if you are only AOA board certified opposed to Acgme board certified. Once again, these employers are a minority, but probably more common than those who will simply not take any DOs.

Being a DO does not exclude you from training at a mid/upper tier program. I would agree that matching at an upper tier internal medicine program is probably significantly more difficult for a DO than a USMD, but matching at a solid mid-tier university program is probably only slightly more difficult and, in some cases, exactly the same as a US-MD.

Nevertheless, if you are content with training at a community based internal medicine residency program and practicing at a local community hospital, working 2 weeks on and 2 weeks off, and getting paid in the low $200s, you should have zero problems as a DO.

I'm not sure if you're a pre-med or not, but your interests may change when you start medical school, so just to give you a heads up on the opportunities as a DO:

If you do anesthesia, PM&R, family medicine, pyschiatry or pathology, it is realistic, if you deserve it, to match at an upper tier acgme program.

If you do internal medicine, Ob/gyn, peds, radiology, or general surgery, it's realistic to match at a middle tier acgme program. Probably lower tier for general surgery and (maybe) radiology, however.

It is unrealistic, as a DO, to match at any Acgme neurosurgery, orthopedic, urology, ENT, derm, plastics, rad/onc and (maybe) opthamology. I'm not saying DOs cannot match into these residencies, it's just unlikely.

If you decide on doing surgery, AOA general surgery and AOA orthopedic surgery are abundant. However, there are very few (20 spots of less per year) for AOA neurosurgery, ENT, urology, and eyes.

 

[DrEnderW]

Thanks for the detailed response cliquesh.

I know know this may not be your specific area of expertise, but could your or others comment on how this applies to surgery? Is it difficult to obtain jobs of equivalent pay to say a mid-tier trained residency grad compared to a community/ AOA residency grad for gen surg and surg sub-specialties?

 

[babdoc]

Maybe think of it like this:

Even if you're wanting to go into private, community-based practice, what happens when something truly off the wall comes in? The goal of residency is to get as much experience as you can. You want to see and do a lot. So, that means going to a program that is busy enough and has enough volume to get some of the zebras.

This is much easier to accomplish in ACGME university-based programs. I'm not saying you can't do it in an AOA program I'm just saying, don't lose stream or discount yourself as far as residency goes. You want to force yourself to work harder than you did in medical school. You'll have the basic knowledge, now you should solidify everything.

 

[SurgeDO]

Thanks for the detailed response cliquesh.

I know know this may not be your specific area of expertise, but could your or others comment on how this applies to surgery? Is it difficult to obtain jobs of equivalent pay to say a mid-tier trained residency grad compared to a community/ AOA residency grad for gen surg and surg sub-specialties?

no.

as it was mentioned previously, pay tends to be higher in rural areas/community hospitals. if you position your practice right, you could rake in much more dough than even the top dogs at MGH.

 

[SurgeDO]

Maybe think of it like this:

Even if you're wanting to go into private, community-based practice, what happens when something truly off the wall comes in? The goal of residency is to get as much experience as you can. You want to see and do a lot. So, that means going to a program that is busy enough and has enough volume to get some of the zebras.

This is much easier to accomplish in ACGME university-based programs. I'm not saying you can't do it in an AOA program I'm just saying, don't lose stream or discount yourself as far as residency goes. You want to force yourself to work harder than you did in medical school. You'll have the basic knowledge, now you should solidify everything.

i would like to add that many physicians continue learning after residency as well. just because you were not able to fully master the whipple before residency was over, does not mean you are doomed to never be able to perform it. there are many ways to continue your medical education after residency is over.

 

[cliquesh]

Thanks for the detailed response cliquesh.

I know know this may not be your specific area of expertise, but could your or others comment on how this applies to surgery? Is it difficult to obtain jobs of equivalent pay to say a mid-tier trained residency grad compared to a community/ AOA residency grad for gen surg and surg sub-specialties?

I know in anesthesia, and I believe the same applies to surgery, your employment opportunities has more to do with Acgme vs. AOA board certified rather than where you trained (community vs. university). Hospitals seem to be more selective when giving hospital privileges to members of surgical teams (anesthesiologists and surgeons) than other types of physicians, and they want to see Acgme board certifications. So, with that said, as an AOA board certified surgeon, it's more difficult to find a job in the sense that you'll likely not be granted practicing privileges at university programs and some private hospitals with only an AOA board certification. However, there are plenty of hospitals in smaller communities that will hire AOA trainned surgeons, and, as surgeDO reinforced, your salary will be equal to, if not higher, than surgeons practicing in major cities. When I say small cities, I'm not talking rural Alaska. I'm talking about the communities that surround major cities.

What I said is just a generalization, though, and it is not completely set in stone. I know, for instance, a group of DOs, who are all AOA trained ENTs, that work mostly out of a university hospital in a major city. A recent graduate that i met entering the group will start at around 400k.

 

[DrEnderW]

Thanks for taking the time to write that up - much appreciated!

 

[NYEMMED]

For one, you get paid less in academia, about 1/4 to 1/2 less than private work. Moreover, in general, the pay is inversely related to the prestige of the instituition, so Ivy league hospitals tend to pay like crap, like 120k/year for a hospialist.

Going to a mid/upper tier program will provide you with, in all likelihood, a better education, more fellowship opportunities and increased employment opportunities. The most important thing, at least for someone who is only interested in becoming a hospitialist, is probably education. Some "low tier" community programs are completely fine in regards to education. Christiana in Delaware, for example, is a 900 bed hospital with numerous fellowship opportunities. I'd imagine that the training there is more than sufficient. On the other hand, there are other community internal medicine residencies at hospitals with only 150 beds and no in house fellowships, which makes me suspicious of the residents' education.

Being a DO will not matter for most jobs. Some elite private groups and academic hospitals will not hire you solely because of your degree. These exclusionary groups are a small minority, however. Other institutions may potentially not hire you if you are only AOA board certified opposed to Acgme board certified. Once again, these employers are a minority, but probably more common than those who will simply not take any DOs.

Being a DO does not exclude you from training at a mid/upper tier program. I would agree that matching at an upper tier internal medicine program is probably significantly more difficult for a DO than a USMD, but matching at a solid mid-tier university program is probably only slightly more difficult and, in some cases, exactly the same as a US-MD.

Nevertheless, if you are content with training at a community based internal medicine residency program and practicing at a local community hospital, working 2 weeks on and 2 weeks off, and getting paid in the low $200s, you should have zero problems as a DO.

I'm not sure if you're a pre-med or not, but your interests may change when you start medical school, so just to give you a heads up on the opportunities as a DO:

If you do anesthesia, PM&R, family medicine, pyschiatry or pathology, it is realistic, if you deserve it, to match at an upper tier acgme program.

If you do internal medicine, Ob/gyn, peds, radiology, or general surgery, it's realistic to match at a middle tier acgme program. Probably lower tier for general surgery and (maybe) radiology, however.

It is unrealistic, as a DO, to match at any Acgme neurosurgery, orthopedic, urology, ENT, derm, plastics, rad/onc and (maybe) opthamology. I'm not saying DOs cannot match into these residencies, it's just unlikely.

If you decide on doing surgery, AOA general surgery and AOA orthopedic surgery are abundant. However, there are very few (20 spots of less per year) for AOA neurosurgery, ENT, urology, and eyes.

I agree with most of your post. Indeed those fields you listed are hard however NYCOM alone matched ACGME neurosurgery this year at Ohio State, Ophthalmology at Cornell (There are usually 1-2 optho at NYCOM every year), Urological Surgery at Albert Einstein, IM at Georgetown and Dartmouth. There are probably similar matches at other osteopathic medical schools in the country.

 

[SurgeDO]

I know in anesthesia, and I believe the same applies to surgery, your employment opportunities has more to do with Acgme vs. AOA board certified rather than where you trained (community vs. university). Hospitals seem to be more selective when giving hospital privileges to members of surgical teams (anesthesiologists and surgeons) than other types of physicians, and they want to see Acgme board certifications. So, with that said, as an AOA board certified surgeon, it's more difficult to find a job in the sense that you'll likely not be granted practicing privileges at university programs and some private hospitals with only an AOA board certification. However, there are plenty of hospitals in smaller communities that will hire AOA trainned surgeons, and, as surgeDO reinforced, your salary will be equal to, if not higher, than surgeons practicing in major cities. When I say small cities, I'm not talking rural Alaska. I'm talking about the communities that surround major cities.

What I said is just a generalization, though, and it is not completely set in stone. I know, for instance, a group of DOs, who are all AOA trained ENTs, that work mostly out of a university hospital in a major city. A recent graduate that i met entering the group will start at around 400k.

Ehh I am going to have to slightly disagree with you here. I think (for surgery at least) the majority of academic hospitals approve of AOA trained surgeons. I am saying that the large majority of academic hospitals will not simply throw your application in the garbage just because you are AOA trained. I think a hospital looks at a surgeon's individual accomplishments when considering hospital rights.

Just looking at Hopkins, I see an AOA trained orthopod and neurosurgeon. To counter my point, however, I don't see any AOA trained surgeons at MGH.


If you really want to work in an academic center, an AOA residency will not completely close the door.


Side note: ****ing boss.

http://m.hopkinsmedicine.org/doctor...&jh_doc=yes&gs_doc=yes&vip_doc=yes&hch_doc=no

Edit: after re-reading your post, I guess I really don't disagree with you.

 

[cliquesh]

I agree with most of your post. Indeed those fields you listed are hard however NYCOM alone matched ACGME neurosurgery this year at Ohio State, Ophthalmology at Cornell (There are usually 1-2 optho at NYCOM every year), Urological Surgery at Albert Einstein, IM at Georgetown and Dartmouth. There are probably similar matches at other osteopathic medical schools in the country.

Oh, I don't disagree with you. I'm just saying its unlikely. Of the 4913 DO grads this year, 2 matched Acgme neurosurgery, 6 that matched Acgme orthopedics, 1 ENT, 4 derm, 2 rad-onc. Urology and ophthalmology data is unknown because they use a different match service. I have the suspicion that ophthalmology is the most DO friendly Acgme surgical subspecalty, but I could be wrong. I didn't look at nycom's list, but I'd imagine that the urology match at Albert einstein is in Philadelphia, which is an AOA program. Georgetown and Darthmoth are both considered, by SDN standards, to be mid-tier.

I'm not trying to belittle DO schools' match lists. I am simply trying to give a realistic assessment of the post graduate opportunities for pre-meds potentially interested in osteopathic medicine.

Ehh I am going to have to slightly disagree with you here. I think (for surgery at least) the majority of academic hospitals approve of AOA trained surgeons. I am saying that the large majority of academic hospitals will not simply throw your application in the garbage just because you are AOA trained. I think a hospital looks at a surgeon's individual accomplishments when considering hospital rights.

Just looking at Hopkins, I see an AOA trained orthopod and neurosurgeon. To counter my point, however, I don't see any AOA trained surgeons at MGH.


If you really want to work in an academic center, an AOA residency will not completely close the door.


Side note: ****ing boss.

http://m.hopkinsmedicine.org/doctor...&jh_doc=yes&gs_doc=yes&vip_doc=yes&hch_doc=no

I'm just regurgitating what I've been told by my mentors.

 

[SurgeDO]

I agree with most of your post. Indeed those fields you listed are hard however NYCOM alone matched ACGME neurosurgery this year at Ohio State, Ophthalmology at Cornell (There are usually 1-2 optho at NYCOM every year), Urological Surgery at Albert Einstein, IM at Georgetown and Dartmouth. There are probably similar matches at other osteopathic medical schools in the country.

SDN has to be one Ivy match away from writing ophtho up as DO friendly.

 

[redPastel]

Helped a bunch..thanks for giving us some realistic but accurate outlook..

For now, (obviously this might change), I'm interested in doing IM subspecialties...I'm not interested in anything surgery related (I'm pretty sure I won't change my mind on this)..

If I matriculate to DO this year, I will give my best shot at a mid-tier university program.

 

[group_theory]

What tangible difference does it make by going to a mid-tier to top-tier residency program instead of a low-tier?

When said and done, if you don't want to set a foot in the world of academia, your employer only cares if you are board certified or not correct? Granted, I'm sure you will earn a lot more working as a hospitalist at MGH compared to some place like Kaiser... (is it?) I'm sure you'll obviously get better training experience also...

So in the end, as a person trying to become a M-F hospitalist working at some local (mid-sized) hospital, will it impact me much by going DO? By not getting residency at a university hospital?

Agree with what cliquesh (quoted below) said. In academia, you get paid significantly less than your private practice/community setting counterpart - 1/4-1/2 of the salary.

(in addition to higher base salary, depending on how the model is set up, you can buy into a partnership after a few years, which means you can participate in revenue sharing, earning you significantly higher take home pay than your academic counterpart)

There are benefits to working in academic medicine instead of private/nonteaching setting so when it comes time to choose the type of employment, you have to balance out the pros and cons.

Plus hospitalists are typically 7 on, 7 off (not M-F, 9-5)

For one, you get paid less in academia, about 1/4 to 1/2 less than private work. Moreover, in general, the pay is inversely related to the prestige of the instituition, so Ivy league hospitals tend to pay like crap, like 120k/year for a hospialist.

Going to a mid/upper tier program will provide you with, in all likelihood, a better education, more fellowship opportunities and increased employment opportunities. The most important thing, at least for someone who is only interested in becoming a hospitialist, is probably education. Some "low tier" community programs are completely fine in regards to education. Christiana in Delaware, for example, is a 900 bed hospital with numerous fellowship opportunities. I'd imagine that the training there is more than sufficient. On the other hand, there are other community internal medicine residencies at hospitals with only 150 beds and no in house fellowships, which makes me suspicious of the residents' education.

Being a DO will not matter for most jobs. Some elite private groups and academic hospitals will not hire you solely because of your degree. These exclusionary groups are a small minority, however. Other institutions may potentially not hire you if you are only AOA board certified opposed to Acgme board certified. Once again, these employers are a minority, but probably more common than those who will simply not take any DOs.

Being a DO does not exclude you from training at a mid/upper tier program. I would agree that matching at an upper tier internal medicine program is probably significantly more difficult for a DO than a USMD, but matching at a solid mid-tier university program is probably only slightly more difficult and, in some cases, exactly the same as a US-MD.

Nevertheless, if you are content with training at a community based internal medicine residency program and practicing at a local community hospital, working 2 weeks on and 2 weeks off, and getting paid in the low $200s, you should have zero problems as a DO.

.

Try to aim for the place that will give you the most experiences and training possible. It is not usually hospitals who decide who to hire, but the groups contracted with the hospital (that is looking to fill a vacancy or expand). So a surgery group who has an opening will advertise an opening, and will do the interviewing, hiring decision, etc. The hospital's job is to credential you (lots of paperwork), and make sure you obey the hospital bylaws.

Here's where it gets tricky - some hospital bylaws may not acknowledge AOA certifications.

And if you want to be in academic medicine and work with residents and students, it gets trickier since acgme rules may require ABMS certifications (for example, they want IM attendings to be ABIM certified if they are precepting IM residents, Peds attending to be ABP certified if they are precepting peds residents, ABS certified if precepting surgery residents, etc). There may be loopholes and exceptions (especially with ACGME) so I'm not sure if this is a hard ceiling.


Overall, if you are interested in a subspecialty, try to get the best training as you can. Go to a program that has in-house fellowships, or a history of placing lots of its graduates into fellowships. And I believe it matters if you do an IM residency at a 200 bed community hospital (who will refer or transfer any interesting/complicated patients to an academic tertiary center), or a residency in a large 500+ bed academic tertiary center (who will receive the transfer of an interesting/complicated patient from that small community hospital).

 

[thethethe]

I agree with most of your post. Indeed those fields you listed are hard however NYCOM alone matched ACGME neurosurgery this year at Ohio State, Ophthalmology at Cornell (There are usually 1-2 optho at NYCOM every year), Urological Surgery at Albert Einstein, IM at Georgetown and Dartmouth. There are probably similar matches at other osteopathic medical schools in the country.

That ophto match had a connection going on and I heard the same for the neurosurgery match at ohio state