militarymd said:
I guess you're right. I guess I don't understand the osteopathic training pathway.
So correct if I'm wrong.
Close, but no cigar - don't feel bad, it is overly complex & borders on absurd. Many DO-students don't even understand it...it is even worse than the ACGME post-grad system. In essence, the AOA system still closely resemble the structure of ACGME post-grad training 25 years ago. The PGY-1 year, or the intern year, is largely treated as a distinct entity from the remainder of the residency. For many, but not all programs, the matching process is also separate. In other words, the AOA match is for an internship slot & the residency slot entails reapplication/interviewing. For example, if you wanted to do an EM program in the AOA - in the old, typical AOA system - the applicant would apply to & interview for intern year slots. And then, in the course of the intern year, repeat the process for the actual EM slot.
Now, with all of that said, the AOA is working toward modernization - meaning smoothing out the process by linking intern & residency slots, bundling programs where intern/resident is a single slot & not just linked & allowing for applicants to only do the apply/interview/match process once in lieu of multiple times. This transition is on-going & in many ways adds to the confusion because different programs, both between & within specialties, are at differing points in the changeover.
Furthermore, not all programs participate in the AOA match, or at least not in an above the table manner. It is quite (very) common for AOA programs to award some or all of their slots in agreements with tasty applicants while they do audition rotations...up to & including signed contracts. Yes, this violates the "letter of the law" for the matching process, but is so commonplace that not even bats an eye - except for those who were not offered slots prior to the match.
Lastly, the AOA 'requires' a traditional rotating internship for any sort of AOA-based credentialing. Their definition of an intern year is essentially mimics a 5th year of medical school (1 or 2 month rotations in the various classic medical disciplines: OB, FP, IM, GS + some elective time, but you are paid & function as a PGY-1 physician). To ever hold an elected or voting position in the AOA, a tenure-track faculty position at a DO school or be credentialed by an AOA specialty board - you must have either completed an AOA-sanctioned internship or have applied to have your ACGME PGY-1 year approved...and they do not give away those approvals! Basically, if you ACGME PGY-1 year does not CLOSELY correspond with what you would have done in an AOA program, it is a no-go.
militarymd said:
The osteopathic training pathway is planned from the beginning to switch to the allopathic training pathway once you finish with pre-graduate training.....Is that correct?
Some folks plan to switch from day one, some plan to remain in AOA-sanxtioned programs & others, like myself, focus on picking the programs that best suit what we wish to accomplish personally & professionally.
militarymd said:
The switch over is pre-planned because you know from the get-go that there will be more osteopathic graduates than there will be osteopathic residency slots..right?
The fact of the matter is that DO schools, & hence the number of students, have vastly outpaced any growth in the number of AOA program slots. When I graduated in 2003, there were roughly 1800 DO graduates & around 1200
funded internship slots. At that time, most intern slots were not linked in any way to a residency slot - please see above. Now, in 2006, I think they're going to graduate on the order of 2300~2500 DOs & I
think there are still approx 1200~1500
funded AOA intern slots...more of the linked/combined with residencies, but still vastly deficient vs the number of graduates.
Due to this fact, a significant portion of DO graduates must do their post-grad training through the ACGME. Even more intriguing is that fully 50~65%, depending upon the records you read, of DO grads choose to do ACGME post-grad training for a variety of reasons, including a common perception that some, not all, DO programs are not of as high a quality as their respective ACGME counterparts. As a gestalt, in the primary care realm, this perception is not too common, but for your specialties (anesth being one of them) this is a common & strongly held belief. Is it true? I have no idea. You hear tons of conjecture on why the programs are & are not on parity - but I know of no one who has gone through both types to be able to honestly compare nor do I know of any controlled, randomized studies to compare them either...so your guess on that question is as valid mine.
militarymd said:
After you finish the allopathic residency, then you have the option to switch back over to the osteopathic boards again..right?
No, if a DO does ACGME post-grad training, their board certification will also be through the ACGME board. As I stated above, if you do not do a DO intern year AND an AOA-sanctioned residency, you cannot be boarded through the AOA. All of the "ship jumpers", including myself, will be boarded through their respective ACGME Board.
The reasonable, rational question becomes: "Why in the hell is there such an excess of DO grads?" My answer: damned good question! Basically, unlike the ACGME where there is a gross excess of post-grad slots which is now populated by IMG grads, the AOA does not tie number of post-grad slots to the approval system for new DO schools. I am not totally familiar with the new school application/approval process, but it focuses more on having a large enough pile of $$ to fund a newly operating school than it does upon need of graduates or corresponding training slots. The perception in the DO-world is that we need many more DOs out there & that there is money to be made by opening new schools - my interpretation, of course - hence the massive growth in DO schools. Personally, I think it is unwise to be flooding the physician market at this time. It is not necessarily true that the excess will naturally populate the underserved urban & rural markets - that is naive.
Now...sorry for the long reply, but there really is no short answer. I hope that this makes things much more clear for those who give a $hit.
