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[Dufrane]

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Hi, Since the application process is on the horizon, I like to ask for some advise from those of you who know the match process for psychiatry. I am a USFMG from Germany, graduated five years ago. I have not started in any residency programs since I came back to the US two years ago because of extenuating circumstances. Initially, my intention was to pursue Radiology but did not match despite some research and high board scores. I'm very interested in psychiatry but was very hesitant from the start which I understand is not uncommon for psychiatry. So now, I will be applying for the match. The problem I have is that I have no US experience in psychiatry and therefore no letters from US psychiatrists. Can anyone offer me some advise? What would be my chances without such a letter? I really appreciate any thoughts.

 

[jjbmsiv]

To be frank: Your chances without a letter and being this far removed from your graduation date without anything on your resume to show some further career advancement/interest medically (in the US, at least) is going to make it all but impossible for you to match, and maybe not even result in any interviews. I would begin the process this year of doing unpaid "observerships" or externships, which will help get your foot back in the door and get you some letters for next season. Have you completed all the STEP exams?

 

[Dufrane]

Thanks jjbmsiv. That's exactly what I need now, some good old straight talk. I really need to go through the application cycle this time around though or I'll be even further away from my graduation date!! I've done steps 1 & 2 with 230 & 220. Why is it so hard to find an observership? This is so frustrating. Any ideas on how best to accomplish this ASAP? BTW, I have 2 US letters...they're just not in psych!! 🙁

 

[Doc Samson]

Thanks jjbmsiv. That's exactly what I need now, some good old straight talk. I really need to go through the application cycle this time around though or I'll be even further away from my graduation date!! I've done steps 1 & 2 with 230 & 220. Why is it so hard to find an observership? This is so frustrating. Any ideas on how best to accomplish this ASAP? BTW, I have 2 US letters...they're just not in psych!! 🙁

FWIW, Mass General frequently has observers on its services.

 

[PsychMD2100]

Never say never. Let's be realistic that Psych is not like Derm or Anesthesia. The top programs are quite hard to get into. However, not all programs are top tier. There's a number of programs that are solid and not that selective. They have a number of FMGs and DOs amongst their ranks.

If you're willing to look into programs in small to medium sized cities that are less academic, you've got a chance. I would try to do your observership at one of these smaller places. It could very well pay off as a "back door" way into the program. Best of luck.

 

[slope]

Dufrane,

I think you have a fairly good chance to get into a middle-tier program provided you get a 3rd letter from a US psychiatrist and that you clear Step 3. Ideally, you should add a 4th letter from a related field (i.e., neurologist).

 

[Jack Daniel]

Never say never. Let's be realistic that Psych is not like Derm or Anesthesia. The top programs are quite hard to get into. However, not all programs are top tier. There's a number of programs that are solid and not that selective. They have a number of FMGs and DOs amongst their ranks....

DOs: the barometer of quality? 😡

 

[jjbmsiv]

Yeah, that statement was ridiculous. I'm an MD and I'm embarassed as hell about comments like that.

 

[billypilgrim37]

Using DO or FMG status to evaluate an individual is ridiculous, but due to unfair prejudices in resident selection, the number of DOs and FMGs taken by a program may be a proxy for competitiveness. Or it may be that a good program is enlightened enough to look past a very poor predictor of future success. Given that the latter seems to be an exception rather than a rule, we're left with having PsychMD2100's comment having some validity.

Add that to the fact that for some proportion of DO and FMG graduates, their enrollment represents not gaining entry into an allopathic med school. While that proportion is probably a low one in all actuality, I would tend to believe that the general unfair perception is that most DOs didn't choose to be DOs, they just simply couldn't choose to be MDs.

I'm certainly not endorsing that logic. My best friend just started his general surgery residency as a DO. He applied to allopathic med schools and was not accepted to any, but was accepted to a DO school. This was true not because he wouldn't be an excellent doctor, but because he is terrible at math, and got a 6 on the physical science section of the MCAT, even after a retake. So, a 26, despite being a 10-10-6, just isn't competitive for any allopathic medical school (a 10-10-10 would have been par for the course at the schools to which he was applying), despite the fact that the kid was an A-plus human being in every other way. I'm convinced that many of his classmates a) were simply more drawn to the DO spiel, b) had similarly isolated deficiencies that had little predictive value for future performance, or c) were substantially more interested in community or rural health care, where DO schools probably excel on average compared to many MD schools.

But we have these same prejudices as MDs. We look at programs that list the schools where their residents come from, and we're impressed by Columbia and UCSF or UCLA, but we're not as impressed by Emory or UNC or Michigan. Those latter programs are excellent programs as well, certainly programs I'll be excited to interview at, but we evaluate programs by whatever proxy we can. Sometimes those proxies hurt us by providing us with little predictive value. I get a little excited when I look at a program that I've heard good things about, and none of the residents come from a school in the same-tier as my medical school. That may also mean that the program just simply won't be impressed by the fact that I'm coming from a top-10 med school.

Damn proxies.

 

[PsychMD2100]

No one chooses to become a DO outright. If they say so, then they're not being honest with themselves. A DO is a second-choice degree. If they have DO residents, then they're drawing from second-choice applicants.

How does your friend with a 6 in physical sciences calculate his pressor dosages in the ICU? I hope he knows his math well enough to keep people alive. I've known people who use English as a second language who have doubled your friend's physical science score--pretty scary.

Save the A-plus human being bulls*&t for the next Nickleodeon TV special. It doesn't work here. If I'm picking a doctor in any field, I'm going to the guy who did the best at every stage and trained at the most competitive programs.

 

[OldPsychDoc]

No one chooses to become a DO outright. If they say so, then they're not being honest with themselves. A DO is a second-choice degree. If they have DO residents, then they're drawing from second-choice applicants.

How does your friend with a 6 in physical sciences calculate his pressor dosages in the ICU? I hope he knows his math well enough to keep people alive. I've known people who use English as a second language who have doubled your friend's physical science score--pretty scary.

Save the A-plus human being bulls*&t for the next Nickleodeon TV special. It doesn't work here. If I'm picking a doctor in any field, I'm going to the guy who did the best at every stage and trained at the most competitive programs.

That attitude is out of line here--and by "here" I mean both on this forum AND in your chosen field of psychiatry. I'll pass it off for now as inexperience on your part, and not as arrogance or prejudice.

I've trained with (and been trained by) plenty of DO's and they are equivalent if not better than many MD's--especially those MD's with a self-entitled "be the best" demigod complex. At ranking time, we've placed many DO's above MD's from "name" schools. Most of the DO's I know did choose the DO route as their primary path for philosophical reasons. And yes, for what it's worth, I am an MD. I also have a DO as my primary care physician.

Doing "the best at every stage" is not correlated with clinical accumen as a psychiatrist. Frankly, you can calculate your pressor doses well enough to keep people alive with 9th grade algebra, or for that matter with my 6th grader's ability to enter numbers into a computer program. And it is NOT "A-plus human being bulls*&t" to assert that psychiatry in particular is a field where humanism and the ability to relate interpersonally will trump physical science scores. Actually, I find it "pretty scary" that you consider a physical science score as more indicative of clinical skills than the ability to communicate fluently in a culturally-relevant manner.

 

[billypilgrim37]

How does your friend with a 6 in physical sciences calculate his pressor dosages in the ICU? I hope he knows his math well enough to keep people alive. I've known people who use English as a second language who have doubled your friend's physical science score--pretty scary.

As someone who got a 14 on the physical sciences section, I'd say he can calculate his pressor dosages just fine.

No one chooses to become a DO outright. If they say so, then they're not being honest with themselves. A DO is a second-choice degree. If they have DO residents, then they're drawing from second-choice applicants.

Plenty of folks apply only to DO schools. Many of them are interested mostly in primary care, and many of them accept the DO schools creed that they approach medicine from a more holistic standpoint (which, I would argue with, but that's not the thread).

 

[jay dub]

Well said, OPD. We can always count on you to be the voice of reason. 🙂

 

[PsychMD2100]

That attitude is out of line here--and by "here" I mean both on this forum AND in your chosen field of psychiatry. I'll pass it off for now as inexperience on your part, and not as arrogance or prejudice.

I've trained with (and been trained by) plenty of DO's and they are equivalent if not better than many MD's--especially those MD's with a self-entitled "be the best" demigod complex. At ranking time, we've placed many DO's above MD's from "name" schools. Most of the DO's I know did choose the DO route as their primary path for philosophical reasons. And yes, for what it's worth, I am an MD. I also have a DO as my primary care physician.

Doing "the best at every stage" is not correlated with clinical accumen as a psychiatrist. Frankly, you can calculate your pressor doses well enough to keep people alive with 9th grade algebra, or for that matter with my 6th grader's ability to enter numbers into a computer program. And it is NOT "A-plus human being bulls*&t" to assert that psychiatry in particular is a field where humanism and the ability to relate interpersonally will trump physical science scores. Actually, I find it "pretty scary" that you consider a physical science score as more indicative of clinical skills than the ability to communicate fluently in a culturally-relevant manner.

OldPsychDoc,

I appreciate reading your posts on other threads. However, I can't agree with you on this one.

To start, my attitudes and feelings towards patients are entirely different than my views towards osteopaths. To suggest that my partial acceptance of DOs reflects upon my patient care or humanism is a bit misguided. While my points were stated in a provocative manner, I would never go so far as to say that a physical science score is more important than interpersonal skills.

I strongly disagree with the claim that MDs and DOs are equivalent. The training for DOs is often patchy and inconsistent. While allopathic schools are drawing down, DO schools are expanding both in size and number. DO schools are often unusually large (NY COOM is 1176 strong) and charge tuitions higher than many MD schools, which makes one wonder about the "Diploma Mill" schools that Abraham Flexner helped close in the early 20th Century.

DO schools rarely have a parent university hospital with its accompanying resources. This results in a couple of undesired effects:

1) DO students will rarely enjoy the continuity and coherence of training enjoyed by their university-based MD counterparts with regular faculty
2) DO students often have to fight for time with "home" students, or train in understaffed public facilities where training can take a back seat, resulting in gaps in knowledge

The Osteopathic Founder, Dr. Andrew Taylor Still, created Osteopathic Medicine in response to the tragic loss of three of his children to meningitis. Ironically, one of the things that sets DOs apart (Osteopathic Manipulative Medicine/Therapy) is of no value in treating infectious disease.

I'm happy to hear that you were trained by DOs. It's also good to know that you trust your personal health to a DO. I can cite just as many anecdotal examples, including expulsion of a DO at a neighboring program as well as substandard medical care from a prominent DO in the community.

Psychiatry is always being scrutinized and questioned by the lay public. Are there great DOs and bad MDs? Of course there are. But when given a choice, a Psychiatrist should have gleaming academic credentials AND outstanding "people" skills. DOs don't have those academic credentials even if they're A-plus human beings. This is why the top-tier programs don't have DOs. It's not to say that they're lesser human beings but it is to say that they come up short in half of the equation.

After all, this entire thread started with a question about an FMG's chances at a US Psych residency. I don't see what is so offensive about stating that DO-heavy programs are less competitive.

Lastly, to use your term, "arrogance" is believing that, with time, I will inevitably see things your way. Could it be that we have a real difference of opinion? Dismissing an opposing viewpoint as "inexperience" is the mark of arrogance.

 

[futuredo32]

No one chooses to become a DO outright. If they say so, then they're not being honest with themselves. A DO is a second-choice degree.

You could not be more incorrect. I chose to be a DO. Initially, I thought I wanted to specialize in geriatrics and realized how useful OMM could be for seniors in particular. Some of my friends in D.O school opted to become a D.O. because they wanted to go into PM&R, or simply respected the way they were treated by osteopaths who treated them in the past. For some students, an osteopathic medical school is a second choice, but definitely not for all of us.

I strongly disagree with the claim that MDs and DOs are equivalent. The training for DOs is often patchy and inconsistent. While allopathic schools are drawing down, DO schools are expanding both in size and number. DO schools are often unusually large (NY COOM is 1176 strong) and charge tuitions higher than many MD schools, which makes one wonder about the "Diploma Mill" schools that Abraham Flexner helped close in the early 20th Century.

While I do have issues with the rapid expansion of osteopathic schools, I definitely would not wonder about any comparison to diploma mills. If they were just diploma mills or "often patchy and inconsistent," you would obviously be able to come up with more than a few anecdotes about expelled DOs. There would be a consistent pattern unparalleled by similar anecdotes about MDs.

MSU has both a D.O. school an M.D school where the osteopathic and allopathic students have all of their basic science classes together and take the same tests. Second year classes are separate since the allo school has a PBL curriculum while the osteo students have a systems based curriculum. However, the instructors for both schools are essentially the same. The exam questions for both schools are written by the same instructors.

DO schools rarely have a parent university hospital with its accompanying resources. This results in a couple of undesired effects:

1) DO students will rarely enjoy the continuity and coherence of training enjoyed by their university-based MD counterparts with regular faculty
2) DO students often have to fight for time with "home" students, or train in understaffed public facilities where training can take a back seat, resulting in gaps in knowledge

While it is true that DO schools rarely have a parent university hospital, the effects you mention have not been true thus far in my training. I'm only a third-year student, but I haven't had any of the "undesired effects" you mentioned. The training I have received thus far has been excellent. I have never had to fight for time with any other students. On most rotations, I am the only student on the service. Furthermore, some of our base hospitals are hospitals we share with allopathic students.

To the OP, I am sorry that this is so off the topic of your thread, I just felt compelled to correct the many inaccuracies that have lead PsychMD2100 to his opinion of DOs.

 

[ioh]

.

 

[parvas24]

I am an IMG with passing scores on both parts in first attempt... preparing for my step 3 now .. shall be applying to psyc programs ... I had been working for 10 years at regional hospitals in Central America as Emergency physician ... I recently did an observership in USA ... I do have US LORS .... do I stand a chance ... if so where should I apply ... any ideas which are competitive programs ...

 

[novacek88]

No one chooses to become a DO outright. If they say so, then they're not being honest with themselves. A DO is a second-choice degree. If they have DO residents, then they're drawing from second-choice applicants.

How does your friend with a 6 in physical sciences calculate his pressor dosages in the ICU? I hope he knows his math well enough to keep people alive. I've known people who use English as a second language who have doubled your friend's physical science score--pretty scary.

Save the A-plus human being bulls*&t for the next Nickleodeon TV special. It doesn't work here. If I'm picking a doctor in any field, I'm going to the guy who did the best at every stage and trained at the most competitive programs.

Likewise, there are plenty of medical students (both M.D.'s and D.O.'s) who say that psych is a second choice residency and would say you only chose psych because you couldn't get into one of the more competitive lifestyle fields of medicine, but I'm sure you "chose psych" and are not lying to yourself. Remember, there is always a bigger fish! I hope you attended an Ivy League undergraduate, medical and post-graduate program otherwise your very argument could be used against you. And if you are going to base your opinion strictly on the numbers, what do you have to say in regards to the D.O.'s who do better than some M.D.'s on the boards? So having a better MCAT score suddenly makes one a superior physician than a better USMLE Step I? Yes, yes, yes, you can apply the "if all else is equal" argument but we all know that seldom applies and usually a student will have an edge in one area or another.

A lot of DO applicants get into top programs. They have amazing research and killer board scores. Sure, they might have initially did poor on the MCAT but they compensated for it in medical school. Likewise, there are plenty of U.S. M.D. students who rest on their laurels of being accepted into medical school and then get lazy in medical school. When does the M.D. acceptance/passport end and the grades/boards/research/personality apply? There are plenty of U.S. grads who barely pass Step I or fail it. So that student is somehow better than a DO student who did well in medical school simply because he got accepted into a U.S. allopathic school?

Finally, there are DO schools that are more competitive than the lower tiered M.D. schools in this country. Also, your state residency plays a big part into getting accepted into medical school. Sorry but not all of us were fortunate to grow up in states like Mississippi, Alabama, Arkansas, Texas or Oklahoma where it's relatively easy to get into their medical schools if you are a resident. If you grew up in California or New York, it's much more difficult to get into their state's medical schools. Or what about schools like Howard or Meharry? They are M.D. schools but everyone knows they cater to affirmative action applicants who traditionally have lower scores. I suppose they are inferior doctors as well. Or what about the post-bac or masters students who applied 2 or 3 times to get into their allopathic school? Are they better doctors than the student who chose to go to a DO school than reapply?

Yes, your argument is downright embarrassing let alone loosely constructed. It took all of 2 minutes to cite the various holes in it. The most amusing thing about your attitude is your failure to identify your future clients/patient/target base. Sure, if all of your patients were narcisistic physicians like yourself then you would be correct. However, the reality is the majority of your patients will be Joe American and could care lesss about your initials. The issues that will be the most important to them will be whether their friends or colleagues liked you, the driving time to your office and whether they liked you based on their initial consult. Sure there are some narcisistic individuals like yourself who place more credibility in credentials than one's ability but the overwhelming majority of people do not.

 

[PsychMD2100]

novacek88,

That all ya got?