Osteopathy and Oncology

[maestrohuang]

Now that I have been accepted, I have been honestly looking back at my experiences and what I enjoyed. I completed a summer internship at Memorial Sloan-Kettering Cancer Center in NYC and loved oncology and really would enjoy going into it. One thing that is hard for me to understand is the new ACGME/AOA rules that allows MDs into AOA residencies and then opens fellowships for DOs even if they have done an AOA residency. (I believe this is the case).

Now, if this is true, hypothetically, fellowships like a medical oncology/heme fellowship would theoretically become more open to DOs? I know that academic medicine is not typical for DOs, but I would love to return to MSKCC sometime in my future, whether is be during my GME years or even to work. Does the new ruling by the ACGME and AOA somewhat hinder or help me if I wanted to go this path?

How do rotations work in terms of 'getting my foot in the door' with the locations that I would potentially apply for residency? Can I simply ask hospitals if I may complete rotations with them or must they be affiliated with my medical school?

Obviously, this is a naive post since I don't honestly know what I want to do yet, but the questions are still helpful in understanding what the future will be for us.

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[maestrohuang]

anybody have real insight into these things? Might move this to the medical forum..

 

[abolt18]

None whatsoever... Désolé.

 

[munchymanRX]

Now that I have been accepted, I have been honestly looking back at my experiences and what I enjoyed. I completed a summer internship at Memorial Sloan-Kettering Cancer Center in NYC and loved oncology and really would enjoy going into it. One thing that is hard for me to understand is the new ACGME/AOA rules that allows MDs into AOA residencies and then opens fellowships for DOs even if they have done an AOA residency. (I believe this is the case).

Now, if this is true, hypothetically, fellowships like a medical oncology/heme fellowship would theoretically become more open to DOs? I know that academic medicine is not typical for DOs, but I would love to return to MSKCC sometime in my future, whether is be during my GME years or even to work. Does the new ruling by the ACGME and AOA somewhat hinder or help me if I wanted to go this path?

How do rotations work in terms of 'getting my foot in the door' with the locations that I would potentially apply for residency? Can I simply ask hospitals if I may complete rotations with them or must they be affiliated with my medical school?

Obviously, this is a naive post since I don't honestly know what I want to do yet, but the questions are still helpful in understanding what the future will be for us.

Under the new rules, there will be no more AOA residencies. All residency programs in the US will be accredited by the ACGME. Hypothetically it does make things more manageable for DO's wanting to go into academic medicine.

Most medical schools have set 3rd years at places affiliated with your school, but any chance you get at elective rotations you should be scoping out programs you want to do audition rotations at to make connections with attendings and even PDs. You're not applying for school anymore. People are more likely to hire you if they know you.

 

[cliquesh]

Now that I have been accepted, I have been honestly looking back at my experiences and what I enjoyed. I completed a summer internship at Memorial Sloan-Kettering Cancer Center in NYC and loved oncology and really would enjoy going into it. One thing that is hard for me to understand is the new ACGME/AOA rules that allows MDs into AOA residencies and then opens fellowships for DOs even if they have done an AOA residency. (I believe this is the case).

Now, if this is true, hypothetically, fellowships like a medical oncology/heme fellowship would theoretically become more open to DOs? I know that academic medicine is not typical for DOs, but I would love to return to MSKCC sometime in my future, whether is be during my GME years or even to work. Does the new ruling by the ACGME and AOA somewhat hinder or help me if I wanted to go this path?

How do rotations work in terms of 'getting my foot in the door' with the locations that I would potentially apply for residency? Can I simply ask hospitals if I may complete rotations with them or must they be affiliated with my medical school?

Obviously, this is a naive post since I don't honestly know what I want to do yet, but the questions are still helpful in understanding what the future will be for us.

Acgme fellowships will not be more open to DOs. It will be basically the same as it is now. There were 486 Acgme hema/onc fellowship positions in 2012 and 20 of those were filled with DOs. There are roughly 300 DOs that match into Acgme internal medicine each year.

Do well in school, do a research project between m1 and m2 at a cancer center, take the usmle and do well, match into the best internal medicine program you can get into that has a hematology oncology fellowship.

Mskcc has DOs on staff and accepts DOs into their fellowship and residency programs. They also accept DOs for their summer fellowship program and electives. You apply to mskcc's medical student programs directly through their web page.

I used VSAS,https://www.aamc.org/students/medstudents/vsas/, to set up my 4th year electives. Not all programs, like mskcc, use VSAS, however.

 

[maestrohuang]

Acgme fellowships will not be more open to DOs. It will be basically the same as it is now. There were 486 Acgme hema/onc fellowship positions in 2012 and 20 of those were filled with DOs. There are roughly 300 DOs that match into Acgme internal medicine each year.

Do well in school, do a research project between m1 and m2 at a cancer center, take the usmle and do well, match into the best internal medicine program you can get into that has a hematology oncology fellowship.

Mskcc has DOs on staff and accepts DOs into their fellowship and residency programs.

I understand the path to get into it. I am wondering if anything has changed with the new stipulations between the AOA and ACGME since that is the effect that I will have to follow. Are there heme onc fellowships provided by the AOA or is my only real hope of returning to a place like MSKCC through the ACGME?

 

[maestrohuang]

I used VSAS,https://www.aamc.org/students/medstudents/vsas/, to set up my 4th year electives. Not all programs, like mskcc, use VSAS, however.

thanks

 

[cliquesh]

I understand the path to get into it. I am wondering if anything has changed with the new stipulations between the AOA and ACGME since that is the effect that I will have to follow. Are there heme onc fellowships provided by the AOA or is my only real hope of returning to a place like MSKCC through the ACGME?

Nothing has changed, really. The status quo remains the same. It should not be any easier or harder for you to become a hema/onc doctor.

Yes, there are 7 AOA hem/onc fellowships. Each program takes 1 or 2 fellows per year.

With the career goals you have mentioned, however, you should focus your efforts on the best, well known Acgme program you can get into. Where you went to medical school, residency and fellowship are important in academics.

 

[DrBowtie]

Basically to get into H/O, match at the best academic IM residency program you can.

 

[group_theory]

Basically if you want a decent shot at a heme/onc fellowship, you want to match at an acgme university-based IM program. Even with this new AOA/ACGME merger, none of the current AOA IM program is up to the same caliber as a your typical university-based IM program, and suddenly becoming ACGME won't change that. Just talk to residents in community IM programs and what their odds are in terms of matching into cards, GI, or heme/onc, and it is more of an uphill battle coming from a community program versus university program (of course, there are community programs with their own in-house fellowships, but you want OPPORTUNITY, and not compete for an in-house program).

Going to unknown formerly AOA now ACGME IM program will put you at a disadvantage should you be interested in heme/onc, and wanting to go to a top program like MSKCC, MD Anderson, Hopkins, NIH, etc. will be extremely competitive. Going to a bigger university-based program will not only carry prestige, but also more research opportunities, and working with faculty that will be known in academic medicine (and have connections)

 

[maestrohuang]

Basically if you want a decent shot at a heme/onc fellowship, you want to match at an acgme university-based IM program. Even with this new AOA/ACGME merger, none of the current AOA IM program is up to the same caliber as a your typical university-based IM program, and suddenly becoming ACGME won't change that. Just talk to residents in community IM programs and what their odds are in terms of matching into cards, GI, or heme/onc, and it is more of an uphill battle coming from a community program versus university program (of course, there are community programs with their own in-house fellowships, but you want OPPORTUNITY, and not compete for an in-house program).

Going to unknown formerly AOA now ACGME IM program will put you at a disadvantage should you be interested in heme/onc, and wanting to go to a top program like MSKCC, MD Anderson, Hopkins, NIH, etc. will be extremely competitive. Going to a bigger university-based program will not only carry prestige, but also more research opportunities, and working with faculty that will be known in academic medicine (and have connections)

So now my ability to get a few rotations at academic hospitals will likely bring up my chances to get into a university based residency? Does completing a few rotations at a hospital help me to get a position once it is time to match? I do not know the matching process all too well, but I can imagine that having experience at that hospital, it should help so long as I maintain competitive scores, grades, ECs...

 

[group_theory]

So now my ability to get a few rotations at academic hospitals will likely bring up my chances to get into a university based residency? Does completing a few rotations at a hospital help me to get a position once it is time to match? I do not know the matching process all too well, but I can imagine that having experience at that hospital, it should help so long as I maintain competitive scores, grades, ECs...

It really depends on how your medical school 3rd and 4th year clinical rotations are set up. Some DO schools are notorious for poor experience/exposure during their 3rd/4th year to inpatient rotations, or rotate through small community hospitals. Other DO schools have excellent and diverse clinical exposures during their 3rd/4th years. Your opportunities to do a visiting student rotation at a university hospital will be based on whether the particular hospital accept visiting DO students (some do not), and whether your school will give you the flexibility to do the visiting student electives.

Now if you do get the opportunity to do a rotation at a university hospital, it helps get your foot in the door. Not only do you get to work with the residents, but you also get to work with the academic faculty there ... and their input will factor in with the program director/associated program director(s) when it comes time to deciding who to interview (and ultimately, who to rank and where on the rank list). Sometimes it might bump you up on the rank list if the residents/faculty likes you. The downside is if you don't shine or do extremely poorly during your audition rotation ... then you might be moved down the rank list (or not even be ranked)

Now do you need to rotate at every hospital that you want to match? No. And every year, the vast majority of people match at programs that they never rotated through. But rotating does give you a legs-up, and getting a good LOR from an academic attending at a big-name hospital will also help when it comes to other university IM programs.

However, there are certain IM programs that are extreme reach for DO students, such as MGH, Hopkins Osler, USCF, Stanford, UCLA, Duke, Columbia Presby, NYU, Emory, etc.

 

[gmcguitar4]

I would like to get into onc as well..pediatric specifically. So far this cycle it looks as though I might go to a DO program cause I haven't even heard from MD schools yet but I am still waiting. Just gotta work harder for it!

 

[maestrohuang]

It really depends on how your medical school 3rd and 4th year clinical rotations are set up. Some DO schools are notorious for poor experience/exposure during their 3rd/4th year to inpatient rotations, or rotate through small community hospitals. Other DO schools have excellent and diverse clinical exposures during their 3rd/4th years. Your opportunities to do a visiting student rotation at a university hospital will be based on whether the particular hospital accept visiting DO students (some do not), and whether your school will give you the flexibility to do the visiting student electives.

Now if you do get the opportunity to do a rotation at a university hospital, it helps get your foot in the door. Not only do you get to work with the residents, but you also get to work with the academic faculty there ... and their input will factor in with the program director/associated program director(s) when it comes time to deciding who to interview (and ultimately, who to rank and where on the rank list). Sometimes it might bump you up on the rank list if the residents/faculty likes you. The downside is if you don't shine or do extremely poorly during your audition rotation ... then you might be moved down the rank list (or not even be ranked)

Now do you need to rotate at every hospital that you want to match? No. And every year, the vast majority of people match at programs that they never rotated through. But rotating does give you a legs-up, and getting a good LOR from an academic attending at a big-name hospital will also help when it comes to other university IM programs.

However, there are certain IM programs that are extreme reach for DO students, such as MGH, Hopkins Osler, USCF, Stanford, UCLA, Duke, Columbia Presby, NYU, Emory, etc.

I will likely use my connections with MSKCC to return for a summer internship, but DO schools are known to have shorter summers than MD schools and especially at MSUCOM, where I hope to end up, their summers are only 8 weeks long. Most summer internships are 10 weeks and I believe MSKCCs is also 10 weeks long so I will have to see what can be done for me. They have the connection to the Rockefeller Institute, which is amazing as well. I recently interviewed at MSUCOMs physician scientist training program, but because of the timeline with family, I do not think I can actually pursue that as much as I would love to. My goal, even without the PhD, is to earn myself a residency there or nearby respected hospitals if that is possible for a DO. I will obviously know my limitations in 2 years once I complete the COMLEX/USMLE, but this is where my 'dreams' lie.

Am I missing any other details in terms of hoping to match at a place like MSKCC? ECs like research and internships are the typical additions to an app for residency, correct?

EDIT: also, I can assume that any undergraduate medical related work is irrelevant?

 

[cliquesh]

Usmle scores, letters of recommendations, research, and clinical grades are what matters most. You can put research and jobs from pre medical years. From my experience interviewing no one knows anything about comlex scores.

 

[xenotype]

I will likely use my connections with MSKCC to return for a summer internship, but DO schools are known to have shorter summers than MD schools and especially at MSUCOM, where I hope to end up, their summers are only 8 weeks long. Most summer internships are 10 weeks and I believe MSKCCs is also 10 weeks long so I will have to see what can be done for me. They have the connection to the Rockefeller Institute, which is amazing as well. I recently interviewed at MSUCOMs physician scientist training program, but because of the timeline with family, I do not think I can actually pursue that as much as I would love to. My goal, even without the PhD, is to earn myself a residency there or nearby respected hospitals if that is possible for a DO. I will obviously know my limitations in 2 years once I complete the COMLEX/USMLE, but this is where my 'dreams' lie.

Am I missing any other details in terms of hoping to match at a place like MSKCC? ECs like research and internships are the typical additions to an app for residency, correct?

EDIT: also, I can assume that any undergraduate medical related work is irrelevant?

This is a two piece problem for a high level heme/onc fellowship. First, you need to have an extremely high caliber IM match with significant research opportunities and top faculty. This means it needs to be a well known unversity IM program, and preferably a top 20. The top 10 IM programs are nearly impossible for DOs to get into due to discrimination, so even a 250 on step 1 won't save you there. The next 10 are possible, but will require a 240+ USMLE step 1 score to match, as MD grads are barely competitive for them in the 230s. Any old university IM program likely will not cut it for one of the most competitive fellowship positions in IM. You'll likely want an away rotation or two in these programs to make yourself more competitive and research during med school to show scholarly interest as well as good third year grades.

If you manage to overcome that hump, the next one is bigger. MSKCC is the number two heme/onc program in the country, second only to MD Anderson. They only take the best of the best. The top heme/onc programs are extremely competitive and usually only matched by MD grads with pedigrees, connections, and research. You would need to have great connections with the heme/onc attendings and fellows in your top IM residency and have published articles with them in journals with a decent impact factor. Any MD grad would need these things to be competitive for an MSKCC spot, and I'd imagine you would be discriminated against coming from a DO program and would need more to make up for it. There are not many DOs on staff, so the chances of you managing to pull all of this off is low. The ACGME residency merge is not going to change this anytime soon. A PhD could be helpful, but only if you manage to get some impressive pubs, also unlikely. Most PhDs don't get published in Cell or Nature.

If you want to do academic heme/onc anywhere, that is much more doable. Not easy, but possible with decent scores and any university IM match with some research in residency. MSKCC is an uphill battle for an MD grad out of a name school; you will already have a huge disadvantage. It is not impossible and certainly has been done before, and trying hard for it certainly will help you in getting into any good IM program and a heme/onc fellowship afterwards. Its just important to be realistic. You'll probably change your mind about what you want to do anyways in medical school.

 

[maestrohuang]

This is a two piece problem for a high level heme/onc fellowship. First, you need to have an extremely high caliber IM match with significant research opportunities and top faculty. This means it needs to be a well known unversity IM program, and preferably a top 20. The top 10 IM programs are nearly impossible for DOs to get into due to discrimination, so even a 250 on step 1 won't save you there. The next 10 are possible, but will require a 240+ USMLE step 1 score to match, as MD grads are barely competitive for them in the 230s. Any old university IM program likely will not cut it for one of the most competitive fellowship positions in IM. You'll likely want an away rotation or two in these programs to make yourself more competitive and research during med school to show scholarly interest as well as good third year grades.

If you manage to overcome that hump, the next one is bigger. MSKCC is the number two heme/onc program in the country, second only to MD Anderson. They only take the best of the best. The top heme/onc programs are extremely competitive and usually only matched by MD grads with pedigrees, connections, and research. You would need to have great connections with the heme/onc attendings and fellows in your top IM residency and have published articles with them in journals with a decent impact factor. Any MD grad would need these things to be competitive for an MSKCC spot, and I'd imagine you would be discriminated against coming from a DO program and would need more to make up for it. There are not many DOs on staff, so the chances of you managing to pull all of this off is low. The ACGME residency merge is not going to change this anytime soon. A PhD could be helpful, but only if you manage to get some impressive pubs, also unlikely. Most PhDs don't get published in Cell or Nature.

If you want to do academic heme/onc anywhere, that is much more doable. Not easy, but possible with decent scores and any university IM match with some research in residency. MSKCC is an uphill battle for an MD grad out of a name school; you will already have a huge disadvantage. It is not impossible and certainly has been done before, and trying hard for it certainly will help you in getting into any good IM program and a heme/onc fellowship afterwards. Its just important to be realistic. You'll probably change your mind about what you want to do anyways in medical school.

Yeah, thanks for the response. I am just going off of what I know and from what I have experience, I really enjoy heme/onc and I don't really think I mind doing this elsewhere because I enjoyed what they did. I am sure the environment helped me to enjoy what they were doing and what I was following and learning, but I still enjoyed what they were doing without knowing they were MSKCC physicians. I am sure I will come across things that I enjoy during medical school and will change my path,but obviously, I want to be realistic, yet maintain my hopes and options.

 

[batndz]

OP I'm in a very similar situation as you. However subsitute MSKCC with the NIH/NCI and MSUCOM with PCOM

Does anyone know how much of an uphill battle is the medical oncology program at the NCI for a DO?

 

[maestrohuang]

OP I'm in a very similar situation as you. However subsitute MSKCC with the NIH/NCI and MSUCOM with PCOM

Does anyone know how much of an uphill battle is the medical oncology program at the NCI for a DO?

It's gotta be awesome working at the NCI. I have read all about that place, just never been. Realistically, I think I just want to get into heme-onc regardless of the location, but obviously it would be awesome to be at MSKCC or the NCI.

 

[cliquesh]

It's gotta be awesome working at the NCI. I have read all about that place, just never been. Realistically, I think I just want to get into heme-onc regardless of the location, but obviously it would be awesome to be at MSKCC or the NCI.

No one really talks about NIH. People always talk about MSKCC and MD Anderson.

 

[destinedtocure]

I'll preface this with the fact that I am just a pre-med trying to get into med school, but I also have a few years on me, and have had the privilege of working with some fine physicians. I also have had the unfortunate experience of losing both parents to cancer, and having been through their experiences at close quarters.

That said, one of the finest oncologists I know is a D.O. He did his fellowship at M.D. Anderson, so it is without question, doable. I cannot speak to his status in his med school class, although he graduated from, in my humble opinion, the finest Osteopathic school there is. I can tell you, from being "attached to him at the hip" from patient to patient, he is deeply committed to his patients, to keeping his knowledge current, and to evaluating each situation with a comprehensiveness that I could only aspire to.

One other thing, in writing a journal entry about my experience with him, I said, "Before we entered the exam room with every patient, Dr. P gave me a complete synopsis of the patient, where they were in their course, and the treatment history to date, along with his plan going forward. I am pretty sure I could call him at 4:00 am, wake him out of a dead sleep, and ask him about any patient, and he could rattle off everything about them before he even woke up."

I don't think this is the result of any abnormal gift, I think it is simply the result of a physician that cares deeply about his patients, and his profession. It is about as genuine a commitment as I have had the pleasure of witnessing. He is a gifted physician, that I can attest to, but I believe the folks at M.D. Anderson simply saw the pure commitment to excellence in him, and simply determined that he would make a damn fine oncologist. No doubt, it was obvious they would be doing a disservice to the fight against cancer that they exist for, if they didn't give him every chance in the world to follow his calling.

Numbers, pedigrees, etc. are what they are, but the folks at M.D. A. don't have the reputation they do because they can't see the forest for the trees. To their credit, they were bright enough, and passionate enough to recognize excellence when they saw it, no matter where it came from, and that, IMHO is the "big secret".

I will add this: After this and other experiences, there was no question in my mind whatsoever that I wanted my own medical education to be in osteopathic medicine. I take nothing away from allopathic medicine. I know some exceptional physicians that are M.D.'s, and I admire them tremendously. I simply knew that Osteopathy was the right "path" for me, and determined that, should I be fortunate enough to have a choice, I would choose an osteopathic school over allopathic, but I would be privileged to join the medical profession from either discipline.

I hope that lends a little perspective.

 

[costales]

I'll preface this with the fact that I am just a pre-med trying to get into med school, but I also have a few years on me, and have had the privilege of working with some fine physicians. I also have had the unfortunate experience of losing both parents to cancer, and having been through their experiences at close quarters.

That said, one of the finest oncologists I know is a D.O. He did his fellowship at M.D. Anderson, so it is without question, doable. I cannot speak to his status in his med school class, although he graduated from, in my humble opinion, the finest Osteopathic school there is. I can tell you, from being "attached to him at the hip" from patient to patient, he is deeply committed to his patients, to keeping his knowledge current, and to evaluating each situation with a comprehensiveness that I could only aspire to.

One other thing, in writing a journal entry about my experience with him, I said, "Before we entered the exam room with every patient, Dr. P gave me a complete synopsis of the patient, where they were in their course, and the treatment history to date, along with his plan going forward. I am pretty sure I could call him at 4:00 am, wake him out of a dead sleep, and ask him about any patient, and he could rattle off everything about them before he even woke up."

You're not referring to Dr. Ray Page (TCOM, 1991) by any chance? 🙂