Planning early

[FutureHeartDOctor]

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Hey everyone, recently accepted OMS here!!! Been lurking around here for a while but with a new chapter of my life beginning, I figured it is time to make an account and join in on the fun.

I'm absolutely jumping the gun here but have always been a planner. I am open to absolutely all areas of medicine and know different systems / pathologies that I never even thought of will interest me. However, despite all my experience in the healthcare field from FM to IM to EM to Anesthesia to Surgery (some were jobs and others strictly volunteering and shadowing obviously) my love for the heart has stood the test of time and would be shocked if I don't end up gunning for Cardiology, Peds Cardiology, IC, Thoracic Surg or even Congenital Surg as the end result. Plus, if I begin pursuing these areas as early as possible, I may learn sooner rather than later if these are the right areas for me at all, instead of scrambling during OMS 3 and 4.

As a DO, I'm aware of the battles for these fields and want to begin planning early (I6, good luck). The merger will be in effect by this time as a graduate from the class of 2023. I know the training on each of these regardless of the different routes:

IM/Peds --> Cards --> IC

Gen Surg --> Thoracic --> Congenital

Thoracic --> Congenital

How should I begin planning IN ADDITION to killing the USMLE?

 

[InternistDO]

Good grades, some hobbies to stay sane, and get some research done in the first two years. All those things will help regardless of what you specialize in.

Otherwise keep an open mind as to what you enjoy. For better or worse, you really won't get a good idea of what you'll like or not until 3rd year, so try not to stress about it until then.

 

[FutureHeartDOctor]

Good grades, some hobbies to stay sane, and get some research done in the first two years. All those things will help regardless of what you specialize in.

Otherwise keep an open mind as to what you enjoy. For better or worse, you really won't get a good idea of what you'll like or not until 3rd year, so try not to stress about it until then.

Thanks! How do you recommend going about research with hearts? Many DO schools don't have a ton of research opportunities it seems...

 

[Goro]

Hey everyone, recently accepted OMS here!!! Been lurking around here for a while but with a new chapter of my life beginning, I figured it is time to make an account and join in on the fun.

I'm absolutely jumping the gun here but have always been a planner. I am open to absolutely all areas of medicine and know different systems / pathologies that I never even thought of will interest me. However, despite all my experience in the healthcare field from FM to IM to EM to Anesthesia to Surgery (some were jobs and others strictly volunteering and shadowing obviously) my love for the heart has stood the test of time and would be shocked if I don't end up gunning for Cardiology, Peds Cardiology, IC, Thoracic Surg or even Congenital Surg as the end result. Plus, if I begin pursuing these areas as early as possible, I may learn sooner rather than later if these are the right areas for me at all, instead of scrambling during OMS 3 and 4.

As a DO, I'm aware of the battles for these fields and want to begin planning early (I6, good luck). The merger will be in effect by this time as a graduate from the class of 2023. I know the training on each of these regardless of the different routes:

IM/Peds --> Cards --> IC

Gen Surg --> Thoracic --> Congenital

Thoracic --> Congenital

How should I begin planning IN ADDITION to killing the USMLE?

Read this:
Goro's Guide to Success in Medical School (2018 edition)

 

[dj-Roomba]

Not to rain on your parade but congenital cardiac surgery will be next to impossible as a DO

 

[_Rod_of_Asclepius_]

Not to rain on your parade but congenital cardiac surgery will be next to impossible as a DO

Really! I’ve heard these are more selective / competitive in terms of skill as opposed to MD vs DO. Very few spots yes but have heard it’s not a field one typically wishes to pursue due to length of training, lack of jobs post fellowship and lack of operating autonomy during the first several years post fellowship. Either way, any input is highly appreciated since I have an interest in cardio as well!

 

[FutureHeartDOctor]

Not to rain on your parade but congenital cardiac surgery will be next to impossible as a DO

I’m curious to hear more about this as well. Thought congenital wasn’t too bad. Easier than getting into an I6 Thoracic

 

[QueenJames]

Nobody knows how the merger will play out but just be prepared to enter primary care as most DO schools have that as their primary focus first and foremost.

Good luck to you but enjoy ur rest.

Med school sucks balls.

But I love it.

 

[BorntobeDO?]

Nobody knows how the merger will play out but just be prepared to enter primary care as most DO schools have that as their primary focus first and foremost.

Good luck to you but enjoy ur rest.

Med school sucks balls.

But I love it.

everyone who goes to DO school should be aware of this possibility.

 

[FutureHeartDOctor]

Nobody knows how the merger will play out but just be prepared to enter primary care as most DO schools have that as their primary focus first and foremost.

Good luck to you but enjoy ur rest.

Med school sucks balls.

But I love it.

What’s your take on fellowships? For example IM is no sweat as a DO but what about all the fellowships? I know generally Cards, Gas and Heme/Onc are the toughest...

Even Gen Surg is still on the table as far as I know but what about the subspecialties after?

 

[acapnial]

What are

What’s your take on fellowships? For example IM is no sweat as a DO but what about all the fellowships? I know generally Cards, Gas and Heme/Onc are the toughest...

Even Gen Surg is still on the table as far as I know but what about the subspecialties after?

I assume by gas you meant gastroenterology. Fellowship competitiveness goes GI > cards > heme/onc for the three you mentioned. Creating a competitive app for fellowship has very little to do with anything you do in med school, lots to do with where you go to residency and what you do there. The bias against DO's there in fellowship apps but less so than residency. The best thing you can do for entering those fields is to try to get in as strong an IM/peds residency possible, so for the first two years of med school the best thing you can do is to study hard and eventually get a good step score. It wouldn't hurt to get into some research while in med school so that you know a little better what you are doing when you enter residency, but research in residency is what will count for fellowship.

 

[QueenJames]

What’s your take on fellowships? For example IM is no sweat as a DO but what about all the fellowships? I know generally Cards, Gas and Heme/Onc are the toughest...

Even Gen Surg is still on the table as far as I know but what about the subspecialties after?

No idea my man. I'm a confused ass third year who doesn't know wtf to do and my school sucks huge penis in terms of scheduling and advising in general. They told half of our class not to take USMLE step 1 and comlex would be enough and our rotations are subpar thus far. IDK what the **** I'm learning and why I'm paying them but it is what it is.

No. I'm not going to throw my school's name out there either.....

atlteast until after graduation.

But you got a good answer there by an actual resident so there ya go!

 

[dj-Roomba]

Really! I’ve heard these are more selective / competitive in terms of skill as opposed to MD vs DO. Very few spots yes but have heard it’s not a field one typically wishes to pursue due to length of training, lack of jobs post fellowship and lack of operating autonomy during the first several years post fellowship. Either way, any input is highly appreciated since I have an interest in cardio as well!

There are 12 programs offering 1-2 spots (or 0) in congenital cardiac surgery each year. The difficulty starts with either landing a residency in I6 or through the traditional route. In the program director survey for 2018, 22% of 11 respondents in the I6 programs said they would rank a DO. There were around 35 spots total if I remember correctly. I'm not sure about the fellowship match after general surgery into adult cardiothoracic but my guess is that the numbers are just as low.

My son has CHD and we have been to Stanford 3 times for open heart surgeries. I have interacted with the congenital cardiac surgery fellow quite a bit and the guy is a genius with a pedigree to match. Undergrad in biochemical engineering at Stanford. MD at Columbia and residency/fellowship at Stanford. I can't find match data for the congenital fellowhip match but with so few programs offering just 1-2 spots you would be competing with the best of the best of the best.

Pediatric cardiology is doable as a DO. My son's cardiologist before we moved for med school was a DO from NOVA. As others have said landing a fellowship has a lot to do with where you did residency and what you did during residency.

I would love you for you to prove me wrong and become a congenital cardiac surgeon. However my opinion is that is an even more uphill battle than matching ACGME derm or ortho.

 

[FutureHeartDOctor]

There are 12 programs offering 1-2 spots (or 0) in congenital cardiac surgery each year. The difficulty starts with either landing a residency in I6 or through the traditional route. In the program director survey for 2018, 22% of 11 respondents in the I6 programs said they would rank a DO. There were around 35 spots total if I remember correctly. I'm not sure about the fellowship match after general surgery into adult cardiothoracic but my guess is that the numbers are just as low.

My son has CHD and we have been to Stanford 3 times for open heart surgeries. I have interacted with the congenital cardiac surgery fellow quite a bit and the guy is a genius with a pedigree to match. Undergrad in biochemical engineering at Stanford. MD at Columbia and residency/fellowship at Stanford. I can't find match data for the congenital fellowhip match but with so few programs offering just 1-2 spots you would be competing with the best of the best of the best.

Pediatric cardiology is doable as a DO. My son's cardiologist before we moved for med school was a DO from NOVA. As others have said landing a fellowship has a lot to do with where you did residency and what you did during residency.

I would love you for you to prove me wrong and become a congenital cardiac surgeon. However my opinion is that is an even more uphill battle than matching ACGME derm or ortho.

Great response thank you. I never claimed to know a ton about the path but it has always interested me and I wanted to remain open to everything. I’ve seen several congenital surgeries; TOF repair, Norwood, Fontan, ASD closure and suffice it to say I could not see myself doing any more as a doctor or even a human being than doing what these guys did. While I’m open to the heart in general, these surgeries were insane.

I also appreciate you sharing data and your (unfortunate) personal experience with the field instead of just spewing how as a DO you won’t do anything but FM blah blah blah

 

[_Rod_of_Asclepius_]

There are 12 programs offering 1-2 spots (or 0) in congenital cardiac surgery each year. The difficulty starts with either landing a residency in I6 or through the traditional route. In the program director survey for 2018, 22% of 11 respondents in the I6 programs said they would rank a DO. There were around 35 spots total if I remember correctly. I'm not sure about the fellowship match after general surgery into adult cardiothoracic but my guess is that the numbers are just as low.

My son has CHD and we have been to Stanford 3 times for open heart surgeries. I have interacted with the congenital cardiac surgery fellow quite a bit and the guy is a genius with a pedigree to match. Undergrad in biochemical engineering at Stanford. MD at Columbia and residency/fellowship at Stanford. I can't find match data for the congenital fellowhip match but with so few programs offering just 1-2 spots you would be competing with the best of the best of the best.

Pediatric cardiology is doable as a DO. My son's cardiologist before we moved for med school was a DO from NOVA. As others have said landing a fellowship has a lot to do with where you did residency and what you did during residency.

I would love you for you to prove me wrong and become a congenital cardiac surgeon. However my opinion is that is an even more uphill battle than matching ACGME derm or ortho.

Thanks for all that info! Didn’t know it was so rough either compared to Derm or Ortho. Saw one Congenital Surgeon go overseas for his fellowship, think it was Melbourne, perhaps this is why...

 

[FutureHeartDOctor]

I assume by gas you meant gastroenterology. Fellowship competitiveness goes GI > cards > heme/onc for the three you mentioned. Creating a competitive app for fellowship has very little to do with anything you do in med school, lots to do with where you go to residency and what you do there. The bias against DO's there in fellowship apps but less so than residency. The best thing you can do for entering those fields is to try to get in as strong an IM/peds residency possible, so for the first two years of med school the best thing you can do is to study hard and eventually get a good step score. It wouldn't hurt to get into some research while in med school so that you know a little better what you are doing when you enter residency, but research in residency is what will count for fellowship.

Yes I meant Gastroenterology,not anesthesia like some assume with “gas” lol. It’s good to know that fellowships in the competitive fellowships are more about your residency than your degree. Still I assume getting a higher tier IM residency as a DO presents some hurdles.
Can you do DO residency and then MD fellowships? Or is the merger wiping that away?

 

[LBJLA23]

It's too early man. I went into med school thinking Cards 100%. Next thing I know I'm an MS4 who hates Cards. Going into Radiology.

Just study hard, kill STEP(s), and see what you enjoy during rotations. Most specialities aren't what they seem.

 

[workaholic181]

Yes I meant Gastroenterology,not anesthesia like some assume with “gas” lol. It’s good to know that fellowships in the competitive fellowships are more about your residency than your degree. Still I assume getting a higher tier IM residency as a DO presents some hurdles.
Can you do DO residency and then MD fellowships? Or is the merger wiping that away?

No the merger is allowing DOs to do an AOA residency and then apply for ACGME fellowships. The thing is now residency grads (MD and DO) who did ACGME residencies can also apply to AOA fellowships. So there used to be AOA cardiology fellowships that MDs couldn't go for. The merger will change that.

The above poster is right, odds are your interests will change. You absolutely wont be relegated to FM as a DO student. But you should be aware that these things you're interested in now are competitive for MD and DO students, and DO students generally have to do more to get these spots. Work hard, see where your interests take you. Good luck.

 

[InternistDO]

Thanks! How do you recommend going about research with hearts? Many DO schools don't have a ton of research opportunities it seems...

I don't have any first hand knowledge (I find cardiac surgery too mind numbing for my ADHD brain), but I'd recommend reaching out first to med school faculty who do research, then other academic institutions/doctors in the area who are doing research, and finally if nothing else works trying to write some stuff on your own like lit reviews. I had a classmate in DO school who did research (and several publications) with a very prestigious med school just by applying to some summer research fellowships and doing some shadowing to make connections. Obviously this is much easier if you're in a big city like NYC or Chicago where there are med schools and research everywhere.

The biggest thing right now is just doing research. Author credit on a pneumonia study in the NEJM is worth way more than a lit review on CABG submitted to a journal that isn't even pubmed indexed.

And like others have said, you might not even like heart stuff, so try to keep an open mind.

 

[AnatomyGrey12]

How should I begin planning IN ADDITION to killing the USMLE?

Research. Getting a good board score is paramount but having quality research is a huge necessity for competitive fields now with the merger.

Not to rain on your parade but congenital cardiac surgery will be next to impossible as a DO

Eh, kinda sorta. It's a super fellowship, therefore lots of self selection. The route for a DO would be solid gen surg program, thoracic fellowship at a solid program, and then congenital fellowship. It's doable for someone who wants to jump through all the hoops but it's an extremely long path.

What’s your take on fellowships? For example IM is no sweat as a DO but what about all the fellowships? I know generally Cards, Gas and Heme/Onc are the toughest...

Even Gen Surg is still on the table as far as I know but what about the subspecialties after?

The bias is still there but not nearly to the same level that exist in residency selection. A good number of DOs match all IM fellowships every year, with 47 in cards last year and 23 in gastro. Getting into a solid IM program is key to getting the fellowships. Even a low tier university program or community program with in house fellowships can land you an IM fellowship in cards or GI.

Gen surg fellowships range from very doable (trauma, transplant) to highly unlikely (peds and surg onc). Those two require lots of research and connections. Can still happen but would require lots of leg work. In between you have vascular, CT, and plastics that aren't shoe ins like the first two but are doable for a motivated resident.

I'm not sure about the fellowship match after general surgery into adult cardiothoracic but my guess is that the numbers are just as low.

Nope, CT fellowships are more competitive than say trauma or transplant but not nearly to the extent of peds or surg onc. People have matched CT fellowships even from former AOA programs. Some of them at well known academic centers.

 

[AnatomyGrey12]

So there used to be AOA cardiology fellowships that MDs couldn't go for.

Just want to point out that this is true however there aren't very many DO fellowships, and most DOs that did fellowship did so through ACGME. I wouldn't be too concerned about MDs now being able to apply to DO fellowships, I'm not sure it changes all that much for a DO looking for any specific fellowship.

 

[dj-Roomba]

Thanks for all that info! Didn’t know it was so rough either compared to Derm or Ortho. Saw one Congenital Surgeon go overseas for his fellowship, think it was Melbourne, perhaps this is why...

Roger Mee is a world renowned surgeon did his training in Melbourne. Royal Children's Hospital in Melbourne made great strides in the field of congenital cardiac surgery. There are many places outside the US that offer top quality education and training.

For anyone that has interest in the world of congenital heart defects and congenital surgery check out "Walk on Water: The Miracle of Saving Childrens' Lives" by Michael Ruhlman

 

[ortnakas]

Cardio to interventional, after IM or after peds, is a difficult but manageable goal— a lot more manageable than congenital surgery. If you love the heart but don’t have to be in the OR, that’s what I would focus on.

 

[QueenJames]

Cardio to interventional, after IM or after peds, is a difficult but manageable goal— a lot more manageable than congenital surgery. If you love the heart but don’t have to be in the OR, that’s what I would focus on.

But so many goddamn stents and so much call...

Piping is where that $$$ is at though.

 

[AlbinoHawk DO]

So do we start taking bets that the premed magically falls in love with FM primary care right after step 1?

 

[FutureHeartDOctor]

You’re all amazing for the info you’re providing rather than ripping me a new one for such high interests and aspirations. There is absolutely a good chance I will change my mind so I’m remaining open but at the same time minding my interests now as well. I’d rather know before I even begin OMSI what I’m getting into then blindly believing it will be a walk in the park or even being unaware of the routes to get there.

I actually have the book on Roger Mee! Still just waiting to read it.

 

[FutureHeartDOctor]

So do we start taking bets that the premed magically falls in love with FM primary care right after step 1?

Hahahaha right!? I may even have to put down a small wager

 

[FutureHeartDOctor]

Cardio to interventional, after IM or after peds, is a difficult but manageable goal— a lot more manageable than congenital surgery. If you love the heart but don’t have to be in the OR, that’s what I would focus on.

Agreed from what I’ve heard

 

[FutureHeartDOctor]

Research. Getting a good board score is paramount but having quality research is a huge necessity for competitive fields now with the merger.


Eh, kinda sorta. It's a super fellowship, therefore lots of self selection. The route for a DO would be solid gen surg program, thoracic fellowship at a solid program, and then congenital fellowship. It's doable for someone who wants to jump through all the hoops but it's an extremely long path.



The bias is still there but not nearly to the same level that exist in residency selection. A good number of DOs match all IM fellowships every year, with 47 in cards last year and 23 in gastro. Getting into a solid IM program is key to getting the fellowships. Even a low tier university program or community program with in house fellowships can land you an IM fellowship in cards or GI.

Gen surg fellowships range from very doable (trauma, transplant) to highly unlikely (peds and surg onc). Those two require lots of research and connections. Can still happen but would require lots of leg work. In between you have vascular, CT, and plastics that aren't shoe ins like the first two but are doable for a motivated resident.



Nope, CT fellowships are more competitive than say trauma or transplant but not nearly to the extent of peds or surg onc. People have matched CT fellowships even from former AOA programs. Some of them at well known academic centers.

Your knowledge and facts again are second to none! Thank you, I’ve always held your word in very high esteem on these forums in the DO world. Keeping telling it how it is, no room for sugarcoating here!

 

[Hippocrates II]

As the great Mike Tyson once said, "everyone has a plan until they get punched in the mouth." Med school is that punch in the mouth.

Med school is so consuming of your day-to-day life, and such a drastic adjustment, that (I'm guessing this is true for most of us) the vast majority of people rapidly go from ambitious plans to survival mode. I had all of these pre-med school plans of research, doing zanki every day (why doesn't everyone just zanki their way to a high step 1?!), etc.. now I'm just trying to survive test to test while spending whatever little time I have left after studying with family/friends. Your goals right now should be to enjoy life, relax, and come up with a decent study plan at some point (in that order). Everything else is so far off and weighs so heavily on your performance both in years 1/2 and the boards that it's almost nonsensical to worry about it. Before I started school I saw myself potentially doing all sorts of specialties. Now I'm at a point where I will be grateful to graduate.

Just my $0.02.

 

[QueenJames]

So do we start taking bets that the premed magically falls in love with FM primary care right after step 1?

Then there's a twist suddenly... Until we find out mommy and daddy paid for his/her entire loans off and after 3 years, he'll be making 200/250K plus and can start stacking while a majority of chumps are still paying a house note in moolah that is barely chipping away at the interest.

He has the last laugh while I cry myself to sleep at night while sucking on my thumb. 🙁