Politics of Postgraduate Training for D.O.’s

[DazedNConfused9]

Hello,

I am currently facing a difficult decision on whether or not I would like to attend an osteopathic medical school in the states or St. George’s University in Grenada, both institutions of which I have already been accepted to.

I have already tried to compare the pros and cons of each, but I have been unable to come up with a final answer, and my deadline is within the next two weeks. The issues that are making this much harder for me do not have anything to do with stigma, but rather residency opportunities for osteopathic physicians, and in consequence, employment opportunities.

It is my understanding that if I pursue an ACGME-approved residency, I will be excluded from obtaining a faculty position in an osteopathic medical school or in an osteopathic organization such as the AOA itself. Similarly, if I do not complete an AOA transitional rotating internship, I will be excluded from practicing in five states throughout the United States. Is this true?

In the event that I do complete an AOA-approved residency, will I be precluded from working as a program director or an administrator in a hospital that offers ACGME-accredited residencies only? Also, will I be able to find employment at one of these major hospitals, or will I be shut out considering that nearly all of the other physicians will have done their residency training at an ACGME-approved site, most of which the employers (at the hospital) will have some experience with (as opposed to hiring a D.O. who completed a less known AOA residency, for which they cannot assess the quality of)? In this case, will I be forced to practice in an osteopathic hospital for the rest of my career? Also, if I complete an AOA residency, will I still be able to teach at a major undergraduate institution or serve in a faculty position at an allopathic medical school?

Also, I looked at the continuing medical education requirements for the Medical Board of California and the Osteopathic Medical Board of California. Apparently, the MBC requires M.D.’s to complete 25 hours of CME credit per year, whereas the OMBC requires D.O.’s to complete 50 hours of CME credit per year (both within a time span of 3 years, thus 75 hours vs. 150 hours). Also, according to the two websites, the MBC awards a Physician Recognition Award if an MD does 150 hours of CME credit within 3 years, however, no award seems to be in place for DO’s from the OMBC. What do you physicians make of this discrepancy? Is this not a major concern, and should I not worry about it?

Considering that only 70% of DO’s matched into ACGME residencies and the fact that the AOA match occurs before the allopathic match, is there a mechanism in place to ensure that a DO will have some type of PGY1 training upon graduation? If this were to happen, would you have to scramble into a preliminary medicine year (AOA or ACGME) and then transfer into a PGY2 categorical ACGME residency spot? Would I lose a year of my residency by doing this?

I know that these are a lot of questions, but I doubt I can make a proper decision on where to attend a medical school unless I am completely informed as to what opportunities will be available to me as a physician, depending on which type (AOA or ACGME) residency I complete. After I graduate medical school or after residency training, I am hoping to return to California to practice. I have my sight set on Anesthesiology as a specialty right now, but more than likely I will change my decisions numerous times over the course of rotations.

Thank you for taking the time to read this post, and I would really appreciate any feedback that any one of you might be able to share with me. Thanks so much.

---

Members don't see this ad.

 

[Winged Scapula]

It is my understanding that if I pursue an ACGME-approved residency, I will be excluded from obtaining a faculty position in an osteopathic medical school or in an osteopathic organization such as the AOA itself. Similarly, if I do not complete an AOA transitional rotating internship, I will be excluded from practicing in five states throughout the United States. Is this true?

Generally yes.

In the event that I do complete an AOA-approved residency, will I be precluded from working as a program director or an administrator in a hospital that offers ACGME-accredited residencies only?

Perhaps. There are no regulations regarding this, but you may find some institutional bias.

Also, will I be able to find employment at one of these major hospitals, or will I be shut out considering that nearly all of the other physicians will have done their residency training at an ACGME-approved site, most of which the employers (at the hospital) will have some experience with (as opposed to hiring a D.O. who completed a less known AOA residency, for which they cannot assess the quality of)? In this case, will I be forced to practice in an osteopathic hospital for the rest of my career?

Again, its hard to say definitively. I'm sure you would be able to find employment; there are many DOs working in hospitals with only allopathic residencies. The higher academic echelons such as PD may be more difficult to obtain as a DO in an allopathic institution but I doubt they are out of the question.

Also, if I complete an AOA residency, will I still be able to teach at a major undergraduate institution or serve in a faculty position at an allopathic medical school?

There is no regulation that requires only allopathic physicians to teach at allopathic schools. Again, you may find some institutional bias, but it is not formalized.

Also, I looked at the continuing medical education requirements for the Medical Board of California and the Osteopathic Medical Board of California. Apparently, the MBC requires M.D.’s to complete 25 hours of CME credit per year, whereas the OMBC requires D.O.’s to complete 50 hours of CME credit per year (both within a time span of 3 years, thus 75 hours vs. 150 hours). Also, according to the two websites, the MBC awards a Physician Recognition Award if an MD does 150 hours of CME credit within 3 years, however, no award seems to be in place for DO’s from the OMBC. What do you physicians make of this discrepancy? Is this not a major concern, and should I not worry about it?

This is the first I've heard of it and therefore, without more information and/or experience from someone in the same situation I would be loathe to comment on it except to find it hard to believe that this would exist as simply as you put it (ie, it doesn't make sense that Cali would require DOs to have twice the amount of CME credits).

Considering that only 70% of DO’s matched into ACGME residencies and the fact that the AOA match occurs before the allopathic match, is there a mechanism in place to ensure that a DO will have some type of PGY1 training upon graduation?

Of course not. There is no guarantee for anyone and schools cannot promise this.

If this were to happen, would you have to scramble into a preliminary medicine year (AOA or ACGME) and then transfer into a PGY2 categorical ACGME residency spot? Would I lose a year of my residency by doing this?

If you were to fail to match into either an osteopathic or allopathic residency, you would then have to scramble for a position or otherwise find one outside of the matches. You are not however required to match into a Prelim position, if there are available Categorical positions you are interested in. Prelim positions are more common, especially in the scramble, but you are not limited to these - only to what is available and what you can obtain.

Obviously it would be desirable to be able to pick up a PGY2 Categorical position in your second year, but again there are no guarantees. Your best option is to hope that the program at which you spend your intern year offers you a PGY2 Categorical spot (which they generally will if you were a Categorical intern), or that a PGY2 position in your field opens up at another program. However, if you do not get into a Categorical PGY2 position, you may have to repeat your intern year if you are offered a PGY1 Categorical position and have no other offers. You will "lose" a year of residency but for some people, especially those interested in getting into a competitive field, it is generally worth it.

Since you are interested in California as a potential residency or practice option, please avail yourself of the information regarding California licensure now - they are one of the toughest states to get a license in and you would hate to be denied a license there because, for example, you didn't have 4 weeks of family practice during medical school.

You have asked a lot of difficult questions and I'm afraid there are no hard and fast answers. I'm sure you can find allopathic hospitals which really are not interested in having osteopaths in high ranking academic positions, just as you will find those who care not what your degree is. And just as likely, if not more so, you may find an IMG status effectively barring you from the higher academic rungs as well, at some institutions.

Hope this helps.

 

[MasterintuBater]

The real diff. between D.O. and IMG comes during match season. For competitive allopathic residencies, there seems to be a heirarchy. M.D's considered first, then D.O.'s, then IMG's. If you're going for a competitive residency, I think your chances are better going the D.O. route.

As far as teaching....I think you'll always have the opportunity; D.O., M.D., IMG whatever. My program director is a D.O. at a university allopathic instution. If you're a D.O. and the AOA won't let you teach because you did an Allo residency, just teach on the Allo side. Screw the AOA. I went to a D.O. school and went to an Allo residency program. Having teaching priveleges at an osteopathic school or program just wasn't a priority for me. Opportunities are everywhere....even in California. One of my buddies landed a nice Emergency Medicine resident spot at USC.....probably the first D.O. ever in that program. You can blaze a new trail anywhere you wanna go. But I think for the most part, life will be a little easier as a D.O. than as an IMG. I have just seen too many IMG's begging and pleading for residency spots and picking up the scraps left over by M.D.'s and D.O.'s.

Good luck with your decision. You're in the enviable position of choosing WHERE to go to medical school, instead of IF you are going to medical school.

 

[mddo2b]

Hello,

I am currently facing a difficult decision on whether or not I would like to attend an osteopathic medical school in the states or St. George’s University in Grenada, both institutions of which I have already been accepted to.

I have already tried to compare the pros and cons of each, but I have been unable to come up with a final answer, and my deadline is within the next two weeks. The issues that are making this much harder for me do not have anything to do with stigma, but rather residency opportunities for osteopathic physicians, and in consequence, employment opportunities.

It is my understanding that if I pursue an ACGME-approved residency, I will be excluded from obtaining a faculty position in an osteopathic medical school or in an osteopathic organization such as the AOA itself. Similarly, if I do not complete an AOA transitional rotating internship, I will be excluded from practicing in five states throughout the United States. Is this true?

In the event that I do complete an AOA-approved residency, will I be precluded from working as a program director or an administrator in a hospital that offers ACGME-accredited residencies only? Also, will I be able to find employment at one of these major hospitals, or will I be shut out considering that nearly all of the other physicians will have done their residency training at an ACGME-approved site, most of which the employers (at the hospital) will have some experience with (as opposed to hiring a D.O. who completed a less known AOA residency, for which they cannot assess the quality of)? In this case, will I be forced to practice in an osteopathic hospital for the rest of my career? Also, if I complete an AOA residency, will I still be able to teach at a major undergraduate institution or serve in a faculty position at an allopathic medical school?

Also, I looked at the continuing medical education requirements for the Medical Board of California and the Osteopathic Medical Board of California. Apparently, the MBC requires M.D.’s to complete 25 hours of CME credit per year, whereas the OMBC requires D.O.’s to complete 50 hours of CME credit per year (both within a time span of 3 years, thus 75 hours vs. 150 hours). Also, according to the two websites, the MBC awards a Physician Recognition Award if an MD does 150 hours of CME credit within 3 years, however, no award seems to be in place for DO’s from the OMBC. What do you physicians make of this discrepancy? Is this not a major concern, and should I not worry about it?

Considering that only 70% of DO’s matched into ACGME residencies and the fact that the AOA match occurs before the allopathic match, is there a mechanism in place to ensure that a DO will have some type of PGY1 training upon graduation? If this were to happen, would you have to scramble into a preliminary medicine year (AOA or ACGME) and then transfer into a PGY2 categorical ACGME residency spot? Would I lose a year of my residency by doing this?

I know that these are a lot of questions, but I doubt I can make a proper decision on where to attend a medical school unless I am completely informed as to what opportunities will be available to me as a physician, depending on which type (AOA or ACGME) residency I complete. After I graduate medical school or after residency training, I am hoping to return to California to practice. I have my sight set on Anesthesiology as a specialty right now, but more than likely I will change my decisions numerous times over the course of rotations.

Thank you for taking the time to read this post, and I would really appreciate any feedback that any one of you might be able to share with me. Thanks so much.

Well all your answers seemto have been answered....i will add that as far as not working in the states, there are ways to work in those states even if you dont do an internship....its a pain in the ass, but if you are a pain, there are ways...also, i am in an allopathic residency, and had my intern year in surgery count as my rotating intership...again a pain in the neck but doable

 

[timtye78]

Also, many programs are either dual-acredited or in the process of being dual acredited. What does this mean?

Literally, you can receive your residency/internship training at an MD institution, and have your intern year acredited by the AOA either prospectively or even retrospectively. I matched into MD anesthesia and found out later that I was going to have the AOA approval for my intern year thus all the 'rights and priveleges' namely licensure eligibility in all 50 states. I was told by a big wig at my DO school that many DOs simply match MD then apply (one page application) for AOA approval. Which according to him is easy.

Also, remember you are comparing DO American Med Grad to MD Int'l Med Grad and you are not comparing to American MD. A few comments I heard from MD from international school grads:

1)no moonlighting priveleges during residency (Texas for sure)
2)difficulty in obtaining competitive residency slots


I would recommend American DO if I was in your place. Remember American DO gains wider acceptance everyday, and in many places (TX,OK, MI,OH) etc you are just another doc. Yes it is easier to obtain competitive residency as DO. If you choose MD from carib or whatever, remember once you obtain your residency lay people have no clue where you went to med school as long as you have the MD on your badge, even if it was in Sweden, India, or Yale University for example.

My $0.02 hope it helps