Should I go to my states MD school (with conditions) or DO school. Please help.

[MCDT]

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Hello I am in need of your opinion. I currently hold acceptances to both my states MD school and a DO school in my state. Now I know the norm is usually always go MD over DO if you have the opportunity because it opens the door to more specialties however I am in a special circumstance. With the MD School I was not offered admission to the regular program but through a primary care tract (no I did not originally apply for this program I was waitlisted and subsequently offered a spot as a way to get off the waitlist) This program states that upon completion of my residency I must return to my state and practice primary care in a rural area for a period of 4 years. And it limits the specialties to family med, General internal med, pediatrics, geriatrics Ob/gyn emergency med or general surgery. Now as of right now I would not mind doing emergency med or general surgery as I have extensive experience in both and living in a rural area won’t be a problem as I’m from one however I am somewhat apprehensive because I have not been to medical school yet so I don’t know if I will eventually fall in love with something else, anesthesiology, cardiology , GI radiology or anything of the nature.

I may end up in Emergency med regardless but is it worth giving up the opportunity to do something else just for the MD or should I try and keep my option open and have the opportunity to to match in whatever I want as a DO (yes I know there are limitations here as well but there is a chance vs no chance with the other option) thanks

 

[efle]

To quote @PreMedMissteps "A fool and his acceptance are soon parted" (I knew I would steal that line )

You applied to the school, they offered you a spot, you jumped on it, and now you regret it.

How is this school enforcing the residency selection? Are they offering loan with forgiveness if you serve the 4 years in a PC residency? They cant "force" you into the residency simply by admission as that violates a whole bunch of LCME/NRMP rules

Couldn't they refuse to give him letters of support for residency application to other fields? Can't imagine any anesthesia programs would take someone with a Dean's Letter outlining how they lied to the school about wanting to be rural primary care...

 

[jurisburger]

Wow I've never heard of this kind of stipulation for admissions.

 

[subdermallight]

What if OP does IM, follow through with 4 years of practice, then tries to sub-specialize in cardio, GI, etc? Do people do that or does the training have to be continuous?

 

[DokterMom]

So as it currently stands, your choice would be either MD into a primary care, EM or GS residency by agreement, or DO then into a primary care residency because that's just how things almost invariably shake out for DO grads. While it feels like a scope of practice restriction, the bottom line is that both degree paths currently on your table offer a very similar range of practice options.

With the MD option, you would then need to move back to your state and practice in a rural area for 4 years -- which you've implied you actually wouldn't mind. Note also that rural medicine often has some of the highest-paying jobs out there, so it may not be a bad gig at all. (I got the impression it's the specialty limitations that concern you more?) With the DO, you would go off and practice primary care wherever for the next 4 years, and after that, you can do what you want in either case. So really, the difference amounts to 4 years of geographic restriction.

From either IM or GS you'd have a lot of fellowship options 4 years down the road if you were still interested.

Sounds to me like MD is still going to be your best option.

 

[Gastrapathy]

What are they giving you for limiting your specialty choice?

DO might unofficially limit you more.

 

[DPTinthemaking15]

If I’m not mistaken, I believe I know which school you are speaking of (I’m being a bit presumptious). I have a friend that matriculated into that program and he was deciding between MD and DO. He finally decided he wanted the MD degree.

Honestly, I would pick the MD degree without hesitation. But I’m from a small town and love it. Plus, PCP is looking pretty good to me.

 

[MCDT]

So as it currently stands, your choice would be either MD into a primary care, EM or GS residency by agreement, or DO then into a primary care residency because that's just how things almost invariably shake out for DO grads. While it feels like a scope of practice restriction, the bottom line is that both degree paths currently on your table offer a very similar range of practice options.

With the MD option, you would then need to move back to your state and practice in a rural area for 4 years -- which you've implied you actually wouldn't mind. Note also that rural medicine often has some of the highest-paying jobs out there, so it may not be a bad gig at all. (I got the impression it's the specialty limitations that concern you more?) With the DO, you would go off and practice primary care wherever for the next 4 years, and after that, you can do what you want in either case. So really, the difference amounts to 4 years of geographic restriction.

From either IM or GS you'd have a lot of fellowship options 4 years down the road if you were still interested.

Sounds to me like MD is still going to be your best option.

Thank you so much for this ! This is the guidance I was looking for.

 

[MCDT]

For clarity it is a loan/loan forgiveness program however it goes beyond having to pay back the loans. The program is instituted by the state in order to increase primary care physicians in rural areas. It allows alternates to move off the list while filling the “void” of primary care. the school is just the medium the program is run through. I would be contractually obligated by the state to return and practice in one of those areas for the specified time and if I do not I will be unable to obtain a medical license in the state. And it was stated to me that if I default it would be reported to whatever licensing entity that would make it almost impossible for me to obtain a licenses in any state because I defaulted on the contract.

 

[mcat_taker]

Sounds like the scope of primary care is cast pretty wide for OP- OP says he can do emergency med, OBGYN, or gen surg as well. That covers the likeliest paths he would take regardless. Most likely not getting urology, derm, ortho, plastics, NSGY out of the DO. Guess he needs to reflect on whether he would be interested in rads or Anes.

Tough decision to make because people do fall in love during clinicals with certain fields that surprise them. Never like to be limited from the get go.

But if he doesn't mind the geographic restriction MD better option based on what he would most likely go into.

 

[theKingLT]

Guess he needs to reflect on whether he would be interested in rads or Anes.

Or path!

 

[IlDestriero]

I wouldn’t accept any contract that obligated me to any specialty. The state thinks that they are being helpful and clever, but they should offer loan forgiveness instead to applicants during residency or once people come back for those jobs.
I wouldn’t want to limit my career choices. People change their minds during medical school all the time. It’s a bad deal.

 

[DokterMom]

I wouldn’t accept any contract that obligated me to any specialty. The state thinks that they are being helpful and clever, but they should offer loan forgiveness instead to applicants during residency or once people come back for those jobs.
I wouldn’t want to limit my career choices. People change their minds during medical school all the time. It’s a bad deal.

It's not the best choice, but at this point, it seems to be the only choice s/he has. Are you on any other wait lists @MCDT ?

 

[Moose A Moose]

Primary care encompasses FM, IM and peds.

They need to advertise whatever this “track” is you speak of a little better.

Tough call.

 

[ThrowawayShmoaway]

Primary care encompasses FM, IM and peds.

They need to advertise whatever this “track” is you speak of a little better.

OP listed the specialties that the track limits them to in the first post (specifically: “family med, General internal med, pediatrics, geriatrics Ob/gyn, emergency med or general surgery”.

 

[mcat_taker]

OP listed the specialties that the track limits them to in the first post (specifically: “family med, General internal med, pediatrics, geriatrics Ob/gyn, emergency med or general surgery”.

which doesn't make a lot of sense either considering geriatrics is a fellowship.

 

[NotAProgDirector]

For clarity it is a loan/loan forgiveness program however it goes beyond having to pay back the loans. The program is instituted by the state in order to increase primary care physicians in rural areas. It allows alternates to move off the list while filling the “void” of primary care. the school is just the medium the program is run through. I would be contractually obligated by the state to return and practice in one of those areas for the specified time and if I do not I will be unable to obtain a medical license in the state. And it was stated to me that if I default it would be reported to whatever licensing entity that would make it almost impossible for me to obtain a licenses in any state because I defaulted on the contract.

A loan forgiveness program is fine. Several medical schools have similar programs, sometimes focused on specialty, and sometimes just focused on returning to that state or an underserved area. Should you choose not to do this, then you pay them back the loan.

But not licensing you because you train in a different field, or work in a different state, is almost certainly illegal. Arguing that this is a professionalism issue is ridiculous. That state could try to prevent you from getting licensed, but I expect it would fail in court (although that's a long and painful process). But perhaps more importantly, whom do they think they would "report" it to for another state? There's no national database, this isn't a misdemeanor or felony. It's an empty threat.

 

[Moose A Moose]

OP listed the specialties that the track limits them to in the first post (specifically: “family med, General internal med, pediatrics, geriatrics Ob/gyn, emergency med or general surgery”.

Why are you speaking? I had no confusion about what the OP said in their post. The school states it’s a “primary care track”, and then goes to list specialties like general surgery. It should not be advertised as primary care.

 

[PreMedMissteps]

What if OP does IM, follow through with 4 years of practice, then tries to sub-specialize in cardio, GI, etc? Do people do that or does the training have to be continuous?

I’ve wondered about that sort of thing as well.

 

[ThrowawayShmoaway]

Why are you speaking?

Yikes, someone's cranky. I actually did think you missed that list, so I apologize for misunderstanding your post. Didn't realize it would ruffle Your Highness' feathers so much, though.

 

[907914]

Why are you speaking? I had no confusion about what the OP said in their post. The school states it’s a “primary care track”, and then goes to list specialties like general surgery. It should not be advertised as primary care.

So this school is advertising primary care as having more specialties than traditional "primary care" typically has. I see nothing wrong with a school advertising something that has more options than would normally be in a given category. If this state needs more general surgeons in rural areas (even Appalachia needs colonoscopies..) then the state can call "primary care" whatever they want if it gets more people in those needed roles.

 

[mcat_taker]

I’ve wondered about that sort of thing as well.

People can do an eligible fellowship whenever they want. Obviously many people do them right after residency before they get used to the big bucks. It gets harder to take such a hit to your pay later on. And programs like that you are more malleable and less set in your ways fresh out of residency. But you can certainly apply and do a fellowship years down the line.