Specializing as a DO part II..please share so we can all understand...

[mizzoudude]

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The last thread about residencies/matches from DO schools brought up some questions...as I admitted as a premed I hadn't even given the thought about ACGME vs. AOA residencies...I have some questions if some of you wise med students could share some answers...
I understand that there are ACGME programs, AOA programs, and some limited dual programs...
I also understand that 5 states (PA, MI, FL, and two more I can't think of) need a DO internship before getting into a ACGME (MD) residency program to practice there...
Are these assumptions correct?

Here are some more questions if you don't mind; some of them might sound really dumb...but I am new to the subject:
1) Why does one need to worry if they go to a ACGME program? Why are some concerned about getting the AOA to approve the ACGME program? Why do you need AOA accreditation?
2) What limitations do you have if you do the one year DO internship? Are there limitations if you do it? funding limitations of some sort?
3) Will there be jobs that specify that the physician must be ACGME certified? AOA certified? Both?
4) Matching into these programs is much harder for a DO? Easier to match into a AOA residency for a DO right? Also, in general what are the consequences/differences between doing an AOA residency vs. ACGME residency?

Thank you all that are helping out with my dumb questions....

 

[(nicedream)]

The last thread about residencies/matches from DO schools brought up some questions...as I admitted as a premed I hadn't even given the thought about ACGME vs. AOA residencies...I have some questions if some of you wise med students could share some answers...
I understand that there are ACGME programs, AOA programs, and some limited dual programs...
I also understand that 5 states (PA, MI, FL, and two more I can't think of) need a DO internship before getting into a ACGME (MD) residency program to practice there...
Are these assumptions correct?

Here are some more questions if you don't mind; some of them might sound really dumb...but I am new to the subject:
1) Why does one need to worry if they go to a ACGME program? Why are some concerned about getting the AOA to approve the ACGME program? Why do you need AOA accreditation?
2) What limitations do you have if you do the one year DO internship? Are there limitations if you do it? funding limitations of some sort?
3) Will there be jobs that specify that the physician must be ACGME certified? AOA certified? Both?
4) Matching into these programs is much harder for a DO? Easier to match into a AOA residency for a DO right? Also, in general what are the consequences/differences between doing an AOA residency vs. ACGME residency?

Thank you all that are helping out with my dumb questions....

First off, the 5 state rule is that you have to do an AOA internship if you want to practice in those 5 states - whether you do an ACGME residency or AOA residency (obviously if you do an AOA residency you are doing an AOA internship anyway).

1) You need AOA accreditation of the first year in order to practice in those 5 states. That is why people worry about getting accred, or may be dissuaded from doing an ACGME residency. There is a procedure for getting ACGME internship years approved therefore waiving the AOA year requirement - traditionally this has been basically automatic if you file the papers, however it is reportedly becoming more difficult. Whether this is true is debatable.

2) There are no limitations, the reason it sucks is if you do an AOA internship and then go into an ACGME residency, then you wind up doing 2 internship years. That is hell. Well, hell twice. That is why you would want to get the ACGME internship year approved (or do a dual-accredited internship).

3) I don't think you will find jobs that require one board certification vs. the other. Only way that would really play a role is in prestige (not being board certified by the same board that certifies MDs, therefore in some minds putting the certification in question).

4) It varies by specialty. In primary care, DOs have no problem matching into ACGME residencies. Lately DOs have also done very well in matching into ACGME anesthesiology and EM at some programs. In others, as well as fellowships, more difficult. Yes, much easier matching into an AOA residency for a DO (open only to DOs, no prejudice obviously). In general, given the choice between two equally qualified candidates, one an MD and one a DO, an ACGME program will take the MD. What are the consequences of ACGME vs AOA? Differences in prestige, and in many cases quality. There are some poor ACGME programs, but percentage-wise, more poor AOA programs.


Another thing you will learn about are the two separate matches (one for AOA programs and one for ACGME programs). The AOA match occurs before the ACGME match. Currently, if one matches in the AOA match, they are automatically pulled from the ACGME match. This discourages a lot of people from entering the AOA match at all since it basically means forfeiting ones chances in the ACGME match. Students have been fighting for a combined match, but it has been resisted by the AOA. The AOA recently ordered a study to be done on the effects of a potential combined match and will review it next year.


Hope that helps.

 

[mizzoudude]

Nicedream...thanks so much for the information...this gives me a lot to think about when making my decision for going to medical school...

I will be applying next year and won't know where I will be going...MD or DO so I have a while to wait...but it is great to know about these matches...what a mess...sucks that if one matches AOA, they are pulled from the ACGME match...

But you said that it was easy for a DO to match internal medicine? That is in a ACGME program? Why is that? High demand for internal med residents?

Thank you so much, I feel as though I have learned so much...

 

[(nicedream)]

Nicedream...thanks so much for the information...this gives me a lot to think about when making my decision for going to medical school...

I will be applying next year and won't know where I will be going...MD or DO so I have a while to wait...but it is great to know about these matches...what a mess...sucks that if one matches AOA, they are pulled from the ACGME match...

But you said that it was easy for a DO to match internal medicine? That is in a ACGME program? Why is that? High demand for internal med residents?

Thank you so much, I feel as though I have learned so much...

The reason all of primary care is relatively easy now is less students want to do it. The reasons for that are primary care doctors are paid less for their time when compared to other specialties.
The top ACGME programs still are not "easy", but they are certainly open to DOs. Compare this to say, ACGME derm/plastic surg/ophtho/ENT, where it's essentially impossible to get any spot at all. Someone will inevitably post about someone getting one - but it is extremely rare. If you were shooting for those specialties, you would for all intents and purposes be limited to the AOA programs.

 

[mizzoudude]

Say that I attended a DO program and decided that I wanted to do a dermatology residency (extremely competetive as I understand)....would I be limited to AOA residencies only since the ACGME residencies for dermatology would be extremely hard to get?

And if I do a AOA dermatology residency, would I be less likely to land a good job? Would I be passed up for a dermatology opening somewhere? Or once again does it go to prestige, etc?

 

[djnels01]

Say that I attended a DO program and decided that I wanted to do a dermatology residency (extremely competetive as I understand)....would I be limited to AOA residencies only since the ACGME residencies for dermatology would be extremely hard to get?

And if I do a AOA dermatology residency, would I be less likely to land a good job? Would I be passed up for a dermatology opening somewhere? Or once again does it go to prestige, etc?

Yea I think that's what he's saying. I'm pretty sure that your chances of getting an ACGME Derm Res. are pretty much nil if you're a DO. I've heard that there's only like 20-30 AOA derm spots in the country too, so that will be challenging in itself...

About the job, I'm sure if you are smart enough to get a Derm residency, no matter where, you will be able to get a job somewhere. If a health care setting is in need of a Dermatologist they will not care what letters go after your name, just so long as you know your $h!t.

(nicedream), anything I missed?

 

[(nicedream)]

Yea I think that's what he's saying. I'm pretty sure that your chances of getting an ACGME Derm Res. are pretty much nil if you're a DO. I've heard that there's only like 20-30 AOA derm spots in the country too, so that will be challenging in itself...

About the job, I'm sure if you are smart enough to get a Derm residency, no matter where, you will be able to get a job somewhere. If a health care setting is in need of a Dermatologist they will not care what letters go after your name, just so long as you know your $h!t.

(nicedream), anything I missed?

Yeah, that's accurate. There are 19 osteopathic graduates in ACGME derm residencies right now - that would be an average of 6 accepted per year - so not impossible, but certainly not comparable to the 350 or so MD residents. Even taking into account the fact that DOs only make up about 5% of total med grads, that's a significant underrepresentation.
Whether derm overall is more difficult for MDs or DOs is debatable, since there are more MDs applying to more ACGME slots and less DOs applying to less AOA slots. Looking at the numbers, about 350 first year ACGME slots for something like 150,000 MD graduates (how many that apply to derm I do not know) vs. about 30 first year AOA slots for something like 2,000 DO graduates. That's 429 MD grads per ACGME slot vs. 67 DO grads per AOA slot. At face value that would indicate an easier time for DOs getting derm (AOA) than MDs (ACGME). The usefulness of this statistic is certainly questionable, but it's food for thought.
Ophtho is worse for DOs with only 1% of ACGME residents being DOs and even less AOA programs. Plastic surg is probably the absolute worse with currently ONE DO in an ACGME program and only 2 AOA programs available. Rad onc is also particularly difficult for DOs with 1.5% of ACGME slots going to DOs and I believe NO AOA programs. ENT and orthopedic surg would also likely restrict one to AOA programs (0.9% and 0.6% DO).
ACGME Anesth, EM, FP, IM, Neuro, ObGyn, Peds, and Psych are currently wide open.

 

[OSUdoc08]

The last thread about residencies/matches from DO schools brought up some questions...as I admitted as a premed I hadn't even given the thought about ACGME vs. AOA residencies...I have some questions if some of you wise med students could share some answers...
I understand that there are ACGME programs, AOA programs, and some limited dual programs...
I also understand that 5 states (PA, MI, FL, and two more I can't think of) need a DO internship before getting into a ACGME (MD) residency program to practice there...
Are these assumptions correct?

Here are some more questions if you don't mind; some of them might sound really dumb...but I am new to the subject:
1) Why does one need to worry if they go to a ACGME program? Why are some concerned about getting the AOA to approve the ACGME program? Why do you need AOA accreditation?
2) What limitations do you have if you do the one year DO internship? Are there limitations if you do it? funding limitations of some sort?
3) Will there be jobs that specify that the physician must be ACGME certified? AOA certified? Both?
4) Matching into these programs is much harder for a DO? Easier to match into a AOA residency for a DO right? Also, in general what are the consequences/differences between doing an AOA residency vs. ACGME residency?

Thank you all that are helping out with my dumb questions....

1. To practice in the 5 states you listed.
2. No, no limitations.
3. Not likely, as this is not legal.
4. Easier to match into AOA because you are only competing with other DO's, a MUCH smaller number of people. ACGME residency allows you to skip the extra year of internship.

 

[mizzoudude]

Thanks for all the info you guys...especially nicedream...

Due to my shi*ty stats from undergrad (3.2/3.1) and a 25 on the MCAT, I know that I do not have a good shot at MD schools as I stand. I am doing a masters program at a state school and will try to get a 3.5+ in the program with an improved MCAT score to go with it (hope to get a 30+). Perhaps I will get into the MD program.

I am glad that I learned about DO schools as well. I have been shadowing some DO physicians and have learned that they do the same exact thing as MD docs...just a different way of learning. I have yet to ask them about their medical school experiences...but I will post that when I do have some information.

Also, it is good to know that I will be somewhat limited in specializing if I do choose the DO route. Yes there are some that go to a DO school and get into a cosmetic/plastic surgery residency, but I understand that it is fairly rare.

I am going to concentrate on getting in somewhere...may it be MD or DO (hopefully I will know around this time next year) and then I will decide if the fact that I will have a harder time speciailizing will effect the decisions that I make...perhaps I will want to be an internal medicine doc...

Once again thanks for all the info guys....inspires me to definately post and help people out once I am in med school and even after I am a doc (if I have the time I suppose).

 

[(nicedream)]

Thanks for all the info you guys...especially nicedream...

Due to my shi*ty stats from undergrad (3.2/3.1) and a 25 on the MCAT, I know that I do not have a good shot at MD schools as I stand. I am doing a masters program at a state school and will try to get a 3.5+ in the program with an improved MCAT score to go with it (hope to get a 30+). Perhaps I will get into the MD program.

I am glad that I learned about DO schools as well. I have been shadowing some DO physicians and have learned that they do the same exact thing as MD docs...just a different way of learning. I have yet to ask them about their medical school experiences...but I will post that when I do have some information.

Also, it is good to know that I will be somewhat limited in specializing if I do choose the DO route. Yes there are some that go to a DO school and get into a cosmetic/plastic surgery residency, but I understand that it is fairly rare.

I am going to concentrate on getting in somewhere...may it be MD or DO (hopefully I will know around this time next year) and then I will decide if the fact that I will have a harder time speciailizing will effect the decisions that I make...perhaps I will want to be an internal medicine doc...

Once again thanks for all the info guys....inspires me to definately post and help people out once I am in med school and even after I am a doc (if I have the time I suppose).

It's not the end of the world if you go DO and still want to specialize - I'm in DO school and would like to specialize. However, for some specialties (rad onc, plastic surg), it's basically out of the realm of possibility. For others it just means doing AOA programs instead of ACGME - which when doing a specialty, probably isn't going to bother you much. You're still going to be doing what you want, doing the same work, making the same money. Also, whatever you think you want to do before school is probably going to change multiple times.

 

[beastmaster]

Yeah, that's accurate. There are 19 osteopathic graduates in ACGME derm residencies right now - that would be an average of 6 accepted per year - so not impossible, but certainly not comparable to the 350 or so MD residents. Even taking into account the fact that DOs only make up about 5% of total med grads, that's a significant underrepresentation.
Whether derm overall is more difficult for MDs or DOs is debatable, since there are more MDs applying to more ACGME slots and less DOs applying to less AOA slots. Looking at the numbers, about 350 first year ACGME slots for something like 150,000 MD graduates (how many that apply to derm I do not know) vs. about 30 first year AOA slots for something like 2,000 DO graduates. That's 429 MD grads per ACGME slot vs. 67 DO grads per AOA slot. At face value that would indicate an easier time for DOs getting derm (AOA) than MDs (ACGME). The usefulness of this statistic is certainly questionable, but it's food for thought.
Ophtho is worse for DOs with only 1% of ACGME residents being DOs and even less AOA programs. Plastic surg is probably the absolute worse with currently ONE DO in an ACGME program and only 2 AOA programs available. Rad onc is also particularly difficult for DOs with 1.5% of ACGME slots going to DOs and I believe NO AOA programs. ENT and orthopedic surg would also likely restrict one to AOA programs (0.9% and 0.6% DO).
ACGME Anesth, EM, FP, IM, Neuro, ObGyn, Peds, and Psych are currently wide open.

Is it possible that many of the very-qualified candidates just go with the AOA match because they have a higher chance at the top fields, rather than take a bigger risk? Meaning, if they were forced to do the ACGME match they would do better than expected and the overall numbers would potentially look different.

 

[(nicedream)]

Is it possible that many of the very-qualified candidates just go with the AOA match because they have a higher chance at the top fields, rather than take a bigger risk? Meaning, if they were forced to do the ACGME match they would do better than expected and the overall numbers would potentially look different.

Sure, it's possible. It wouldn't affect the #s that much though because there are not that many AOA slots - therefore those not matching (and there would be a lot) would still do ACGME.
Also, in the fields with basically no AOA slots (rad onc, plastic), that wouldn't be an explanation.

 

[NRAI2001]

How difficult is it for a DO to get a fellowship after doing an IM residency?

What about after doing a general surg. residency?

 

[(nicedream)]

How difficult is it for a DO to get a fellowship after doing an IM residency?

What about after doing a general surg. residency?

After doing an AOA residency, DOs would be restricted to DO fellowships - depending on the subspecialty, that make it more difficult or impossible.
After doing an ACGME residency, I think being a DO would matter less when applying for fellowships than when applying for residency. Not really sure though, it's difficult to analyze the statistics on that.

 

[Arch Guillotti]

After doing an AOA residency, DOs would be restricted to DO fellowships - depending on the subspecialty, that make it more difficult or impossible.
After doing an ACGME residency, I think being a DO would matter less when applying for fellowships than when applying for residency. Not really sure though, it's difficult to analyze the statistics on that.

You might want to double-check your facts on that statement buddy before you go throwing around statements like that. During my fourth year of med school I met a DO who did an AOA general surgery residency in Michigan and was pursuing an ACGME felllowship in a very allopathic hospital.

Your second statement is pretty accurate though.

 

[Dr Alo]

2) There are no limitations, the reason it sucks is if you do an AOA internship and then go into an ACGME residency, then you wind up doing 2 internship years. That is hell. Well, hell twice. That is why you would want to get the ACGME internship year approved (or do a dual-accredited internship).

That is not true. Most programs are dually accredited, and if they are not, you do not repeat a year. If you want to do gen surg at an MD program, in Michigan, they all have DO places for you to do your internship year, and if you do your first year at a DO place, you don't repeat it when applying for PGY2 positions.

All of this will become clear to you in the future. The reason the AOA does not approve all programs is to "protect" the DO ones. If all programs were dual, then there would be no more DO-only programs. It's complicated. Its the same reason tehy are afraid to combine the match.

 

[OSUdoc08]

That is not true. Most programs are dually accredited, and if they are not, you do not repeat a year. If you want to do gen surg at an MD program, in Michigan, they all have DO places for you to do your internship year, and if you do your first year at a DO place, you don't repeat it when applying for PGY2 positions.

All of this will become clear to you in the future. The reason the AOA does not approve all programs is to "protect" the DO ones. If all programs were dual, then there would be no more DO-only programs. It's complicated. Its the same reason tehy are afraid to combine the match.

This is rare in my part of the country.

 

[nrddct]

I'm glad I read this post. I've been pro DO for a while and have been accepted to KCUMB. I want to go to TCOM but it seems like it doesn't really matter which DO program I go to. If I'm end up at the top of my class in a DO school and want to specialize in a competitive ACGME residency, then it'll be a uphill battle b/c of my title.

 

[(nicedream)]

That is not true. Most programs are dually accredited, and if they are not, you do not repeat a year. If you want to do gen surg at an MD program, in Michigan, they all have DO places for you to do your internship year, and if you do your first year at a DO place, you don't repeat it when applying for PGY2 positions.

All of this will become clear to you in the future. The reason the AOA does not approve all programs is to "protect" the DO ones. If all programs were dual, then there would be no more DO-only programs. It's complicated. Its the same reason tehy are afraid to combine the match.

That is why I said "or do a dual-accredited internship." And it may be true in Michigan, seemingly the DO capital of the country/world, but it's not true in the vast majority of the country.

 

[(nicedream)]

You might want to double-check your facts on that statement buddy before you go throwing around statements like that. During my fourth year of med school I met a DO who did an AOA general surgery residency in Michigan and was pursuing an ACGME felllowship in a very allopathic hospital.

Your second statement is pretty accurate though.

I love anecdotes.
It's rare to be able to get board certification in a subspecialty if you don't have board certification in the residency.

 

[raptor5]

This is rare in my part of the country.

I would say rare in most of the country. In PA some programs are dual approved (FP and IM only for the most part) but I thinks PA has more DO residencies than any other state so your not getting out of a AOA approved internship here.

 

[Arch Guillotti]

I love anecdotes.
It's rare to be able to get board certification in a subspecialty if you don't have board certification in the residency.

It may be an anecdote but it is true. I didn't say anything about board certification. I doubt ACGME cert. would possible, but AOA might.

Do well, take the USMLE if so inclined (I was), get good letters, try and do research, apply to lots of programs and roll the dice.