Usually if you are a rock star (ex. >250 step I, multiple pubs, good LOR from home program) then it would damage your application more than help in the ACGME world. However, as DOs our schools have no rep. and we don't have home programs, so we are more inclined to take the risk.
I'm kind of curious as to why one's image is damaged more often than not during these auditions? I mean you can't expect an MS-4 to walk into a new hospital and health system and expect them to function like a PGY-3 off the bat. I mean they are already used to students rotating with their programs from their respective medical schools. Why the radical difference in treatment?
Medicine programs are pretty comfortable making decisions about applicants based on their on paper attributes and how they interact with people on interview day. If you're realistically competitive, you don't need a sub-I at a given program to get the program's attention, and giving a performance that lies somewhere between lackluster and outstanding won't change their mind about you very much one way or another. So it's generally not worth the risk.
Some specialties, like surgery, can be a little hesitant to take people without seeing them first- seeing if they are hard-working, enthusiastic, a good fit for their program, etc. So even though they run the same risk of coming across as a bad student, it's generally worth the risk for them, because being unproven can hurt applicants in surgery but it doesn't really hurt applicants in medicine, so it's not really worth it in medicine. If you do a sub-I and really wow the program you rotate at, it still helps quite a bit. As a DO specifically if you get a good letter from someone in an academic center it will also help your chances at other academic centers (if they respect the program you got your letter from).
Also bear in mind how programs perceive you on sub-I's isn't always completely in your control. I did a sub-I at an academic MD residency that didn't have any DO's on the roster, and the senior resident and the interns I worked with liked me, and recommended me to the PD. Great! But we also worked with an ancient attending who trained at MGH way back in the day, who didn't really work as an attending, but ran academic sessions where we presented uncommon cases to him and discussed current research into experimental treatments that could potentially help these patients. He clearly didn't like DO's. Or maybe he just didn't like me, I was the only DO student around for that rotation. He was very understanding and forgiving of little mistakes the MD students made, but whenever I made the exact same mistakes at other times in the rotation, he'd have a comment like "Ah, they didn't train you in that area at your school, eh?" or other like-minded comments, and not in a good natured ribbing manner. Jackass. Anyway, I still got invited for an interview, but had the resident had the same attitude as ye olde attending, or if the PD didn't trust the senior resident's opinion, I don't think I would have.
I think it's still worthwhile to do an away at an academic center for the educational experience, even if it doesn't help you get more interviews.
Title says all.
Higher focus on programs in cities with >500k metros and potentially on the coastal areas, midwest is good too.
I'll say 240+ if you don't have anything else in your app that stands out. You CAN do it with a 230ish score but at that point you start looking like an average student that happens to be a DO, and will start being a victim of the tie goes to the MD mentality. You will still totally be able to match university programs but you'll notice you mostly get love from low tier and mid-low tier places, and mid tier starts becoming a reach. You never know what attributes about you make you seem like a good fit to PD's and aPD's so it's worth trying, and mid tier matches do happen in that range. It just becomes hard, and less likely. Of course it depends on how you draw the lines for the aforementioned categories too. Apply broadly!
