What makes DO's more desirable than Big Three Carib grads?

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lemonlove

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I was looking into some Psychiatry positions and have been told a few times, that DO candidates are preferred over those from the Big Three Caribbean schools for ACGME residencies.

I'm a Ross grad, and this doesn't make a whole lot of sense to me. I thought DO's have their own residencies and would first have a better chance matching there.

Is there some funding issue or licensing issue this has to do with? I know that being international, at some places, one can't get their license without 3 years of postgraduate training. What's the deal?

Thanks
 
J DUB said:
DO's mostly apply to US MD residencies. SO the advantage is simply you get a residency. Or at least you have a better shot. US trained is still best.
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They are US trained, but a lot of Caribbean students do their rotations at the same hospitals?
 
oh for the LOVE OF GOD...stop this...

some places like DO over Carib, some like Carib over DO...work hard, get great score apply broadly and pray...when you are interviewing you will see the same people interviewing with you...

and btw training IS residency...anyone practicing in the US is US trained...you can't work in the US without being US trained.
 
rokshana said:
oh for the LOVE OF GOD...stop this...

some places like DO over Carib, some like Carib over DO...work hard, get great score apply broadly and pray...when you are interviewing you will see the same people interviewing with you...

and btw training IS residency...anyone practicing in the US is US trained...you can't work in the US without being US trained.
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I was asking simply out of curiosity, was wondering if taking somone who is a DO gives the program an advantage in terms of licensure or funding.
 
The hierarchy, as explained by a few PDs here on SDN state the following: US MD > US DO >>>>>>>>> US IMG >>>>>>>>>>FMG.

However, I guess the landscape has changed since you matched. Most folks coming from the Carib are jumping through more hoops to get much less. If all you want is psych, FM, or IM in a location that is not your top choice, then by all means go for it! (Not taking anything away from those fields, but if you do not want to do any of those, well then it is honestly better to do something else rather than waste your money or time heading to the island.)

With the USMLE scores that the students who make it through the Caribbean end up with... they could have so many opportunities if they had taken the time and energy to properly apply to schools here in the states. Whether they reapply to MD programs or put aside their ego and apply to DO programs. Either way.. they certainly have a much harder struggle than students here do. Though more self-imposed if anything... it still is a struggle.
 
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QueenJames said:
The hierarchy, as explained by a few PDs here on SDN state the following: US MD >>>>>>>>> US DO > US IMG >FMG.
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J DUB said:
fixed
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actually fixed, and depending upon the PD in the real world either one of the last two ">" could be "=" instead. As has been pointed out multiple times, there's a reason DOs are grouped along with IMGs in the "independent" category in the NRMP reports. DO outcomes are much more similar to IMG than USMD.
 
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the argus said:
actually fixed, and depending upon the PD in the real world either one of the last two ">" could be "=" instead.
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With all due respect to you, as I know that you are an IMG who successfully made it through the path, you have a lot more experience with this process. If you had to do it all over again, would you go to the Carib all over again, or would you have reapplied to DO programs if MD programs were out of your reach? What residency did you choose and was it your first choice or did you feel you had to settle for something that was attainable to other fellow IMGs?
 
QueenJames said:
However, I guess the landscape has changed since you matched. Most folks coming from the Carib are jumping through more hoops to get much less. If all you want is psych, FM, or IM in a location that is not your top choice, then by all means go for it! (Not taking anything away from those fields, but if you do not want to do any of those, well then it is honestly better to do something else rather than waste your money or time heading to the island.)

With the USMLE scores that the students who make it through the Caribbean end up with... they could have so many opportunities if they had taken the time and energy to properly apply to schools here in the states. Whether they reapply to MD programs or put aside their ego and apply to DO programs. Either way.. they certainly have a much harder struggle than students here do. Though more self-imposed if anything... it still is a struggle.
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Much of this is incorrect as well.

US-IMGs continue to enter ACGME residencies in the same numbers they have for the past 10 years. And for matched applicants, US-IMG board scores are lower in practically every specialty than their USMD counterparts.

I do agree though that you shouldn't go to the Caribbean if you would not be happy in IM, FM, or psych. And also that even great board scores for a US-IMG will not open doors that are open for less-achieving USMDs.
 
QueenJames said:
With all due respect to you, as I know that you are an IMG who successfully made it through the path, you have a lot more experience with this process. If you had to do it all over again, would you go to the Carib all over again, or would you have reapplied to DO programs if MD programs were out of your reach? What residency did you choose and was it your first choice or did you feel you had to settle for something that was attainable to other fellow IMGs?
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I advice people to go DO over Caribbean, but that is mostly due to the protected AOA residency positions (will won't be around in a couple years). There are also a very small number of AOA residency positions in the competitive specialties, and there's also a handful of competitive ACGME residency programs across the specialties which will interview/match DOs but not US-IMGs.

That being said, the same specialties, and tier within specialties, that are available to DOs in most cases are also available to US-IMGs. The vast majority of DO grads in ACGME residencies are in programs that also interview/match US-IMGs. Only in the fake world of SDN are DO outcomes more comparable to USMDs than to US-IMGs.

I personally am in my first choice specialty (which I knew before starting medical school) in a University program alongside USMDs and DOs. The program is considered a strong match for DO grads as well. If I had to do it over again I would likely choose the same path, but I'm sure there would be people I graduated with who would say the opposite.
 
Eh... At least in the programs that I've had direct exposure to:

US MD >>> US DO >>>>>>>>FMG>>>>>>US IMG

It all comes down to quality of applicants. Even if US IMG applicants have strong board scores, they never have the CV of USMD or FMG. Certainly will be different for less competitive programs and less competitive specialties, but we have no reason to consider US IMG.
 
Residency comes down to risk. Which applicant is more risky than another?

Is someone clinically competent? USMLE, other than being a test of test taking skills, is suppose to be a standardized clinical compentency exam. But does a test tell the entire story in regards to clinical competency? No. Someone with stronger clinical rotations has a huge advantage over someone who does not. DOs and IMG/FMGs are at a disadvantage on the whole in this regard.

There are also questions regarding the type of person who enters an IMG situation. After all, who would enter a scenario in which you would leave the country to achieve a sub-par education, for just as much money, and with SIGNIFICANT higher rate of attrition? You would look at it one of two ways. The first way: "Wow, IMGs are such go-getters. They are willing to do everything possible to be part of this profession." The second way, "What a stupid decision. Why in the world would they do that? Could they not delay gratification for one more year to improve their scores? Did they have a significant, perhaps personality, red-flag during the application process that would make them so desperate to invest in such a horrible investment?" Unfortunately for IMGs, the second line of thinking is more prominent.

Third, PDs want to take a know commodity. If they have had nothing but USMDs, the USMDs have done fantastic in the past, they why would they pass on a known commodity for a DO or IMG/FMG? You take the known versus the unknown with a good test score. Also, in regards to known versus unknown...DOs live in the states. They have the ability to audition. About half of my med school class matched ACGME, and they did so by auditioning and doing well. If someone does well on an audition, it reduces the applicants risk level. It is difficult for IMGs to audition at most sites beside IMG-slave factories.

There are SERIOUS questions about the quality of education at IMG programs, the personality type of IMGs, and the reduced opportunity for audition. It's why IMGs are in the lowest rung of medical applicants...frankly, why applicants would be stupid to go that route in today's medical landscape...and why the military won't even allow them.
 
The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score.

There was a time when folks whose only flaw was being a late bloomer went Carib, but those days are gone. There are a number of spots at US schools with grade replacement for these candidates.

Yes, there are AOA residencies for DO grads, but these can't take all DO grads. Hence, the majority of DO grads will go into ACGME residencies. Only the DOs from the oldest schools (KCOM, DMU, PCOM) seem to match more into AOA. About 60% of my own students go for ACGME, mainly because we're on the western side of the Mississippi, where AOA residencies are fewer.

lemonlove said:
I was looking into some Psychiatry positions and have been told a few times, that DO candidates are preferred over those from the Big Three Caribbean schools for ACGME residencies.

I'm a Ross grad, and this doesn't make a whole lot of sense to me. I thought DO's have their own residencies and would first have a better chance matching there.

Is there some funding issue or licensing issue this has to do with? I know that being international, at some places, one can't get their license without 3 years of postgraduate training. What's the deal?

Thanks
Click to expand...
 
OP, is this not you?

I am feeling as if I don't find anything by end of March, I will just give my program my 3 month notice (so that they can find someone, and my looking at some of the candidates we have had for PGY-1, that should be no issue) and start planning for the match next year in September and not sign my contract for 2nd year. I am also going to get letters from my program. I have had no problems here and would love to stay if only my husband did not have his job restrictions. It's very difficult doing a long distance relationship with a 3 hour time change. Again, I'm sad to be leaving my co-interns who have become very good friends with but I also have other considerations that involve starting a family.

Any tips on what I should do during my time off? I plan on sitting for step 3 and doing some volunteering, but anything more useful you would suggest?
Click to expand...

You do understand that by taking a year off, your medical career is likely done? Read Goro's post...

bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior
Click to expand...

You do realize why you are going to struggle to keep your career afloat if you do not renew?
 
j4pac said:
Residency comes down to risk. Which applicant is more risky than another?

Is someone clinically competent? USMLE, other than being a test of test taking skills, is suppose to be a standardized clinical compentency exam. But does a test tell the entire story in regards to clinical competency? No. Someone with stronger clinical rotations has a huge advantage over someone who does not. DOs and IMG/FMGs are at a disadvantage on the whole in this regard.

There are also questions regarding the type of person who enters an IMG situation. After all, who would enter a scenario in which you would leave the country to achieve a sub-par education, for just as much money, and with SIGNIFICANT higher rate of attrition? You would look at it one of two ways. The first way: "Wow, IMGs are such go-getters. They are willing to do everything possible to be part of this profession." The second way, "What a stupid decision. Why in the world would they do that? Could they not delay gratification for one more year to improve their scores? Did they have a significant, perhaps personality, red-flag during the application process that would make them so desperate to invest in such a horrible investment?" Unfortunately for IMGs, the second line of thinking is more prominent.

Third, PDs want to take a know commodity. If they have had nothing but USMDs, the USMDs have done fantastic in the past, they why would they pass on a known commodity for a DO or IMG/FMG? You take the known versus the unknown with a good test score. Also, in regards to known versus unknown...DOs live in the states. They have the ability to audition. About half of my med school class matched ACGME, and they did so by auditioning and doing well. If someone does well on an audition, it reduces the applicants risk level. It is difficult for IMGs to audition at most sites beside IMG-slave factories.

There are SERIOUS questions about the quality of education at IMG programs, the personality type of IMGs, and the reduced opportunity for audition. It's why IMGs are in the lowest rung of medical applicants...frankly, why applicants would be stupid to go that route in today's medical landscape...and why the military won't even allow them.
Click to expand...
Goro said:
The pool of US applicants from the Caribbean is viewed differently by Program Directors. The DDx for a Caribbean grad is pretty off-putting: bad judgment, bad advice, egotism, gullibility, overbearing parents, inability to delay gratification, IA's, legal problems, weak research skills, high risk behavior. This is not to say that all of them still have the quality that drew them into this situation. There is just no way to know which ones they are. Some PD's are in a position where they need to, or can afford to take risks too! So, some do get interviews.

Bad grades and scores are the least of the deficits from a PD's standpoint. A strong academic showing in a Caribbean medical school does not erase this stigma. It fact it increases the perception that the reason for the choice was on the above-mentioned list!

Just about everyone from a Caribbean school has one or more of these problems and PDs know it. That's why their grads are the last choice even with a high Step 1 score.

There was a time when folks whose only flaw was being a late bloomer went Carib, but those days are gone. There are a number of spots at US schools with grade replacement for these candidates.

Yes, there are AOA residencies for DO grads, but these can't take all DO grads. Hence, the majority of DO grads will go into ACGME residencies. Only the DOs from the oldest schools (KCOM, DMU, PCOM) seem to match more into AOA. About 60% of my own students go for ACGME, mainly because we're on the western side of the Mississippi, where AOA residencies are fewer.
Click to expand...
Wow, those are long and scary. I'm mean, sure, they're mostly just nonsense, but super scary!
 
Having experience in the ranking process for two separate residencies (one university, one community), and from talking to numerous other residency programs at conventions, it may not surprise people but...

Every program is different!

And it ultimately comes down to the PD and their personal biases. I've talked to PDs with a pure allopathic bias, PDs with a pure US grad bias, PDs who prefer DOs before USIMG, PDs who prefer USIMG over DOs.

It's completely silly watching people trying to argue this fact over and over again when it's impossible to generalize. Toss in the deviance between different specialties, and it's even worse. Pretty much the only common factor that everyone can agree on is that USMD is the preferred top choice (unless you are some horrible program in the middle of nowhere and are desperate to fill your slots with FMGs for the sake of filling... don't envy that position at all.)

What comes next on the list is completely variable.
 
QueenJames said:
The hierarchy, as explained by a few PDs here on SDN state the following: US MD > US DO >>>>>>>>> US IMG >>>>>>>>>>FMG.

However, I guess the landscape has changed since you matched. Most folks coming from the Carib are jumping through more hoops to get much less. If all you want is psych, FM, or IM in a location that is not your top choice, then by all means go for it! (Not taking anything away from those fields, but if you do not want to do any of those, well then it is honestly better to do something else rather than waste your money or time heading to the island.)

With the USMLE scores that the students who make it through the Caribbean end up with... they could have so many opportunities if they had taken the time and energy to properly apply to schools here in the states. Whether they reapply to MD programs or put aside their ego and apply to DO programs. Either way.. they certainly have a much harder struggle than students here do. Though more self-imposed if anything... it still is a struggle.
Click to expand...
please show which actual PDs here have said that...aPD, IMPD, etc have AFAIK have NOT said that...link me to a post form a PD on sdn that gives your description...you will not find one.
 
the argus said:
actually fixed, and depending upon the PD in the real world either one of the last two ">" could be "=" instead. As has been pointed out multiple times, there's a reason DOs are grouped along with IMGs in the "independent" category in the NRMP reports. DO outcomes are much more similar to IMG than USMD.
Click to expand...
QFT
 
My program (non-competitive field, but competitive residency program) interviewed a handful of Carribbean grads this year,

But when it came to ranking meeting, the Carribbean grads stayed at the bottom end of the list, despite every one of them having board scores that were on par with our best applicants. This was because of the perception that having Carribbean grads may create the most everyone feared.
 
SLC said:
My program (non-competitive field, but competitive residency program) interviewed a handful of Carribbean grads this year,

But when it came to ranking meeting, the Carribbean grads stayed at the bottom end of the list, despite every one of them having board scores that were on par with our best applicants. This was because of the perception that having Carribbean grads may create the most everyone feared.
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Sorry but didn't get the last part. They may create the most what exactly? Btw been following you on sdn for a while. Congrats on all of the success!
 
DetectiveAlonzo said:
Sorry but didn't get the last part. They may create the most what exactly? Btw been following you on sdn for a while. Congrats on all of the success!
Click to expand...

Sorry, poor sentence structure.

People here fear that having Carribbean grads on house-staff may create a perception that our program is not as good as it is.

Truth of the matter is that having IMG's in this field tends to give the impression that something must be lacking about the program. High quality applicants tend to pass those programs by (I know I did).

In some fields, having too many DO's can do the same (though in my field, even the best programs have traditionally been very DO friendly.).
 
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SLC said:
Sorry, poor sentence structure.

People here fear that having Carribbean grads on house-staff may create a perception that our problem is not as good as it is.

Truth of the matter is that having IMG's in this field tends to give the impression that something must be lacking about the program. High quality applicants tend to pass those programs by (I know I did).

In some fields, having too many DO's can do the same (though in my field, even the best programs have traditionally been very DO friendly.).
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Just out of curiosity did you notice a similar ranking system against DOs?

Sent from my SM-G900V using SDN mobile
 
MLT2MT2DO said:
Just out of curiosity did you notice a similar ranking system against DOs?

Sent from my SM-G900V using SDN mobile
Click to expand...

Not really. DO's tended to fall in right where they landed in terms of scores and interview impressions, we had them sprinkled across the entire list, mainly in the top half, but a few with poor scores near the bottom.

But my program has a long history of matching (and fully embracing) DO's, so it might not be reflective of the way programs in general do things.
 
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tatsuchi said:
...
It's completely silly watching people trying to argue this fact over and over again when it's impossible to generalize...
Click to expand...

Actually it's pretty easy to generalize and the fact that you have an outlier view on this doesn't really undermine the concept of generalization. 🙂 US schools have insignificant attrition and about a 94% match rate, with most of the remainder finding things in soap. DO has insignificant attrition, about 70% allo match rate, with most of the remainder finding things through the osteo match or soap. Everyone else as a group has about a 40% match rate, and for offshore schools that's after very high attrition. (Yes I get that the Big Three "claim" to do a lot better than that 40%, and they might, but statistically the attrition risk still makes that riskier than DO). And reportedly the offshore places struggle more with soap than back in the scramble days. So from the match statistics from the NRMP, it's actually pretty easy and objective to generalize that people are better off coming from a US school.
 
There's this perception that, as SLC alluded to, having too many Carib grads means that your program was unable to get any US MDs OR DOs to rank your program highly, so something must be wrong. It isn't fair, but most programs don't want to risk having nothing but Carib grads on their roster, so they sprinkle a few of their foreign favorites higher up while ranking US MDs and DOs higher to show MDs and DOs in future years that US grads actually want to train there.
 
Mad Jack said:
There's this perception that, as SLC alluded to, having too many Carib grads means that your program was unable to get any US MDs OR DOs to rank your program highly, so something must be wrong. It isn't fair, but most programs don't want to risk having nothing but Carib grads on their roster, so they sprinkle a few of their foreign favorites higher up while ranking US MDs and DOs higher to show MDs and DOs in future years that US grads actually want to train there.
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How is it not fair?
 
Psai said:
How is it not fair?
Click to expand...

It's not fair on the individual level, but on the global level you can see why a PD would use such reasoning. If there happens to be one late bloomer among the mass of red flags (probably an exaggeration)...it's not worth it for a PD to seek out that late bloomer. Quite frankly it's impossible. The PD would rather go with what has worked in the past. If it helps the perception of his program...than even better. There are some great IMG candidates out there that get screwed in the process...but they knew the risk going in. Tough to feel incredibly bad.
 
I've made plenty of mistakes.

Getting totally hammered and beating up random individuals while proceeding to thrash their property is not one of them.

A few spritzers and I am outttt. I'm a classy lady. 😉
 
Law2Doc said:
Actually it's pretty easy to generalize and the fact that you have an outlier view on this doesn't really undermine the concept of generalization. 🙂 US schools have insignificant attrition and about a 94% match rate, with most of the remainder finding things in soap. DO has insignificant attrition, about 70% allo match rate, with most of the remainder finding things through the osteo match or soap. Everyone else as a group has about a 40% match rate, and for offshore schools that's after very high attrition. (Yes I get that the Big Three "claim" to do a lot better than that 40%, and they might, but statistically the attrition risk still makes that riskier than DO). And reportedly the offshore places struggle more with soap than back in the scramble days. So from the match statistics from the NRMP, it's actually pretty easy and objective to generalize that people are better off coming from a US school.
Click to expand...

Which is... a great statement and all (agree that the Big Three may "claim" to do better, but honestly it may not be by much), but one which has no relation as to the original statement of which I was responding to?

I was responding to the assertion if all PDs carried a general bias in terms of USMD vs DO vs USIMG. And I still stand by my stance from my personal experience (appreciate the ad hominem attack, guess talking to actual PDs is an outlier event!) that no, actually, most PDs have their own way of doing things.

If you want to argue what percentage of each candidate type successfully matches, that's a different discussion and one where I probably will not disagree much with in regards to the advantages that being a US school graduate creates. Even if the rationale behind why each type of US school graduate is successful is different.
 
tatsuchi said:
Which is... a great statement and all (agree that the Big Three may "claim" to do better, but honestly it may not be by much), but one which has no relation as to the original statement of which I was responding to?

I was responding to the assertion if all PDs carried a general bias in terms of USMD vs DO vs USIMG. And I still stand by my stance from my personal experience (appreciate the ad hominem attack, guess talking to actual PDs is an outlier event!) that no, actually, most PDs have their own way of doing things.

If you want to argue what percentage of each candidate type successfully matches, that's a different discussion and one where I probably will not disagree much with in regards to the advantages that being a US school graduate creates. Even if the rationale behind why each type of US school graduate is successful is different.
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Um my point is when percentages break out a certain way, year after year it's not reasonable to say it's just a matter of some PDs individual preferences. This is pretty broadly applied, and the match percentages absolutely have direct bearing on your statement of whether we can generalize.
 
Again, I am referring to personal biases, not trends. Match percentages only show the percentage of each category that matches. That is inclusive of the pool of the applicants that each school interviewed. A PD who is open to DO candidates but instead gets a pool of impressive USMD candidates and ranks them as such and fills up states nothing about the program director's openness to DO applicants.

The point of my original statement was that there are programs out there that look at things differently. It's not a blanket "all program directors prefer X over Z" when it comes to the discrepancy between DO and USIMGs candidates.
 
Mad Jack said:
Occasionally they overlook legitimately better candidates just to superficially look better to future candidates. I'm okay with that, but it isn't quite fair.
Click to expand...

j4pac said:
It's not fair on the individual level, but on the global level you can see why a PD would use such reasoning. If there happens to be one late bloomer among the mass of red flags (probably an exaggeration)...it's not worth it for a PD to seek out that late bloomer. Quite frankly it's impossible. The PD would rather go with what has worked in the past. If it helps the perception of his program...than even better. There are some great IMG candidates out there that get screwed in the process...but they knew the risk going in. Tough to feel incredibly bad.
Click to expand...

If you're a do or Caribbean, you are a worse candidate almost by definition. Getting into medical school is the bottleneck and is very difficult. If you got in some other way, you should be glad to get what you get. I would take the person with a track record over the person who doesn't any day. I would prefer a penn grad over a Drexel grad. That's just how it is
 
Psai said:
If you're a do or Caribbean, you are a worse candidate almost by definition. Getting into medical school is the bottleneck and is very difficult. If you got in some other way, you should be glad to get what you get. I would take the person with a track record over the person who doesn't any day. I would prefer a penn grad over a Drexel grad. That's just how it is
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Like I said, I don't have a problem with it. And "proven track record" is kind of subjective. I never applied MD, but I've got an entirely solid track record aside, there's a lot of people that go to state schools that never even applied to higher tier schools, etc. That's why the whole process isn't just looking at where someone went to school and taking them on board based on that, or just based on who got the best Step scores, or any other singular factor.
 
Psai said:
If you're a do or Caribbean, you are a worse candidate almost by definition. Getting into medical school is the bottleneck and is very difficult. If you got in some other way, you should be glad to get what you get. I would take the person with a track record over the person who doesn't any day. I would prefer a penn grad over a Drexel grad. That's just how it is
Click to expand...

I have to say that all of our DNR's this year were USMD's, and I was shocked at the names of the schools they went to.

And track record? Of what? Of being a good undergraduate student? To assume that USMD is a better candidate "almost by definition" is to have blinders on "almost by definition"
 
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