residency options

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danny

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This is something that I'm really confused about and have heard just about everything from everyone. My basic question pertains to what the feasibility of a DO student is regarding landing a "tough" residency like surgery or orthopedics? Does the AOA have these residencies or would you have to go for an allopathic residency? If they do, why would a DO student NOT go for a DO residency?A general overview of the topic would be greatly appreciated. Thanks.
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I have a good friend who is a radioloy resident(MD), and he says that surgical residencies are extremely difficult to get for DOs. I am only repeating what he said and he is a bit biased, but he was echoing the sentiments of many of his MD colleages.
 
AOA has just about every residency you can think of, including orthopedics as well as radiology. Having not gone through them, I don't have an opinion on the reason that some DOs choose allopathic residencies in these areas over osteopathic. From what I hear the toughest allopathic residency for DOs to get into is surgery. However, some do get in, and as a side note, surgery is tough even for MD graduates to compete in so any the possible for anyone these days.
 
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Danny,

Just wanted to let you know that my cousin is a DO and is now an Anesthesiologist, which is one of the hardest professions to get into. He also has a good friend who is currently going through cardiovascular/thoracic surgery residency. Both were accepted into a group of 12 out of 500-1000 applicants. So there is definetely a chance. Here's the thing that he told me. Most DO's that go for MD residencies do so only because the MD programs have had much more time to establish themselves as one of the best. But, he said that there are many DO hospitals today that are establishing themselves as great residency programs. For instance, in Indianapolis they set up an Osteopathic Hospital, Westview Hospital, which now has a surgical team. Thus, they are there, but like the previous person said, no matter what it will be hard to get into. Good luck and I hope that helped.
 
Anesthesiology is one of the hardest professions to get into???? You are extremely misinformed if you believe this. Ivy league residencies cannot fill their slots in anes because it is increasingly difficult to find work. Hospitals are hiring nurse anesthesthesists for a fraction of what they would pay an anesthesiologist. I have letters from program directors offering room, board, travel expenses and a stipend to do a rotation with them. After visiting most of the top DO hospitals, IMHO, they have a long way to go to have "great" residencies in surgery (or just about anything). DO's go to ACGME residencies because they have a higher minimal standard to maintain accreditation; a greater variety of patient's with pathology; attendings that are paid to teach and not volunteers; attendings that are board certified from residency training and not just grandfathered in; protected didactics, etc. Complete an AOA surgical residency and then see what hospitals will grant you privileges. Perhaps the local community hospital...if you are lucky. See what insurance companies will refuse payments because you are not ABMS certified. If your goal is to practice at Grandview in Dayton, then perhaps this is a non-issue. Then again, since they are deeply in debt and struggling to stay afloat, maybe it is a concern.
 
Alas...it's true. The last I heard was that more than 65% of grads pursue
Allopathic residencies. The Osteopathic community has not done a great job
of making AOA residencies competitive. However, I'm not sure it's QUITE as
bad as Pre says (most if not all of our faculty at UHS are "Board Certified"
in their fields and our rotations include both Osteopathic and Allopathic
hospitals, ie. lots of pathology). I've also heard that our Family Medicine
Residency is quite good. However, for those of you interested in an Allopathic
surgical residency...you have your work cut out for you. From what I've heard
(this is JUST rumor) it's still a little bit of an "old boys club" (ie. DO's
need not apply). I'm NOT saying it can't be done, but I wouldn't get my heart
set on it. In fact, the Dean of one school (not UHS) told my entire interview
group that if we were interested in surgery we would be much better off at an
Allopathic school. Unfortunately, I can't really think of a good reason for
choosing ANY osteopathic residency (with the possible exception of primary care
specialties or of course OMT board certification). Just my 2 cents.
 
How depressing folks. The thought that all M.D. residencies are better than all D.O. residencies is bunk. I worked in an osteopathic hospital for awhile and I'm presently doing an internship in a huge allopathic teaching hospital. Let me tell you, I'm hoping for an IM residency at that osteopathic hospital over this allopathic hospital and for a lot of reasons. First, the allopathic hospital is way too focused on research. After graduate school, I know I don't want to be a researcher. Rather, I want to spend all of my time on the clinical aspect of medicine rather than competing with my colleagues for more publications. Secondly, the osteopathic hospital is located within a retirement community which is perfect for someone like myself who wants to practice some aspect of geriatric medicine. And finally, after working in a genuine osteopathic hospital I *KNOW* there is a difference and I want to be a part of that difference (i.e., better communication with patients, manipulative therapy available when needed, and an overall friendlier environment).

I'm not against D.O.s doing M.D. residencies, but when someone says they can't find any reason to do an AOA residency they are not being fair to the AOA programs. There are some excellent programs out there, and some not-so-excellent programs. An applicant should assess them all individually. (Incidentally, this is the same respect the osteopathic profession paid you when they considered your application to medical school ... we all know they don't rule out vast categories of people as quickly as allopathic medical schools tend to do.)

Finally, someone mentioned that it is difficult for a D.O. to get a surgical residency in an allopathic hospital. You should also realize that the discrimination is not solely based on the degree. Female and minority M.D.s will face similar difficulties getting into "The Boy's Club." It is the way the allopathic medical world has worked for many years and it is changing slowly.

Welcome to medicine. Personally, I'm not all that keen on fitting into the existing system. I'm quite content to stand out and be different. It will be my greatest asset ... will it be yours? Or will it be your greatest weakness?

Rocking the boat,

Gregory Gulick
http://www.osteopathic.com/gregory
 
Your point is well made. However, I think you may have misunderstood part
of my response (or maybe I just didn't do a good job of explaining myself).
I chose osteopathy because I too understand and appreciate the DO "difference".
I'm sure there are some really great programs out there but I can assure you
there are not NEARLY enough of them. This leads to a problem. It is unethical
(not to mention unfair) to participate in both matches. Therefore, I think alot
of people tend to go with the allopathic match to have a better chance of landing
a good residency. Better to be safe than sorry. Your future job prospects will,
in large part, be determined by the reputation of your residency. Also, please
know that just because one chooses an allopathic residency DOESN'T mean they have
abandoned osteopathic methods or principles! Nothing could be further from the truth!!
For more information on this subject, please read the following articles: (1)"Time
To Abolish Most Osteopathic Graduate Medical Education Programs" J.A.O.A., Vol. 95,
No.6, 1995. (2)"The Osteopathic Medicine Game: New Strategies for Winning" J.A.O.A.,
Vol.94, No.9, 1994. (3)"Osteopathic Graduate Medical Education: Don't Give Up The
Ship--Yet!" J.A.O.A., Vol.95, No.6, 1995. (4)"Factors Influencing Osteopathic Physician's
Decisions to Enroll in Allopathic Residency Programs" J.A.O.A., Vol.90, No.6, 1990.


 
Who said that all MD (I assume you are referring to ACGME) residencies are better than all DO residencies? I have been to a few of the better AOA hospitals (Grandview, Doctors, Botsford, POH) and they might fall into the bottom 1/3 of (some) the ACGME programs in the US. There was nothing uniquely osteopathic about any of the programs and OMT was a non issue. Indeed, it is probably easier for a patient to receive manual medicine from a PT in most facilities, than to find a DO than was skilled in delivering OMT at one of the above. As a tax payer, I have every right to fill an ACGME slot, since they are funded by Medicare and I have paid into the system. Interestingly, I have found the atmosphere at Cleveland Clinic and Temple to be more collegial and nurturing than any of my DO rotations.
Deb, from my recollection of UHS, many of the family docs are BC, but not residency trained. That is, they achieved board certification prior to residency being a requirement. Correct me if I am mistaken. I do agree with you that there might be some good programs out there, but they are rare.
Oh, and I would consider a few of the AOA programs,ie the few that are ACGME/AOA dually approved. For example, MSU/COM has dual approved programs in FP, IM, PMR, psych, EM and perhaps others. Steve
 
I must admit that I'm a bit ignorant on the subject but have been told that some excellent osteopathic residencies exist (e.g., PCOM residencies). What is your criteria for judging the residencies? Have you visited (I know you haven't participated in yet) a vast amount of both DO and MD residency programs (say, a random stratified sample). Also, paying taxes does not confer the right to an ACGME spot (or my uncle the engineer deserves a spot too... and many, many others). Also, non-taxpayers can get spots too. As a medical student, the RIGHT TO COMPETE for an ACGME spot is conferred.
 
2003, the medical student aspect is to be assumed. The point is that ACGME slots are not the pure domain of MD's. I agree with your first sentence and since you seem to like to split hairs, your last statement is not accurate...but you have several years to figure it out.
 
My statement is more accurate than your tax paying one (it is generally true)!! Of course, you didn't reply to the body of my message b/c you have little evidence to support what you are saying. Everyone knows that ACGME spots are not only the domain of MDs -- did you just find out? I don't, however, want to get into petty name-calling or insults. I'll be the first to wish you good luck (in all sincerity) in pursuing whatever residency you wish. Merry Christmas!
 
The different reasons that Prefontaine has raised, particularly BC/BE faculty (almost all physicians (MD or DO) are these days or they aren't practicing, and most are residency trained) and pathology, are without support; they are the reason that people who have a bias toward ACGME programs raise to support their own prejudice, but there are many ACGME programs at small community hospitals with level 3 trauma centers. Not all ACGME programs are big university hospitals.

One issue that needs to be raised in terms of residency choice that IS an important factor,however, is location. For those of us who are not from Ohio, Michigan, Indiana, Illinois, etc., there is very little option. In the entire Northwest there is ONE AOA program, an FP residency in Portland--the next closest Oakland (1) and then LA, Phoenix, and Denver. Some of us would like to practice and live in States/areas without AOA programs, which is why I will almost certainly do a ACGME residency.
 
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Its funny how you try to give a small example to try and help someone, and you get lashed at. Prefontaine, my only question is why did you choose osteopathic medicine if you are so quick to tear all its programs down. My only guess is that you did not choose to go into it, you were one of those that did not get accepted to an allopathic school, thus went the osteopathic route. If you truly believed in the osteopathic philosophy, I would think you might want to defend it, not lash out at all of its weaknesses. My advice to you, if you truly believe in the DO is that you work to improve all of these weaknesses that you so dearly like to point out. Maybe the reason all of the residencies are considered so poor is because eager students aren't willing to take a chance. Isn't it up to the person on how a residency will turn out. The name game is what I thought most of us would like to get away from, not take part in. Being a good or even great doctor is not because you went to a top notch residency, its because you wanted to be a great doctor. My feeling is that going to an allopathic residency (no matter how great the name is) does not give you the chance to give osteopathic principles, which is not all OMT. By the way, why do you think you don't see much OMT in the osteopathic hospital. Did you think that the hospital beds could be the cause. Anyway, I see and hear too many people saying how great allopathic medicine. I feel it is up to us to let all know how mistaken they really are. DO is where its at.

Bursting your bubble,

Josh
 
Nicely said, Josh. If we are able to suppress our ego, we can get a great GME at any residency in the country. It is the person, not the program. It is true for medical school; it is true for GME.
 
It is interesting to read the comments from the posters that are actually in DO school (Deb and myself) vs. the wishful, idealistic rationalizations from the others. Josh, you are far from bursting my bubble, that happened once I discovered the all-too-often low quality of osteopathic medical school's clinical training. And you are sorely wrong about me possibly being an MD school hopeful/reject. In fact, far from it. Prior to O school, I acquired close to 1000 hours in CME's in OMT with Upledger, Ursa Foundation, Leon Chaitow and others. I applied only to O schools and was thoroughly grounded in the history, philosophy and literature of the osteopathic profession. As a student, I was involved with several of the nat'l student organizations and attended a number of the meetings, including representing my school at three AAO convocations. The comment about BE/BC AOA DO's not being residency trained was meant to be in reference to FP and EM docs, not all specialties. Until quite recently, a DO could become BC, without being residency trained, in these two specialties. It is still possible to achieve a SP in OMM without a residency. Stillborn, if you question the #'s, check in past issues of the JAOA. 2003, I did not reply to the body of your message because I was on call at the time and your apparent general lack of comprehension on my post(s) left me undecided about where (or if to bother) to begin to get you up to speed. As you may find out, some academic DO's will suggest to students to avoid ACGME residencies as they are the domain of MD's. As far as my comment on paying into medicare and being eligible for an ACGME residency, you appear to have misconstrued my intention, but after some experience in DO school, it will probably dawn on you. And Josh, as a student, I spent time at the NIH representing the osteopathic medical student community, as well as my previously mentioned student activities. Interestingly, my dean's letter states that I have been one of MOST active students in nat'l organizations from my school. My point is, I have worked for improvement(s) and have probably been more active as a student than most of you will ever be. My posts were FYI, you can find out on your own how accurate they are. If you think that I am off of the mark, then perhaps you should visit POL and solocit other comments from those with experience. So what are my opinions about GME based on? Rotations at Eastmoreland, Doctor's, Grandview, POH, Ingham Regional, Botsford and a few of the smaller DO training sites. Electives at several of the 125 academic medical centers and rotations at a few community hospitals with ACGME residencies. Also, site visits at >30 ACGME residencies, in addition to ten completed interviews for residency positions. During the visits, I gathered information on ratios of attendings to housestaff; # of patient visits; resources; didactics (# hours and if protected); resident esprit de corps; call schedule; stability of program (staff turnover, attrition rate of residents) and may of the other aspects that are relevant when evaluating a program. Plus, many hours of conversation(s) with DME's, chief residents and house staff, that are privy 'insider' information. My posts are based on my personal experience(s) and are informed comments and not a product of the "well, I heard from my cousin that osteopathic residencies are great " mentality. That is, not from the naive, idealistic view of a pre-osteopathic student.
Josh, if you are going to use the word 'allopathic' or any of it's derivatives, you should visit Taber's medical encyclopedia, as you are using it erroneously. Your comment about OMT and hospital beds reinforces my opinion that you have little practical experience with OMT/OPP. OMT is a valuable modality that could probably decrease hospital stays (in some patients) and improve patient function. The only hospital (that I am aware of) that allows it's consistent use on patients, in most departments, is at a hospital in NY. When I entered the DO profession, it was with the aim of becoming BC in IM and/or FP and CSP in OMM. I still plan on it, except through the ACGME/ABMS route for primary care. I have far from abandoned OPP, even though it is a non issue in the 3rd & 4th years of most DO schools and AOA residencies. The AOA convocations will continue to be my OMT/OPP 'fix', but I will accept an ACGME position for a better combination of GME and experience. And when or if any of you eventually do get around to deciding to pursue the AOA, ACGME/AOA or ACGME residencies, be sure to visit with malpractice insurance companies and see if they still have higher premiums for AOA BE/BC DO's. Also, investigate what hospitals will deny you privileges due to your AOA BE/BC status and what insurance companies will reject/reduce your payments for the same reason(s). While you are at it, ask the AOA how can their residencies be so unique and osteopathicly distinctive, if they are willing to allow ACGME trained DO's to become AOA BC (as the current AOA newletter recommends). Seems like a mixed message. Maybe this post will be a wakeup call for some of you, investigate for yourself, you will find that my statements about GME are much more accurate than you may want to believe. Perhaps, once you are in the system, your comments will have some merit, but it is amusing to have pre-meds tell a 4th year student that they must have it wrong, it simply can't be that way. The osteopathic 'difference' is primarily a partyline. Reality bites.
 
The discussion is so heated, I can't resist myself so I'm going to attempt to interject my two-cent worth of opinion. First let me say that I agree with Pre. As a third year med student reflecting back on the Osteopathic "difference" and "advantage", I am indeed deeply disappointed - not at the quality of education we receive here, but rather the lack of a real difference as I perceive it from an MD education (and my sister is in MD school) so I know what I'm talking about). The only difference I see is a strong push for primary care medicine, and even that is paid only by lips service. And the OMT courses we took were mostly technical courses. As far as I know, OMT is good just for improving ROM. It's not good for any serious internal pathology so in the end, the only real advantage DOs have over MDs is minimal. Again, all our classes were supposed to be integrated and holistic. Far from it. Pharmacology is pharmacology, physiology is physiology, pathology is pathology, etc...(you get my point? and the point being that no osteopathic principles were actually tied in to any basic science courses. May be because they are actually taught by PhDs). What I find amazing is even family medicine department courses lack osteopathic in influence. We learn to diagnose and treat, but in the whole first two years, I could only find one sentence remotely paying homage to anything remotely osteopathic. It said something like osteopathic manipulations can be effective for some musculoskeletal disorders. I imagine what I say is harsh or discouraging to entering students, but what you learn will be nothing really unique, and as more and more MD schools wise up to alternative medicine (due to financial pressure no doubt), how holistic is osteopathy? I once asked someone from the OMM department why complementary medicine is not being taught at our school for I am interested in acupuncture since my father is a pharmacist who's quite adept at this, she told me flat out that since DOs have so recently gained acceptance from mainstream medicine, that most DOs don't want to 'rock the boat' and everyone wants to be "straight as an arrow" when it comes to practicing medicine. Perhaps, DOs, particularly those who remember old prejudice, avoid alternatives because they no longer want to be labeled 'alternative'. If this attitude prevades, it's not hard to imagine that DOs will once again have to play the catchup game with MDs in alternative care arena.
 
Prefontaine,

You might want to follow your own advice and reread my post. I did not intent to dispute your claims about ACGME vs AOA residencies, I simply suggested that your assertions were without any concrete support. In other words, you can crunch all the numbers that you want about faculty to resident ratio, pathology, ER admits, etc, but there is absolutley no evidence that the physicians coming out of ACGME residencies are superior in any way to those coming out of AOA residencies. Indeed, since you rotated through Eastmoreland (I assume you mean Portland) you know that they spend the majority of their time in other places--Adventists, Emmanuel, Good Sam, etc. These are all large MD medical centers, so your case doesn't seem to stand on this point.

By the way, I am a 2nd year osteopathic medical student, and no great fan of the AOA or their residencies. Like you, I have done a great deal of research into GME, and discussed the various issues with several DMEs--both ACGME and AOA. It is hubris to presume that because I disagree with your analysis of the information that I am ill-informed or naive. You seem to think that your resume is impressive, and perhaps rightly so. I will save you the boredom of reading my accomplishments, but I also have some savvy when it comes to higher education, having taught at the college level for several years before starting medical school. I am neither ill-informed, nor naive when it comes to education. As I said, and my only real point, was that the doc matters much more than the program. You can get a great education at an AOA program, or a mediocre education at an ACGME program; the reciprocal is also true.

I must agree with on one point though, I am somewhat put off by the AOA programs not investing in full-time faculty. Whether or not it is detrimental to the resident, it indicates a lack of commitment to education that I find disconcerting.

[This message has been edited by StillBorn (edited 12-25-98).]

[This message has been edited by StillBorn (edited 12-25-98).]
 
To everyone,

I don't want to dispute all of your fantastic experiences, but the bottom line of the discussion is that DO's are being looked at as second to MD's. I agree, my words before might have been idealistic, but it sounds to me that prefontaine is willing to give up. You had to have known going into the osteopathic field, since it was only four years ago, that there is not much difference between the two. That is exactly my point. Why should there be any difference in the way both doctors are treated when they both have the same education. I would want to fight for that right instead of giving up and saying how the MD's have won. You have put to many years into this to say that. I know that my experience is small, but I also know that I have made a strong effort to work with both doctors to try and find out if there was a difference between the two. Just as all of you I obviously chose osteopathic medicine, but it was not all for the differences. I felt DO's were more well rounded, cared more for their patients, and dedicated every minute to defending their position. My mother works for Abbott Laboratories and has had many experiences with both. She as well feels the difference is in the personality of the doctor, but has also found they are almost scared, as you said, to stand up for their profession. Only 1/3 of the DO's in Indiana actually take part in their own organization, which as it sounds, is the same every where else. My biggest point is that we, as individuals, need to stick together on this issue as a group for only then will we make any strides in others understanding. I think it is funny how we have spent this much time defending each others position on this issue, while the MD forum is probably laughing right now. Do you think they go through these discussions? No, yet there boards are our boards. I never wanted to dispute your knowledge on the issue, I just was upset that you weren't willing to step up and defend yourself. I am afraid that I am going into a profession where too many are willing to give up and roll over to doctors that have no business telling us what to do. I am idealistic and I admit it. I just wish more of you were the same.

Rocking the boat,

Josh
 
Excuse me but who views DOs as second to MDs? Perhaps only those MDs who think too highly of themselves or Joe Q. Public who knows nothing of osteopathic system. DOs and MDs are nothing but birds of the same feather but just don't flock together - that's all, due to political rivalry and ignorance in both camp. From an MD standpoint, they're more well recognized. From a DO standpoint, we think, and I emphasize 'think', that we can offer something more than the average MD. Think again. Shadow a DO for a day and see if the diagnoses/treatments aren't the same. Sure DOs taut they listen to their patients and care more for their patients. Anyone can do that. My mother, an Ob/Gyn MD specialist, was the a damn caring doctor if I may say so. Therefore it's ridiculous to claim that DOs are somehow more sympathetic toward their patients just because of their bestowed DO degree. To be frank, in my DO school, we don't have a course on 'how to listen to your patients' or on 'how to treat patients more holistically' so I could be wrong about other DO schools offering these. But I'm being sarcastic of course. The real DO/MD rivalry is really a tuff war. DOs have this complex about being discriminated for so long so they don't want to 'jump into bed with MDs' when they are invited or at least encouraged to do so, but on the other hand, old timer MDs now suddenly find themselves having to share 'status' and authority with their old enemies and are reluctant to get with the game. In the end, there's really only one brand of medicine - not allopathic or osteopathic since it's outright stupid to say a DO practices osteopathic medicine when he prescribes or does surgery, and it's equally so to say an MD practices allopathic medicine when he does what he does. When the playing field is the same and shared by both groups of people doing the same things, then whatever differences perceived by the individual is more fanciful than real. So practice 'holisticly' if you want to (and I still don't know what the buzzword holism really means in medical context), but don't take your holism as something uniquely osteopathic or, worse yet, something exclusively in the domain of osteopathy because you just might run into some of your MD colleagues or friends that practice it more often and better than you.
 
I would be interested in any responce KCOM students might have to the comments previously made by DO PHD Student. Is this lack of an "osteopathic difference" the case at KCOM?

Carrie
KCOM Class of 2003 (to be)
 
hi.

I am intrigued be everyone's thoughtful and empassioned responses. Here are my three cents.

Cent one. If anyone is REALLY interested in these issues they need to dial (212) 486-2424 . This is the number to the Josiah Macy Jr. Foundation in New York. Request 2 books, which they sent to me free of charge. 1st ask for "Osteopathic Medicine: Past, Present, and Future.' 2nd ask for " Current Challenges to MDs and DOs." These are from a 1995 conference funded by a group which involves the AMA/AOA/MDs/PhDs/DOs/&c. It presents both sides of all the arguments eccompassed in this thread. These books are edited by Coimbria M Sirica. I found these in a corner, while investigating exactly what becoming a DO involves, in the bio-med library at the U. of Chicago

Briefly,cent two. I will be entering either KCOM or COMP (Big stress in my life now!?!?). I have a very strong neuroscience research background (UCLA and U. of Iowa) and come from a family of South African trained doctors now practicing in MI and CA. I do not want to be a scientist. I am excited to become a DO because I can choose, down the road quite a way, to what extent I want to be mainstream or non-mainstream.

Cent three. I was talking this afternoon with my uncle who is surgeon in MI. He was saying that as a DO you have more choices of hospitals to get surgery residencies at than MD students. As a person who teaches surgery and practices his best students have been DO prepped. I think the bottom line you are mostly overlooking is that being a surgeon, or any type of specialist, is simply being that. You should not care where, why, for who. You should be so lucky to be able to choose where you want to practice, live and raise your family. These things should dictate your choice of residency hospitals. As a DO you have the choice. Apply to both and see which accept you. The one you get accepted to I think will be the best and just fine. Just take the COMLEX and USMLE, kick ass, and....

As a quote from 1 of the books goes..."an effort has to be made in BOTH professions (DO and MD) to ensure that there is still some private practice and the ability to choose where WE want to go and what WE want to do."
 
Cliff,

I am not disagreeing with your post, but you can not apply to both ACGME and AOA residencies. Actually you can apply to both, but you can only go through one of the matches since by the definition of the match a student is commited to the program that he matches with. I agree that you should look at all options, but then a student must decide whether to go to an AOA (match is in Frbruary I think) or a ACGME (match is in March) program.
 
StillBorn,
The AOA match is in January, ACGME in March (except for neuro and some other specialties that are in the SFmatch). One can go through both matches and in some of the dual accredited programs, you will have to. Also, for some specialties (neuro, PMR, etc), one must apply for the PG-2 position as a 4th year student. I think I understand what you meant, but there are exceptions (like with everything else in medicine). Also, my background was mentioned only to demonstrate that I am not an MD school reject and that I do have (some) commitment to the DO profession and no I do not think my resume is 'impressive'. Yes, it is possible to become a well trained physician at an AOA residency, however, IMHO, I have found it is more difficult and less likely. Up to date journals and libraries; patient volume and variety; a balance between service and education; faculty dedicated to teaching and residency centered programs and satisfied residents contribute to the training of superior docs. From my observation(s), it is difficult to find many of these components in AOA programs. Too many of the AOA residencies appear to be geared toward having the housestaff be of service for the convenience of the attendings and hospitals, while being grossly underpaid. Yes, many ACGME programs also fit this description, but it is much easier to find a quality program (and to get into it).



Cliff,
The Macy Foundation books are worth reading and are relatively familiar to the students that have been active in the nat'l organizations, though they are already becoming a bit dated. Theoretically speaking, DO's do have more residency choices, AOA (DO's only) and ACGME (DO's and MD's or their respective equivalents with ECFMG certificates). This is a benefit (of being a DO) that is often overlooked and I applaud your mentioning it.

Hskermdik,
Other than the historical perspective, KCOM is essentially the same as the other schools. Most of the students wanted to attend MD schools and ~80% are not particularly interested in OMT/OPP. I think they call it OTM (osteopathic theories and methods?) at KCOM. That's just the way it is...

DOPhD,
Do you attend TCOM? The reason I ask, is that supposedly, it is the only DO school that included the integration of OPP into the curricula prior to the school opening. This is from Irwin Korr, PhD, a former faculty member and early contributor to the school. In case you did not know, the UCLA East-West Center has a very good rotation for medical students that are interested in acupuncture. I believe that they are associated with the same group that offers 'medical acupuncture' training for DO/MD's.

Everyone,
In no way are my comments meant to be interpreted that DO's are second class physicians. The quality of students continues to improve and hopefully, the quality of clinical training (undergraduate and graduate) will too. I am hopeful that the OPTI programs will be a success and the inconsistencies between the AOA partyline and the realities of AOA clinical training will decrease. Unfortunately, it did not happen soon enough and I will definitely be heading the ACGME route (though I may eventually seek AOA BC). Somewhere along the line, in their efforts to become MAINstream, the AOA has forgotten that osteopathic medicine came to be because it wanted to take healthcare UPstream. Happy holidays!
 
Prefontaine,
I do not believe that you are correct in saying that students going to KCOM wanted to be MDs (~80%?) I don't believe it. KCOMs average MCAT for last year was higher than for many MD schools. It these students wanted to be MDs why didn't they go to an MD school.
Anyhow we will never know what people really wanted who are now in DO schools. I just know that I am going to KCOM to be a DO because I want to be and I have been throwing away all of the recreitment letters that I have been getting from MD schools around the country because I am choosing to be a DO not going to by default because I couldn't get into any MD schools. I know that for many that is the case but I guess I don't think that saying 80% at KCOM are that way is correct.

Carrie

 
Carrie,
You are right, it is probably closer to 90%. Anyway, you will soon find out for yourself. KCOM's MCAT average is higher for many of the state MD schools. However, if you compare their average with the private MD schools and the more competitive state schools on the west coast, their 9.3 mean looks anemic. They did not go to MD schools because they could not get in. Check the stats on the # of students (at KCOM) from California and other highly competitive states. Very few are from the states with a high %age of in-state applicants being accepted into MD schools,eg TX, LA, KS. You will find (as I did) that you are a minority. Oh, by the way, I grew up in the Kirksville area and have known many students from KCOM. As recently as this year's AAO convocation, I discussed this very topic with students and KCOM OMT faculty. After a little thought, the 80% figure is definitely conservative. Steve

 
I'm curious as to what you mean by "couldn't" get into MD programs. Do you actually mean couldn't, or do you mean didn't. For example, I applied to 6 osteo programs and one MD program (my state university). My MCAT mean was 2 points higher and my Undergrad GPA exactly the same, science was .3 higher than the MD programs means. I also have a graduate degree--I was not accepted at the MD school, but was accepted at AZCOM and subsequently declined all my other interviews since AZCOM was at the top of my list. I applied one time to medical school. Now, is it that I am at an osteopathic program because I couldn't get into an MD program, or because I didn't get into on. Certainly I would have attended the MD program had I been accepted because it is 1/3 the tuition.

I realize that this is a question of semantics, but the implication of the statement you made is that osteopathic students are not qualified for MD schools. There are many applicatants that are qualified for medical school who don't get in, for whatever reason; some of those applicants that don't get into MD programs do get into DO programs. I know 3 students who appied to AZCOM who did not get accepted--2 interviewed and then rejected, 1 was flat out rejected--all three ended up in MD prgrams the same year. Did they go to an MD program because they couldn't get into an osteopathic one?

Now if you are saying that 80% of DO students didn't get into MD programs, I might be inclined to agree with you since included in the 80% are all the students who either appied and were rejected, or didn't apply to MD programs at all (I didn't get into Harvard--I didn't apply, but I didn't get in). The only students not included in the number are the people who applied to both programs, were accepted at both, and chose to go to a DO school. In that case 80% is probably conservative.
 
StillBorn,

Actually, what I said was that ~80% are not particularly interested in OMT/OPP. Carrie appears to have interpreted that to mean the same %age wanted to be MD's. However, it would certainly not surprise me if ~80% did want to be MD's. So, I was NOT saying 'could not' or 'did not'.

But, since it has been brought up...my 2 cents.

From my observation(s), most DO students would do just as well in an MD program and most would have preferred to go the MD route. A recent JAOA article and subsequent letters to the editor appear to support (part of) my observations.

The pre-clinical years are virtually the same, the clinical years are where I notice more of a difference in quality. There are very few students in DO schools that were also accepted into LCME MD schools (irrespective of what they may tell you). For whatever reason(s), most DO students could not and/or did not get in to an LCME program.

Though I did not apply to the LCME schools, and now knowing that the osteopathic difference is primarily a PR/political tool, for all practical purposes, I may as well have.

If my comments are still unclear to you, then feel free to interpret them however you like.
I am back on medicine in the AM and off of this BB for the rest of 1998.

Steve
 
To everyone, Pre is probably correct in his assessment in stating that the majority of current DO students would have chosen to study at an LCME-accredited school rather than where they are right now. However, that doesn't negate the fact that these students are extremely bright and dedicated individuals so the MD loss is the DO gain I suppose. Furthermore, even as they did not get into MD schools, we cannot automatically assume the reason is some academic deficiency. Gaining admission to a medical school is, more than anything, dependent on luck when everyone's stat is so impressive and seats are hard to come by. Not rarely, I hear of people of considerable achievements get rejected by MD schools for some reason. A friend of mine who's doing rotation at this moment accumulated an undergraduate GPA of 3.8 or so and an MCAT score of 35, but he ended up my classmate presumably due to his advanced age (well, he was 29 when he applied). Being old, thus, can be a crippling factor when applying for allopathic medical school. Another friend of mine, also a classmate on rotation, is a very bright fellow with good achievement background (as far as GPA and MCAT go), but he took a two-year work hiatus after college and never managed to get into an MD school. On a personal note, I did get admission to a straight MD (damn no PhD) out-of-state program, but the price was not right so here I am at a DO school, a bit disappointed by the hyped up but empty philosophy. Therefore, as one can clearly see, there are a myriad of reasons that one ends up studying osteopathy rather than allopathy, but in the end, what the HELL is the difference anyway???
 
Well, this has certainly turned into an interesting thread. A lot of formerly pro-D.O. folks have turned lukewarm and each has completely valid reasons for doing so. Very interesting and sad (for the profession, not the students). It would be nice if the AOA was listening.

There is one thing that was mentioned earlier in this thread that I want someone to comment further on (i.e., offer some citation or source) so I can investigate it further. That is, the suggestion that AOA BC/BE D.O.s pay higher insurance premiums than those from ACGME programs. This concerns me and may finally tilt the scale in favor of my choosing an ACGME residency after medical school. So please elaborate on this as it may be good for a future article of some type.

Gregory Gulick ([email protected])
Accepted, NSUCOM '03
http://www.osteopathic.com/gregory


 
It surprises me that this has become such a heated debate. Different people have different views on OTM. But I don't think 80% of KCOM students do not care about OTM. I'll be conservative and say the figure is probably closer to 50%. Most of us first-years coming to KCOM are eager to learn OTM and are turned off by the way it was taught the first quarter. Does that make us turn our back against OTM? No. OTM is an art and science, and thus, just as in any sciences, there will no black or white. Just because some NBA players play ugly basketball doesn't make you hate the sport, does it? Does the fact that it wasn't well taught make it less of a science or art in anyway? I don't think so. Just because you have a bad chemistry teacher doesn't mean chemistry is just a hoax. It's no coincidence why most of people who likes OTM in my class are older students. And everytime one student is treated by an OTM fellow, he becomes a believer.

And OTM is more than just for improving ROM. Cranial and visceral manipulation are also possible. If you say, "But it's not completely proven", remember much of medicine is not. Much of research in science is trial and error. You give a cell this chemical and it dies. You give it another and it lives. Why, you don't know, you just know that it prolongs the life of the cell. With OTM, sometimes, you don't know why such and such a treatment works. You just know that it does and your patients prove it. Research will prove it one day.

Life goes on. As for now, I will continue to learn OTM as much as I can and plan to practice it as I see fit. Your hands, they can do wonderful things. And remember, when patients show up with pain at your office, most likely they don't care what your initials are. They only care if you can fix and make them healthy, again. Being a good DO, you can do it as good as anyone, only faster, less invasive, and with less medications.
 
At the risk of being heckled, I think it's time for a mini-tutorial. Osteopathy
is about a philosophy and treatments which are VERY unique. To be specific, DO's
reject reductionism (cartesianism) in favor of a more holistic (dialectic)
approach. It forces us to always be aware of the multidimensional nature of
human beings and to recognize their many "emergent properties" (the whole
displays properties not recognized in the parts). This type of philosopy allows
us to appreciate the uniqueness of each individual and to treat each accordingly.
Obviously, many MD's also value this approach, but traditional allopathy still
relies primarily on cartesianism (the whole can be understood by simply understanding
the parts). We received at least 3 or 4 lectures on this topic...I assumed all DO
schools included this in the curriculum, but maybe they don't. In regard to
treatments, we have been taught a number of techniques for use in a variety of
situations. For example, lymphatic treatments can be used to reduce the severity
of many types of infection. According to one instructor they can reduce the
recurrence of otitis media by as much as 50%. Other forms (ME, MR, CS, HVLA) can
be used to reduce or eliminate musculoskeletal or visceral pain. After performing
ME and CS on an individual with arthritis and osteoporosis, she reported that she
remained PAIN FREE for three weeks (she had never recieved OMT and was initially very
skeptical). This was a person who had been given pain medication but refused it (she
was fearful of addiction). We have one instructor who uses OMT during labor and
delivery. She stated that it reduces the amount of pain medication needed and speeds
recovery for the mother. These techniques don't work every time or on every person,
however, when they do work they can be powerful tools. The point is, DO's ARE different,
and holism is NOT just a buzz word! When we talk about pursuing ACGME residencies, it
has nothing to do with the type of physician we'll eventually become (you should learn
enough OMT during med school to be able to incorporate it into many types of treatment
regimens). It's about getting good residencies...period. Actually I consider this
essential for improving our image in the allopathic community. How can they ever
appreciate our philosophy and techniques if they haven't been exposed to them? Sorry
to be soooo long winded.
 
This question may be a little out of line here but it is kind of related. That is, when international medical graduates come to US, they take the USMLEs and do an AMA residency and then tag an MD at the end of their names. Now if a DO student in the US does the same exact thing (i.e. take USMLE and do MD residency), shouldn't s/he be able to do the same? perhaps an MD, DO? Does this happen? Is there a legal problem with that?

Its just a technical question, I know, but I am just curious. Thanks!

 
The answer to your question is no, it is not allowed. If you want
to be an MD you should attend an allopathic school. Your title is
bestowed by the medical school you attend. It is NOT determined
by the residency you choose. Also, DO's take the COMLEX, not the
USMLE (they may take both, but it is not necessary).
 
Deb,

Since you are so certain there is a difference, please define a "DO" in some specific way so that all DOs (or even most DOs) are included, and all MDs (or even most MDs) are excluded. It is easy to claim there is a difference, it is much harder to support that with anything resembling a reasonable argument. If you can define the two "professions" (I can make a much better case that there is only one profession) as different, you don't need to claim they are different, if you can not define them as different, then claiming they are different is meaningless. Please don't try the "treating the whole patient" argument. There are as many DOs that are "reductionist" as there are MDs that are "holistic." Let us also make our comparisons uniform. Don't compare an MD hand surgeon to a DO family practitioner.
 
While I hate to say this because it would seem I am recanting my earlier loyalty to the profession, but I will say this for the sake of pre-med students and DO students alike. The DO profession is deeply in need of nation-wide advertisement to educate the public what the profession and its professionals are about. It is extremely disconcerting for me to realize that even people residing in the local areas surrounding my school are not aware of the existence of a medical institution literally a few blocks from their homes. If one were to ask these folks about my school or what DOs are, you will be lucky to illicit any sort of intelligible response from them. If by some miracle they have heard of DOs or are under DOs' care, then they will basically describe DOs as some MD clones. For others who never heard of DOs, we don't exist, at least not in the context of a medical discipline. This is very sad, but true, and do not scold me for revealing the truth. Why is it that MDs know more about DOs than patients whose trust and confidence is more important to us than any other healthcare professionals'? I do not advocate changing our degree to anything else, ie. MDO or MD/DO, etc...but I do advocate that the AOA and other osteopathic organizations take a really honest assessment of the present situation and take appropriate action to make DOs publicly more visible. If DOs can achieve parity with MDs only to remain forever in shadows, then what use do they have to (or are they so foolish as to) retain a degree which our patients know little about or have little trust in? If that is the case, then a point can be made that DOs go ahead and become MDs. A few friends of mine and I sometimes ponder about the feasibility of DO schools seeking dual accreditation by both AOA and LCME, but that is another matter to be expounded upon later should other less drastic options fail. The future of the profession rests in the hands of younger DOs and students who will inherit either a viable or dying profession, and we must do what is best for the profession and, yes, what is best for ourselves, for we ARE the profession.
 
Stillborn

Who compared a hand surgeon to a family medicine physician? Not me.
As to your main question, the primary difference is manual medicine
(it can be utilized in virtually every area of medicine). Are MDs
trained in this area? The last time I checked they weren't. Have
you ever seen someone relieved of pain without medication? If you
had you might have more respect for these techniques (please see
the specific examples I gave for utilizing OMT in PEDS, Geriatrics,
and OB/GYN). Your point about the philosophy practiced by different
MDs and DOs is well made. I don't disagree with your comment.
However, the difference (at least at my school) is that there is
a concerted effort to produce physicians that employ a holistic
approach to their patients. What does that actually mean? In
addition to the aforementioned lectures on philosophy, we've had
labs and lectures that dealt specifically with how to talk to
patients, how to interpret and display body language, how to
appreciate the uniqueness of each individual presentation (as
opposed to a focus on "textbook presentations") and how to recognize
and deal with the psychological problems that often plague those
with pathology. Are there MDs who incorporate these ideas in their
practice? Of course...that goes without saying. Are MDs trained
in these areas? I don't know, but as someone who has dealt with MDs
not familiar with these aspects of patient care I can tell you it
makes a world of difference in how one responds (or rather, doesn't
respond) to advice and treatment. The point is that DOs are trained
to treat people, while MDs are trained to treat disease. How one
chooses to utilize their training is up to them.
 
You miss the point...again. You can not even come up with a simple definition of what a DO is. My friends at MD schools all take classes on talking to patients, and dealing with the "whole" patient, and the psychology of patients, etc. Manipulation? certainly DOs are trained in it for the first two years, and SOME (few) actually use it during clerkships, but only 5-10% use it in practice, so I guess that might be the difference between osteopathic and allopathic medical school curriculum, but it is certainly not the difference between MDs and DOs. Since you've never been in an MD school you really don't know how the curriculum differs, and even if it does differ significantly, the point I was making isn't about how MDs and DOs are trained, but how they practice. Your cute little catch phrase "DOs are trained to treat people, and MDs are trained to treat disease" probably sounded really profound when your OPP prof said it in class, but in the real world of medicine the difference between MDs and DOs is nonexistant.

By the way, there are several MD schools that offer courses in OMT.

[This message has been edited by StillBorn (edited 01-09-99).]
 
Stillborn and Deb,

Stillborn, I was curious which MD schools teach OMT. Do they just discuss the philosophy and techniques theoretically, or do they actually teach them? Deb, I agree with Stillborn that it is the individual's personality and background that will determine if they are a "holistic" physician, rather than the classes they have taken in medical school. The AOA likes to say that DOs "treat the patient rather than the disease" but I am skeptical if they have any research/data to support this statement. One of the most "holistic" physicians I have ever met is an MD orthopedic surgeon. He almost always is attentive of, and supportive of his patient's feelings about their medical conditions and is very interested in their family backgrounds. Especially since the distinctions between DOs and MDs have largely faded in recent years, it is more difficult to catergorize MDs as being "reductionist" and DOs as being "holistic." And it also depends on who you are talking to. I believe that an MD family practioner would be much more accepting of "alternative therapies" than a DO nephrologist. In my opinion, it doesn't matter anyways because DOs and MDs are fully-licensed physicians who fit the same job description and practice in the same hospitals and clinics.

EDGAR
 
Many of the LCME schools offer an overview of complementary/alternative medicine that sometimes includes a cursory overview of OMT. There are residencies that are affiliated with medical schools that offer OMT, usually as an elective. Most are in PM&R, though Andrew Weil's program at the U of AZ also has it. Technically, this is a fellowship. A very small number of family practice programs have an OMT component, usually as a result of having a DO residency director or a program that has joint approval. Otherwise, I do not think that OMT is offered at LCME schools...except as a treatment option by some of the attendings, housestaff and/or therapists.
 
I did not mean to imply that LCME schools were offering intensive curriculum in OMT, but rather that MDs have the ability to learn it if they choose. U Arizona offers a course for their Integrative med fellowship, although I was told by a student that they can take it as an elective--I have heard that Mayo, New Mexico, and ETSU offer electives in manipulative med (this is unverified information from students and docs). My point was that OMT is not the exclusive realm of DOs. At AZCOM we had had several guest lecturers come in to do workshops that have been attended by DOs and MDs from the community to gain hands on training.

[This message has been edited by StillBorn (edited 01-10-99).]
 
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