DO vs MD

Pre-Med & Medical School Pre-Med Topics
1

Having some discussions about this with likely future pre-med kids at school. Any chance those of you with more experience can summarize what specialties are best avoiding DO schools coupled with which ones are fine with it?

I’m aware that high school students shouldn’t have their heart set on a specialty in general, but sometimes they do - esp if their choice is related to a family member or friend. It’s good for them “going in” to know the current facts and/or general odds of being able to reach their goal from the type of schools out there. Like anyone else, they can always switch to Plan B (or C/D/E) if necessary in the future.

2

What specific specialty is the kid interested in?

The chances of being in primary care is much higher in DO than MD.
There are approximately 600K active physicians in US, about 200K of them are in primary care. Whereas 45% DOs are practicing in primary care.

3

There’s more than one, but the one who seems the most focused (vs general information) really wants dermatology/oncology, and yes, due to family experience.

Otherwise, I get a lot of questions about the process due to having a lad in med school. That’s not common among teachers where I work.

4

All of the competitive surgical subspecialties are not DO-friendly: ENT, orthopedics, neurosurgery, ophthalmology, vascular surgery, plastic & reconstructive surgery, thoracic & cardiac surgery, interventional radiology, urology, plus derm, radiation oncology and medical genetics.

But TBH, all of those fields are extremely difficult for MDs to match into also.

Derm is probably out of the question for a DO. Oncology too, because oncology is one of the most competitive fellowships for IM grads and DOs are much more likely to do their IM training at a community hospital program instead of academic hospital. Academic hospitals offer the research opportunities and community hospitals (generally) don’t. Having oncology research is critical for a successful oncology match. (So are networking, audition rotations and top IM-ITE scores.)

DO-friendly fields include pediatrics, family medicine, IM, psych (though the competitiveness of psych has jumped recently), neurology, PM&R, pathology.

Procedural medical specialties (EM, OB/GYN, general surgery, anesthesia) and radiology are open to top DO students, especially if they’re not gunning for academic hospital programs.

CAVEAT–no one can predict what will be happening w/r/t to the competitiveness of specialties 10 -15 years from now. Specialties go in and out of favor all the time. Psych, EM and OB/GYN have become much more competitive in the last 5 year. Anesthesia, radiology and gastroenterology have become less competitive in the last 5 years.

5

[Results and Data: Specialties Matching Service](https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2019/02/Results-and-Data-SMS-2019.pdf)

In case you want a look at various fellowships matches

Most competitive fellowships–

Hem/onc had 758 applicants for 573 positions
Cardiovascular disease had 1315 applicants for 951 positions
Gastroenterology had 803 applicants for 535 positions
Pulmonary disease/critical care had 848 applicants for 601 positions

Gyn onc had 104 applicants for 68 positions
Minimally invasive gyn surgery has 82 applicants for 43 positions
Reproductive endocrinology had 82 applicants for 52 positions
Maternal-fetal medicine had 142 applicants for 119 positions

Pediatric EM had 270 applicants for 194 positions
Pediatric surgery had 76 applicants for 46 positions

6

@WayOutWestMom Thanks for the detailed info. I’ll share it tomorrow. I know my knowledge is rather limited even if better than those around me. I appreciate a place where I can get more specifics to share so students can “go in” with a better understanding.

7

My dermatologist is a D.O. But she has been in practice for 10 years or so. My neurologist is also a D.O.

But I wouldn’t count on these specialties when applying to Med schools…for MD or DO.

My understanding is that getting residencies in certain programs is more difficult for D.O. students than M.D. ones. Some residency programs have never had a D.O. resident…ever. So for D.O. students it’s important to target D.O. “friendly” residency applications.

I’m wondering how or if any of this will change in 2020 when the residency match process is completely merged between MD and DO. I guess we would only be guessing to answer that now. But I’m thinking the programs that have never had a D.O. resident aren’t likely to change their positions.

8

Around here we have a fair number of DO doctors, though I haven’t paid attention to specialties TBH. We’re more rural, so I suppose places can’t be choosy with who they get to locate in the area. The main “problem” as I see it for current pre-meds looking forward will be residency availability, not placement as a doctor afterward, esp if they want to return anywhere near their hometown (quite a few openings locally). If they won’t be able to get a desired residency they won’t be able to do what they really want to even if they still become a doctor. This is the caution flag I’m warning them about - esp as things change. Just because something used to be able to happen - will it still be able to?

I recall listening to a talk from the head of a Top 10 medical school who was telling us about the process a few years back. He said so much has changed that if he were a college student now, he’d have never made it in to med school, much less end up as a tippy top doctor leading the place. It’s a good warning to kids to let them know to beware and be informed. I see it as very similar to how college prices have changed from the “old days” and how many parents are surprised by it all if they don’t keep up.

9

DOs are not evenly spread out through the US. I grew up near Philadelphia where DOs were very common and even had their own DO-only hospital system. Where I live now–there just aren’t many DOs. Less than 75 in the entire state with most of them clustered in a single town. Most people here don’t even know what a DO is.

@Creekland

There isn’t a “problem” of residency availability. There are more available residency slots than there are US medical grads each year (MD and DO combined) and will be for some years going forward. The issue is that a particular individual may not be a competitive for the specialty he/she wants. But that’s not MD-DO issue; that’s a individual student issue and one of the reasons why med school adcomms are very leery of any applicant who come to an interview saying “I know I want to be a neurosurgeon-orthopedist-dermatologist-pediatric cardiologist.”

Any student heading to med school has to be willing to roll with the punches, be honest about their competitiveness for a given specialty, and be willing to relocate for residency. Two of the top 3 reasons why med students fail to Match are 1) not being competitive for their desired specialty (over-reach), and 2) being too restrictive in their geographic preferences. In some ways going to med school is like being in the military. Your life is no longer completely your own. Your sacrifice some your autonomy for the privilege of being a doctor and for the greater good.

10

There are specialties for which a DO background is an actual advantage, if one is so inclined. As a PT with an osteopathic manual therapy background, I find DO’s often to be a lot more insightful about functional biomechanics than their MD counterparts, particularly in specialties like PM&R. If a student knew they wanted to be a rehab doc with a pain-management specialty, I’d be pro-DO even if both options were on the table. I think it’s unfortunate when people think of DO programs as some sort of watered-down alternative; there’s a lot of value there for those who take advantage of the enhanced knowledge base. But it depends what the students hopes to end up doing.

11

@WayOutWestMom I agree with you and talk with kids about the whole thing. I just see no need for them to stop having their dream at the high school level. If they end up with a Plan B (even within medicine) it will come in its own timing and they’ll most likely be content with it at that point - perhaps even changing Plan B to Plan A themselves once they get experience.

It’s no different than a future engineer telling me s/he wants to work for Space X. We discuss majors and decent colleges as if that will happen while at the same time reminding them that there are other similar opportunities out there they might end up in or even find appealing once they get their feet wet.

My advice to any student is to have in mind what they think they want (specific or general) and keep their eyes open once on the journey in case something else turns up that they like better or seems to align better.

That said, I never advise a future engineer to attend a college that doesn’t offer engineering as a major nor do I want to advise considering a DO school if getting to Point A is unlikely if one chooses that route. For those who want primary care in our area, DO is popular/common. I’m at the point where that doesn’t look like it’s the case for at least certain specialties so want to advise accordingly. Some kids who choose a future in medicine do so because of family experiences and I feel they can keep their dream going because it could come true if they take the correct path. One lad about a decade+ ago wanted to be an oncologist because his dad died from colorectal cancer. He’s a PhD/MD researcher in that field now. It can happen if one doesn’t close doors. It might not happen, but it could.

12

Probably we just have a different approach. When I was teaching, I didn’t want to crush the dreams of my students, but I did want them to be aware that sometimes achieving their goal faced very long odds. I never said you can’t do this. I said this goal is extremely difficult to achieve and has a high risk of failure, are you Ok with that?

It’s not impossible for a DO to become a dermatologist or pediatric cardiologist or neurosurgeon–every year a handful do match to competitive specialties–but it does make the journey more difficult.

Just be sure to tell your aspiring dermatologist that both my daughters unanimously agree–skin is " just plain creepy and gross." :wink: Necrotizing fasciitis–'nuff said.

13

I’m quite similar in my approach to students.

I’m also not cut out to do anything medical with people personally. It’s all pretty gross to me even though I can handle critter things - or my own injuries - with no problem at all. However, encountering a student with plans to become an undertaker fairly early in my teaching career showed me just how different humans are and our job is to help guide them along their path even if we’d stay far away from it ourselves. I remind myself that I’m glad there are folks wired for different niches!

I’d have never predicted any of my offspring would be interested in anything medical, but now I’m rather glad my one lad is. He’s been super helpful already and that should only get better.

14

I’m not really sure what the point of this conversation is. These days, there’s no reason anyone should choose DO over MD. The degrees have shifted towards each other (I think largely MD recognizing the values of humanism and holistic medicine that DO always championed) such that there is no logical argument for pursuing DO over MD.

I’m of course talking about american MD programs. DO is a better route than leaving the country.

15

There is no problem to get residency for a med school student. However, to get into competitive residency some times need to intern in a PGY-1 residency( for example, derm, card, onc and ortho) and apply for PGY-2 residency afterwards. It is extremely difficult if the intern year is at a community hospital (or even some time University affiliated hospital). You need to have very high scores in order to be in the top 20 University Teaching Hospital to have a better chance, because the research facilities are readily available and the PDs do have biased eyes, there is no equal opportunity laws governing here. Some specialties such as REI and MFM, you need to complete a 4 years OB residency to be accepted as fellowship and it is still possible to join community hospital program and get accepted into those fellowship, but, based on my observation, the chances are 50-50. Whereas the top University Teaching Hospitals have much better chance. In addition, the professors in top hospitals are mostly well known in their own field, working with them have great advantages because some times a phone call can make or brake an acceptance.

The number of positions in competitive residency some times is misleading, because the applicants all have strong credentials in their specialties and no one will have the right mind to apply for derm(for example) if they are in unrelated field with low scores. Therefore, the competition is fierce even at 60-80% success rate.

16

^^ @WayOutWestMom

I just notice there are still about 50 AOA derm residency positions that have not get ACGME accreditation. So it is still possible for a DO to be matched into derm.

In any case, what we discussed here has NOTHING to do with high school students who are inspired to be a derm. What a high school student should do is to get the highest grade in their own class and get a high score in SAT/ACT, any thing else is just a pipe dream.

17

@artloversplus

By the terms of ACGME/AOA merger agreement, the AOA will cease issuing GME accreditation for all AOA-only residency programs no later than 6/30/2020. This means that as of 6/30/2020, any program that has not transitioned to ACGME accreditation will cease to be recognized as an accredited residency program. Unaccredited programs may not legally accept new residents for training and any resident still in training at those program is required to transfer to another program to complete their residency (assuming they can find one willing to accept them). Anyone who completes an unaccredited residency program is not eligible to take specialty boards and may not be eligible for a medical license.

All AOA residency programs lasting longer than 2 years were required by the AOA to apply for and receive provisional ACGME not later than May 1, 2018.

https://osteopathic.org/graduate-medical-educators/single-gme/aoa-policies-on-single-gme/

AOA programs that have not already transitioned to ACGME accreditation cannot participate in the 2019-2020 match.

18

And multi-year AOA only residencies that had not applied to transition to ACGME accreditation by 5/1/18 were not allowed to participate in the 2018-19 Match.

19

For those residents in an aoa program that has not been accredited by ACGME in 2020, there is a solution on the AOA web site:

The AOA, ACGME and AACOM are committed to protecting residents during the transition to the single graduate medical education (GME) accreditation system. The terms of the new system require that the AOA no longer accredit GME programs after June 30, 2020.
The three organizations recognize there may be unique circumstances whereby some programs make a good faith effort to achieve ACGME accreditation but still have not transitioned successfully to ACGME accreditation by that date. An agreement reached by the three organizations seeks to protect residents in such programs or situations so they have the ability to complete AOA-accredited training and advance to AOA board eligibility.
The agreement will give the AOA restricted authority to extend the AOA accreditation date to allow any remaining resident in such programs to complete training in an accredited program. The AOA Council on Postdoctoral Training (COPT) and AOA Program and Trainee Review Council (PTRC) are currently developing a structure for AOA accreditation of GME programs after 2020.
The councils for will look at each program/resident on a case-by-case basis to determine the appropriate route to complete training. Please direct questions related to this agreement …

20

It looks like DO is a very good path if you want to become a family practitioner or a pediatrician. Is there a reason students who want one for these specialties to apply to MD programs? (Considering the difficulty, time, and expense).