Looking for insight/clarification on a topic somewhat foreign to me, spawned by a recent conversation regarding orthopedic surgery residencies. The medical education program at a hospital in my area applied to for an allopathic residency but their program wasn’t “strong enough” and they “settled” for an osteopathic residency program in ortho.
This suggests an inferior component may apply to a DO program, but I’m not sure that’s entirely accurate; suppose it’s a matter of opinion. Although I am aware that it’s almost impossible for a DO to match into ortho at an allopathic residency. Residency programs elevate the prestige of an institution but it also provides manpower for the hospital at a relatively low cost since most of the cost of medical residencies is funded by the Federal government–our tax dollars.
It’s my understanding that allopathic and osteopathic residencies are merging in the next few years and will no longer have different programming. I’m aware that orthopedics is one of the most competitive residencies—it’s not unusual for only about 65% of the applicants match into an orthopedic surgery residency.
Can anybody here offer insight? Am I missing something? Is ortho unique in this regard? What other medical specialties that have separate allopathic and osteopathic residencies? Is there a negative bias toward orthopedic DOs?
Currently, there is a 100% parallel system for osteopathic and allopathic residencies–including separate interview and match cycles. Whatever specialty is offered by allopathic residencies is also offered by osteopathic residencies. This duplication is a pretty inefficient use of resources. This was part of the driver for residency merger that goes into effect starting 2020.
(Another part is that allopathic schools lusted over the unfilled residency slots that osteopathic schools controlled since there has been a hard cap on the number of residency slots since the 90s and allopathic schools are seeing a time when all ACGME slots are going to be completely filled. In return the AOA lusted after the fellowship–subspecialty-- training positions that the ACGME controlled. Doctors cannot enter an ACGME fellowship unless they graduate from a ACGME accredited residency. The third --and more self-serving-- reason was that US allopathic and osteopathic schools wanted to band together for greater political power to keep Caribbean grads/IMGs/FMGs out of US training slots.)
There are some difference between the accreditation standards for AOA (osteopathic) and ACGME (allopathic) residencies. Some were relatively unimportant-- number of professional journal subscribed to, square footage of locker space allotted for resident lockers-- but there were 2 big areas of difference: the requirement for a certain level of academic research for each specialty offered by a hospital and the patient volume for each specialty.
For all specialties, but for surgical specialties in particular, AOA residency programs required residents to perform fewer procedures and less complex procedures to graduate from residency than ACGME programs did. This is not saying that DO surgical grads from AOA residencies have poorer skills, but they may have graduated with less hands-on surgical experience compared to their allopathic peers.
RE: bias toward DOs–
Some specialties are super competitive like ortho. And people who want to do ortho really WANT to do ortho and are extremely reluctant to consider another specialty.
There is some speculation–and it’s just speculation at this point-- that allo ortho hopefuls are going to flood into the newly open AOA ortho residencies and outcompete osteopathic grads for those positions. Generally speaking, allopathic grads have higher USMLE scores, more ortho research experience and more hands on surgical exposure to ortho during med school than osteopathic ortho hopefuls.
But as to what is actually going to happen–no one knows.
Thanks for your input, WOWM.
Are you saying an AOA-residency graduate is not eligible for an allopathic fellowship? Are there AOA fellowships for their graduates? Might be a bit of a deal-breaker as there are few ‘generalists’ in the world of orthopedic surgery nowadays.
In my very limited experience, the really smart med school applicants–the ones with the highest scores, etc-- went to allo schools. The ones who didn’t have the highest scores went to osteopathic med schools. It makes sense to me that the allo schools will expect more of their residents, but I’m sure there are exceptions.
@rutgersmamma
Under the current system, that’s exactly how it works.
This will change in 2020 when all the current AOA residencies are required to meet ACGME standards or close.
There are some, but not as many and not in as many sub-disciplines as the ACGME offers.
In 2020, all current AOA fellowship programs will also be required to meet ACGME accreditation standards or close.
I think you’re over-estimating how many recognized sub-specialties there are in ortho.
The only fellowships offered in ortho are:
Pediatric Orthopedics
Foot and Ankle Orthopedics
Hand Surgery & Upper Extremity
Joint Preservation
Orthopedic Sports Medicine
Orthopedic Surgery of the Spine
Orthopedic Trauma
And just as an aside, Canada is considering creating a PA-level training program for the most common/routine ortho surgeries–knee replacement and hip replacement because neither are technically difficult surgeries and really don’t required a highly specialized expertise.
Didn’t know about the Canadian program consideration…Not sure how I’d feel about a PA doing surgery but I’m no fan of podiatrists doing surgery either! Old school ideas, I suppose!
The number of subspecialties is irrelevant. (There’s also oncology.) There just aren’t as many opportunities for the ortho generalist since most–like 90%–ortho residents pursue a fellowship and often choose to do more than one. The competitive nature of this medical specialty continues …