ACGME Brings the Hammer Down on the AOA

[Postictal Raiden]

I think the issue is better framed by what we as a profession owe the American public for their support of our institutions and regulatory bodies.

I would say that would be american doc's who are competent in american style medicine and culture. We might also owe them an open system that allows continual invigoration with new global talent. But they should be held to higher standards for that opportunity if only because why would you want a mediocre foreign doc over a mediocre american one. Makes no sense.

Indirectly we can say that residency training should be aligned with these goals. Which they are.

I'm not in favor of going down the path of law school training. In which there is little concern for the sustainability of individual careers. The huge commitment of medical school and training necessitates a social contract. The word owe has a psycho/political dimension that inspires rejection in certain minds.

But if you follow through you're idea into reality of training--which is where most of us are currently--you would see that it would basically suck as a premise.

I do think we owe DO medical schools consideration for AGME residencies. But....it does make things more difficult when the AOA is going rogue and determined to sink its claws deeper into an ever shrinking false historical dichotomy.

Excellent post!

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[SurgeDO]

the AOA leaders deserve their own reality show with all the **** they pull.

 

[Nasrudin]

I think the idea that medicine in this country owes the public "american doc's who are competent in american style medicine and culture" is a crock and this coming from a US grad. We need to try to get the best doctors possible. This is I why equate US MDs and US FMGs in ACGME residencies, both trained in their home countries for the most part rather than US IMGs who couldn't crack tier one medical education in the US so they leave to go countries outside the purview of US medical education. This doesn't work and hopefully is coming to an end with the increased US MD spots.

As for DO's, the AOA owes them enough residency spots to match grad numbers not the ACGME. This is because the AOA has chosent to be isolated in not allowing MDs into their positions. Based on that the ACGME should not offer even consideration to any DO grads until all US MDs have matched.

I flat will not train in a system that has a vast majority foreign medical faculty (if this is yours please make it obvious on your website) and co-resident constituency. It's perfectly fine with me in proper proportions though. As a patient I don't care if you're not from the states but I will not have you caring for my teenager if you are not well adapted to modern western culture. That simple. Radiology reads or surgery...probably doesn't matter.

But in a venn diagram of quality I think it's MD grads roughly equal to DO grads > FMG's > USIMG's. With the potential for any one of those to be individually superior to anyone.

The match statistics seem to display a similar logic. With the exception of particular FMG preference for foreign intellectual elites at places that are prestigious in name but not considered great by american residents.

 

[Nasrudin]

You're a med student so I will give you the benefit of the doubt about your ignorance. I have trained at and worked at top 10 institutions and community hospitals alike and had colleagues from every type of medical education background. being a radiation oncologist, I didnt have any co-residents that were FMGs but can tell you that the ones I know are top of the top. You would be amazed by the skill sets of many FMGs which far exceed many US MDs; American culture can be taught, I've seen it from my parents who were FMGs. Id rather have a slightly unadjusted FMG who knows what they are doing rather than a US grad who has only seen somoene perform procedure X prior to training.

There are some DOs that are on par with some MDs. However, it is my experience that a top 50 school US MD grad on average has a far superior CV to a top DO grad. some is selection as most DOs wanted to be in an MD schol and couldnt get in. Further, MD schools have infrastructures for research, etc. enhancing the CV. I equate MD and DO for degree but the reality is in terms of desirability 8 to 9 times out of 10 the MD has a better overall CV, at least in my specialty.

There's no ignorance, I assure you. Just preference--a different one than yours. I suspected you had a horse in the race. Culture is not as easily learned or more importantly unlearned as you suggest. I will never agree with you. But that disagreement doesn't pertain to this topic. So I'm finished entertaining the notion of it with you.

 

[thepoopologist]

You're a med student so I will give you the benefit of the doubt about your ignorance. I have trained at and worked at top 10 institutions and community hospitals alike and had colleagues from every type of medical education background. being a radiation oncologist, I didnt have any co-residents that were FMGs but can tell you that the ones I know are top of the top. You would be amazed by the skill sets of many FMGs which far exceed many US MDs; American culture can be taught, I've seen it from my parents who were FMGs. Id rather have a slightly unadjusted FMG who knows what they are doing rather than a US grad who has only seen somoene perform procedure X prior to training.

There are some DOs that are on par with some MDs. However, it is my experience that a top 50 school US MD grad on average has a far superior CV to a top DO grad. some is selection as most DOs wanted to be in an MD schol and couldnt get in. Further, MD schools have infrastructures for research, etc. enhancing the CV. I equate MD and DO for degree but the reality is in terms of desirability 8 to 9 times out of 10 the MD has a better overall CV, at least in my specialty.

Not the greatest way of getting someone to listen, however benign you meant it.

 

[jw3600]

I flat will not train in a system that has a vast majority foreign medical faculty (if this is yours please make it obvious on your website) and co-resident constituency. It's perfectly fine with me in proper proportions though. As a patient I don't care if you're not from the states but I will not have you caring for my teenager if you are not well adapted to modern western culture. That simple. Radiology reads or surgery...probably doesn't matter.

But in a venn diagram of quality I think it's MD grads roughly equal to DO grads > FMG's > USIMG's. With the potential for any one of those to be individually superior to anyone.

The match statistics seem to display a similar logic. With the exception of particular FMG preference for foreign intellectual elites at places that are prestigious in name but not considered great by american residents.

Um, do you know what that word means?

 

[Nasrudin]

Um, do you know what that word means?

Overlapping circles. Depicting overlapping subsets. Implying yes....there are probably the top md schools that have research aces that are in a different league competition-wise, but that MD's and DO's are still largely the same. You see how it's easier to use an image....

Make a point please...

 

[as1212559]

the AOA leaders deserve their own reality show with all the **** they pull.

Breaking AOA: Kirksville. Tuesdays @ 9/8 central only on TLC.

 

[Nasrudin]

Horse in the race...my family is long since established, no issue there so that horse was put to sleep a long time ago. As a US MD, the only horse I have is to want the best colleagues. As for your perceived realities, I would suggest you check out some major academic centers and see for yourself. Top faculty at many are foreign grads who had to get residencies here and prove themselves and are now at the top of the game in large part to what they brough to the table from their foreign training.

Culture is absolutely something that can be learned; it is easier for FMGs from western countries (UK, France, Italy, Germany, etc), but I have a few colleagues over the years that are from India, China, etc. who have adapted extremely well in less than 10 years. They retain their culture but are able to adapt quite easily due to immersion in the US medical system.

How about offering some useful advice to the few unfortunate DO's (And non top US MD's) who despite their non-pedigreed undergraduate, high school, middle school, elementary and preschool careers find themselves, rather unfortunately so if you ask me, trying to ascend to the top of the nerd jock game.

And how is that changing going forward for them. That is, let's say, that they don't have the ability or inclination to mention their "top 10" something or other apropos of nothing in particular. How would advise they make it to such awesome if humorless and perpetual butt clenched heights?

Do you see things getting worse for these people wanting in the club. We should direct this conversation towards them. Nothing in your point of view is anything but repulsive to me and thankfully I require your advice not in the least.

 

[notbobtrustme]

Your commentary sounds like you assume that I came from such a pedigree. Quite the contrary, I came from a non-pedigreed US undergrad and med school and have worked my way up to the top of the "nerd jock game." Not much to advise other than to bust your butt, thats what I did. Get step scores that make people blush, go out and find research outside of your school and do whatever it takes (even if it means taking a loan to get the money to present at a conference) to present/publish. Bust your butt at audition rotations and when yhou gain a residency don't stop. Publish and max out in service exams. At the end of day its about putting everything you have into it. Thats the way to the top, at some point you have to put in the work.

I don't see things getting worse, just more hard work required. The AOA screwed over MD grads for too long by locking them out and its a shame that only now is the ACGME starting to respond. I would see things getting harder if the AOA doesn't relent.

or just go private practice and make 5x the money

 

[SpecterGT260]

From the Results of the 2012 NRMP Program Director Survey:

Percentage of Programs that Typically Interview and Rank Each Applicant Groups (Osteopathic)

Physical Medicine and Rehabilitation: 97% (N=33)
Psychiatry: 94% (N=86)
Family Medicine: 93% (N=230)
Pathology: 91% (N=75)
Pediatrics: 87% (N=128)
Child Neurology: 86% (N=44)
Anesthesiology: 83% (N=87)
Neurology: 81% (N=57)
Internal Medicine: 79% (N=286)
Internal Medicine/Pediatrics: 77% (N=35)
Obstetrics and Gynecology: 77% (N=112)
Radiology: 69% (N=86)
Emergency Medicine: 68% (N=96)
Transitional Year: 68% (N=47)
Radiation Oncology: 63% (N=43)
General Surgery: 53% (N=160)
Plastic Surgery: 50% (N=26)
Vascular Surgery: 50% (N=12)
Neurological Surgery: 38% (N=40)
Dermatology: 31% (N=52)
Orthopedic Surgery: 30% (N=83)
Otolaryngology: 28% (N=50)

All Specialties: 73% (N=1,868)

So just in that survey alone, 504 programs were identified that do not typically interview and rank DO students.

And just as an exercise, there are 946 AOA residency and fellowship programs (216 FM, 115 IM, 20 Peds...) and 121 traditional internships (TRI). But obviously these are just broad strokes.. what really matters if we're truly talking 'equal opportunities' is the number of residency spots per specialty available to DO vs MD since programs vary in size.

EDIT: Also, that year there were 4,371 surveys sent out but less than half of the PD's responded. We can't exactly extrapolate the data but it's very possible that in sheer quantity the number of programs that don't normally consider DOs may in fact outnumber the total number of AOA residency programs

what page is that on? I've been through that document several times and only ever found the listings for relative importance of US Allo graduate, which doesn't directly imply that DOs are not granted interview or ranked as it seem to imply above.

 

[pattr]

what page is that on? I've been through that document several times and only ever found the listings for relative importance of US Allo graduate, which doesn't directly imply that DOs are not granted interview or ranked as it seem to imply above.

It's not on a single page. It's at the bottom of the last page for each specific specialty: pg. 9 for all specialties, pg. 17 for gas, 25 for child neuro, 33 for derm etc etc

 

[SurgeDO]

From the Results of the 2012 NRMP Program Director Survey:

Percentage of Programs that Typically Interview and Rank Each Applicant Groups (Osteopathic)

Physical Medicine and Rehabilitation: 97% (N=33)
Psychiatry: 94% (N=86)
Family Medicine: 93% (N=230)
Pathology: 91% (N=75)
Pediatrics: 87% (N=128)
Child Neurology: 86% (N=44)
Anesthesiology: 83% (N=87)
Neurology: 81% (N=57)
Internal Medicine: 79% (N=286)
Internal Medicine/Pediatrics: 77% (N=35)
Obstetrics and Gynecology: 77% (N=112)
Radiology: 69% (N=86)
Emergency Medicine: 68% (N=96)
Transitional Year: 68% (N=47)
Radiation Oncology: 63% (N=43)
General Surgery: 53% (N=160)
Plastic Surgery: 50% (N=26)
Vascular Surgery: 50% (N=12)
Neurological Surgery: 38% (N=40)
Dermatology: 31% (N=52)
Orthopedic Surgery: 30% (N=83)
Otolaryngology: 28% (N=50)

All Specialties: 73% (N=1,868)

So just in that survey alone, 504 programs were identified that do not typically interview and rank DO students.

And just as an exercise, there are 946 AOA residency and fellowship programs (216 FM, 115 IM, 20 Peds...) and 121 traditional internships (TRI). But obviously these are just broad strokes.. what really matters if we're truly talking 'equal opportunities' is the number of residency spots per specialty available to DO vs MD since programs vary in size.

EDIT: Also, that year there were 4,371 surveys sent out but less than half of the PD's responded. We can't exactly extrapolate the data but it's very possible that in sheer quantity the number of programs that don't normally consider DOs may in fact outnumber the total number of AOA residency programs

50% of the reporting plastic surgery residencies seriously consider accepting DOs into their program? am i reading this right? this number seems WAY higher than what i would have thought.

 

[Dharma]

self awareness of a tendency towards redundancy... make a point, then move along...

 

[PrimaryCare11]

50% of the reporting plastic surgery residencies seriously consider accepting DOs into their program? am i reading this right? this number seems WAY higher than what i would have thought.

I'm guessing not the 7 year integrated plastic residencies but the 2 year fellowships for those who already did a gen surg residency.

 

[hallowmann]

It's not on a single page. It's at the bottom of the last page for each specific specialty: pg. 9 for all specialties, pg. 17 for gas, 25 for child neuro, 33 for derm etc etc

This is the thing that I find hilarious of the argument that the AOA is really hurting MDs. Honestly do you think not having access to the 1000 AOA residency programs (many of which are FM & IM) is in some way screwing over MDs, when their own ACGME IM & FM programs stay unfilled even when DOs and IMGs are in the match? Most of the MDs wishing for access to DO residencies are those in the bottom 5% of their classes that fail to match, and I'm willing to bet my reimbursement check that most DO grads have better stats than them.

 

[ChrisGriffen]

Anybody got an extra dead horse I could borrow???

 

[Imnoglbln]

How about offering some useful advice to the few unfortunate DO's (And non top US MD's) who despite their non-pedigreed undergraduate, high school, middle school, elementary and preschool careers find themselves, rather unfortunately so if you ask me, trying to ascend to the top of the nerd jock game.

And how is that changing going forward for them. That is, let's say, that they don't have the ability or inclination to mention their "top 10" something or other apropos of nothing in particular. How would advise they make it to such awesome if humorless and perpetual butt clenched heights?

Do you see things getting worse for these people wanting in the club. We should direct this conversation towards them. Nothing in your point of view is anything but repulsive to me and thankfully I require your advice not in the least.

How about stop making excuses and blaming the brilliant foreigners who leave their country and family behind to contribute to American medical science? Are you afraid to compete?

If you didn't go to anywhere prestigious, and have a mediocre outcome in medical school, why would you expect to study among the elite regardless of what country from?

Obviously the reason to choose elite FMG's is out of self-interest for these Academic centers. There are FMG's at the NIH in the highest positions and they are driving bleeding-edge research, as they should. And yes, those FMG's that make it to those positions are the 0.0001 % of every soeciety, they are outliers that many countries compete for.

 

[GUH]

This is the thing that I find hilarious of the argument that the AOA is really hurting MDs. Honestly do you think not having access to the 1000 AOA residency programs (many of which are FM & IM) is in some way screwing over MDs, when their own ACGME IM & FM programs stay unfilled even when DOs and IMGs are in the match? Most of the MDs wishing for access to DO residencies are those in the bottom 5% of their classes that fail to match, and I'm willing to bet my reimbursement check that most DO grads have better stats than them.

I would love to see a response to this.

 

[Nasrudin]

How about stop making excuses and blaming the brilliant foreigners who leave their country and family behind to contribute to American medical science? Are you afraid to compete?

If you didn't go to anywhere prestigious, and have a mediocre outcome in medical school, why would you expect to study among the elite regardless of what country from?

Obviously the reason to choose elite FMG's is out of self-interest for these Academic centers. There are FMG's at the NIH in the highest positions and they are driving bleeding-edge research, as they should. And yes, those FMG's that make it to those positions are the 0.0001 % of every soeciety, they are outliers that many countries compete for.

I can see nuance isn't your forte. I am happy that our society is continually invigorated by foreign talent and labor in all sectors top to bottom.

I don't want to train in an elite place. They wouldn't want me either. I have not one haterish bone in my body. I could care less about what you or the other rad onc guy think about such matters. You're welcome to these places or the fawning over them.

I simply want a balanced place. Not snobby. Not overly acdemic. With good clinical training and good supportive teachers. Definitely not one that consists solely of IMG's. I'm suspicious of program directors who want all people who's visas are also contingent on their contract renewal. I also think a critical mass of a cross section of modern western culture is important to the type of vibe I like. I've worked in clinical situations and departments dominated by one nonwestern hyper-religious culture and I don't dig it.

I don't have any tears for the hypersensitivity to this notion nor any liberal guilt over it.

Let's let this thread stay on course and move on with our respective lives shall we?

 

[Nasrudin]

I would love to see a response to this.

I agree with him/her. --inconsequential MD colleague.

 

[SurgeDO]

I can see nuance isn't your forte. I am happy that our society is continually invigorated by foreign talent and labor in all sectors top to bottom.

I don't want to train in an elite place. They wouldn't want me either. I have not one haterish bone in my body. I could care less about what you or the other rad onc guy think about such matters. You're welcome to these places or the fawning over them.

I simply want a balanced place. Not snobby. Not overly acdemic. With good clinical training and good supportive teachers. Definitely not one that consists solely of IMG's. I'm suspicious of program directors who want all people who's visas are also contingent on their contract renewal. I also think a critical mass of a cross section of modern western culture is important to the type of vibe I like. I've worked in clinical situations and departments dominated by one nonwestern hyper-religious culture and I don't dig it.

I don't have any tears for the hypersensitivity to this notion nor any liberal guilt over it.

Let's let this thread stay on course and move on with our respective lives shall we?

seriously. i do not know why this is not more coveted in the physician world.

 

[BinderClip]

I would love to see a response to this.

It's pretty clear that we argue from totally different perspectives. While you have been making your statement with regards to the entirety that the AOA has to offer, my arguments are only concerned with competitive specialties that both sides covet. I have always agreed that both the AOA and the ACGME had many less desirable residencies, especially in rural FM/IM.

 

[Textbookversion]

I can see nuance isn't your forte. I am happy that our society is continually invigorated by foreign talent and labor in all sectors top to bottom.

I don't want to train in an elite place. They wouldn't want me either. I have not one haterish bone in my body. I could care less about what you or the other rad onc guy think about such matters. You're welcome to these places or the fawning over them.

I simply want a balanced place. Not snobby. Not overly academic. With good clinical training and good supportive teachers. Definitely not one that consists solely of IMG's. I'm suspicious of program directors who want all people who's visas are also contingent on their contract renewal. I also think a critical mass of a cross section of modern western culture is important to the type of vibe I like. I've worked in clinical situations and departments dominated by one nonwestern hyper-religious culture and I don't dig it.

I don't have any tears for the hypersensitivity to this notion nor any liberal guilt over it.

Let's let this thread stay on course and move on with our respective lives shall we?

Totally my take as well. Mid tier is where it's at.

 

[Imnoglbln]

I can see nuance isn't your forte. I am happy that our society is continually invigorated by foreign talent and labor in all sectors top to bottom.

I don't want to train in an elite place. They wouldn't want me either. I have not one haterish bone in my body. I could care less about what you or the other rad onc guy think about such matters. You're welcome to these places or the fawning over them.

I simply want a balanced place. Not snobby. Not overly acdemic. With good clinical training and good supportive teachers. Definitely not one that consists solely of IMG's. I'm suspicious of program directors who want all people who's visas are also contingent on their contract renewal. I also think a critical mass of a cross section of modern western culture is important to the type of vibe I like. I've worked in clinical situations and departments dominated by one nonwestern hyper-religious culture and I don't dig it.

I don't have any tears for the hypersensitivity to this notion nor any liberal guilt over it.

Let's let this thread stay on course and move on with our respective lives shall we?

Not much to respond here but I think everyone wants a place that is "not too snobby, overly academic, with good and training and supportive teachers", who wouldn't want that? You brought up "elite" not me, so calling me hypersensitive by responding to your black/white generalization and fear of competition doesn't do you a favor. Also, the hyper-religiosity is practically absent among the individuals we are talking about. And since we are talking about the ivy league elite here I can assure you that VISAS and positions are not contingent on contracts, as these are easily obtained by foreign outliers who are at the top of the international game.

Seems to me you need to work in Kentucky next to a river.

 

[Nasrudin]

Not much to respond here but I think everyone wants a place that is "not too snobby, overly academic, with good and training and supportive teachers", who wouldn't want that? You brought up "elite" not me, so calling me hypersensitive by responding to your black/white generalization and fear of competition doesn't do you a favor. Also, the hyper-religiosity is practically absent among the individuals we are talking about. And since we are talking about the ivy league elite here I can assure you that VISAS and positions are not contingent on contracts, as these are easily obtained by foreign outliers who are at the top of the international game.

Seems to me you need to work in Kentucky next to a river.

I simply indicated that some ivy programs, at least in the specialty that I'm going into, have a predilection for foreign elites. Whereas the urban blighted communities I work in or your riverside Kentucky example are populated with foreign medical grads that may have overcome a lot to get there or perhaps were just extremely well funded or had support from a stateside sponsor/relative but are not necessarily elite. Within these scenarios that I will be trying to sift from my wide net to mid tier programs are pockets of nepotism and highly concentrated in one particular demographic or another. Not always but they exist.

I would like to avoid these. I've been working for for 20 years before med school. Many times over the only English speaker on many work crews I've been on. Perfectly happy as such. But for a professional environment. One that has no comparison to the absolute hold your program director has over your career. I want a balanced demographic.

And no, I have nothing in common with the pious. I don't like highly competitive environments. But I'm failing to get any insight from your angled psychoanalytic take on that.

Did I mention I'd be happy to see DO's as my colleagues. And tha I have no idea wtf you're talking about...

 

[hallowmann]

Not really the point. With regards to FM/IM, maybe there are some mid-tier MD applicants who would like to go to a top tier DO program. It doesnt really matter to be honest. If MDs aren't going to rush in droves to the DO spots, why the protectionism over the spots in the first place. The other issue is the competitive speciality spots which you fail to mention or acknowledge; their are a small number of AOA spots in these specialties and I am sure that MD grads not in the bottom 5% would love access to these just as DOs are given access to coveted ACGME residencies in competitive specialties. Its not always about absolute numbers in terms of spots but perceived equity; why should DOs have protected residencies and access when MDs don't?

Yeah, but MDs do have protected residency spots. All residencies in which 60-70% of PDs don't even consider ranking DOs are residencies that are outright protected for MDs. You could be a DO at the top of their class, have a 275 Step 1 score and publications all over the place and you would never match at those programs, because the second they see DO, they cross out your app and send you a (usually) polite letter saying they don't accept DOs. Sure many top programs just want the best candidate, but there are a hell of a lot that "just want an MD".

As far as the protectionism goes, I honestly don't care if the AOA starts allowing MDs to apply. I strongly doubt that the AOA PDs are going to run after the few MDs that couldn't make it in ACGME even when they had access to every single ACGME spot unlike DOs. It is ridiculous though that you consider the AOA holding handfuls of competitive specialties for DOs a travesty, when the ACGME PDs are already securing a fair amount of spots for MDs only.

 

[Silent Cool]

You're a med student so I will give you the benefit of the doubt about your ignorance. I have trained at and worked at top 10 institutions and community hospitals alike and had colleagues from every type of medical education background. being a radiation oncologist, I didnt have any co-residents that were FMGs but can tell you that the ones I know are top of the top. You would be amazed by the skill sets of many FMGs which far exceed many US MDs; American culture can be taught, I've seen it from my parents who were FMGs. Id rather have a slightly unadjusted FMG who knows what they are doing rather than a US grad who has only seen somoene perform procedure X prior to training.

There are some DOs that are on par with some MDs. However, it is my experience that a top 50 school US MD grad on average has a far superior CV to a top DO grad. some is selection as most DOs wanted to be in an MD schol and couldnt get in. Further, MD schools have infrastructures for research, etc. enhancing the CV. I equate MD and DO for degree but the reality is in terms of desirability 8 to 9 times out of 10 the MD has a better overall CV, at least in my specialty.

Sad, but true. The truth does hurt sometimes.

 

[DrBowtie]

Yeah, but MDs do have protected residency spots. All residencies in which 60-70% of PDs don't even consider ranking DOs are residencies that are outright protected for MDs. You could be a DO at the top of their class, have a 275 Step 1 score and publications all over the place and you would never match at those programs, because the second they see DO, they cross out your app and send you a (usually) polite letter saying they don't accept DOs. Sure many top programs just want the best candidate, but there are a hell of a lot that "just want an MD".

As far as the protectionism goes, I honestly don't care if the AOA starts allowing MDs to apply. I strongly doubt that the AOA PDs are going to run after the few MDs that couldn't make it in ACGME even when they had access to every single ACGME spot unlike DOs. It is ridiculous though that you consider the AOA holding handfuls of competitive specialties for DOs a travesty, when the ACGME PDs are already securing a fair amount of spots for MDs only.

The "protected" MD spots are not protected the same as the DO spots. The DO spots are such by regulation. The MD spots are "protected" because they can fill their spots with high quality MDs without even needing to consider the DO pool.

Would it make you feel better if all PDs gave lip service and "consider" DOs when in actuality they would just filter them out on "pedigree" or "clinical experiences"?

 

[GUH]

The "protected" MD spots are not protected the same as the DO spots. The DO spots are such by regulation. The MD spots are "protected" because they can fill their spots with high quality MDs without even needing to consider the DO pool.

Would it make you feel better if all PDs gave lip service and "consider" DOs when in actuality they would just filter them out on "pedigree" or "clinical experiences"?

No. But as long as there is discrimination on the part of MD residencies against DO's, there shouldn't be any crying foul about the reverse, even if you really think that MD's are soooooooooo much better qualified than DO's.

 

[DrBowtie]

No. But as long as there is discrimination on the part of MD residencies against DO's, there shouldn't be any crying foul about the reverse, even if you really think that MD's are soooooooooo much better qualified than DO's.

Discrimination does not equal regulation.
Discrimination is fluid and on a continuum, PDs change, specialties and programs rise and fall in competitiveness.

The regulation is static and binary.

 

[IMcda]

Reading this as an MD student, I can understand this move completely. For those maligning this change, frankly- you became a DO student. Be proud of that but understand that you have no inherent right to be able to train in MD residencies nor are MD residencies obliged to take you. DOs and MDs are equally privileged but different physicians, and DO medical training qualifies you for a DO residency and not necessarily, as is being demonstrated, MD post-graduate training.

For years now the only sure way to get away from ridiculousness of DO world is to take USMLE and match into a MD residency. I'm not surprised MD residencies are tightening their standards.

 

[Nasrudin]

Reading this as an MD student, I can understand this move completely. For those maligning this change, frankly- you became a DO student. Be proud of that but understand that you have no inherent right to be able to train in MD residencies nor are MD residencies obliged to take you. DOs and MDs are equally privileged but different physicians, and DO medical training qualifies you for a DO residency and not necessarily, as is being demonstrated, MD post-graduate training.

Nonsense. PD's run their programs how they see fit. And the admissions committees will choose whoever they like. This is not a civil rights matter. It's an employer to job applicant scenario. The accrediting bodies don't care who fills the spots. Although they can change requirements. Which is what this and many other threads are about. Telling the one type of kid they can't swim in a public pool you don't own is silliness. Or worse.

 

[Dharma]

Reading this as an MD student, I can understand this move completely. For those maligning this change, frankly- you became a DO student. Be proud of that but understand that you have no inherent right to be able to train in MD residencies nor are MD residencies obliged to take you. DOs and MDs are equally privileged but different physicians, and DO medical training qualifies you for a DO residency and not necessarily, as is being demonstrated, MD post-graduate training.

ACGME programs are not exclusively MD post graduate training programs, contrary to your allusion of some FUBU predominance. A DO education actually DOES qualify one for all but very few programs, and guess what... Most DO students are well aware of those places. For those programs where DOs are SOL, many MDs won't qualify either, so it's virtually moot. In the end it is a much smaller issue than most make it out to be. And it certainly isn't one of "you were trained for this, not that, nah nah! Too bad! (Smiles inside feeling smug)."

All of that said, I agree that a DO student should've gone into all of this knowing that there would be certain obstacles and roadblocks that are inherent to the pathway of becoming/being a DO. Its just that some of these new ones are a bit of a shock, but clearly those of a power play between political bodies and has very little to do with quality, education, medicine, pedigree or exclusivity. It's about power and control, on both sides.

 

[JediZero]

Reading this as an MD student, I can understand this move completely. For those maligning this change, frankly- you became a DO student. Be proud of that but understand that you have no inherent right to be able to train in MD residencies nor are MD residencies obliged to take you. DOs and MDs are equally privileged but different physicians, and DO medical training qualifies you for a DO residency and not necessarily, as is being demonstrated, MD post-graduate training.

People forget this. ACGME would be perfectly within their rights to just flat-out stop taking DO's.

And there are differences between COCA and LCME standards, especially when it comes to clinical rotations. I think in an ideal world, everyone graduating with a DO degree would be qualified for an ACGME residency, and I don't think we're all that far from the ideal. But the fact of the matter is that some of the clinical rotations fall short. I just wish that it didn't turn into a blanket excuse to ignore DO's.

 

[Nasrudin]

People forget this. ACGME would be perfectly within their rights to just flat-out stop taking DO's.

And there are differences between COCA and LCME standards, especially when it comes to clinical rotations. I think in an ideal world, everyone graduating with a DO degree would be qualified for an ACGME residency, and I don't think we're all that far from the ideal. But the fact of the matter is that some of the clinical rotations fall short. I just wish that it didn't turn into a blanket excuse to ignore DO's.

Sure. The LCME is within their rights to restrict access. But as 4th year medical students we have no rights over who programs choose--that doesn't even make any coherent sense.

It's something to consider as a DO applicant--that the AOA is flirting with its own extinction. But for current students it seems like there's not much to worry about in terms of getting interviews from Allopathic programs in most fields for most people.

 

[Dharma]

People forget this. ACGME would be perfectly within their rights to just flat-out stop taking DO's.

Hypothetically yes. Not gonna happen though, at least not anytime soon. You could pretty much guarantee that before it does, the suits from the Hill would be stepping in and starting an uproar about tax dollars, budgets, physician shortages, and wasted ducats long before some major c0ckblock goes down. This is public money at play here… I'm honestly surprised the government hasn't already taken the time to put on some media display as it slides its greasy hands into this GME mess.

 

[preDoGuy24]

People forget this. ACGME would be perfectly within their rights to just flat-out stop taking DO's.

And there are differences between COCA and LCME standards, especially when it comes to clinical rotations. I think in an ideal world, everyone graduating with a DO degree would be qualified for an ACGME residency, and I don't think we're all that far from the ideal. But the fact of the matter is that some of the clinical rotations fall short. I just wish that it didn't turn into a blanket excuse to ignore DO's.

I think if you are a graduate of an American medical school (do and md), have passed 2/3 boards, you're inherently qualified for a acgme residency...competitive is a different question. Yes clinical rotations are important, I think a lot of DO schools should have there feet put to the fire for some of there rotations, BUT if you want to think you are doing critical anything as a 3rd year (md or do) that somehow creates a giant rift causing DO students to be unqualified for acgme residencies I would have to disagree.

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[NOsaintsfan]

It's a privilege for those of us DOs who get into ACGME residencies (NOT because we are inferior, but because they are allotting their resources to support us, when our own parent organization is not looking own for our interests).

You may think it's unfair for MD residencies to discriminate somewhat to DOs, but in actuality they have no obligation to take us on AT ALL.

Where does the fact that ACGME residencies are paid for with OUR tax dollars fall into this argument? I'm not a traditional student and have written MANY 5 figured checks to Uncle Sam over the years. Does that even matter? After all the point of the government spending our money to train docs is to have qualified docs for the US population right? So why should a doc that is going to be licensed to practice in the US and paying federal income taxes not be eligible to train in a government funded (our tax money) program. I'm not talking about selection on merit, I'm talking about not being eligible to apply simply because your a DO. The DO degree is fully recognized by the US government. Many AOA residencies are funded by federal money as well and should be open to MD's in my opinion for the same reason.

I don't see the logic in the above quotes. Please enlighten me?

 

[preDoGuy24]

Where does the fact that ACGME residencies are paid for with OUR tax dollars fall into this argument? I'm not a traditional student and have written MANY 5 figured checks to Uncle Sam over the years. Does that even matter? After all the point of the government spending our money to train docs is to have qualified docs for the US population right? So why should a doc that is going to be licensed to practice in the US and paying federal income taxes not be eligible to train in a government funded (our tax money) program. I'm not talking about selection on merit, I'm talking about not being eligible to apply simply because your a DO. The DO degree is fully recognized by the US government. Many AOA residencies are funded by federal money as well and should be open to MD's in my opinion for the same reason.

I don't see the logic in the above quotes. Please enlighten me?

Agree 100%; good point on what medical students (and the AOA/ACGME) seem to not understand is that the residencies are not "ours" or "theirs" unless they are privately funded, there is billions of tax (read public) dollars being spent on training physicians. I think discrimination based on degree (looking at you aoa) if you are recognized as a fully licensed physician otherwise is ridiculous, there should not be any inherent "right" to anything when it is funded with public money. The AOA is more guilty in my eyes then the acgme, though I have seen plenty of mine vs theirs when it comes to residency programs for md's as well.

 

[JediZero]

I think if you are a graduate of an American medical school (do and md), have passed 2/3 boards, you're inherently qualified for a acgme residency...competitive is a different question. Yes clinical rotations are important, I think a lot of DO schools should have there feet put to the fire for some of there rotations, BUT if you want to think you are doing critical anything as a 3rd year (md or do) that somehow creates a giant rift causing DO students to be unqualified for acgme residencies I would have to disagree.

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Personally, I'd agree that there's not much difference between MD and DO candidates by the time July 1st rolls around. But if the ACGME says they can't necessarily trust the quality of the clinical training for non-LCME candidates, well, I can't really disagree with that. Basically, if they were to block DO's entirely, it would kind of a jerk move, but it would be both within their rights and defensible/justifiable.

Of course, COCA could solve this by just ensuring that all DO students get a high-quality clinical education...

 

[JediZero]

Where does the fact that ACGME residencies are paid for with OUR tax dollars fall into this argument? I'm not a traditional student and have written MANY 5 figured checks to Uncle Sam over the years. Does that even matter? After all the point of the government spending our money to train docs is to have qualified docs for the US population right? So why should a doc that is going to be licensed to practice in the US and paying federal income taxes not be eligible to train in a government funded (our tax money) program. I'm not talking about selection on merit, I'm talking about not being eligible to apply simply because your a DO. The DO degree is fully recognized by the US government. Many AOA residencies are funded by federal money as well and should be open to MD's in my opinion for the same reason.

I don't see the logic in the above quotes. Please enlighten me?

The tax money serves the public. In this case, what the public gets out of it is healthcare provided by the doctors produced in the program. Taxpayers are entitled to that service, not to access to the program itself. Rather, the program is both required and entitled to set standards for who it trains, so that it produces high-quality physicians. If you'll forgive me for running your argument through reductio ad absurdum, shouldn't that mean that anyone who pays taxes should be eligible to apply? NP's, PA's, PT's, naturopaths, homeopaths, craniosacral therapists, massage therapists, EMTs, high schoolers who took a first aid course... where do you draw the line? Right now, the ACGME draws it around MDs and DOs. The AOA draws it around DOs only. They're both within their rights on that, and there's no obligation to consider anyone else just because they're a taxpayer.

 

[NontradCA]

Where does the fact that ACGME residencies are paid for with OUR tax dollars fall into this argument? I'm not a traditional student and have written MANY 5 figured checks to Uncle Sam over the years. Does that even matter? After all the point of the government spending our money to train docs is to have qualified docs for the US population right? So why should a doc that is going to be licensed to practice in the US and paying federal income taxes not be eligible to train in a government funded (our tax money) program. I'm not talking about selection on merit, I'm talking about not being eligible to apply simply because your a DO. The DO degree is fully recognized by the US government. Many AOA residencies are funded by federal money as well and should be open to MD's in my opinion for the same reason.

I don't see the logic in the above quotes. Please enlighten me?

Win thread.

 

[NOsaintsfan]

If you'll forgive me for running your argument through reductio ad absurdum, shouldn't that mean that anyone who pays taxes should be eligible to apply? NP's, PA's, PT's, naturopaths, homeopaths, craniosacral therapists, massage therapists, EMTs, high schoolers who took a first aid course... where do you draw the line? Right now, the ACGME draws it around MDs and DOs.

You did over simplify the point which is that all US trained physicians recognized by the US government should be eligible to apply for a tax payer funded residency program. I'm certainly not saying that every tax payer should be able to apply for residency, that's way out of the scope of what is being said here. What I'm talking about is the US government and tax money used to fund graduate medical education. Like it or not in the federal governments eyes DO = MD. As such programs funded with public money should be open to all physicians. Another point that I should stress is that eligibility =/= qualification. So I'm not saying that anyone DO or MD should be guaranteed a spot in any program. I'm all for programs using things like board scores, grades, ect. to screen applicants however DO's or MD's shouldn't be unable to apply simply because the letters behind their name. Currently ACGME residencies are open for DO's to apply as they should be, AOA residencies should do the same based on the above arguments. If AOA residencies want to make requirements for MD applicants that include having to be proficient in osteopathic techniques that's fine, but saying that MD's can't apply simply because they are MD's is a misuse of public money in my opinion. This is my opinion, feel free to disagree.

 

[ChrisGriffen]

NOsaintsfan is correct. As a group though, can we agree to stop beating this very very dead horse. There will never be a day where DOs are formally banned from ACGME residency spots. NEVER. Can we please stop talking about this, in this thread and in every other thread?


edit: to clarify for the slower users on SDN. The US government would not allow the ACGME to increase the physician deficit by hogging medicare funding and barring out DOs.

 

[JediZero]

You did over simplify the point which is that all US trained physicians recognized by the US government should be eligible to apply for a tax payer funded residency program. I'm certainly not saying that every tax payer should be able to apply for residency, that's way out of the scope of what is being said here. What I'm talking about is the US government and tax money used to fund graduate medical education. Like it or not in the federal governments eyes DO = MD. As such programs funded with public money should be open to all physicians. Another point that I should stress is that eligibility =/= qualification. So I'm not saying that anyone DO or MD should be guaranteed a spot in any program. I'm all for programs using things like board scores, grades, ect. to screen applicants however DO's or MD's shouldn't be unable to apply simply because the letters behind their name. Currently ACGME residencies are open for DO's to apply as they should be, AOA residencies should do the same based on the above arguments. If AOA residencies want to make requirements for MD applicants that include having to be proficient in osteopathic techniques that's fine, but saying that MD's can't apply simply because they are MD's is a misuse of public money in my opinion. This is my opinion, feel free to disagree.

Well, like I said , you've got to draw the line somewhere- the garden path there was just illustrating that. While I agree that that line should include MD and DO, I'm also saying if the ACGME wanted to, they could decide otherwise. I do still think the taxpayer status is irrelevant.

Just my opinion, too...

 

[notbobtrustme]

Where does the fact that ACGME residencies are paid for with OUR tax dollars fall into this argument? I'm not a traditional student and have written MANY 5 figured checks to Uncle Sam over the years. Does that even matter? After all the point of the government spending our money to train docs is to have qualified docs for the US population right? So why should a doc that is going to be licensed to practice in the US and paying federal income taxes not be eligible to train in a government funded (our tax money) program. I'm not talking about selection on merit, I'm talking about not being eligible to apply simply because your a DO. The DO degree is fully recognized by the US government. Many AOA residencies are funded by federal money as well and should be open to MD's in my opinion for the same reason.

I don't see the logic in the above quotes. Please enlighten me?

The same can be said about flying jet planes or driving a tank. Just because you pay for it doesn't give you the right to use it's services. The ACGME has a set of criteria and is free to revise that criteria as it sees fit. Just because you pay for it doesn't give you any intrinsic right to participate in the program, just like I can't drive down to the local Army base and demand to do doughnuts with an Abrams.

 

[NontradCA]

The same can be said about flying jet planes or driving a tank. Just because you pay for it doesn't give you the right to use it's services. The ACGME has a set of criteria and is free to revise that criteria as it sees fit. Just because you pay for it doesn't give you any intrinsic right to participate in the program, just like I can't drive down to the local Army base and demand to do doughnuts with an Abrams.

Such a ridiculous post.

 

[MSmentor018]

it's simple supply and demand. if there were plenty of residencies for both md/do then it wouldn't be a problem. md has their own residencies and if a DO wants to get in it, you're expected to work harder, better,faster than your MD counterparts. that's just how it is and that should be an expected trait. the competition is tougher, having to compete with MD students as well as the limited number of do slots available. program directors can do what they want but are also under scrutiny and won't pack their programs with DO's without reason. if I was a PD i'd want the best mix for my program, stack the match in my favor, and most of all play ball to keep everyone happy.

on the other hand the aoa won't let MD's into the DO residencies for multiple fears and one being "they don't understand the osteopathic philosophy and training". sounds a little silly but I understand the importance of keeping your traditions. maybe they can make the MD's do OMM electives during residencies or require an aoa internship first with emphasis on osteopathic principals. the do match allowed hundreds of fm/im/transition positions to be unfilled. if i was a MD, esp a IMG/FMG and desperate to get into medicine, I'd be pissed.

it has nothing to do with money, the slots are out there and all paid for by you and me. we just have to figure out a way to keep both societies satisfied while increasing the number of residency positions. and with the new healthcare act, it may be a game changer. who knows

 

[darklabel]

it's simple supply and demand. if there were plenty of residencies for both md/do then it wouldn't be a problem. md has their own residencies and if a DO wants to get in it, you're expected to work harder, better,faster than your MD counterparts. that's just how it is and that should be an expected trait. the competition is tougher, having to compete with MD students as well as the limited number of do slots available. program directors can do what they want but are also under scrutiny and won't pack their programs with DO's without reason. if I was a PD i'd want the best mix for my program, stack the match in my favor, and most of all play ball to keep everyone happy.

on the other hand the aoa won't let MD's into the DO residencies for multiple fears and one being "they don't understand the osteopathic philosophy and training". sounds a little silly but I understand the importance of keeping your traditions. maybe they can make the MD's do OMM electives during residencies or require an aoa internship first with emphasis on osteopathic principals. the do match allowed hundreds of fm/im/transition positions to be unfilled. if i was a MD, esp a IMG/FMG and desperate to get into medicine, I'd be pissed.

it has nothing to do with money, the slots are out there and all paid for by you and me. we just have to figure out a way to keep both societies satisfied while increasing the number of residency positions. and with the new healthcare act, it may be a game changer. who knows

But IMG/FMG aren't true MDs correct? They do not train in a school accredited from a US agency and, i.m.o., are the group that are least owed anything to.

However, I think most DO students are open to the idea of a reciprocal relationship of allowing MD students to match into AOA while DO students match ACGME and (hopefully) have more opportunities of matching into competitive fields and vice versa because lets be honest, only reason MD students would care about this is for more slots in competitive fields. I doubt any MD student is clamoring for an AOA IM position.

Also, I don't understand the idea of osteopathic philosophy and don't really believe in it. In multiple DO interviews, I've heard admissions people say that DOs are "MD+" since DOs can attend both matches while MDs can't so clearly the whole thing is hogwash from that perspective and some DO students use the separate matches as an advantage. Such as applying for only ortho in the AOA match and then being safe and applying FM/IM for the ACGME. Seems a little unfair.