REALITY of the merger: PD: "We went from 170 applications to 450 applications our first cycle"

[Ioannes Paulus]

Very interesting interview with Dr. Rush former president of AOAO and PD of NOVA's orthopedic surgery residency at Broward Hospital that recruited 2 DOs and 1MD this past cycle.

Episode 4 Dr. Joel Rush | Program Director Insights

Key takeaways:
- believes many programs will not make it to initial accreditation by 2020
- significantly more competitive with almost a tripling of applications their first cycle
- USMLE is now practically a requirement for his program
- his program will slowly stop taking rotating students from other med schools as elective rotations (this used to be a requirement of DO applicants)
- higher expectations of applicants

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[Drrrrrr. Celty]

I think the surgical subspecialties will tank hard for many DO students unless they seek out opportunities and connections to programs and or obtain comparable applications ( DOs with 240s and multiple publications). Or maybe it won't.

I wonder truly how many DOs there are with stats that actually parallel the average orthopedic applicant.

 

[Ioannes Paulus]

I think the surgical subspecialties will tank hard for many DO students unless they seek out opportunities and connections to programs and or obtain comparable applications ( DOs with 240s and multiple publications). Or maybe it won't.

I wonder truly how many DOs there are with stats that actually parallel the average orthopedic applicant.

Also, I hope this podcast puts to rest this myth of DO programs still being an "old boy's club" post-merger where DO PDs will continue to give preference to DO students to rest. The PD outright said that if 1 student doesn't pass the ACGME qualifying boards, his program automatically goes into probation and he doesn't want to risk it with taking a DO student with 500s on the COMLEX (his words).

Keep in mind that Broward is a community hospital in Davis and was a relatively small DO program. Imagine what the numbers will be for PCOM, Riverside CA, or New York's programs that are more established and larger.

 

[Drrrrrr. Celty]

Also, I hope this podcast puts to rest this myth of DO programs still being an "old boy's club" post-merger where DO PDs will continue to give preference to DO students to rest. The PD outright said that if 1 student doesn't pass the ACGME qualifying boards, his program automatically goes into probation and he doesn't want to risk it with taking a DO student with 500s on the COMLEX (his words).

Keep in mind that Broward is a community hospital in Davis and was a relatively small DO program. Imagine what the numbers will be for PCOM, Riverside CA, or New York's programs that are more established and larger.

The average for Ortho is around a 600 I think. Most people with 600s probably would at least score average on the usmle. So I'm not sure that's a real threat.

But honestly, I think for some time there will be preference and probably connections. But overtime it will probably lessen, so hopefully by then DO apps adjust to the new requirements and more MD programs start accepting DOs too.

 

[Ioannes Paulus]

But honestly, I think for some time there will be preference and probably connections. But overtime it will probably lessen, so hopefully by then DO apps adjust to the new requirements and more MD programs start accepting DOs too.

He mentions in the podcast that this what he hopes will happen.

 

[hallowmann]

The average for Ortho is around a 600 I think. Most people with 600s probably would at least score average on the usmle. So I'm not sure that's a real threat.

But honestly, I think for some time there will be preference and probably connections. But overtime it will probably lessen, so hopefully by then DO apps adjust to the new requirements and more MD programs start accepting DOs too.

Yeah, the majority of DO ortho programs aren't "risking it" with a 500 applicant, they're getting people with 600+. Plus, it's hard to extrapolate 1 PD's words and apply it to all almost 800 AOA programs. We'll just have to wait and see how it goes down. We knew that eventually the surgical programs were going to take a hit, only time will tell how hard that hit is.

 

[IsWhat]

This shouldn't be a surprise. Most MD ortho applicants under a 250 step 1 are told to apply heavily to community programs, and thus former AOA ortho will inevitably receive a wave of solid 240+ step 1 applicants. It could get ugly for the average subspecialty surgery DO applicant, because at least at my program I get the feeling a lot of people completely underestimate just how competitive MD students are in these specialty choices.

 

[Drrrrrr. Celty]

This shouldn't be a surprise. Most MD ortho applicants under a 250 step 1 are told to apply heavily to community programs, and thus former AOA ortho will inevitably receive a wave of solid 240+ step 1 applicants. It could get ugly for the average subspecialty surgery DO applicant, because at least at my program I get the feeling a lot of people completely underestimate just how competitive MD students are in these specialty choices.

I don't think it'll change too extremely tho. 2-3 people from each DO school will likely still continue to match.

 

[68PGunner]

Very interesting interview with Dr. Rush former president of AOAO and PD of NOVA's orthopedic surgery residency at Broward Hospital that recruited 2 DOs and 1MD this past cycle.

Episode 4 Dr. Joel Rush | Program Director Insights

Key takeaways:
- believes many programs will not make it to initial accreditation by 2020
- significantly more competitive with almost a tripling of applications their first cycle
- USMLE is now practically a requirement for his program
- his program will slowly stop taking rotating students from other med schools as elective rotations (this used to be a requirement of DO applicants)
- higher expectations of applicants

Reality check for those people out there taking only the COMLEX. The COMLEX is a straight up garbage test for the Class of 2020 and after.

 

[acapnial]

Reality check for those people out there taking only the COMLEX. The COMLEX is a straight up garbage test for the Class of 2020 and after.

This is in no way limited to the class of 2020 and after!

 

[68PGunner]

This is in no way limited to the class of 2020 and after!

I'm only saying that bc all residencies for 2020 and after are ACGME. However, it seems that there is a sizable number of delusional students who think that PDs will learn to evaluate the COMLEX. Wrong.

 

[Drrrrrr. Celty]

I'm only saying that bc all residencies for 2020 and after are ACGME. However, it seems that there is a sizable number of delusional students who think that PDs will learn to evaluate the COMLEX. Wrong.

Plenty of them do already. Pretty much every FM residency in the country accepts COMLEX. Psych, Path, low tier IM and a few others 70-90% accept COMLEX.

 

[Ioannes Paulus]

This shouldn't be a surprise. Most MD ortho applicants under a 250 step 1 are told to apply heavily to community programs, and thus former AOA ortho will inevitably receive a wave of solid 240+ step 1 applicants. It could get ugly for the average subspecialty surgery DO applicant, because at least at my program I get the feeling a lot of people completely underestimate just how competitive MD students are in these specialty choices.

Exactly. I also think Dr. Ross who is very, very established in the osteopathic community has set a precedent that lets other DO PDs know that there are MDs out there who are not applying to formerly DO programs as safeties.
Also, by saying that elective rotations will slowly be fased out, he's essentially saying that the way they will be selecting interview applicants will be te traditional MD way where they screen applicants based on board scores. In the past, if you did an away at a DO ortho program you were at least given a curtesy interview.


Will other programs follow this same route or see similar changes (I.e. Ridiculously large increases in applicant number in an imcreadibly short period of time)? No one knows but this is the first kind of data we have now and it seems that the competition went up exponentially.

 

[AnatomyGrey12]

I've said it before, the days of a DO student with low scores sneaking into a competitive specialty because of a good audition rotation are over. If you want to do ortho (or any other competitive field honestly) you need to have the scores and app necessary for that field. You wan ortho? Put together an ortho worthy app.

 

[acapnial]

I'm only saying that bc all residencies for 2020 and after are ACGME. However, it seems that there is a sizable number of delusional students who think that PDs will learn to evaluate the COMLEX. Wrong.

I'm 100% in agreement, I was just always of the opinion that the comlex is a garbage test

 

[grapefruit17]

I've said it before, the days of a DO student with low scores sneaking into a competitive specialty because of a good audition rotation are over. If you want to do ortho (or any other competitive field honestly) you need to have the scores and app necessary for that field. You wan ortho? Put together an ortho worthy app.

Most people with low scores don't match competive specialities even with an audition. That's been the case for a while. Unfortunately scores determine a lot. We have an ortho residency where I did a lot of my clinicals. Do one. If I recall, they generally didn't even let students audition without a 600 or somewhere around there.

The match will get more and more competive every year, even if the merger had not happened. It's tough lol. Even the least competive specialities want good applicants.

 

[Drrrrrr. Celty]

I've said it before, the days of a DO student with low scores sneaking into a competitive specialty because of a good audition rotation are over. If you want to do ortho (or any other competitive field honestly) you need to have the scores and app necessary for that field. You wan ortho? Put together an ortho worthy app.

Connections will always be an enormous part of matching in my opinion. I think people who want Ortho will likely want it coming in and will need to build connections if they want to match.

 

[68PGunner]

Connections will always be an enormous part of matching in my opinion. I think people who want Ortho will likely want it coming in and will need to build connections if they want to match.

Connections won't help you if you don't have the stats to hit the average numbers for that program. They're not going to make their programs look bad to future applicants by admitting people that will push their normal averages by 10-20 USMLE pts unless that person is the son/daughter of the PD.

 

[SurgeDO]

sucks guys. it's probably going to be rough for a couple years, but in the end, this merger is going to be a good thing.

study hard. crush boards. make connections. publish papers. get LORs from leaders in the field. hope for the best.

 

[68PGunner]

sucks guys. it's probably going to be rough for a couple years, but in the end, this merger is going to be a good thing.

study hard. crush boards. make connections. publish papers. get LORs from leaders in the field. hope for the best.

Curious to your take on why it's a good thing. Would you mind sharing?

 

[Ioannes Paulus]

Curious to your take on why it's a good thing. Would you mind sharing?

- Standardization of GME
- ACGME has higher standards
- more fellowships may be open to DOs
- DOs now go through 2 matches. This will allow them to only participate in 1 match. The advantages of this are overwhelming.

 

[NurWollen]

Lol, remember when we all thought the lack of OMM training was going to be a barrier to MDs applying for these spots?

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[ThreeCheers]

Eh, I've heard too many horror stories about "IMG sweatshops" to agree that the ACGME definitively has higher standards.

The only thing that really surprises me about this article is the PD saying that most AOA programs won't survive the merger. I was under the impression that most (with the possible exception of IM residencies, which I hear require a pretty significant overhaul) were on tract to make the transition.

 

[Mr Roboto]

Lol, remember when we all thought the lack of OMM training was going to be a barrier to MDs applying for these spots?

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People thought that...?

 

[68PGunner]

People thought that...?

Unfortunately, I've heard of this little bs rumor myself. I had a good chuckle of it a while ago. Medicine is driven by #s and prestige. It's multifactorial in term of your fit for specialities. However, if you don't have the #s to meet the baseline, you might as well think about a backup plan.

 

[Ioannes Paulus]

Unfortunately, I've heard of this little bs rumor myself. I had a good chuckle of it a while ago. Medicine is driven by #s and prestige. It's multifactorial in term of your fit for specialities. However, if you don't have the #s to meet the baseline, you might as well think about a backup plan.

I'm just having a hard time realizing that nearly 300 MDs sent their application to a program that received initial accreditation literally a few months ago, that had never taken an MD ever, that had a DO PD, and was a tiny community program with ~2-3 residents per year. 300 is a huge number in my opinion. I don't think many of us can visualize just what 300 more applicants looks like. 450 students vying for 2-3 slots. It's like they were tigers waiting to pounce on the prey. And this is just their first cycle. Imagine what the subsequent years will look like.

 

[68PGunner]

I'm just having a hard time realizing that nearly 300 MDs sent their application to a program that received initial accreditation literally a few months ago, that had never taken an MD ever, that had a DO PD, and was a tiny community program with ~2-3 residents per year. 300 is a huge number in my opinion. I don't think many of us can visualize just what 300 more applicants looks like. 450 students vying for 2-3 slots. It's like they were tigers waiting to pounce on the prey. And this is just their first cycle. Imagine what the subsequent years will look like.

People want to make 450-500K a year doing ortho. It's that simple.

 

[AnatomyGrey12]

People want to make 450-500K a year doing ortho. It's that simple.

And that's just starting. Not to mention the training in Florida by the beach.

 

[SurgeDO]

Curious to your take on why it's a good thing. Would you mind sharing?

I don't know; I'm probably a little biased because I'm in one of these residencies.

my politically correct answer is that the merger standardizes graduate medical education. prior to the merger, the ACGME and AOA had different requirements for my specialty. in my specialty, the AOA requirements were less rigid and less organized. the merger improved the requirements for my program, and I think that will make my training better overall.

the merger will also get rid of the "should I stay or should I go" thought process that goes through every osteopathic student's head when it comes time to submit a rank list. having two matches kinda sucks for competitive DO students seeking a competitive specialty. I've seen a lot of students get burned on that gamble, and I saw a lot of students who wanted to take the gamble but didn't in fear of getting burned.


my less-political answer is that it validates my training in a sense. i had my heart set on matching into the program that I matched into since 1st year of medical school. I spent a lot of time at this program in medical school. I got to see how amazing my program is and how incredible the faculty and staff were at this program. I knew that this is where I wanted to be from very early on, and it was nice to see that someone else realized that as well. it makes me feel all warm and fuzzy inside for the lack of a better explanation. there are a **** ton of incredible AOA programs out there with incredible residents. whether I like it or not, a lot of medical students view AOA residencies as subpar to ACGME residencies (at least in my field). the merger will help eliminate that.

another great advantage (possibly the best one) is that I will no longer have to pay a ****ing penny to the blood-sucking AOA. I've cancelled every single newsletter from them and cut off all my ties with them. feels fantastic. I don't have to bother becoming board certified by the AOA specialty board of my specialty. in order to maintain board certification in an AOA specialty, you need to pay dues, which is ****ing insane.

it'll be a little easier to get a job. I'd say 10-15% of the job postings for my specialty specifically request that the applicant be BCed by the ACGME specialty board in my field. while 85-90% of these postings are also cool with the AOA equivalent, it still opens up a couple more doors this way. this is probably more unique to my specialty than others, but I think it's worth pointing out.

I don't know. reading this back just sounds like a bunch of ramblings. while my heart does go out for the class of 2018, 2019, and maybe 2020, I do think this is the best thing for graduate medical education. hopefully I got my point across.

 

[SurgeDO]

I'm just having a hard time realizing that nearly 300 MDs sent their application to a program that received initial accreditation literally a few months ago, that had never taken an MD ever, that had a DO PD, and was a tiny community program with ~2-3 residents per year. 300 is a huge number in my opinion. I don't think many of us can visualize just what 300 more applicants looks like. 450 students vying for 2-3 slots. It's like they were tigers waiting to pounce on the prey. And this is just their first cycle. Imagine what the subsequent years will look like.

I don't know what level of training you are in, so forgive me if this comes off as condescending. But when you fill out your ERAS application and send it out to residencies, you literally just check a box for which residency program you want to send it to.

you complete your ERAS application. select the specialty you want to apply to from a drop down window, and you are provided with ALL the residency programs in that specialty. you then go down and check boxes for which program you want to send it to. a bunch of MD students probably just saw "ortho" and "Florida" and checked that box. there are a decent amount of people who apply to a very large portion of programs (like 80-100% of programs in a given specialty).

 

[QualityProcess]

Keep in mind that Broward is a community hospital in Davis and was a relatively small DO program. Imagine what the numbers will be for PCOM, Riverside CA, or New York's programs that are more established and larger.

I think you mean Davie. Community hospital is a bit misleading, as Broward is an 800 bed county hospital with a level 1 trauma center. The ortho residents are... busy. Would surprise me if they do not try to expand, as they are opening EM and GS residencies in the coming years, among others.

 

[ThreeCheers]

Congratulations on matching into your dream program, and you make some excellent arguments. But with all due respect, you have to admit that its easier for you to see the merger through rose-colored glasses when you graduated early enough to avoid its many many downsides.

I don't know; I'm probably a little biased because I'm in one of these residencies.

my politically correct answer is that the merger standardizes graduate medical education. prior to the merger, the ACGME and AOA had different requirements for my specialty. in my specialty, the AOA requirements were less rigid and less organized. the merger improved the requirements for my program, and I think that will make my training better overall.

the merger will also get rid of the "should I stay or should I go" thought process that goes through every osteopathic student's head when it comes time to submit a rank list. having two matches kinda sucks for competitive DO students seeking a competitive specialty. I've seen a lot of students get burned on that gamble, and I saw a lot of students who wanted to take the gamble but didn't in fear of getting burned.


my less-political answer is that it validates my training in a sense. i had my heart set on matching into the program that I matched into since 1st year of medical school. I spent a lot of time at this program in medical school. I got to see how amazing my program is and how incredible the faculty and staff were at this program. I knew that this is where I wanted to be from very early on, and it was nice to see that someone else realized that as well. it makes me feel all warm and fuzzy inside for the lack of a better explanation. there are a **** ton of incredible AOA programs out there with incredible residents. whether I like it or not, a lot of medical students view AOA residencies as subpar to ACGME residencies (at least in my field). the merger will help eliminate that.

another great advantage (possibly the best one) is that I will no longer have to pay a ****ing penny to the blood-sucking AOA. I've cancelled every single newsletter from them and cut off all my ties with them. feels fantastic. I don't have to bother becoming board certified by the AOA specialty board of my specialty. in order to maintain board certification in an AOA specialty, you need to pay dues, which is ****ing insane.

it'll be a little easier to get a job. I'd say 10-15% of the job postings for my specialty specifically request that the applicant be BCed by the ACGME specialty board in my field. while 85-90% of these postings are also cool with the AOA equivalent, it still opens up a couple more doors this way. this is probably more unique to my specialty than others, but I think it's worth pointing out.

I don't know. reading this back just sounds like a bunch of ramblings. while my heart does go out for the class of 2018, 2019, and maybe 2020, I do think this is the best thing for graduate medical education. hopefully I got my point across.

 

[SurgeDO]

I agree. I definitely think it is going to be rough for the upcoming classes. overall, I think it will be for the best.

 

[TheaterOfTheme]

I agree. I definitely think it is going to be rough for the upcoming classes. overall, I think it will be for the best.

Why do you think it will get better post-2020 (as implied in your previous post)?


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[IsWhat]

Exactly. I also think Dr. Ross who is very, very established in the osteopathic community has set a precedent that lets other DO PDs know that there are MDs out there who are not applying to formerly DO programs as safeties.
Also, by saying that elective rotations will slowly be fased out, he's essentially saying that the way they will be selecting interview applicants will be te traditional MD way where they screen applicants based on board scores. In the past, if you did an away at a DO ortho program you were at least given a curtesy interview.


Will other programs follow this same route or see similar changes (I.e. Ridiculously large increases in applicant number in an imcreadibly short period of time)? No one knows but this is the first kind of data we have now and it seems that the competition went up exponentially.

This was the most telling part of the interview and should be a wake-up call for any DO student looking to match into a competitive specialty. This PD - after one cycle of MD applications - is going to throw away a decades long tradition of audition rotations to ensure the door doesn't close on the dozens of stellar MD applicants he now knows are coming his way every cycle.

The top DO students will obviously still land somewhere, and many ceilings will probably be broken with the merger. But, the average DO student looking at surgery needs to be very, very caucious.

 

[SurgeDO]

Why do you think it will get better post-2020 (as implied in your previous post)


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because there will only be one match. not sure where you are in your training, but it is a real pain in the ass to determine if you're willing to take the gamble in the NRMP (ACGME) match vs the NMS (AOA) match. you won't have to deal with that problem in 2020 (when there will only be one match...hopefully).

 

[Drrrrrr. Celty]

Connections won't help you if you don't have the stats to hit the average numbers for that program. They're not going to make their programs look bad to future applicants by admitting people that will push their normal averages by 10-20 USMLE pts unless that person is the son/daughter of the PD.

Oh sweet summer child, your belief in meritocracy is delicious.

 

[68PGunner]

Oh sweet summer child, your belief in meritocracy is delicious.

I thought that my point is common sense. Obviously, it's not common sense among the delusional DO students out there that have been brainwashed by the higher up machine.

 

[68PGunner]

Oh sweet summer child, your belief in meritocracy is delicious.

Meritocracy is a system in which the best man for the job wins the spot. I am sorry to let you now that your knowledge for OMM isn't going to give you a backdoor advantage to a desired specialty placement.

 

[Drrrrrr. Celty]

Lol, remember when we all thought the lack of OMM training was going to be a barrier to MDs applying for these spots?

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I do legitimately wonder what the status of osteopathic medicine will be as time progresses honestly. How long until OMM is a residency training only.

 

[Drrrrrr. Celty]

Meritocracy is a system in which the best man for the job wins the spot. I am sorry to let you now that your knowledge for OMM isn't going to give you a backdoor advantage to a desired specialty placement.

That's a strawman and you can take your common sense and shove it. Real life sucks and if someone knows someone they'll beat you 9 times out of 10.

Also what does omm have to do anything? I'm hardly intent on using it in medicine nor do I frankly consider it a well developed knowledge set or talent.

 

[68PGunner]

That's a strawman and you can take your common sense and shove it. Real life sucks and if someone knows someone they'll beat you 9 times out of 10.
Also what does omm have to do anything? I'm hardly intent on using it in medicine nor do I frankly consider it a well developed knowledge set or talent.

I'm a nontrad. I know a few things about connections when it comes to competition for a job. Connections won't get you the job if you don't have the baseline credentials. For example, a 220-228 Step 1 isn't going land you an orthopedic residency even if you audition there and impress everyone. Connection will go a long way as icing on an already finished cake. There's no point to work on the icing when you have a crappy base for your cake.

 

[Azete]

I think with anecdotes like this, it becomes easy to lose sight of the macro picture. No doubt about it, previously DO-only residencies in competitive specialties are going to be inundated with very highly qualified MD applicants. Which means, initially, we're going to have many top tier MD graduates being trained by DOs. In practice this means we'll have Harvard graduates being trained by PCOM graduates. Assuming there really is no difference between MDs and DOs, these interactions should only lead to more equal opportunities for future DO graduates.

DOs will always place more people into primary care. Collectively they're worse students, and it happens to be in the mission statement of most DO schools. But, in the few instances where a DO does score a 260, they should be afforded the same opportunities as an MD with a 260. I think the merger ultimately will get us to that point.

Anyone saying DOs should still be allowed to match ortho with a 220 is delusional.

 

[jw3600]

Funny, when a bunch of us from the MD/residency side predicted exactly this we were told this group of applicants (competitive MD applicants who would apply to DO subspecialty programs and raise the bar) didn't exist.

Someone posted what the stats/qualifications of the average unmatched ortho applicant were last year. It was legitimately the description of what I would call a superstar applicant. You are 100% correct.

 

[jw3600]

Reality check for those people out there taking only the COMLEX. The COMLEX is a straight up garbage test for the Class of 2020 and after.

I would say if you are currently in medical school and not matched, you should be very worried if you do not have or plan on having a USMLE score.

 

[Drrrrrr. Celty]

I would say if you are currently in medical school and not matched, you should be very worried if you do not have or plan on having a USMLE score.

Even as someone taking usmle, I think this is pretty heavy bs and needs qualifier before it is in any way true.

 

[Drrrrrr. Celty]

I'm a nontrad. I know a few things about connections when it comes to competition for a job. Connections won't get you the job if you don't have the baseline credentials. For example, a 220-228 Step 1 isn't going land you an orthopedic residency even if you audition there and impress everyone. Connection will go a long way as icing on an already finished cake. There's no point to work on the icing when you have a crappy base for your cake.

I literally know the most incompetent people ever who got jobs because they networked. It happens all the time. You just eat the whipped cream and you forget that the strawberries were plastic.

 

[Señor S]

I think with anecdotes like this, it becomes easy to lose sight of the macro picture. No doubt about it, previously DO-only residencies in competitive specialties are going to be inundated with very highly qualified MD applicants. Which means, initially, we're going to have many top tier MD graduates being trained by DOs. In practice this means we'll have Harvard graduates being trained by PCOM graduates. Assuming there really is no difference between MDs and DOs, these interactions should only lead to more equal opportunities for future DO graduates.

How is that going to work? These DO programs are (mostly) going to be a last-ditch effort for MD applicants and the majority of their graduates will end up in non-academic positions. The Harvard graduate who trains at a community hospital in Florida is unlikely to then become a PD at MGH. And most of the people taking these spots won't be from Harvard, they'll be graduates of state/no-name private MD schools with good scores and grades but minimal research.

 

[grapefruit17]

I don't usmle is as required as people think it is but it does offer you an advantage in a game where every advantage matters.

 

[Drrrrrr. Celty]

How is that going to work? These DO programs are (mostly) going to be a last-ditch effort for MD applicants and the majority of their graduates will end up in non-academic positions. The Harvard graduate who trains at a community hospital in Florida is unlikely to then become a PD at MGH. And most of the people taking these spots won't be from Harvard, they'll be graduates of state/no-name private MD schools with good scores and grades but minimal research.

I'm not sure about this either tbh.
There are some DOs in academic residencies and then there are plenty of DOs at major powerhouse hospitals, but not many are running or training doctors in the ivory tower.