trauma medicine and D.O.'s

[stoic]

I am a pre-med student who is trying to figure out whether to go DO or MD. I like many of the ideas that are important to a DO education. The catch is that I really want to end up in trauma. I can't picture many of the principles taught to a DO (E.G. preventative medicine) being of regular use for an ER doc. What do you guys think?

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[Ponyboy]

Do you want to go into trauma surgery or emergency medicine? There's a difference between the two.

 

[kimberlicox]

Believe it or not, allopathic schools teach lots of preventative medicine as well!

A large portion of your learning during medical school is not directly applicable to your future career. It is designed to give you a broad based fund of knowledge with exposure to the major fields during 3rd year and a taste of some of the lesser ones during 4th year electives. This fund of knowlege prepares you for residency, but most anyone will tell you they actually learned how to be a doctor and do their job during residency, not medical school. Besides, knowledge of preventative medicine is helpful in any field - perhaps a little talk about seatbelt use might go a long way in talking to persons involved in a minor MVA, for example.

I suspect you are wondering whether going DO will *hurt* our chances of getting into Trauma Surgery/ER. Some of the osteopathic students here can give better info than I about that, especially with regard to DO residencies.I do not know of a decided bias against DOs in allopathic residencies for the above; it may be that the more important determinants are your USMLEs, GPA, AOA, letters, etc.

Hope this helps.

 

[M00se]

almost 45% of emergency physicians are DO's. Thats more than any other specialty,even FP.

 

[Z]

I would echo the question asked by PonyBoy. ER physicians, with respect to trauma, are mostly invovled in the initial evaluation and stabilization of trauma victims. They do not participate in any operative interventions that the patient may need. However, the truama surgeon (usualy a general surgeon who has specialized training in trauma) is inlvovled in the care of criticaly injured patients from the time of arrival at the emergency department until patient discharge. This includes assisting with initial stabilization, interpreting lab and radiographic studies, operating if needed, coordinating the care of the patient from the intensive care unit until discharge and beyond. So, the ER physician has a more limited role in the care of the severly injured trauma patient than the trauma surgeon.
Because trauma surgeons must be general surgeons first, one needs to consider this when applying to medical school. At this time, trauma fellowships after general surgery training are moderatley competitive. However, competition is increasing from year to year. As the competition increases training programs can take the pick of the litter (so to speak) of applicants. This usually means one must train at a University based general surgery training program and particiapte in one-two years of research during residency. Generally, MD's have an easier time getting into university based general surgery programs than DO's, but this, of course, is a generalization and there are other factors involved.
I hope this helps.

 

[kundun]

Gregory Zych DO is director of orthopedic trauma at Ryder Trauma Center at the University of Miami School of Medicine...one of the largest, most comprehensive and recongnized centers in the world

 

[Detroit Rock City]

Yes trauma surg and ER are 2 different specalities, but the previous poster is not 100% accurate. Many times a patient who is a trauma patient is brought to an ed which does not have a staff surgeon in house or surgeons are not always in the ed. many lifesaving surgical procedures are perfromed in the ed by em physicians including thoracostomies and thoracotomies pericardiocentesis and other procedures as well. Yes, em doc's are not surgeons, but speaking for myself, I don't want to be one either.
DRC
By the way, em doc's know how to interpret lab data and x-rays as well. That is not solely the domian of the trauma doc.

 

[Z]

Sorry for any misunderstandings caused by my last post. I did not mean to imply that ER physicians are not capable or not competent to interpret lab or radiographic information, and for this I am sorry. I did say that ER physicians are key members of a good trauma team in that they assist with the initial stabilization of trauma patients (implying ER thoracotomies, chest tubes, etc) although I did not explicitly state these examples.

In a level 1 trauma center a staff surgeon must be in house while on call. This is by mandate of the American College of Surgeon's Committee on Trauma which accredits trauma centers accross the country. It is true that they are not required to be in house for Level 2 and lower trauma centers. However, I would venture to say that if a surgeon is not immediately available, an ER thoracotmy will be of only academic importance no matter who performs it.

Anyway, I still think that one should consider the potential negative consequences of going the DO route, including a more difficult time getting into a good surgery residency with good chances of obtaining a fellowship position, if one wants to be a trauma surgeon. I do not want to open the debate as to whether DO's are capable of being good surgeons. All I am saying is that, whether deserved or not, there is inertia in the surgical community that a DO must overcome. It would be easier to go the route most traveled, in this case MD school, in order to pursue a career in trauma surgery.

 

[jdaasbo]

Hmm,

As a third year med student who just finished his trauma/gen surgery rotation at a level one trauma center, I will throw my two cents in.

1) all level one trauma centers are different. At the one I was at, the Trauma Team ran all trauma patients. When EM was involved it was to manage the airway, and then with Anesthesiology backup standing in the corner usually.

2) Most trauma surgeons have not done trauma fellowships. This is changing I suspect, and it is probably the case that at level one centers most of the trauma surgeons are so by fellowship. At the one I was at, there was only one (out of seven) who was not. Moreover Trauma is not yet a specialty with a credentialling system yet. There is no way to be "boarded" in trauma surgery. Most trauma fellowships thus pair the trauma training with critical care med. Thus you become boarded in critical care medicine. At the hospital I was at the trauma department ran the SICU.

3) At the hospital I was at all the trauma surgeons were MDs. However the trauma fellow was a DO. Moreover he, untill his fellowship, had done all of his training at an osteopathic institution. Obviously no one had a problem with this.

4) You will get a trauma fellowship if you have the goods and qualifications to back it up. It does not matter if you have an MD or a DO. You just have to realize that these are very competitive fields and that you have to kick as no matter what degree you have.

Johan
M3 CCOM