Category Archives: Medical Residency

Osteopathic Medicine: The DO Degree

There are a variety of paths to practicing medicine, and an alternative route to the MD (Doctor of Medicine) degree offered by traditional “allopathic” medical schools is the DO (Doctor of Osteopathic) degree offered by “osteopathic” medical schools. Over recent years, there has been a boom in the number of osteopathic schools and graduates, largely stimulated by the shortage of primary care physicians.  As a result of baby boomers becoming eligible for Medicare, combined with the increased patient population under the Affordable Care Act, the country is expected to face a shortage of 45,000 primary care doctors and 46,100 surgeons and specialists by 2020.  60% of DO-trained physicians enter primary care, compared to 30% of MD graduates.

A principal difference in the two approaches is that MD programs offer the traditional approach of Western medicine, whereas the DO philosophy is more holistic. DO medicine believes in the unity of the body, the impact of lifestyle and environmental factors on health, and the potential of the body to self-heal.

DO doctors practice primary care to a greater degree than MDs, including the specialties of internal medicine, family medicine and pediatrics, and help fill physician shortages in these fields.  Many DO programs also have an added mission of providing doctors to underserved populations (poorer neighborhoods and towns that have doctor shortages). For example, Touro’s Osteopathic Program is located in Harlem.

How are DO and MD Doctors Similar?
  • Attend 4-year medical school
  • Complete specialty training through internships, residencies, and fellowships
  • Require licenses from state medical specialty boards to practice
  • Can practice in all 50 states in any specialty and provide all medical services
  • May prescribe medications as appropriate
How are Osteopathic Students Unique?

According to Steve Toplan, Director of Admissions at Touro College of Osteopathic Medicine, “The biggest difference [between MD and DO programs] is the fact that in the OM realm, students are taught osteopathic muscle manipulation (OMM). Other than that, the medical school curriculum is virtually the same.”

Interestingly, while OMM is the big differentiator between MD and DO training, “only 5% of DOs use hands-on techniques; mostly it’s in their heads in terms of the philosophy of how the body fully integrates,” said Brooke Birdsong, Associate Director of Admissions at Kansas City College of Osteopathic Medicine,.

Why Pursue a DO Degree?

There are several reasons why students may choose to pursue a DO degree.

Some students may feel that the holistic philosophy is more aligned with their values regarding medical care. Dr. Jennifer Caudle, DO and Associate Professor at Rowan University School of Osteopathic Medicine, says that she was drawn to its “mind-body-spirit whole-body approach to medicine.” In addition, she felt that historically DO schools were more open to non-traditional applicants, as well as a more diverse pool, noting that “DOs were some of the earliest institutions that accepted women and people of color.”

Others are drawn to the “hands-on” osteopathic manipulation approach.  David Abend, DO, has had his own private practice for almost a decade. He began in primary care and now exclusively practices OMM because “I enjoy using my hands.”  He treats a variety of physical ailments beyond neck and back pain, which is the traditional application. He also treats “arthritis, headaches, fibromyalgia, babies born with misshapen heads, patients with CP, Down Palsy, even reflux.”

Finally, DO programs are typically less selective than MD programs, so students who are not as competitive a candidate for MD admissions in terms of GPA and MCAT scores, or extracurricular activities, may benefit from the higher admit rate of most DO programs.

For example, Ben Kramer, a DO student at New York Institute of Technology College of Osteopathic Medicine, was always motivated to become a doctor, but did not realize how important it was to pursue medically-related activities during college, such as research, in order to be a competitive MD applicant. He spent the year after college as a scribe in the Emergency Department of a hospital, which provided patient contact and shadowing. He is now thriving at NYIT, and seeks to become a cardio-thoracic surgeon.

DO Programs MD Programs
2014 Mean GPA 3.45 3.69
2014 Median MCAT Score 26 31.4
2016 Mean GPA 3.45 3.7
2016 Median MCAT Score 499.32 508.7
2017 Mean GPA 3.45 3.71
2017 Median MCAT Score 501.1 510.4

Finally, cost may be another factor to consider. For the 2017-2018 school year, the majority of private medical schools charged more than $50,000 in tuition and fees (U.S. News). In contrast, 7 of the 10 least expensive private medical schools are osteopathic schools.

What is the Availability of DO Medical Colleges?

There has been a significant increase in the numbers of osteopathic medical colleges (from 5 in 1968 to 34 in 2018), as well as the numbers of osteopathic graduates (increasing from 971 in 1978 to 6,015 in 2017). This compares with 141 accredited MD schools and 89,904 MD graduates in 2017. For example, New York State has two osteopathic medical colleges:  New York Institute of Technology and Touro, compared with 14 allopathic medical schools, including Columbia, NYU, and Weil Cornell.

 

Changes Ahead in Residency Matching

After graduating from medical school (either with an MD or DO degree), the next step in medical education is to participate in a residency program to obtain clinical experience. The process of applying for a spot occurs through a “matching” system in which students and programs rank each other, and are then matched by an algorithm. Up until now, there have been two separate processes for MDs and DOs.

DO students have the option of participating in the AOA Match (matching program for osteopathic students), the NRMP Match (National Resident Matching Program for allopathic students), or both matches. The AOA Match takes place earlier than the NRMP Match, which currently can create a dilemma for students who wish to participate in both.

But in 2014, the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM) announced that they would create a single graduate medical education accreditation system that would integrate all allopathic and osteopathic residencies under a single authority by 2020. Once finished, it will streamline applying to all residencies for DO applicants.

According to Thomas J. Mohr, MS, DO, trustee for the Association of Osteopathic Directors and Medical Educators (AODME), “If your top choice is in the NRMP Match and your next three choices are in the AOA Match, you have a bit of a dilemma. If you match with an AOA program, you will be removed from the NRMP and have no shot at your top choice. But, if you don’t enter the AOA Match and don’t get your top choice in the NRMP, you have lost the opportunity for your back-up selection. This will no longer be an issue once all programs have transitioned to the ACGME.”

The participation of DO students in the NRMP residency match program has increased by 68.6% from 2014 to 2018. In 2016, 99.61% of DO graduates seeking graduate medical education (GME) achieved a residency position. 4.33% attained a Military Match, 48.97% received an AOA Match, and 45.84% were awarded an NRMP Match.

Which Path is Best for You?

 It all depends! If you are passionate about primary care and think the osteopathic approach to medicine could be an asset to your education, a DO program could be the right fit for you.

According to Alan Stricoff, DO FACP, Cigna Medical Director for Onsite Health, “If want to become a highly competitive specialist, like an ophthalmologist, dermatologist, or specialty surgeon, the path is easier from a good MD program. However, if you are interested in primary care, there is no difference, and you may even be better off coming from a DO program, because of the focus on primary care.”

Navigating the many tracks to medical school can be daunting, but here at Collegiate Gateway, we are happy to help you in finding the best path to reaching your goals. Feel free to contact us!

The Clinical Years of Med School: What to Expect

Once medical students complete their time in the classroom, they move on to what many consider to be the real reason they went to med school in the first place: treating patients. This transition usually occurs during the second or third year depending on the length of a school’s pre-clinical curriculum, and is comprised of clerkships, selectives, electives, sub-internships, away rotations, and various other scholarly pursuits. If you are considering medical school, here is an overview of the opportunities and experiences during these clinical years.

Clerkships, Selectives and Electives

The core clerkships beginning in the second or third year of medical school are mandatory for all students. They typically include rotations through some variation of the following: neurology, internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery. Each core clerkship lasts several weeks, with many schools also mandating a certain number of selectives interspersed throughout.

A selective will be in a more specialized area as compared to the more general core clerkships. Georgetown University School of Medicine offers a multitude of selectives ranging from anesthesia to child psychiatry. Schools also require a certain amount of elective time, which can span a variety of areas. Thus, even in the universal core clerkships, there is still substantial room for personalization during the clinical years.

Sub-Internships

During a sub-internship, the medical student assumes even more responsibility than he or she would during a clerkship or elective. According to Dartmouth Geisel School of Medicine, the level of clinical responsibility expected during a sub-internship is comparable to that of an intern (someone who already graduated medical school). Students typically choose their sub-internship in an area that they are considering applying to for residency.

Away Rotations

Away rotations provide a unique opportunity for fourth year medical students to explore residency opportunities at other institutions. To streamline the process of applying, there is a universal application through the AAMC, known as VSAS. However, policies vary by school so it is important to carefully research the specific program you are planning on applying to. Pritzker School of Medicine explains that some specialties, such as dermatology and emergency medicine, essentially require students to complete away rotations before applying for residency.

Other Opportunities

There are a number of additional opportunities available to medical students during their clinical years. Many schools offer a focused, in-depth experience in a specific area of interest. Several medical programs, such as Weill Cornell Medical College, Alpert Medical School, and Columbia University’s Vagelos College of Physicians and Surgeons offer a scholarly concentration program, which allows students to participate in an in-depth study of a particular area of medical practice or research under the mentorship of faculty. Certain schools, such as Duke University School of Medicine, dedicate an entire year to scholarly research.

Another important element of these years is dedicating sufficient time to prepare for the United States Medical Licensing Examinations (USMLE) Step 1 and Step 2. However, it should be noted that the timing of these exams varies widely among different medical schools.

The clinical years of medical school are fundamental in shaping students’ future paths. During this time, students gain in-depth clinical experience while pursuing scholarly endeavors and delving deeper into their individual interests. It is essential to carefully compare the curricula of various medical schools so that you ultimately attend one that is compatible with your future goals.

For guidance on navigating the medical school application process, feel free to contact us. As always at Collegiate Gateway, we’re happy to help!

The Three-Year MD Program

The three-year medical school program is a fairly new development in medical education. And while there are many benefits to pursing these accelerated programs, but they’re not for everyone. In this blog, we will take an in-depth look at three-year MD program requirements and formats, as well as which schools currently offer this alternative, in order to determine which students it serves best.

What are Three-Year MD Programs?

Three-year MD programs satisfy a demand for shorter medical school programs. They save the student a year of tuition and living expenses (as well as a year with no income), and the student is often guaranteed a spot in a specialized residency. The education and training to become a doctor can often take up to a decade, and so taking a year off of this process is very alluring to some students.

According to the Washington Post, “Some medical school administrators and policymakers see three-year programs as a way to produce physicians, particularly primary-care doctors, faster as the new health-care law funnels millions of previously uninsured patients into the medical system.” And given that specialists are now making double the income of primary care doctors, primary care physicians are at a particular shortage.

With four-year medical programs, the last year is focused on electives and the process of securing a residency position. But there is some debate as to the value of this final year. According to Ezekial Emanuel and Victor Fuchs, writing in the Journal of American Medicine Association, “Years of [medical school] training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care.”

Which Schools Currently Offer 3-Year MD Programs?

At present, there are very few opportunities to pursue a 3-year MD program. Of all the options, NYU offers the broadest program. Most others are limited to primary care or family medicine, and some carry an obligation to practice within the state.

Students must choose their residency of interest prior to application to the 3YMD Pathway. For the Class of 2018, there are 34 positions, across 20 residency programs. Students can apply at the time of acceptance or in February of their freshman year. The Three-Year Pathway program starts six weeks before the Four-Year Pathway program, and students work in a summer fellowship between their first and second year. Students can transfer to Four-Year MD pathway, if necessary, due to residency change or otherwise. The graphic below gives a detailed summary of the timeline differences between the 3-Year and 4-Year MD Pathway programs.

Three-Year MD Pathway

Screen Shot 2016-02-24 at 12.14.10 PM

Four-Year MD Pathway

Screen Shot 2016-02-24 at 12.15.28 PM

 

FMAT’s goal is to prepare primary care physicians more efficiently with lower cost. This program culminates in the M.D. degree and leads to a standard three-year family medicine residency at one of three Texas Tech programs, in Lubbock, Amarillo, or the Permian Basin. FMAT is limited to 16 students per year in each class. Students may apply for the FMAT program when they apply for admission or during the fall semester of the MS1 year. Tech School of Medicine provides scholarship support to FMAT students for at least one year of medical school. Students may choose to return to the regular four-year program at any time. However, any FMAT scholarship support will revert to loan status and must be repaid.

  • UC-Davis, School of Medicine: ACE-PC

This program is only for students committed to careers in primary care. ACE-PC students start working in Kaiser Permanente primary care clinics within the first few weeks of starting the program and continue in these clinics for three years. Unique curricular content includes population management, chronic disease management, quality improvement, patient safety, team-based care and preventive health skills with special emphasis on diverse and underserved populations. ACE-PC is limited to six students and classes begin in June. Students can apply for the program during the secondary application, and may choose to return to the four-year program at any time.

This program is only for students interested in practicing Family Medicine who have a strong desire to remain in Georgia. Students apply during the Spring of Year 1 and may opt to return to the four-year program at any time. The curriculum is very similar to their four-year MD program, but is compressed into 131 weeks of instructional time and offers more educational contact opportunities between students and the Family Medicine faculty.

Columbia’s accelerated program is only open to students who have already earned a PhD in biological sciences and intend to pursue biomedical research as a physician scientist. To this end, applicants are restricted to studying cognitive specialties, such as internal medicine, pediatrics, neurology, psychiatry, or pathology. You can apply for this program when you receive the secondary in the regular medical school application process. The program is divided into preclinical courses (18 Months), major clinical year (12 Months), and subinternship and electives (6 Months). Students begin in August of their first year and finish in May of their third year, working over the summers.

PCSP students must commit to complete a residency in family medicine or general internal medicine, and practice primary care medicine for a minimum of five years upon completion of residency. If a student does not fulfill these requirements, they will be asked to return the scholarship award (one year of medical school tuition). There are about 12 positions available in this program each year. Students complete all courses and learning modules required in the first two years of preclinical education in 18 months, as well as several courses during the summer months. Students participate in a sub-internship at the hospital where they will continue their clinical training after graduation. In addition to saving the student from paying for the fourth year of medical school, this program includes a scholarship for the third year of medical school.

In Conclusion…

Accelerated three-year medical school programs are often geared towards careers in primary care, but have the opportunity to expand to more specialties (as at NYU) as they experience increasing success. The shortened programs are extremely academically rigorous, and if students are not meeting academic benchmarks, they are transferred back to the four-year program.

Three-year medical programs mark a specialized pathway of study for those students who are already committed to the type of doctor they wish to become and who are willing to work at an advanced pace to opt out of a year of medical school. Nevertheless it is important to weigh the pros and cons of these programs in order to determine whether or not they might be right for you. Pros of the three-year program include lower costs, practicing medicine a year earlier, and knowing where your residency will take place from the start. Cons include less time off for vacation and test prep, committing to one specialty before gaining experience in medical school, and losing out on a fourth year of consolidated learning.

In the New England Journal of Medicine, Dr. Stanley Goldfarb and Dr. Gail Morrison argue that the fourth year of medical school is a valuable year that should be enhanced with more intense clinical training in outpatient and inpatient settings, as well as increased advising and mentoring, creating a better transition to residency.

“There may be exceptional students capable of accelerated learning and small programs that create unusual opportunities for such students, but we believe that for the typical student seeking an M.D. degree, the duration of medical school should not be shortened.”

Graduate medical study offers many options, and Collegiate Gateway has extensive experience in understanding and weighing the pros and cons of medical training opportunities. Feel free to contact us to find out more!

Trends in Residency Matching for 2015

 

matchday7

Earlier this month, hopeful and anxious medical school students gathered at Match Day ceremonies across the country. Match Day, an annual rite of passage for budding physicians, is the day students learn which U.S. residency programs at which they will train for the next three to seven years.

This year was record setting in several respects and, as usual, Collegiate Gateway is here to bring you the most important trends and developments.

More people, more positions

The National Resident Matching Program (NRMP) recently announced that 2015 is the largest Main Residency Match in NRMP history. This year included 41,334 total registrants, the largest number on record. This growth in the number of U.S. seniors is attributable to rising medical school enrollments and the development of new medical schools across the country. In keeping, more than 30,000 total positions were offered in 2015, another record high.

MRM-2015-Largest-in-History-Infographic-with-photos

Good News for US Graduates

Of this year’s 18,025 U.S. allopathic seniors participating in the match, 16,932 were matched to first-year positions, achieving an overall match rate of 93.9 percent. Of those, 51.6 percent matched to their first choice for training. In addition, 2,949 osteopathic students and graduates submitted program preferences, an increase of more than 200. Their match rate rose to 79.3 percent – another record high.

Osteopathic medicine is very similar to the traditional allopathic approach, but with a greater emphasis on hands-on physical diagnosis techniques, as well as a more personal, holistic approach. In the past, there had been distinct accreditations for allopathic (MD) and osteopathic (DO) residency programs. However, in February 2014, the accrediting agencies decided on a single system for residencies and fellowships to begin in 2015 and be fully implemented by 2020. Keep an eye out for our upcoming blog that will delve deeper into the similarities and differences between MD and DO training.

According to a recent report in Slate, the outlook is also good for those who have not, unfortunately, been matched:

“Although failure to match is chastening, U.S. graduates have an excellent chance at finding a program the next year. In the meantime, many of them get a master’s degree, or they teach or work in a laboratory to strengthen their applications. If they decide not to pursue a residency, it’s almost always by choice. Despite the pressure of Match Day, life is pretty forgiving to U.S. medical school graduates.”

Another option for unmatched applicants is the Supplemental Offer and Acceptance Program (SOAP), during which unfilled positions are made available to unmatched applicants. In fact, there were 1,193 unfilled positions offered during the 2015 SOAP.

For Internationals, Challenges Remain

In keeping with previous years, however, graduates of foreign medical schools have a more difficult time matching. This year, 12,380 doctors attempted to match from medical schools outside the United States. Only 6,301 were successful, yielding an approximately 50 percent acceptance rate. Though low compared to the numbers for U.S. medical school graduates, 50 percent is actually a somewhat inflated statistic; these students often apply for programs such as family medicine that generally have difficulty filling their many available positions.

Couples matching

The NRMP allows those with spouses, partners, and significant others, to participate in the Match as a couple: any two candidates can link their preference lists together in the hopes of being paired to the same or nearby programs. An all-time high of 1,035 couples participated in the Match – 110 more than last year – with a 94.8 percent match rate.

Trends in Specialties

Over the next decade, the AAMC predicts that the US will face a shortage of as many as 90,000 doctors. As such, efforts to expand residency positions are common, with particularly high growth in several key areas. Notably, nearly 60% of all new positions were attributable to primary care, an area particularly in need of new doctors.

 

Specialty                     Total positions             New positions           % Filled

Internal Medicine 6,770 246 98.9
Family Medicine 3,195 86 95.1
Pediatrics 2,668 28 99.5

 Some of the most competitive specialty areas included the following, which filled 100% of available first-year positions:

  • Dermatology
  • Medicine-Psychiatry
  • Obstetrics and Gynecology
  • Orthopedic Surgery
  • Pediatrics-Primary Care
  • Physical Medicine/Rehabilitation
  • Thoracic Surgery

Additionally, General Surgery, Neurological Surgery, Otolaryngology, Plastic Surgery, and Radiation Oncology had fewer than 5 unfilled positions remaining after the matching algorithm was processed. Watch for our upcoming blog on the differences between various specialty residency programs.

The road to becoming a doctor is a long and complex one. For more information on the residency match process, or any other part of the process, contact Collegiate Gateway – as always, we’re happy to help.