FMG, but US Citizen…what are my chances?

FMG-US citizens are statistically favored over non-US citizens.

(One of my readers brought up a good point (thank you!) regarding this subject a while ago, so I decided to shed some light on this topic.)

Now that medical school admissions is becoming really competitive, the recent trend is that pre-medical students apply to the Carribbean or other foreign medical schools.  At the end of their education, they will be awarded an MD degree.

While it is true that DO applicants fare better in the US Allopathic Residency Match than foreign medical graduates (FMGs), FMGs who are US citizens fare better than those FMGs who are not.  There are two reasons why this happens, that I can think of:

1. US residency directors know how competitive it is becoming to obtain admission to US medical schools.  At the same time, these foreign medical schools are churning out more doctors over the years, and becoming more well established.   So, these residency directors are probably considering that there are more well qualified applicants than there are medical school spots within the US, and with the rising quality of certain foreign medical schools, it could be plausible to give these new FMG-US citizens a shot.

2. The second reason why FMG-US citizens fare better than non-US citizens could be because there is a higher chance that a US citizen will continue to stay in the US and practice, rather than returning to his/her native country permanently.  This helps increase the population of doctors in America, where we are currently experiencing a shortage of physicians.

This will conclude my MD/DO posts, unless readers have questions/comments for which I will compile additional posts.  Thanks for reading!

Foreign M.D. vs. U.S. D.O.

So, you’d rather have a foreign MD than a US DO degree? Welcome to Slaughter House VI.

Many pre-medical students who are re-thinking their chances at a US allopathic medical school think that it’s better to have an MD from elsewhere in the world, than have a D.O. from an osteopathic medical school in the United States.

This argument is completely true if you’d rather practice medicine outside the United States. Since the U.S. osteopathic degree is not 100% universally recognized, you may fare better by attending a foreign allopathic medical school to receive your MD. However, as we shall soon see, the odds of matching into a United States residency program as a foreign medical medical graduate is like going through a slaughter house – it becomes exceedingly competitive.

If you wish to practice in the United States, I strongly believe that a US Osteopathic degree holder will fare much better in the residency matching process than a foreign MD degree holder. I will provide hard evidence for this a little further down. But first, let’s consider some general information:

Here’s a general overview.

First of all, there are allopathic and osteopathic residencies. MDs can only match into the allopathic residencies, but DOs (licensed in the United States) are given the opportunity to enroll in both, the allopathic and osteopathic residency matches.

There are many more MD residency spots than there are US MD graduates. This means that these spots can be filled by other qualified medical graduates. Since the US DO graduates are granted a United States medical license that is grants them equal practicing rights as MDs under US law, these graduates are given more preference than a foreign MD graduate in the allopathic residency match process. For more competitive specialties, these programs are more likely to pick US graduates than foreign medical graduates (FMG). So, as a general rule of thumb, here’s the order of preference for allopathic residencies: MD>DO>FMG. Once again, this order of preference does not speak of the extent of qualification or the capability of the graduate to practice medicine. That is, I’m not saying MDs are better than DOs, who are in turn better than FMGs. What I’m trying to convey is that this is the general rule of thumb in terms of preference of the admissions committees for residency spots.

Still not convinced that it is better to apply to allopathic residencies with a DO degree than a foreign MD degree?

Don’t just take my word on it. I’ll show you some facts – facts that may seem misleading at first, but upon closer inspection, the staggering truth is revealed.

Here are the results and data of the 2008 NRMP Residency Match. Scroll down to page 5, and you’ll see into which specialties various medical school graduates matched. The total number of PGY-1 (Post graduate year 1, which is just a fancy name for first year of residency) positions available was 22, 240, out of which 20, 940 were filled. Out of these 20,940 who matched, 14,880 were US MD graduates (14,359 US MD seniors who applied during their 4th year of medical school + 521 US MD graduates who graduated medical school and then applied to residency). So, approximately 71% of the filled residency spots were US MD graduates. This provides evidence to the claim that US MD seniors fill up most of the MD residency spots. There are several reasons for this, including that there are many more US MD graduates who apply (compared to US DO and FMG MD), osteopathic graduates are lesser in number than US MD graduates, many osteopathic students elect to take osteopathic residencies, etc.

Now that we’ve established that US MD graduates occupy the majority of allopathic residency spots, let’s get to the heart of the argument: US DOs fare better when applying to US MD residencies, than FMG MDs. Initially looking at Page 5, you could say that more FMG MDs match than US DOs (1,649 FMG MDs, as opposed to only 1, 339 US DOs). These numbers are deceiving, because a lot more FMG MDs apply for residency positions than do US DOs.

Scroll down to Figure 2 on page 8. Here, you are given the number of active applicants to US allopathic residencies, and the percentage of those applicants who matched successfully, organized by the type of applicant. As shown in the dark green bar graphs, in 2008, roughly 70% of 1,870 DO degree holders matched into a US allopathic residency. However, when the light green bar graph is considered, we see that only a little more than 40% of 10,304 FMG MDs matched. So, even though 40% of 10,304 (FMG MD) is greater than 70% of 1,870 (DO) in terms of actual number of people matched, the odds of an FMG MD matching is MUCH lower than a US DO matching. A higher percentage of US DOs who apply get accepted, when compared to FMG MDs. So, your chances of getting into an allopathic residency as a US DO is much better than if you are an FMG MD. In essence, FMG MDs face slaughter in terms of competition involved in matching into an allopathic residency.

With a US DO, you have a better chance of becoming a fully licensed doctor trained in an allopathic residency. Remember, DOs have their own residency match, so as a US DO, you have the additional opportunity of having more spots available to you.

The DO degree is equal under US law to an MD, and as a matter of fact, MDs and DOs have the same payroll code in hospitals – meaning that they are considered equal in clinical practice.

The MD vs. DO War (Part II)

 Continued from Part I…

More common misconceptions of the osteopathic profession answered below.  Before you continue, please make sure you have read the introduction and the “D.O. Stigma” section of The MD vs. DO War (Part I).

3. Osteopathic residencies are not as good as allopathic residencies, so these physicians don’t get trained as well as the allopathic student-doctors. 

Actually, there are some fantastic osteopathic hospitals across the country.  Osteopathic physicians do get trained well.  It may seem as though allopathic students get better training, because they tend to specialize more than their osteopathic counterparts.  Most DOs become primary care physicians, although a good portion go on to surgery and other specialties. DO schools train students to look at medicine from a primary care perspective, so they naturally have the majority of their students entering primary care.   Since most DOs go into primary care, one could easily say that allopathic physicians are better.  However, DOs training in osteopathic primary care residencies get comparable training to MDs in the same field.  Yes, some hospitals get better funding and resources, but so many other factors must be compared while comparing residencies, including location of the hospital, the usual type of patients, whether or not it is affiliated with a medical school, etc.  So, instead of worrying about who is trained better, why don’t we worry about getting through medical school and residency, and make a name for ourselves?

4. The osteopathic medicine curriculum does not match up to their allopathic counterparts, so even the medical students only receive a mediocre medical education.

When I interviewed at the Chicago College of Osteopathic Medicine (CCOM) of Midwestern University, I heard that the head of the anatomy department of Northwestern University visited CCOM too, and concluded that CCOM’s anatomy curriculum was better and more rigorous than the one at Northwestern.  DO students get a solid education.  It may come as a surprise to you, but biochemistry, microbiology, physiology, anatomy, histology, and pharmacology don’t change from one school to another.  No matter where you study the basic sciences, it’s the same science that is taught.  I can assure you that no matter which medical school you attend, you will get your money’s worth of pain and misery for four years.

 

5. The osteopathic medical degree closes many doors in terms of residency and career options, so you can only go into primary care.

This is largely untrue.  Here are the facts:

a. While it is true that most DOs go into primary care, most of the DO graduates actually WANT to become primary care physicians.  Some of these graduates went to DO schools just for this purpose, and others have been trained for four years in a primary-care oriented philosophy.  So naturally, their interest in primary care isn’t unwarranted.

b. There are numerous specialty osteopathic residencies open to DO graduates, including orthopaedic surgery.  However, yes, it is true that there are a few specialties that osteopathic residencies do not provide, like Dermatology.  In these cases, DOs can apply for MD residencies, but they have to do as well as, or better than, MD graduates.

c. There are plenty of MD residency spots, far more than MD graduates.  Thus, these spots are opened up for DO applicants.  Still there will be more spots open, and these are opened up for foreign medical graduates.  For the most competitive allopathic residencies, including Radiology, Dermatology, Ophthalmology, and Orthopaedic surgery, it is true that DOs will have a hard time matching.  However, the harder you work, the better chance you will have.  Also, there are ortopaedic surgery residency spots in the osteopathic match too.  

If you rock the USMLE and score higher than an allopathic medical student, I’m sure the admissions committee won’t completely ignore your application – he/she will compare them closely.  It is not unheard of for a DO to match into a competitive allopathic residency.  When I shadowed the ER doc who was a DO in an allopathic med-school hospital, I also saw two surgery residents assigned to the ER surgical service who were DOs too.  And I know an MD radiologist who once told me that the most respect he has ever had for any one of his colleagues was a radiologist who was a DO. 

d. Currently, the DO “stigma” is fading.  Whichever hospital I go to, its not like the DOs are only allowed to practice medicine in a dark corner of the hospital.  They are doctors, and no one really cares what degree you have, as long as you know what you are doing.  Imagine you are a pre-med student now, just applying to medical school.  You are probably in your junior year.  That means, you have 2 more years of undergrad, 4 years of medical school, and 3-5 years of residency, and a possible fellowship.  Do you really think that in 10-12 years, the healthcare field will have the same dynamic it has today?  The US population is growing older.  And we need more doctors to care for these patients.  There’s a projected shortage of doctors in the near future, in numerous fields in medicine, one of them being primary care (there’s even a shortage now!)  That’s why allopathic and osteopathic schools are trying to open up more spots and new schools.  If we really are in need for doctors, I believe the DO stigma will cease to exist – we shouldnt be worried about what medical degree we hold, as long as we are fully trained physicians, licensed to practice medicine and surgery under United States law.

d. Conclusion: while it maybe harder for a DO to match into a competitive allopathic residency, there are still plenty of spots open in other allopathic and osteopathic residencies (and don’t forget that there are osteopathic residencies also!).  You will still make a great living and career as a doctor in another field – you don’t have to go into ortho or radiology.  But, as always, the harder you work, the more options you will have.  Study hard.

 

6. The DO degree isn’t internationally recognized, so if an osteopathic physician ever wants to work/volunteer in another country, his/her medical license will not be recognized, thereby barring him/her from providing health services.

Although the US DO degree is not fully recognized internationally, many countries of the world do allow the US D.O. a full scope of practice.  Yet, some countries still have not approved DOs from America because they have their own version of the D.O. degree – osteopaths in some countries only have limited practice eligibility and don’t receive the same training MD’s do.  However, since US D.O.s receive a full medical training comparable to that of M.D.s, many countries are now recognizing the degree.  Click the link below:

Countries that recognize the US D.O. degree

The MD vs. DO war (Part I)

First of all, before you read any further, I want you to understand that I do not intend on starting a flame war between MDs and DOs.  I also am NOT saying one degree is better than the other.  However, I do defend the D.O. degree because I believe that the whole debate between the two degrees is completely unwarranted.  I am solely trying to map out why this war exists, the arguments of each side, and why the whole debate is just useless.

 

The D.O. “Stigma”

The D.O., being a less common degree than the M.D., has a history of having to explain how it compares to the established standard of the M.D.  But, there are MANY myths floating around that I would try to shed some light on.  

Please take a moment to understand that the “stigma” mostly circulates among pre-medical students.  I have shadowed numerous physicians and have seen how MDs and DOs interact with eachother – seamlessly.  If they ever have problems with each other, it was because of personal reasons, not because they hated the other for having a different degree.  The majority of pre-medical students think that its somehow demeaning to have a DO degree, or even to apply to DO programs for medical school.  This sort of attitude completely limits the options that pre-medical students have in terms of career choices.  While the pool of allopathic medical school applicants is expanding, the number of available spots is increasing at a much slower rate.  It is true that medical schools are trying to open up more spots in their classes, and a few new medical schools are being introduced, but not fast enough.  Thus, the allopathic medschool process is still highly competitive.  I have heard of people with stellar MCAT scores and GPAs not even getting any interviews!  I’m 100% positive you have heard of these stories.  The 2008 application cycle for allopathic schools had a larger number of applicants than ever before, for a limited number of seats.

What does this all mean? This means that you are limiting yourself if you only apply to allopathic medical schools.  If you apply to DO schools too, you increase your chances of getting into medical school and becoming a physician.  Otherwise, you will lose a year or more, and continue to throw thousands of dollars into the application process.  Remember, each year you postpone being a physician, you lose a year’s worth of chances to help sick people get better, and you lose a year’s worth of income as the highest possible position you will reach in your career.  Some people even elect to enroll in foreign MD schools than do US DO schools (more on this later).  As my mentor during my undergraduate years said (who, by the way, was the director of pediatric ER medicine), you need to think creatively and be open minded while applying to medical school. If your dream is to be a physician, you will make it happen, regardless of what medical degree you get.  So, bottom line, don’t limit yourself by applying to only MD schools – DO schools have an incredible potential to give you more than a solid education.

Below are some common arguments/myths that contribute to the perceived stigma of the DO degree.  I have taken the liberty to comment on each of the presented points, hoping to erase whatever stigma you may have about the osteopathic medical profession.

1a. The standards for admission into D.O. programs are much lower (lower average MCAT and lower average GPA), and thus, the holders of the degree are inferior (or somehow intellectually subordinate) when compared to MDs.  

Yes, it is absolutely true that the average MCAT and GPA of those who apply to, and those who are accepted into, osteopathic medical programs are lower than the averages of the MD programs in the United States.  But, there are several reasons for this.  For one, osteopathic medial programs have a history of accepting non-traditional students.  Many students who pursue the DO degree graduated from college many, many years ago, and while their undergraduate stats and numbers may not have been very good, their graduate studies and life experiences thereafter surely have shaped them into entities that are fully capable of learning medicine, thereby giving them the potential to become fantastic doctors.  Osteopathic programs recognize these qualities in non-traditional students, and since the degree has existed for hundreds of years, it seems to me that the DO admissions committees know what they’re doing.

Secondly, the admissions committees stick true to the DO philosophy when choosing students to enter their programs.  If you read my previous post, you will immediately catch on.  Part of the DO philosophy is that the disease or condition should not be viewed in its own right – it has to be seen from multiple angles to provide the best treatment possible – this means that different factors that have contributed to the ailment needs to be addressed to assess the situation, instead of just concentrating on the condition itself.  The admissions committees don’t just consider the GPA and MCAT of an applicant and move on.  They look at why the GPA/MCAT scores were low, what circumstances the applicant was in during their undergraduate career, how they have picked themselves up after a fall, and how their other life experiences have contributed to their potential for medicine.  So, the adcoms (admission committees) consider the applicant from multiple angles, and then proceed to evaluate their candidacy for their program.  From this line of reasoning, it is easy to see that many people with high GPAs and MCATs are turned down by DO programs – either because all they basically comprised of is their own numbers, or because these students applied to DO programs just as “backups,” in case they don’t get accepted into allopathic programs.  Thus, here is another reason why DO schools have lower GPA/MCAT averages.

Now, let’s consider the second part of statement 1a.  What does admission standards and average undergraduate GPAs have to do with medical graduates being inferior when compared to another?  D.O. schools provide a full medical education to their students, comparable to MD schools.  Even though the applicants to DO schools have lower admission stats, yet their circumstances are understood, and their potential for medicine has been approved, then why even feel the need to establish which degree is superior to the other?  It maybe true that some MD schools have a better reputation for training doctors, when compared to some DO schools. However, this difference exists among MD schools too.  While both, Wash U-St. Louis and Drexel, are fully accredited allopathic schools, most people will say that Wash-U provides better training.  However, both schools graduate doctors.  The type of doctor they become is completely up to each graduate, independent of the school they train at.  Some DO schools, such as Chicago college of osteopathic medicine and Philadelphia College of Osteopathic medicine, are surely comparable to MD schools, and even surpass the training offered by many MD programs.  So, instead of comparing MD schools to DO schools, it’s more productive to discuss which schools offer better program.  At the end of four years, regardless of MD or DO, you will be called a doctor.  Whether or not you are inferior to the MD or DO doctor next to you, is entirely up to you – how much you know, how hard you have worked, how dedicated you are, and how you have used your education to further your understanding of medicine.  Just because someone calls you inferior for going to a DO school doesn’t really make you inferior.  If anything, it makes the other person just a tad bit ignorant.

 

1b. Since the standards of admission are lower, the people who apply to osteopathic (DO) programs are not as “smart” as allopathic (MD) hopefuls.  Thus, allopathic physicians/students are smarter and more well versed than osteopathic physicians/students.

I shadowed a chief resident at a large city-based allopathic university medical center emergency room.  Guess what? He was a DO.  He went to an osteopathic medical program, took the COMLEX (Comprehensive Osteopathic Medical Licensing Examination) to graduate with a DO degree.  In addition, he took the USMLE (United States Medical Licensing Examination, for allopathic, or MD, graduates), passed it with flying colors, applied to an allopathic Emergency Medicine residency, and got in.  Other MDs in the ER treated him just the same as they treated each other, and the attendings just saw him as a resident, not as a mutant MD who has a DO degree.  What does all of this mean? 

It means that osteopathic graduates are equally as capable as allopathic graduates.  Your career doesn’t fully  depend on what school you go to.  It matters more what YOU can make of yourself in medical school and in residency.  You could go to an allopathic medical school, slack through your four years, graduate in the bottom quarter of your class, and end up by default in some residency program that you are not even interested in.  You stole residency options from yourself.  Now take the DO student who graduated in the top 25% of her class, interviewed at multiple residency programs, and has options in residency training.  Which one would you rather be?  It doesn’t matter which school you go to – it matters what you do with the time you’re given.  Study hard, and regardless of your MD or DO school, you will go places.  The “smart” one is the one that values hard work, not the one who goes to one school over another.

Oh, and the current head (the last time I checked) of the ICU at Rush University Medical Center, a large and prestigious medical school and city-based hospital is a D.O.  

 

Continued in The MD vs. DO war (Part II)

The D.O. Degree

What is the D.O. degree?

In the United States, there are two medical degrees that are considered equal under law.  That is, people who have received training in either degree are licensed to practice medicine to the fullest extent of the law.  These degrees are the M.D. and D.O.  The M.D. degree is the most common one that people have heard about.  Less common is the D.O. degree.

What does D.O. stand for?  D.O. = Doctor of Osteopathy, or Doctor of Osteopathic medicine.  The primary difference between the M.D. and D.O. degrees is that the D.O. degree strives to incorporate various factors of the patient’s life into his/her present ailment, rather than solely concentrate on the actual ailment itself.  Osteopathic medicine has a history of focused study in the structure and function of the human anatomy, and how one influences the other.  This additional concentration of musculoskeletal correlation (that is, in addition to learning all the other aspects of medicine) is the basis on which osteopathic manipulative medicne (OMM) exists.  Osteopathic students receive training in being able to use their hands to physically manipulate the patient’s body from the outside to diagnose and treat pain or ailments.  Thus, while MD’s and DO’s are fully licensed to practice medicine and surgery, DO’s actually have more training than MD’s.  In addition, they are trained to see the patient’s current condition as a conglomerate of numerous factors, rather than just the disease alone.  

This is a very brief overview of what my understanding of the osteopathic degree is.  For more information, please visit www.aacom.org.  Here, you will find more information about the degree, the programs available, and information about the application process and requirements.

 

Coming up next: The battle between MDs and DOs