Monday, November 9, 2015

MiM Mail: DO or MD school and motherhood

Dear Mothers in Medicine,

First of all, thank you for being so helpful and encouraging. When trying to decide whether or not to pursue medicine, I read just about every post and every comment on here! Now I am writing to pick your brains about MD/DO. There is a lot of information out there on the residency "merger," and the differences and similarities of the MD and DO approach.

However, I am writing to you because I want to know how getting a DO degree over an MD degree might impact my future specifically as a mother.

Right now I can either apply DO this cycle (the application season is longer) and start school in the Fall of 2016 or wait to apply next year to MD and DO programs and have more options, but start in the Fall of 2017. I am already 27, so starting sooner is very appealing to me, but I don't know how much my age should matter. Either way we will be having children while I am in medical school and residency.

Although I am pretty set on primary care, I worry that I could be wrong. Two years ago when I started this journey, I didn't think I really liked science --- I thought I just needed to get thru the pre-reqs so I could go into pediatrics or FM to provide care to rural and underserved communities. Turns out though, I LOVE science. For a few good hours I considered pursuing a PhD in biochemistry instead of medical school.

Now there is a small part of me that wants to keep my options open incase I fall in love with a specialty I don't even know exists yet, or if I decide to do research. But this --- always wanting to keep all my options open for as long as possible --- is one of my weaknesses and I don't know how much to indulge that part of me!

From reading all the posts on here that mention osteopathic medicine, it seems like a few regret their decision to go DO (momstinfoilhat and RH+) while a few (mostly students) left more positive comments. RH+ wrote in 2008:

"Don’t become a D.O. Right now you are sure that you are going to practice rural family medicine, this will change when you start rotating through different specialties. You are being told that being a D.O. will not affect your ability to get into residency. This is not true. You will seek to match in a competitive specialty, and it will be harder for you to get a spot. It will also make it harder to get a fellowship."

But, this was back in 2008. So I don't know if it is still true? I also saw someone mention that DOs have to do more away rotations in their third year than MDs? With the young children we hope to have, this could be frustrating.

A few physicians on here have mentioned taking time off to care for a newborn and doing research during their time off. Is this an option that is available to DOs? I ask because I haven't heard of any DOs doing it, but I like the flexibility that idea offers.

So, all this to ask, if going the DO route limits our choices later (in terms of a research year to care for a new baby or options for residency locations or job locations... which could limit access to family support), then maybe I should wait the extra year and try for MD while also applying to DO schools?

To those on hiring committees (MD and DO), have you or your colleagues ever passed over DO applicants in favor of MD applicants?

To DOs who are doing their residencies and DOs who are working: Did you feel limited in the match or when applying to jobs? Do you regret your decision to go DO? Do you feel like you have had to work harder to prove yourself as competent as those with MD degrees? Did you feel like your clinical training (years 3+4) was as strong? Can you think of any unexpected ways being a DO might have influenced you and your families lives?

Thank you so, so much for taking the time to read this. I really appreciate any help and advice you can share.

All the best,
Confused pre-med and pre-mom


  1. I would say that if you want to have your options as open as possible, then go for the M.D. There are some specialities at some universities that will favor an M.D. over a D.O. because D.O. schools can be viewed as less competitive. Obviously, there are plenty of superb D.O.s AND M.Ds, but it's all about perception. The residency/fellowship directors and powers that be tend to be older, and thus may have a more "traditionalist" view about M.D. vs D.O.

    As a physician scientist, I would say that doing bench research with a newborn is challenging. When I had my baby, I already had an established scientific foundation, strong grant funding, a very supportive mentor, a research assistant, and 1 post-doc...and it was extremely busy. It made my intern year and all of residency look very, very easy by comparison.

    Family support is key, and if you can obtain this, I would recommend doing whatever you need to do to facilitate it. We are raising our daughter with family support about 4 hrs away, and still we need a cohort of back-up nannies (in addition to our wonderful full-time nanny)...because my research demands a significant weekend commitment too.

    It can all be done, but I would try to stack all the cards so that you have the most options possible going forward.

    best of luck,

  2. I have some indirect experience in this area. I am a practicing outpatient internist, MD trained, and my husband is a DO trained ophthalmology resident in an MD residency and currently applying for fellowship.
    Firstly, until you go through third year rotations, you cannot know for sure what you want to do; it may change many times and you will want to leave your options open for now.
    Secondly, I think for many students, medical school is what you make of it. If you study a lot and work really hard, it probably doesn't matter that much what school you went to in terms of medical knowledge.
    Getting into an MD school may or may not be an option depending on how competitive an applicant you are and if you are willing to relocate.
    As for away rotations, I think it depends on the school. My husband's school did try to send him away for 9 months of third year, but we able to get out of that. That was quite a stressful ordeal, especially since they did not disclose that possibility at the beginning.
    Being MD trained does make things easier if you are applying to a competitive residency or fellowship. But, with that said, you may be able to do anything you want as a DO, but it will be harder. I say "may", because a lot of people don't match into the residency specialty they wanted, but many do. As a DO, you will have to work harder to prove yourself, have higher test scores and an overall more competitive application if you want to apply to a competitive specialty at an allopathic (MD) program. In primary care, the bias is less.
    I base these observations on my husband's experience coming from DO training and applying for ophthalmology MD residency (one of the most competitive specialties) and now fellowship. He went to DO school because of location and because he didn't get into an MD school in the city in which we lived and where I was in school. While it has been seen as weakness on his applications, he has been able to prove himself as equally or more qualified through exam scores, letters of recommendation, etc, and has been able to do exactly what he wanted to. He matched at his first choice for ophthalmology, was the first DO the program had ever accepted, and now has over 30 interview offers at the top programs for fellowship.
    But, it would have been easier as an MD...
    I certainly am not meaning to criticize or insult any DOs, I am just sharing my husband's experiences as a DO from the perspective of applying to a competitive specialty.

  3. I am biased but I would suggest definitely trying for the DO route this year! There's no need to waste a year, start your education now. I just graduated DO school and it has been very easy to have a child during school for me and MANY of my other classmates. A couple women even had two babies during their 4 years. At our school we can complete all of 3rd and 4th year rotations at one hospital if we want. I haven't had any issues applying for residency but I am going into peds however I have classmates that went into anesthesia, derm, ortho, neuro, ohptho, etc so its possible. While there is still a bit of a stigma against DOs in the profession I have found patients don't know and don't care for the most part. I also love being able to offer some more natural remedies for common issues (OMM) although I don't use it very often. Good luck with whatever decision you make!

    1. So would you say that a DO program does not have the same level of stigmas in pediatrics? That is to say, if I go into pediatrics is the view of DOs not any less than MDs? Thanks in advance!!

  4. As a fledgling DO and mama to an eight-month-old, I couldn't be happier with how my lot worked out. I did a DO school because I had a two-body problem, married to a PhD, and it was geographically the best choice. Thought I wanted to do primary care, then fell in love hard with psych. Opted out of the match for a year when I found out I was pregnant, so I'm currently on the interview trail. Since I saved my fourth year vacation up for a maternity leave before graduating, I get to be home and present for the first 1.25 years of kiddo's life before residency. I've got viable options on both AOA and ACGME matches (despite only taking AOA boards, with unremarkable passing scores), but I'm not heading for a terribly competitive specialty, and we will have to move, likely cross-country.

    My school doesn't do a lot of bench research -- I think that's the case at lots of DO schools -- but many of my peers did MPH work during maternity leave (I already had one, or I would have too).

    Data is not the plural of anecdote, but for what it's worth, I have seen many female DO colleagues start families in med school, and can't think of a single one who was 'penalized' in any way. Specialty and geography are going to be important lifestyle considerations on either route, especially with family in the picture. Yes, for something particularly choice you likely have to excel higher as a DO than otherwise, but what I'm seeing on the trail is that places really are more interested in fit to mission than standout quantifiers. But that is highly specialty-dependent.

    To answer some questions more particularly: I am a 2015 graduate of a school in California. I had core rotations in 3/4 at many different sites, but was able to continue living in the same place as for years 1/2. To get that domestic stability, I have up having a teaching hospital for core training; it worked out fine for me, but now my biggest advice to underclassmen is to get at least one month's rotation in an academic setting before starting treat 4. I am an accidental osteopath, but I am unapologetic about being a DO and have not been made to feel second-tier or anything like that. I had mediocre grades in 1/2 and boards, excellent 3/4, graduated with the same GPA as undergrad, active in both AOA and ACGME match. The merger is keeping things interesting but isn't really relevant on my timeline; it will only negatively impact individuals (DOs) going for competitive specialties they would likely not match to in ACGME.

    My advice: know yourself. Your specialty interest may change, but your values shouldn't. Do you have emotional bandwidth for competitive field and family together? Where, geographically, is your support? How set are you on certain timelines/#kids? Is there anything else you could imagine doing as a career, and be fulfilled? Whatever your answers, make sure they are compatible with your intentions to become a doctor, and examine that despite first if things don't line up.

  5. I am a DO in IM, and I love my degree. I can speak for specialties but I am competitive with ,y MD collegues, equally as employable and well trained. I put lifestyle first and have had no issues with multiple international trips and one maternity leave so far. Good luck if I was going to do any thing different I would think about being a PA. Less debt and therfore easier to retire at a reasonable age if you want to be part time, although many part time MDs and DOs

  6. DO or MD, I would just say that 27 is not old and you don't have to rush. This is a marathon (I know, cliche!) and a delay at the start to make sure that you have the best chance for success will be very worth it down the road.

  7. I was also 27 when I started medical school. I had similar questions, concerns and thoughts when I started the process. I liked the philosophy of DO school and I wanted to be sure my options remained open down the road. Due to cost and geography, I went with the MD.

    As an ER doc in an academic program and as part of the review committee for residency applicants, we interview very few DOs. Personally, I have no bias and would be happy as faculty to train either. I do know, however, that there remain biases which make it such that unless you've got stellar scores, publications in said specialty, well demonstrated involvement and potential for long term academic development, the DO may result in an application being moved to the "no offer" pile with regard to the interview. Your long term plan and trajectory may be strengthened by ensuring you have mentors in your specialty of choice and make an impression on them, they can advocate on your behalf. It may not be as challenging in community based emergency medicine programs, but I have no expertise in that area. My experience is limited to my program.

    Best of luck to you in your soul searching. Fact of the matter is, if you want it and work hard for it, you'll make it happen.

  8. The rules have changed. DO vs MD is becoming a nonstarter. Partly because DO schools have shifted toward looking more like MD schools. Partly because there are entirely new rules regarding residencies. Partly because there are so many good DOs out there.

    (Ps I don't know the exact new rules but it makes a more even playing field for DOs)


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