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7 Osteopathic Medical Student FAQs

Christopher Russi, DO
Faculty Development Fellow
Wright State University
Department of Emergency Medicine
Dayton, Ohio
carussi@sbcglobal.net

Kevin Terrell, DO
Clinical Assistant Professor
Indiana University School of Medicine
Department of Emergency Medicine
Indianapolis, Indiana
kterrel@iupui.edu

Many osteopathic students have questions when looking at their options. We attempt to answer some frequently asked questions (FAQs) from osteopathic medical students in this document. Although it may seem that you are entering new territory when you decide to pursue an allopathic EM residency, the reality is that you are not. Osteopathic physicians penetrated into the world of allopathic emergency medicine years ago. Numerous osteopathic students have succeeded in getting into allopathic EM residencies, with many going on to careers in academics.

Despite this, both of us struggled with your same questions and concerns when we were in your shoes. The paucity of information for osteopathic students interested in allopathic EM residencies was frustrating and was the cause of unnecessary worry.

We want to help the many osteopathic students who want more information about allopathic EM. Our purpose in writing this article is to help you, the osteopathic student, answer some of the difficult questions you must ask when considering an allopathic EM residency.

1. Should I do an Osteopathic or Allopathic EM Residency?

Only you can decide what is the right fit for you. It is the responsibility of each osteopathic student to decide what type of program is right for him or her, whether it is osteopathic, allopathic, community-based, university-based, large, small, etc. We simply want to provide you with some of the information needed to help you make the right decision.

Both of us worked at several different osteopathic institutions. There are some very good osteopathic EM residencies. One of those may be the residency of your dreams. You won't know unless you look. Even if you are certain that you want to do an allopathic EM residency, we strongly recommend looking at both osteopathic and allopathic residencies. You should ask yourself exactly why it is that you desire to do an allopathic residency. Do allopathic residencies offer you something that an osteopathic residency cannot? Does an allopathic EM residency meet your individual needs more than an osteopathic residency?

These are difficult, but important, questions to answer. Our advice is to consider several osteopathic and allopathic EM residencies. Look at each objectively. Only by doing this, can you begin to realize what type of program is a good fit for you.

2. Do allopathic programs discriminate against me because I'm a DO?

Many osteopathic students are concerned about discrimination when applying to allopathic residencies. It is possible that there are residencies that do not give osteopathic candidates serious consideration. Even if discrimination does exist in a few programs, it is inconsequential with over 100 different allopathic EM residencies from which to choose.

Don't let the possibility of discrimination prevent you from applying to allopathic programs. Remember, the number of osteopathic residents and faculty at allopathic EM institutions is substantial and is growing.

3. How do I find an advisor?

Finding the appropriate advisor/mentor is one of the most important elements in helping you get the best residency you can. The best advisors are ones that have trained in an EM residency or are currently faculty at an EM residency program.

The role of your advisor is to answer questions, help outline your third and fourth year schedules, write a letter on your behalf when applying to an EM residency, and make recommendations on where to do an elective rotation and where to do your residency. After the match, he or she can help you prepare for your EM residency.

Your advisor does not need to be from your medical school. Search the SAEM website. Under the website's Residency Catalog link, you will find a list of all allopathic EM residencies and their websites. Browse the different programs looking for osteopathic residents and faculty. It is likely that you will find a physician who is willing to advise you. With the advent of e-mail, it is easy to connect with potential advisors from across the country.

The virtual advisor program was recently developed by SAEM. It is located on the SAEM website (www.saem.org) and is available to help you answer many commonly asked questions.

4. Should I take the USMLE?

The USMLE is the allopathic national board examination, the allopathic equivalent of the COMLEX. The COMLEX examination reports a standard score and a percentile score, easily allowing a comparison of one osteopathic student to other osteopathic students.

However, COMLEX scores cannot be directly compared to USMLE scores. The USMLE is viewed by some as an opportunity for the osteopathic student to prove that he or she is as competitive as allopathic applicants. Having a USMLE score available on an osteopathic student allows a residency director to directly compare the osteopathic applicant to allopathic applicants. If the osteopathic student performs well on the exam, then it alleviates concerns that academically the applicant is not as strong as allopathic applicants.

In the opinion of the authors, if you have solid grades, COMLEX scores, and letters of recommendation, then taking the USMLE is risky. Doing well on the test may help you match at the most highly competitive programs. However, if you do poorly, then it damages much of the good that you have done and can significantly damage your credentials. On the other hand, you may have less than solid credentials. In this situation, doing well on the USMLE significantly strengthens your application. However, doing poorly will still blemish your application.

Whether or not osteopathic applicants should take the USMLE is controversial and the decision should not be taken lightly. Discuss this with your advisor. You should also contact the residency directors of the programs in which you are interested and get their thoughts. If you choose to take it, then you will need to study and be prepared to study a significant amount of new material.

5. Where should I do my EM rotations?

Rotate at an institution with an EM residency. The SAEM website has a listing of all allopathic EM residency programs. Review the websites of programs that interest you. Pay particular attention to programs with DOs. However, don't count out any that have no osteopathic physicians. Some programs without DOs may have had them in the past and be very DO-friendly.

If you are not certain whether you are interested in doing an osteopathic or allopathic residency, then rotate at one of each to help you decide. While on the rotation, ask osteopathic residents and faculty members how they decided where to do their residencies. You have much to gain from the experience of others.

The most valuable information you will find on this topic can be found in the article entitled "Advice to Students Beginning a Medical Student Rotation in Emergency Medicine."

6. Should I do an AOA-Approved Rotating Internship?

According to the Still Consortium for Osteopathic Postgraduate Education (S.C.O.P.E.) (www.scope-do.org), the importance of doing an AOA-approved rotating internship is multifold. First, the rotating internship will prepare you for the residency you plan on pursuing. Second, if an osteopathic resident plans on pursuing medical education and perhaps directorship in an osteopathic residency, he or she must have done the AOA rotating internship. Third, you will be able to practice in the five states requiring the AOA-rotating internship.

Osteopathic physicians are required to have completed an AOA-approved internship in order to be licensed in Florida, Michigan, Oklahoma, Pennsylvania, and West Virginia. As you know, requirements can change. We recommend calling the state medical licensing bureau if you are interested in training or practicing in a particular state.

The philosophy behind the requirement is that the internship provides a balanced, well-rounded education for the osteopathic physician in all areas of primary care. Emergency physicians are specialists but they must be equipped to handle any emergency in any field of medicine. The rotating internship can help provide a basis for this challenging task.

On the other hand, allopathic EM residencies provide a similar rotating internship built into their curriculum. This provides similar background training for the emergency physician.

Funding also is an issue when an osteopathic physician chooses to do an allopathic residency following a rotating internship. The healthcare and finance administration (HCFA) provides money to residency programs to support the salary of residents. The money allocated to a residency program is based on the minimum time required to complete the residency.

According to the Association of American Medical Colleges (www.aamc.org), HCFA will fully fund three years of an osteopathic EM residency after an AOA-approved internship. However, if you do the AOA internship before an allopathic EM residency, then the EM program will not be funded by HCFA during the final year of your residency.

If you plan to do an allopathic residency and would like to do the AOA internship first, the safest approach is to contact the residency directors of the EM programs in which you are interested. Ask if the residency would consider an applicant who has completed an AOA internship and ask if they have done this in the past.

7. Where can I find additional information?

We strongly recommend reviewing the entire Medical Student Information link on the SAEM website (www.saem.org) and also the Medical Students link on the Emergency Medicine Residents' Association website (www.emra.org).

In addition to these websites, another valuable source of information is a book written by Dr. Kenneth Iserson entitled Iserson's Getting Into a Residency: A Guide for Medical Students. While you will find the entire book valuable, it includes a section specifically written for you, the osteopathic student.

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