Question about US DO

[Hopelesspremed-]

Hello, 

does going to a DO program significantly limit my future career/specialty options? Right now I’m looking at either Cardiology or Urology. Do I still have a chance for these two specialties if I attend a DO school? Can I still come back to Canada after residency? Is there anything I should know? 

I’d also love to connect with DOs who are currently practising in Canada. 

Thank you. 

[bearded frog]

13 hours ago, Hopelesspremed- said:

does going to a DO program significantly limit my future career/specialty options? Right now I’m looking at either Cardiology or Urology. Do I still have a chance for these two specialties if I attend a DO school? Can I still come back to Canada after residency? Is there anything I should know? 

Answering your second question first, you can apply to CaRMS for residency in Canada after DO, however you would be classified as an IMG, which would severely increase the competitiveness for any residency spot vs going to a US MD, which is classified equal to Canadian MD applicants. IM (leading to cardiology) may not be an impossible ask in this circumstance, but there was only 1 IMG urology spot last year (plus 7 Quebec spots open to both Canadian and IMG applicants, although I do not know how many of these spots typically are filled by IMGs... an option if you speak french?)

The advantage of US DO vs overseas MD is that you are eligible to apply to American residency on equal footing with US MD in theory (ie. not an IMG). That being said, if you look at the American data, US DO itself somewhat limits your competitiveness for high-demand specialty. (Also assuming you're not an American citizen, your competitiveness is also somewhat hampered by the need for a visa) Without looking at the match statistics, I think IM is very doable, however to match urology or some other competitive specialty you need a very excellent application, relative to the requirements for USMD, but it is still possible. Historically that meant required USMLE scores significantly higher for USMD vs DO, however the USMLE is going pass/fail which has the potential to make it even harder for DO students to stand out... this is a big unknown for everyone right now in the American system.

To summarize, the general recommendation is Canadian MD > USMD > USDO > IMG MD, with the USDO preferable to IMG due to increased ability to match to US residency. That being said, if you go that route, you'll have to work a little harder than your DO peers to match IM (in the US) due to visa status and somewhat harder than Canadians going USMD. Urology and other competitive specialties are very unlikely with this route, however, your chance to match at all is better going USDO vs IMG, but you need to be open to primary care or other less compeditive options.

You can usually come back to Canada after residency, doing residency as a DO in the states I think puts you on equal footing with a USMD who did residency in the US, in terms of returning to Canada. Depending on specialty you may have to do an additional year of fellowship or something else (as some residencies are shorter in the US, ie pediatrics) and take the Canadian board exams.

[hopefulcanadian]

On 7/5/2021 at 10:01 PM, Hopelesspremed- said:

Hello, 

does going to a DO program significantly limit my future career/specialty options? Right now I’m looking at either Cardiology or Urology. Do I still have a chance for these two specialties if I attend a DO school? Can I still come back to Canada after residency? Is there anything I should know? 

I’d also love to connect with DOs who are currently practising in Canada. 

Thank you. 

The two specialties you outlined are very different. I would say matching into IM is always decent (which you would need for cardiology). Peds is another option within the internal medicine field where you can match into a lot of specialties from peds. You can come back to Canada, I would look up the College of Physicians and Surgeons for  the province you are interested in and look at the specifics. You can also match in Canada but the person above me outlined perfectly that right now you are seen as an IMG. That may change but I don't know when that will change. Currently USMD is seen as domestic.

I will focus on coming back.

Given that there was a merger now every single residency is under a GME banner. Previously you needed the residency outcomes to be similar in years and training outlined in the College of Physician and Surgeons (insert province) and had to be an accredited ACGME. Now with all being GME all residency programs will be recognized. I would say that there are some residency training differences. I believe in IM not the subspecialties but the general IM the training length can sometimes be different same with EM as well. So you may require an additional year like a chief year in order to fulfill those requirements. It isn't impossible very doable. You may not even want to come back, that is an issue for tomorrow.

 

There are DO's in Canada not a ton but a few. I am seeing more DO's from Canada who just end up staying in the US because they have to fight less and once you are established then you just stay put because why. Doesn't mean you can't come back it just always shifts the opportunity cost. In Canada it seems like if you want to live in a major city you will always be fighting either way to get that job that you covet. In the US the job market is very very different. Not going to go into all the pros and cons but something to consider.

Urology is a difficult specialty to match into either way so if you were keen on becoming that specifically AGAIN your chances in America as a DO are better than going off shore and trying to match into the US and or Canada. US training outside of family medicine is recognized in general, there are some differences, especially when it comes to fellowship training. I may be mistaken but we have medical oncology for example which doesn't exist there they have something else but I can't remember off the top of my head. But back to the point. There are more programs in the USA, by a significant amount. take any specialty and look. For example dermatology which routinely matches less than 20 a year. (sometimes it is as low as 14-17). In the US there are significantly more programs and spots. Bigger chance for you to find your fit.

You will not have a higher chance of getting your specialty going abroad especially if you want to do something other than family medicine.

 

TLDR: DO is more than acceptable and fine, and recognized. That will increase more and more each year.

 

 

[bearded frog]

5 hours ago, hopefulcanadian said:

I may be mistaken but we have medical oncology for example which doesn't exist there they have something else but I can't remember off the top of my head.

I think someone said cardio-thoracic surgery in the states is not recognized in Canada, is that what you're thinking of? Also med-peds is a thing in the US which is not in Canada.

[JohnGrisham]

Matching to hyper competitive fields is hypercompetititve regardless of your medical school designation, some just make it even more so difficult.

For primary care fields, with flexibility of location for training, it is a no brainer. You can easily match to FM, IM(with many subspecialties), gen surg, obgyn, Peds, psych etc in the US simply by virtue of being so much more in the way of spots.  Individual merit will be the deciding factor as a USMD or USDO student.    You might not get the top tier spot at Amazing Medical Residency Program, but for the vast majority of people where you did medical school or residency has little bearing on real life as an attending when you come back to Canada.  Once you have your license and certification, its back to individual merit, networking etc. 

I've worked with Toronto 5 year grads who haven't gotten the posh academic jobs in T.O that they wanted, but some random IMG who simply connected better with the specialist group got a position.  Way more variables in the real world, and "fit" comes into play quite often in some fields.

I have not the slightest clue if there are  specific IM subspecialties that are "harder" than others as a DO vs MD, but having seen enough underemployed Cardiologists and Nephrologists in my centre doing GIM work, I tip my hat to you with good luck - because if you go those routes, you'll probably end up staying in the US anyways for potentially better job opportunities without dealing with serial locum vacation coverages and fellowships on Canadian side. 

Just be in regular contact with the Royal College and your provincial licensing body, and it's not that difficult if you are prepared, on top of things, and aware that sometimes there will be few month or more delays for beuracractic "processing" times. 

[JohnGrisham]

As a Canadian, if you ultimately don't match to a US residency as a USDO, you probably wouldn't have matched as USMD either.  There are common trends for those that don't match, and the designation isn't suddenly going to cure all the potential deficits/poor application strategies/simple bad luck that would have prevented a match.