Opinion

How am I DO-ing in a majority MD residency program?

I was discouraged from pursuing a program where I’d be one of the few DOs there. Here’s what I was told–and the reality that followed.

Editor’s note: This article was first published in 2018 by the Division of Family Medicine at the Department of Family and Preventive Medicine at the University of Utah. It has been posted here with permission and edited for The DO.

In the last year of medical school, all medical students are faced with important decisions about where they would like to complete their residency. For osteopathic students, one key element of this decision is to what extent do they want to be a minority within their program.

I am an osteopathic physician. Osteopathic medicine is core to my identity and pride as a physician. I am one of two osteopathic physicians within my residency program, and we comprise only 7 percent of the group. Today, I am very satisfied with the decision that I made to be in the minority, however, through the application process, I was discouraged from being in this position.

These are some of the things I was told and the reality that followed:

Catherine Vanier, DO

You will be treated differently by your attendings and will need to prove yourself.

No one notices that I am a DO. Being an intern is all it takes for attendings to see you as a deer in the headlights in need of help. I have to prove myself in the same way that anyone embarking on a new career does, but this is no different than my MD peers. People only notice I am a DO when I proudly point it out as the reason I know that T3 is at the level of the superior angle of the scapula. Otherwise, I’m just an intern.

There will be no support for practicing osteopathic manipulative treatment. You will lose your skill set.

Being one of the only DOs in an opiate-avoiding, chronic-pain world has given me the opportunity to provide a much-needed skill set to a group of patients in need. My ability to see an OMT patient and feel confident that I am providing a service that may otherwise go unmet is very rewarding.

You will lose your identity and be forced to conform.

Absolutely not. In fact, being one of the only DOs in my program has given me the opportunity to hold even stronger to my identity as an osteopathic physician. I feel it is my duty to represent my profession and the skills and beliefs that come with it. I can see this being a problem if I had been on the fence about my attachment to osteopathic principles and practice, but as someone who holds them in such high regard, I love the opportunity to teach others about my training.

When applying to an MD-dominant program, you should downplay your osteopathic origins.

I do not know the inner workings of the application process at each program, but this just felt wrong to me, so I did the opposite. This may be true for some programs, but if that was the case I didn’t want to end up there anyway. Hold strong to your passions and emphasize what makes you unique and different and programs will see that as a strength. This was my experience through the application process.

If I was to do it again, I would do the same things. I feel that more osteopathic medical students should consider doing the same. The future of osteopathic medicine is reliant on people branching out and going where they will represent DOs.

Further reading:

Dating in residency: Looking for ‘the one’ while training

Burnout and residency: Focus on growth at work instead of time off, DO writes

7 comments

  1. Dear Catherine,
    I so appreciate your dedication to our profession and it’s tenets. When I was in my internship I remember many fellow DO trainees in DO programs who were hesitant to do OMT. We just need to step up and do OMT in order to improve our skills and confidence regardless of the program we are in. I wish you a long and joyful career.

  2. I have taught residents, interns and students for years in local Osteopathic programs. I have to say I have been very discouraged at the near complete lack of palpatory skills and interest in most of these young Osteopathic physicians to pursue an Osteopathic practice including OMT.

    Regardless of the forum that a young Osteopathic physician trains in, as Dr. Vanier eloquently presents above, it is totally an individual pursuit, from start to finish, whether A, T. Still’s tradition carries on. The patients are hungry for it and demanding it!

  3. Dear Dr Vanier:
    Good job applying your DO skills!
    Most everyone in a training program will judge you by your performance and not the DO after your name. That was true for me doing a nephrology fellowship at the University of California San Diego in 1977 and obviously still true for you today. It also held true during my decades in nephrology private practice where DOs were scarce. I just concluded ten years of teaching inpatient medicine at Brooke Army Medical Center where a good proportion of the trainees are DOs. I can state unequivocally that I was just as blind to the MD or DO after a trainee’s name as any of my other attending colleagues. It’s performance that counts. Any DO students reading this should not unnecessarily limit their post-graduate training opportunities based upon their DO degree.

  4. If you are doing a great job as an intern or a resident, everyone is satisfied. Applying an osteopathic technique doesn’t require an announcement or recognition of such. If it’s done, done well and properly, the patient’s improvement or added comfort is icing on the cake. And your colleagues will recognize the extra time and skill you bring to the patient and inquire ‘How you did that’. Teach them.
    I did my residency in neurology in a large allopathic medical center. I used OMT frequently. I don’t think people really cared about the initials after my name; and, if they did care in a negative way, it was their loss.

  5. Dear Dr Vanier: Congratulations on your article and your embarking on a career I am sure will be highly successful. After training in both DO and MD post grad programs I practiced in a highly specialized field with other MDs. If anything I have earned more accolades from them as compared to being comparatively shunned by the AOA. My current affiliation at a large MD training center is blessed with many DO’s on staff and in training. I have trained two of the DO residents in my fellowship program. We are proud of our Osteopathic heritage which is more than manual medicine, or we would be no different from Chiropractic Doctors, it is the holistic approach to patient care that overrides all else and makes us successful.

  6. I’m the only osteopath in my class of third year family medicine residents and I 100% agree with everything you said. I’ve never been more proud to be a DO and if anything, I’ve had to limit the OMT referrals so I still have time for other cases! I try to encourage 4th year OMS’s interviewing at our program to take the opportunity to review/improve their OMT skills as they too will be asked to fill the role of “the token DO.”

  7. I entered the USAF as an intern in 1970 and my internship was in Calif where the D.O.s had combined with the M.D.s in 1962 and DOs were no longer licensed. There were two DOs in my intern class. We worked hard and proved ourselves and were picked for residency positions; for me highly sought after Ob/Gyn. later on in my career I was the USAFS only candidate to attend Gynecological Oncology Training flor 3 years in 1980. Thus I became one of the USAFs four Gyn oncologists. Eventually I became chief of Ob/Gyn at Wright Patterson teaching both DO and MD residents. Further I became consultant to themUSAF Surgeon General for Gyn and Gyn oncology. As for OMT I used it when I felt indicated and taught my colleagues some OMT. NEVER was I ever discriminated against I admit some initial trepidation but hard work, keeping up with my reading, coming early and staying late to learn all I could all afforded me the opportunity to achieve my goals. I always looked for similar traits in a future resident. I do chuckle somewhat that the same worries I had 49 years ago are still prevalent. My 20 years in the USAF And my 20 years at the university and private practice were wonderful. i wouldn’t’ have done it any other way
    Max A. Clark D.O. FACOG, FACOOG
    COL USAF MC FS RET
    Associate Professor Emeritus
    Boonshoft School of Medicine
    Wright StatenUniversity
    Dayton Ohio

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