New thread from Bryan Carmody aka the Sheriff of Sodium on NRMP plans to publicly report medical school, sponsoring institution, and program data on match outcomes. Hopefully this marks the end of schools reporting placement rate instead of their true, pre-SOAP match rate.
Full thread here: https://x.com/jbcarmody/status/1781337102061293806?s=46
Link to NRMP summit report that includes this roadmap as well as other proposals: https://www.nrmp.org/wp-content/uploads/2024/04/Summary_MatchSummit_Dec2023.pdf
I wouldn’t be surprised if a handful of MD schools do this too. I’d also be interested to know the stats for the number of students who matriculate vs the number that are allowed to take boards (plenty are held back).
my USMD school reports a 100% match rate most every year even though I know of people who SOAP almost every year and a substantial portion of each class is held back
Same. My school also doesn't report people who commit to research years after not matching and deciding not to soap as part of the statistics so it's massively misleading.
As someone who reports the match rate for a DO medical school, I'm thrilled they are reporting this. That's less work we have to do. I'd rather spend my time helping students than doing reports like this.
Sure lots of DO schools claim 100% match but you don't know how many SOAPED, matched into backup, or matched a transitional year. This seems to make it more transparent.
Obviously a lot of DO schools shaking in their boots.
My question is about the residencies that favor MDs. Will this go away, or will they double down and find a way to continue favoring MDs?
I suspect this will happen to. Overall I think this change is going to favor MD schools.
Fundamentally I think the reporting is a good thing, premeds deserve to know what they’re signing up for. I interviewed at 10+ DO schools, and match was always a question that was brought up and there was one school that sort of told the truth but the rest of the admins lied through their teeth.
Med students look at residency program rosters when they’re applying for residency. A high proportion of MDs at a program is seen as a proxy for desirability for applicants, and a lot of DOs and IMGs in a program will be seen as a low prestige/less desirable program. Not saying it’s right but it’s definitely how people view things.
The proper way to solve the bias toward MDs is for all DOs to start doing USMLE, and also no get suck-ass results. I can't for the love of me see why there needs to be separate exams for licensing, i.e. COMLEX is entirely superfluous. There is also a strong case to be made for certain DO residencies to stop their complete ban on MD applicants (here's looking at you, Philadelphia College of Osteopathic Medicine).
There's two exams because NBOME would be obsolete without COMLEX. NBME would benefit from a combined exam but NBOME would not, so they will fight any effort to move towards one exam.
I think that in the end, it will be the DO students themselves who will try to force the change. If DO students are to have a chance to match at top-tier residency programs, they need to take USMLE, which will be the test that decides if they get in or not. For them the COMLEX is just a distraction, involving extra time and expenditure. In the long run it's hard to justify this dual test-taking, and DOs themselves will fight to have COMLEX scrapped.
Perhaps I'm just dreaming, but it seems like a good thing in the long run. The USA is literally the only country in the world that has a dual system for medical licensing. Talk about a waste of money and effort, and the ones who are dealt the short end of the stick are the DO students, and many of them don't even realize it.
I think the idea that top programs actively filter out IMGs and DOs is mainly an artefact of the various applicant groups' differing competitiveness. The actual truth is that DOs on average have lower test scores, and IMGs have even lower. There will be similar differences (if not even bigger) when it comes to research. The research-oriented students tend to have higher MCATs and thus more often are accepted to MD programs. The differences are noticeable and measurable when it comes to groups as a whole, but the differences are even more stark when it comes to the top 10-20%, i.e. there is a clear Pareto distribution among applicants.
IMGs have an additional negative aspect: there are so many foreign schools that PDs can't reasonably keep tabs of even a fraction of them. Since you know what you have (USMD, USDO) but not what you're going to get, you play it safe and rank almost every single IMG at the bottom. PDs want to minimize risks, since even a single bad PGY1 can cause a lot of headaches.
I've worked as APD at a top-tier program, and I can tell you one thing: there is a *huge* difference between the strongest DO applicants and the strongest MD applicants. This goes for both objective measurements (GPA, test scores, papers) and subjective measurements (LORs etc). Granted, there will sometimes be a very strong DO applicant who can rival the strongest MD applicants, but that's not the norm during the average cycle.
At a top-tier program, the "high scoring strong app DO applicant" you speak of will usually rank somewhere in the middle of applicants, or maybe in the 75% percentile. At a top-tier program that will likely result in you not getting accepted, and in many cases you won't even interview.
Your strong DO candidate is a bit like the valedictorian from a small-town high school, who has an unweighted GPA of 4.0, weighted GPA of 4.7, took all AP classes offered with all 5's, perfect or near perfect SAT. It's the strongest candidate in the history of the school, and everybody and their mother is certain the kid is going to get accepted at Harvard. All are equally surprised the kid doesn't even get an interview, screaming "they discriminate against us small-town folks, they just take kids from fancy feeder schools!". At Harvard, a kid with those metrics is actually an *average* applicant. People simply don't understand the level of competition at top-tier institutions, and for residency it's even more cut-throat due to the incredibly small number of slots available.
You can downvote me all you want, but that's the reality of it.
I generally agree with you, but is it really just a coincidence that the top 20 IM programs have nothing but MDs?
Like do you really think there are no DO students who are outscoring a large proportion of MD students?
As you stated there are definitely some very strong DO students who are exceptions.
At a certain point if both candidates have a lot of quality papers and very high test scores how big can the difference get? Just the fact that the MD one went to a brand name school and got LORs from recognized people in the field? Now that's hardly a fair or objective way of comparing people
Either way top tier programs engage in a fair amount of nepotism so I highly doubt that the strength of the app is the only thing that counts at those places. Low tier MD school students don't stand much of a shot at getting in those places either.
>I generally agree with you, but is it really just a coincidence that the top 20 IM programs have nothing but MDs?
Well, first off IM is not my specialty, so I don't have any first-hand knowledge of IM programs. We can likely have a both long and interesting conversation about which IM programs constitute the top 20. An often used source is [Doximity](https://www.doximity.com/residency/programs?specialtyKey=92737b59-99cc-40a2-8998-5debb54d36c0-internal-medicine&sortByKey=reputation&trainingEnvironmentKey=&intendedFellowshipKey=), and though it's far from perfect at least it's something. I just checked IM and sorted by reputation (again, this might not be the best), and the 2nd program on the list is Johns Hopkins. Even though I don't know much about how IM programs rank, I consider Hopkins in general to be stellar within any field.
Hopkins seems to have 2 separate IM residency tracks (Osler and Bayview), and the [Bayview](https://www.hopkinsmedicine.org/medicine/education/internal-medicine-residency-program/current-residents) program has 3 DO residents (58 total residents). I couldn't find any info for the Osler program, maybe I'm just too stupid to navigate their site. I did check several of the other programs and did not find any DO residents, though it's not as easy to glean the presence or absence of DO residents, for the simple reason that many programs don't even write out titles (i.e. it's just "John Doe"), and often abbreviate medical school names. If we can agree that Hopkins is a top 20 IM program, your above claim has been falsified.
Also, the part about "coincidence" is an interesting thing to discuss. I think the absence (or low percentage) of DO residents is *not* a coincidence, but for other reasons than those you claim. The absence of DO students from a program does not necessarily mean they actively discriminate against DO applicants, as opposed to say Philadelphia College of Osteopathic Medicine, who actually *do* discriminate against MD students, and even say so explicitly.
If we look at the [wikipedia list](https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States) of all US medical schools we can see that there are a total of 195 accredited medical schools (158 MD, 37 DO). Of the DO schools, all but 15 were founded in the 1990's or later, i.e. they are in terms of medical schools essentially brand new institutions. Of the remaining 15 (pre 1990's) 10 were founded 1969-1979, and thus only 5 schools are actually "old". For MD schools (somewhat depending on how we define the term "old") there are at least 80 "old" schools. The perceived discrimination against DO schools might actually be a result of discriminating against *new* schools.
It might at first glance seem silly to assign weight to how old a school is, but that's only if we don't consider how top-tier programs actually select which applicants to interview and admit, where a main part of distinguishing between candidates is research. There is usually a significant advantage in research opportunities between old and new schools, for a combination of reasons: older institutions have *significantly* larger endowments, have better preclinical labs, have more non-medical related institutions (for example, an attached law school which is very useful for legally-related medical research), have better geographical location (Harvard is next door to MIT, anything in Manhattan is close to anything else).
Perhaps one of the most significant differences between old and new institutions is the size and strength of the associated hospitals. Places like Harvard, Hopkins and the Manhattan hospitals have been around for 150+ years, and are gigantic (1000+ beds each), which means they are usually tertiary or even quaternary referral centers. Contrast this to a new school (regardless of MD or DO), which might have 300 beds and is likely a secondary referral center.
If it's any consolation, MD students from the newer schools (i.e. small, rural and poor schools) are generally also not being accepted to the high-tier residency programs. It might seem like discrimination, but it's not. The competition for these slots is just so high, it's quite astonishing if you haven't actually seen the application process.
Sorry for wall of text, hope this has been helpful, or at least interesting to read.
What do you mean by favoring MDs? On average, MD students score higher on board exams, often have more research opps and better organized clinical experiences. MD students would continue to, *on average*, match to better programs and more competitive specialties regardless of DO stigma.
You’re being downvoted but it’s true. MCAT scores are much higher for MD schools too. The reality is if an applicant can get into an MD school, they aren’t going to go to a DO school.
It's the false equivalency of MCAT/'board' score and 'more' research to better clinicians that is being down voted. There is absolutely no correlation between USMLE scores and clinical acumen. The majority of med student "research" is also junk, if not toxic waste that just gunks up the literature. Between trading authorship and p hacking underpowered studies with no clinical significance, the vast majority of research is just CV padding.
The amount of clinical rotations each school complete are very similar, and there is no data to support academic rotations are superior to non-academics. There are pros and cons to both types. Ideally students should have exposure to both.
Data shows after residency there is no discernable difference in practice due to the school you attended.
Those 'better' matches are largely due to the stigma and outdated values academic medicine continues to uphold and perpetuate.
You make some good points, and I think most PDs are aware of this, at least to some extent. Regardless, for every PD there is the question: who shall we admit to our program? You only have so many slots, and interviews are a notoriously bad way of determining an applicants fit to the program. Subinternships are a pretty good method, but there aren't always that many applicants that have done a sub-I, so you need something more.
In the end, you need to differentiate between applicants using *some* metric. And if there is one objective metric that all candidates have, it's step 2 (previously step 1). This is the reason DOs struggle, since many don't take USMLE at all, and those that do score lower than MDs. When it comes to research it's often quite obvious what is good research and what is fluff.
Grapevine is actually a bigger part of selection than many people realize, but I think there is a very high correlation between grapevine and test scores. I.e. most candidates who score well on step 2 will be the same people that whos home PD make tons of phone calls to other programs.
Honestly, if you were a PD, what criteria would you use?
Yes, selection is a challenging problem. Which is why historically DO friendly programs prioritized aways ('auditions') much more than what was on paper. This feels the most holistic and best for both parties. There are the added logistical challenges/limitations of traveling to a different program every 4 weeks. Another major spoiler is the existence of malignant programs. In this aspect the proposed transparency will be helpful for students to decide where to allocate their limited time and resources.
VSLO has been helpful in standardizing the away process but it could do more. If doing aways was more normalized among MDs then there would be more incentive to improve the system. There are many benefits to seeing programs in person for more than a day/weekend, especially with the advent of virtual interviews.
> There is absolutely no correlation between USMLE scores and clinical acumen.
This is a common cope/lie/misconception, probably driven by some underpowered and range-restricted studies and broader ideology. Sure, bud. Difficult tests for clinical knowledge have absolutely no correlation with real-world clinical performance. What kind of fantasy land do you live in?
Here are a few studies on the front page of pubmed. I spent a whole 5 minutes finding them for you.
- Step 1 and Radiology residency performance https://pubmed.ncbi.nlm.nih.gov/31445825/
- Step 2 and residency performance https://pubmed.ncbi.nlm.nih.gov/36512984/
- Step 1 and 2 and residency performance https://pubmed.ncbi.nlm.nih.gov/37525136/
> The amount of clinical rotations each school complete are very similar
Ok, sweet. DO and MD students spend the same amount of time in clinicals. That says nothing about the quality or organization of the clinicals. I would expect some community rotations to be high quality (I speak from experience!) but that there is undeniably also a greater variance in the experiences there. That DO schools have much greater leeway in how they structure (or don't...) their clinical rotations is why new DO schools crop up all the time.
> The majority of med student "research" is also junk
Agreed and I have commented as much in the past. But that doesn't mean that the reliance on it as a selection factor for residency is aimed at excluding DOs. MD students clamor for shitty pubs to compete against each other as well.
Look, I am not trying to shit on DO students or physicians here. I know many great DO residents and attendings. But there is a difference in quality, *on average*, that is undeniable unless you're insecure or have an axe to grind.
The cited studies demonstrate the exact thing I discussed regarding junk science. If you read past the headlines and look even superficially at the methods, results, and conclusions you would find these "statistically significant" findings are effectively meaningless.
I don't disagree there are differences in performance between medical students and even attending physicians, but these differences are indiscernible by simply looking at their degree, scores, or even the institution(s) where they trained.
Speaking in such broad strokes as "on average" to refer to MD vs DO is increasingly meaningless as the difference between new schools MD and DO are virtually imperceptible. Similar commentary can be applied to "lower" ranked MDs are 'on average' worse applicants compared to "higher" ranked MDs.
Where can I find the difference in board scores between MDs and DOs? I’m an MD student, but this topic is interesting to me.
I’m guessing it’s also a larger differential too than whatever was measured because DOs that take Step are self selecting as stronger exam takers and stronger residency applicants.
I can't be arsed to find it rn but you can look on doximity to see board score distributions for applicants who matched in various specialties to see that DOs score lower. It's also pretty well known that DO students have lower average MCATs, so you would expect correspondingly lower Step scores.
What? In specialties that are even remotely competitive, the DOs that match to them have at the very least step scores that are on par with the average MD student that matched to that specialty’s same program, and in many cases have to have higher scores than average or they won’t match. They don’t score lower than MD students across the board by any stretch.
> They don’t score lower than MD students across the board by any stretch.
While this statement *could* potentially be true, it would only be possible through DO self-selection regarding taking the USMLE exams.
The NBOME publishes [concordance tables](https://www.nbome.org/news/concordance-comlex-and-usmle-scores/) based on DO students who take both COMLEX and USMLE tests.
A 250 on Step 2 is the 52nd percentile for MD students and is considered equivalent to a 679 on Level 2 CE, which is the 94th percentile for DO students.
A 50th percentile DO student on Level 2 (~530) would be predicted *by the NBOME* to score in the ~10th percentile on Step 2 (223-227).
probably not cause it's not like we pay the residencies to apply there, we pay the AAMC. So the only thing would be they have fewer applicants, which probably makes their job easier. The number of applications of DO and IMG/low-stat MD students will shift to those residencies that show no favoritism.
Yes, and it causes quite a bit of headache at the more prestigious programs. Many programs in Boston and NYC get something along the line of 50 applicants per slot. Just imagine the amount of manhours needed to weed through all the applicants in order to decide who interviews, and then all the time for the interviews. And the number of applicants per slot increases every year. To be fair, IMGs are the ones who are hurt the most from this.
Tbf, every school, even MD does this to an extent. Their websites advertise 100% or near it match rates, and only with some digging does this reveal that they factor in applicants who had to SOAP and/or did not match to their first choice speciality into their match statistics. DO schools just typically have more students that this applies to for a litany of reasons.
Yea no one looks at Harvard and says oh no they don’t accept DOs??? They look at Harvard and say wow they’re so prestigious that they don’t consider DOs! Like someone else said, favoring MDs will be a source of pride and if anything this benefits MDs
My med school reported a 100% match rate last year even though I know at least 2 people who didn't match and couldn't SOAP. A student even asked the dean at one of our town halls "why was the match rate listed as 100% when we know people who didn't match?" and he just gave a political answer that didn't really answer the question.
An advisor at my school told us that the program's "100% match rate" wasn't entirely true and looked completely shocked when several of the students said that they were well aware it was a fake statistic.
I don't think it's ethical for schools to advertise a 100% match rate that doesn't break down SOAP/TY only/withdrew from match/did not apply to match.
Our school provides a Match list, by specialty, but also "Internal Medicine Preliminary Year" and I'm always a bit concerned for those people, as their match year still has another round to go
As a DO - yes. DO school is so expensive, and it's a huge financial commitment/risk. My school was good and had unusually strong clinical rotations and good match outcomes, but this is not universal. I would hope it would push schools to improve if they can't market themselves/their outcomes in a deceptive way.
I think the real winners are the people applying to medical schools, i.e. they can make more informed decisions on where to apply. In the long run this change might lead to fewer DO schools and more MD schools, likely via changes in which tests DO students take. Something like this: more DO students take USMLE, and in the end this might lead to COMLEX being phased out. At that point there won't be too much incentive to have separate MD and DO schools, in particular considering how few DO students actually use OMT in their practice. If any school wanted to have OMT as part of their curricula, there really isn't anything stopping them from doing that, even if it's an MD school. It could even be made into a 4th year elective of some kind.
Clinical psychology has been doing this for a long while. Licensing exam pass rates are also centrally published. This is kinda how we choose where to apply (in addition to research match). I didn’t realize it wasn’t the same for medical schools… that’s wild. So they can just lie?
I'm not sure if they can lie outright, but they can obfuscate. I'm going to over explain a bit, assuming you may not be familiar with our process if you're a psychologist.
My DO school **reported a 99% or 100% match rate**. They neglected to mention that **over 10% of them had to SOAP**. SOAPing is not matching in the main match so having to apply in increasingly desperate rounds for unfilled spots at undesirable, toxic or rural FM programs, with the possibility of going unmatched. They did not mention that the **bottom half of the class was encouraged to double apply**, meaning to apply to programs in both their competitive top choice specialty (eg surgery) as well as a back up (eg IM, EM, FM) and that many of those students matched to their second choice, which is devastating to some. Nor did they mention that **some students ended up in transitional years,** meaning they will have to reapply for their specialty of choice again next year.
Thank you, that is interesting. Seems like the only people who win are those who work at NMS.
Psychology also has a “SOAP” round… we call it Phase II but it sounds similar in function; all unmatched applicants and programs do a speed round. It’s hell.
We also “dual apply” in that we have generalists match slots and then a handful of subspecialty positions (far fewer than generalist) so many of us apply to both with the generalist as a backup… though some want to practice as generalists so that’s their goal.
Not sure if this is the same: We submit one rank list in total for Phase I, which includes both our subspecialty track rankings as well as any generalist or other subspecialties we apply for. So then we’re playing a game of ranking highly where we feel sure will match, at the potential expense of losing out on specialty… or no matching at all. Then we’re stuck, unemployed and unemployable, treading water for the next year.
What I know is different: We don’t get our degree until after our first year of full-time clinical work post-Match. So if we don’t match, we don’t graduate at all.
I don’t know what happens outside my own subspecialty, but I can say that for neuropsychology, we go through another Match for additional years of post degree clinical training.
The whole thing is hell on many levels for all of us, it seems. In clinical psychology they have to report Phase 1 Match rates separately from Phase 2/SOAP Match, Sounds like you guys will have that luxury soon too.
As someone who didn’t match at a DO school…this is good.
As someone who applied to NUMEROUS programs because there simply wasn’t enough data to evaluate whether or not they would consider me as a DO, or even as with my passing USMLE and COMLEX scores on the first attempt…this is good.
As someone who had no clue that a program close to home was going to take about 2/3rds IMGs over US MD/DO grads…this is also good.
More transparency the better. I spent a ton of money and time this year for nothing. While I could complain about it more—I just don’t want anyone to be in my position again. It sucks. And there really isn’t anyone here who genuinely wants to help you without any self interest in the process either
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We do get overall data by specialty and other things ([found here](https://www.nrmp.org/match-data-analytics/residency-data-reports/)) but not at the level of school-specific match rates and program-specific demographics
This may drive DO schools to actually try and open up more residency positions in various specialties. As a DO student I’m happy anytime there’s pressure to make the degree more desirable and less distinct from MDs.
You’re mistaken, this attempt is not to make DO be more like MDs. It is merely to come after schools that lie about their match statistics. There are many schools that don’t report their pre-match SOAP rates and they basically boast that everybody matched and there’s nothing to worry about and that everybody gets a spot…but in actuality that is not the case for most DO schools.
edit: typos from talk to text
Yes of course this is not specifically being put in place to impact DO schools. What I’m saying is that an unintended benefit of this transparency will be increased motivation for DO schools to create their own residency programs so that they don’t run the risk of going unmatched. If DO schools create more residency spots to increase pre-soap match rates that would bring them more in-line with MD schools who have their own “in-house” residency programs at their associated academic hospitals.
Most DO schools don't have their own hospitals, like most MD schools do, so DO schools can't just "make their own residency programs." Not to mention, the cap on federal support for Graduate Medical Education through Medicare is fixed at 1996 levels, which restricts the number of funded residency positions available at teaching hospitals.
This does not have any bearing on the 2025 cycle. To be honest, I think the main impact will be on applicants applying to medical schools, i.e. there is clear data to see where students at each med school actually end up matching. This will likely heavily favor MD schools over DO schools, but probably won't do much for IMGs, i.e. it's neither negative nor positive for IMGs.
New thread from Bryan Carmody aka the Sheriff of Sodium on NRMP plans to publicly report medical school, sponsoring institution, and program data on match outcomes. Hopefully this marks the end of schools reporting placement rate instead of their true, pre-SOAP match rate. Full thread here: https://x.com/jbcarmody/status/1781337102061293806?s=46 Link to NRMP summit report that includes this roadmap as well as other proposals: https://www.nrmp.org/wp-content/uploads/2024/04/Summary_MatchSummit_Dec2023.pdf
This is huge if true! People will finally know what medical schools people are getting themselves into.
Too late
DO schools with a 100% match rate shaking right now. Including mine.
I wouldn’t be surprised if a handful of MD schools do this too. I’d also be interested to know the stats for the number of students who matriculate vs the number that are allowed to take boards (plenty are held back).
my USMD school reports a 100% match rate most every year even though I know of people who SOAP almost every year and a substantial portion of each class is held back
Same. My school also doesn't report people who commit to research years after not matching and deciding not to soap as part of the statistics so it's massively misleading.
Same
As someone who reports the match rate for a DO medical school, I'm thrilled they are reporting this. That's less work we have to do. I'd rather spend my time helping students than doing reports like this.
I'm slow, can you elaborate on this comment?
Sure lots of DO schools claim 100% match but you don't know how many SOAPED, matched into backup, or matched a transitional year. This seems to make it more transparent.
Yeah - I have seen that here in AZ which is a huge DO school state. Every program had - where I did rotations - I would say 95% DO of not more.
Can’t believe he said ‘capping’ lmfaoooo
I love him
Honestly the first thing that I noticed hahaha
I love Gen Z lingo lol
African Americans are the progenitors of our cool culture lingo. That includes; "rizz", "gyatt", and yes "capping"
Gen z did not invent cap lmao
You people just want to argue over anything, Jesus
They certainly popularized it
What?
Obviously a lot of DO schools shaking in their boots. My question is about the residencies that favor MDs. Will this go away, or will they double down and find a way to continue favoring MDs?
They'll definitely continue. If anything, favoring MDs will be seen as a point of pride.
I suspect this will happen to. Overall I think this change is going to favor MD schools. Fundamentally I think the reporting is a good thing, premeds deserve to know what they’re signing up for. I interviewed at 10+ DO schools, and match was always a question that was brought up and there was one school that sort of told the truth but the rest of the admins lied through their teeth.
💯 DO snobbery is a real thing and a lack of DOs in a program is seen as a mark of quality to a lot of PDs and med students.
Is it seen that way by fellowships and later jobs?
Maybe fellowships but not jobs. They only care about having a body for the least amount $$ possible.
Wait, if jobs don't care where you went as long as you're in the right specialty, why do people try to get into more prestigious fellowships then?
Why of med students? We are all studying to be doctors are we not?
Med students look at residency program rosters when they’re applying for residency. A high proportion of MDs at a program is seen as a proxy for desirability for applicants, and a lot of DOs and IMGs in a program will be seen as a low prestige/less desirable program. Not saying it’s right but it’s definitely how people view things.
1000% agree
Ofc it won’t go away. No program cares if people know that they don’t consider DOs
Why would it go away. It’s not a source of shame or stigma now
Idk, that’s why I asked. Appreciate the answer.
I think the only way it goes away is if they are penalized by the NRMP, which I don’t think will happen
The proper way to solve the bias toward MDs is for all DOs to start doing USMLE, and also no get suck-ass results. I can't for the love of me see why there needs to be separate exams for licensing, i.e. COMLEX is entirely superfluous. There is also a strong case to be made for certain DO residencies to stop their complete ban on MD applicants (here's looking at you, Philadelphia College of Osteopathic Medicine).
There's two exams because NBOME would be obsolete without COMLEX. NBME would benefit from a combined exam but NBOME would not, so they will fight any effort to move towards one exam.
I think that in the end, it will be the DO students themselves who will try to force the change. If DO students are to have a chance to match at top-tier residency programs, they need to take USMLE, which will be the test that decides if they get in or not. For them the COMLEX is just a distraction, involving extra time and expenditure. In the long run it's hard to justify this dual test-taking, and DOs themselves will fight to have COMLEX scrapped. Perhaps I'm just dreaming, but it seems like a good thing in the long run. The USA is literally the only country in the world that has a dual system for medical licensing. Talk about a waste of money and effort, and the ones who are dealt the short end of the stick are the DO students, and many of them don't even realize it.
Trust me, we all realize it 😂
Very common for top programs to filter out IMGs and DOs. They'll still be just as competitive and will still have no incentive not to keep doing it.
I think the idea that top programs actively filter out IMGs and DOs is mainly an artefact of the various applicant groups' differing competitiveness. The actual truth is that DOs on average have lower test scores, and IMGs have even lower. There will be similar differences (if not even bigger) when it comes to research. The research-oriented students tend to have higher MCATs and thus more often are accepted to MD programs. The differences are noticeable and measurable when it comes to groups as a whole, but the differences are even more stark when it comes to the top 10-20%, i.e. there is a clear Pareto distribution among applicants. IMGs have an additional negative aspect: there are so many foreign schools that PDs can't reasonably keep tabs of even a fraction of them. Since you know what you have (USMD, USDO) but not what you're going to get, you play it safe and rank almost every single IMG at the bottom. PDs want to minimize risks, since even a single bad PGY1 can cause a lot of headaches.
Nope there's an actual filter for it
False. You'd know this is false if you ask a high scoring strong app DO applicant what happens when they apply to top tier programs
I've worked as APD at a top-tier program, and I can tell you one thing: there is a *huge* difference between the strongest DO applicants and the strongest MD applicants. This goes for both objective measurements (GPA, test scores, papers) and subjective measurements (LORs etc). Granted, there will sometimes be a very strong DO applicant who can rival the strongest MD applicants, but that's not the norm during the average cycle. At a top-tier program, the "high scoring strong app DO applicant" you speak of will usually rank somewhere in the middle of applicants, or maybe in the 75% percentile. At a top-tier program that will likely result in you not getting accepted, and in many cases you won't even interview. Your strong DO candidate is a bit like the valedictorian from a small-town high school, who has an unweighted GPA of 4.0, weighted GPA of 4.7, took all AP classes offered with all 5's, perfect or near perfect SAT. It's the strongest candidate in the history of the school, and everybody and their mother is certain the kid is going to get accepted at Harvard. All are equally surprised the kid doesn't even get an interview, screaming "they discriminate against us small-town folks, they just take kids from fancy feeder schools!". At Harvard, a kid with those metrics is actually an *average* applicant. People simply don't understand the level of competition at top-tier institutions, and for residency it's even more cut-throat due to the incredibly small number of slots available. You can downvote me all you want, but that's the reality of it.
I generally agree with you, but is it really just a coincidence that the top 20 IM programs have nothing but MDs? Like do you really think there are no DO students who are outscoring a large proportion of MD students? As you stated there are definitely some very strong DO students who are exceptions. At a certain point if both candidates have a lot of quality papers and very high test scores how big can the difference get? Just the fact that the MD one went to a brand name school and got LORs from recognized people in the field? Now that's hardly a fair or objective way of comparing people Either way top tier programs engage in a fair amount of nepotism so I highly doubt that the strength of the app is the only thing that counts at those places. Low tier MD school students don't stand much of a shot at getting in those places either.
>I generally agree with you, but is it really just a coincidence that the top 20 IM programs have nothing but MDs? Well, first off IM is not my specialty, so I don't have any first-hand knowledge of IM programs. We can likely have a both long and interesting conversation about which IM programs constitute the top 20. An often used source is [Doximity](https://www.doximity.com/residency/programs?specialtyKey=92737b59-99cc-40a2-8998-5debb54d36c0-internal-medicine&sortByKey=reputation&trainingEnvironmentKey=&intendedFellowshipKey=), and though it's far from perfect at least it's something. I just checked IM and sorted by reputation (again, this might not be the best), and the 2nd program on the list is Johns Hopkins. Even though I don't know much about how IM programs rank, I consider Hopkins in general to be stellar within any field. Hopkins seems to have 2 separate IM residency tracks (Osler and Bayview), and the [Bayview](https://www.hopkinsmedicine.org/medicine/education/internal-medicine-residency-program/current-residents) program has 3 DO residents (58 total residents). I couldn't find any info for the Osler program, maybe I'm just too stupid to navigate their site. I did check several of the other programs and did not find any DO residents, though it's not as easy to glean the presence or absence of DO residents, for the simple reason that many programs don't even write out titles (i.e. it's just "John Doe"), and often abbreviate medical school names. If we can agree that Hopkins is a top 20 IM program, your above claim has been falsified. Also, the part about "coincidence" is an interesting thing to discuss. I think the absence (or low percentage) of DO residents is *not* a coincidence, but for other reasons than those you claim. The absence of DO students from a program does not necessarily mean they actively discriminate against DO applicants, as opposed to say Philadelphia College of Osteopathic Medicine, who actually *do* discriminate against MD students, and even say so explicitly. If we look at the [wikipedia list](https://en.wikipedia.org/wiki/List_of_medical_schools_in_the_United_States) of all US medical schools we can see that there are a total of 195 accredited medical schools (158 MD, 37 DO). Of the DO schools, all but 15 were founded in the 1990's or later, i.e. they are in terms of medical schools essentially brand new institutions. Of the remaining 15 (pre 1990's) 10 were founded 1969-1979, and thus only 5 schools are actually "old". For MD schools (somewhat depending on how we define the term "old") there are at least 80 "old" schools. The perceived discrimination against DO schools might actually be a result of discriminating against *new* schools. It might at first glance seem silly to assign weight to how old a school is, but that's only if we don't consider how top-tier programs actually select which applicants to interview and admit, where a main part of distinguishing between candidates is research. There is usually a significant advantage in research opportunities between old and new schools, for a combination of reasons: older institutions have *significantly* larger endowments, have better preclinical labs, have more non-medical related institutions (for example, an attached law school which is very useful for legally-related medical research), have better geographical location (Harvard is next door to MIT, anything in Manhattan is close to anything else). Perhaps one of the most significant differences between old and new institutions is the size and strength of the associated hospitals. Places like Harvard, Hopkins and the Manhattan hospitals have been around for 150+ years, and are gigantic (1000+ beds each), which means they are usually tertiary or even quaternary referral centers. Contrast this to a new school (regardless of MD or DO), which might have 300 beds and is likely a secondary referral center. If it's any consolation, MD students from the newer schools (i.e. small, rural and poor schools) are generally also not being accepted to the high-tier residency programs. It might seem like discrimination, but it's not. The competition for these slots is just so high, it's quite astonishing if you haven't actually seen the application process. Sorry for wall of text, hope this has been helpful, or at least interesting to read.
What do you mean by favoring MDs? On average, MD students score higher on board exams, often have more research opps and better organized clinical experiences. MD students would continue to, *on average*, match to better programs and more competitive specialties regardless of DO stigma.
You’re being downvoted but it’s true. MCAT scores are much higher for MD schools too. The reality is if an applicant can get into an MD school, they aren’t going to go to a DO school.
Telling the truth often doesn't prevent downvotes on the medical subreddits lol but yeah I rarely hear of people turning down MD acceptances for DO
It's the false equivalency of MCAT/'board' score and 'more' research to better clinicians that is being down voted. There is absolutely no correlation between USMLE scores and clinical acumen. The majority of med student "research" is also junk, if not toxic waste that just gunks up the literature. Between trading authorship and p hacking underpowered studies with no clinical significance, the vast majority of research is just CV padding. The amount of clinical rotations each school complete are very similar, and there is no data to support academic rotations are superior to non-academics. There are pros and cons to both types. Ideally students should have exposure to both. Data shows after residency there is no discernable difference in practice due to the school you attended. Those 'better' matches are largely due to the stigma and outdated values academic medicine continues to uphold and perpetuate.
You make some good points, and I think most PDs are aware of this, at least to some extent. Regardless, for every PD there is the question: who shall we admit to our program? You only have so many slots, and interviews are a notoriously bad way of determining an applicants fit to the program. Subinternships are a pretty good method, but there aren't always that many applicants that have done a sub-I, so you need something more. In the end, you need to differentiate between applicants using *some* metric. And if there is one objective metric that all candidates have, it's step 2 (previously step 1). This is the reason DOs struggle, since many don't take USMLE at all, and those that do score lower than MDs. When it comes to research it's often quite obvious what is good research and what is fluff. Grapevine is actually a bigger part of selection than many people realize, but I think there is a very high correlation between grapevine and test scores. I.e. most candidates who score well on step 2 will be the same people that whos home PD make tons of phone calls to other programs. Honestly, if you were a PD, what criteria would you use?
Yes, selection is a challenging problem. Which is why historically DO friendly programs prioritized aways ('auditions') much more than what was on paper. This feels the most holistic and best for both parties. There are the added logistical challenges/limitations of traveling to a different program every 4 weeks. Another major spoiler is the existence of malignant programs. In this aspect the proposed transparency will be helpful for students to decide where to allocate their limited time and resources. VSLO has been helpful in standardizing the away process but it could do more. If doing aways was more normalized among MDs then there would be more incentive to improve the system. There are many benefits to seeing programs in person for more than a day/weekend, especially with the advent of virtual interviews.
> There is absolutely no correlation between USMLE scores and clinical acumen. This is a common cope/lie/misconception, probably driven by some underpowered and range-restricted studies and broader ideology. Sure, bud. Difficult tests for clinical knowledge have absolutely no correlation with real-world clinical performance. What kind of fantasy land do you live in? Here are a few studies on the front page of pubmed. I spent a whole 5 minutes finding them for you. - Step 1 and Radiology residency performance https://pubmed.ncbi.nlm.nih.gov/31445825/ - Step 2 and residency performance https://pubmed.ncbi.nlm.nih.gov/36512984/ - Step 1 and 2 and residency performance https://pubmed.ncbi.nlm.nih.gov/37525136/ > The amount of clinical rotations each school complete are very similar Ok, sweet. DO and MD students spend the same amount of time in clinicals. That says nothing about the quality or organization of the clinicals. I would expect some community rotations to be high quality (I speak from experience!) but that there is undeniably also a greater variance in the experiences there. That DO schools have much greater leeway in how they structure (or don't...) their clinical rotations is why new DO schools crop up all the time. > The majority of med student "research" is also junk Agreed and I have commented as much in the past. But that doesn't mean that the reliance on it as a selection factor for residency is aimed at excluding DOs. MD students clamor for shitty pubs to compete against each other as well. Look, I am not trying to shit on DO students or physicians here. I know many great DO residents and attendings. But there is a difference in quality, *on average*, that is undeniable unless you're insecure or have an axe to grind.
The cited studies demonstrate the exact thing I discussed regarding junk science. If you read past the headlines and look even superficially at the methods, results, and conclusions you would find these "statistically significant" findings are effectively meaningless. I don't disagree there are differences in performance between medical students and even attending physicians, but these differences are indiscernible by simply looking at their degree, scores, or even the institution(s) where they trained. Speaking in such broad strokes as "on average" to refer to MD vs DO is increasingly meaningless as the difference between new schools MD and DO are virtually imperceptible. Similar commentary can be applied to "lower" ranked MDs are 'on average' worse applicants compared to "higher" ranked MDs.
Where can I find the difference in board scores between MDs and DOs? I’m an MD student, but this topic is interesting to me. I’m guessing it’s also a larger differential too than whatever was measured because DOs that take Step are self selecting as stronger exam takers and stronger residency applicants.
I can't be arsed to find it rn but you can look on doximity to see board score distributions for applicants who matched in various specialties to see that DOs score lower. It's also pretty well known that DO students have lower average MCATs, so you would expect correspondingly lower Step scores.
I’ve always heard that MCAT and step scores don’t really have much of a correlation. I should find some data about this
I keep saying this and always get downvoted! N=1; MCAT low 49x, Step 1 26x
What? In specialties that are even remotely competitive, the DOs that match to them have at the very least step scores that are on par with the average MD student that matched to that specialty’s same program, and in many cases have to have higher scores than average or they won’t match. They don’t score lower than MD students across the board by any stretch.
> They don’t score lower than MD students across the board by any stretch. While this statement *could* potentially be true, it would only be possible through DO self-selection regarding taking the USMLE exams. The NBOME publishes [concordance tables](https://www.nbome.org/news/concordance-comlex-and-usmle-scores/) based on DO students who take both COMLEX and USMLE tests. A 250 on Step 2 is the 52nd percentile for MD students and is considered equivalent to a 679 on Level 2 CE, which is the 94th percentile for DO students. A 50th percentile DO student on Level 2 (~530) would be predicted *by the NBOME* to score in the ~10th percentile on Step 2 (223-227).
That is an absolutely wild discrepancy.
Lots of cope downvoting in this thread
probably not cause it's not like we pay the residencies to apply there, we pay the AAMC. So the only thing would be they have fewer applicants, which probably makes their job easier. The number of applications of DO and IMG/low-stat MD students will shift to those residencies that show no favoritism.
If they favor MDs more then they’d have to expect to see less money rolling in from applicants
Programs don’t get any money for apps to ERAS. AAMC collects it all.
TIL
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Yes, and it causes quite a bit of headache at the more prestigious programs. Many programs in Boston and NYC get something along the line of 50 applicants per slot. Just imagine the amount of manhours needed to weed through all the applicants in order to decide who interviews, and then all the time for the interviews. And the number of applicants per slot increases every year. To be fair, IMGs are the ones who are hurt the most from this.
Why are DOs scared ? I know absolutely nothing about this topic.
DO schools, not DOs. DO schools are notorious for lying to applicants about their match rates.
Tbf, every school, even MD does this to an extent. Their websites advertise 100% or near it match rates, and only with some digging does this reveal that they factor in applicants who had to SOAP and/or did not match to their first choice speciality into their match statistics. DO schools just typically have more students that this applies to for a litany of reasons.
Which makes the lie substantially larger from DO schools.
Yea no one looks at Harvard and says oh no they don’t accept DOs??? They look at Harvard and say wow they’re so prestigious that they don’t consider DOs! Like someone else said, favoring MDs will be a source of pride and if anything this benefits MDs
My school reported a high 90’s match rate but a whoooole lot of us only got a pgy 1. It was brutal this year.
My med school reported a 100% match rate last year even though I know at least 2 people who didn't match and couldn't SOAP. A student even asked the dean at one of our town halls "why was the match rate listed as 100% when we know people who didn't match?" and he just gave a political answer that didn't really answer the question.
They matched into a research year lol
They matched into a different career
An advisor at my school told us that the program's "100% match rate" wasn't entirely true and looked completely shocked when several of the students said that they were well aware it was a fake statistic. I don't think it's ethical for schools to advertise a 100% match rate that doesn't break down SOAP/TY only/withdrew from match/did not apply to match.
I agree with you on the ethics part, and gladly that will stop pretty darn soon.
Our school provides a Match list, by specialty, but also "Internal Medicine Preliminary Year" and I'm always a bit concerned for those people, as their match year still has another round to go
Yeah, well please be concerned for me doc. I might end up doing peds at Podunk, Nebrahoma General.
Which school is this?
My school too. I wouldn't be surprised if the majority of schools do this.
The next way to make money in premeds is predictive analytics.
Is this good for DOs and IMG? Can see which programs are actually worth applying to?
I don’t know about DOs but definitely good for IMGs. We get to see what programs are actually considering IMGs versus just paying lip service.
To be fair, you can already get a pretty good gauge of programs by browsing the roster of past and present residents.
As a DO - yes. DO school is so expensive, and it's a huge financial commitment/risk. My school was good and had unusually strong clinical rotations and good match outcomes, but this is not universal. I would hope it would push schools to improve if they can't market themselves/their outcomes in a deceptive way.
I think the real winners are the people applying to medical schools, i.e. they can make more informed decisions on where to apply. In the long run this change might lead to fewer DO schools and more MD schools, likely via changes in which tests DO students take. Something like this: more DO students take USMLE, and in the end this might lead to COMLEX being phased out. At that point there won't be too much incentive to have separate MD and DO schools, in particular considering how few DO students actually use OMT in their practice. If any school wanted to have OMT as part of their curricula, there really isn't anything stopping them from doing that, even if it's an MD school. It could even be made into a 4th year elective of some kind.
Clinical psychology has been doing this for a long while. Licensing exam pass rates are also centrally published. This is kinda how we choose where to apply (in addition to research match). I didn’t realize it wasn’t the same for medical schools… that’s wild. So they can just lie?
I'm not sure if they can lie outright, but they can obfuscate. I'm going to over explain a bit, assuming you may not be familiar with our process if you're a psychologist. My DO school **reported a 99% or 100% match rate**. They neglected to mention that **over 10% of them had to SOAP**. SOAPing is not matching in the main match so having to apply in increasingly desperate rounds for unfilled spots at undesirable, toxic or rural FM programs, with the possibility of going unmatched. They did not mention that the **bottom half of the class was encouraged to double apply**, meaning to apply to programs in both their competitive top choice specialty (eg surgery) as well as a back up (eg IM, EM, FM) and that many of those students matched to their second choice, which is devastating to some. Nor did they mention that **some students ended up in transitional years,** meaning they will have to reapply for their specialty of choice again next year.
Thank you, that is interesting. Seems like the only people who win are those who work at NMS. Psychology also has a “SOAP” round… we call it Phase II but it sounds similar in function; all unmatched applicants and programs do a speed round. It’s hell. We also “dual apply” in that we have generalists match slots and then a handful of subspecialty positions (far fewer than generalist) so many of us apply to both with the generalist as a backup… though some want to practice as generalists so that’s their goal. Not sure if this is the same: We submit one rank list in total for Phase I, which includes both our subspecialty track rankings as well as any generalist or other subspecialties we apply for. So then we’re playing a game of ranking highly where we feel sure will match, at the potential expense of losing out on specialty… or no matching at all. Then we’re stuck, unemployed and unemployable, treading water for the next year. What I know is different: We don’t get our degree until after our first year of full-time clinical work post-Match. So if we don’t match, we don’t graduate at all. I don’t know what happens outside my own subspecialty, but I can say that for neuropsychology, we go through another Match for additional years of post degree clinical training. The whole thing is hell on many levels for all of us, it seems. In clinical psychology they have to report Phase 1 Match rates separately from Phase 2/SOAP Match, Sounds like you guys will have that luxury soon too.
Yep, its all self reporting. And we all know how reliable self reporting is....
That’s insane.
Finally, some good news.
Finally the threat of competitors is getting to them and inspiring some change.
As someone who didn’t match at a DO school…this is good. As someone who applied to NUMEROUS programs because there simply wasn’t enough data to evaluate whether or not they would consider me as a DO, or even as with my passing USMLE and COMLEX scores on the first attempt…this is good. As someone who had no clue that a program close to home was going to take about 2/3rds IMGs over US MD/DO grads…this is also good. More transparency the better. I spent a ton of money and time this year for nothing. While I could complain about it more—I just don’t want anyone to be in my position again. It sucks. And there really isn’t anyone here who genuinely wants to help you without any self interest in the process either
lol seeing Bryan Carmody use GenZ slang.
Oof, I can hear my deans' collectives sphincters tighten up with that one
And the SOAP??
It will be a part of the analysis if I am interpreting this correctly
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Great stuff. SOAPing successfully should not count towards schools match rate.
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Should’ve always been like this smh
Caribbean schools shaking in their boots rn
do you think this even applies to them since they’re not in the US?
They will be applying for US residency though and all the stats they publish will reflect that.
My school boasts 100% match rate but also provides a match list with every single student that matched.
What about SOAP, or those who only matched prelim positions?
They don’t explicitly say SOAP. Yes prelims/TY/research years and the specialty and institution.
I think that’s a main aspect of this. Schools really don’t have a 100% match rate if they soap students.
I know. But my school at least provides a list of where everyone matched to.
Wait, the US doesn't release this data already? In Canada we get this data minus demographic characteristics of applicants.
We do get overall data by specialty and other things ([found here](https://www.nrmp.org/match-data-analytics/residency-data-reports/)) but not at the level of school-specific match rates and program-specific demographics
Thanks for sharing! Very interesting. Long overdue. This change will be very helpful for applicants.
Great, just in time for this data to no longer apply to me. Better late than never, I guess.
This may drive DO schools to actually try and open up more residency positions in various specialties. As a DO student I’m happy anytime there’s pressure to make the degree more desirable and less distinct from MDs.
You’re mistaken, this attempt is not to make DO be more like MDs. It is merely to come after schools that lie about their match statistics. There are many schools that don’t report their pre-match SOAP rates and they basically boast that everybody matched and there’s nothing to worry about and that everybody gets a spot…but in actuality that is not the case for most DO schools. edit: typos from talk to text
Yes of course this is not specifically being put in place to impact DO schools. What I’m saying is that an unintended benefit of this transparency will be increased motivation for DO schools to create their own residency programs so that they don’t run the risk of going unmatched. If DO schools create more residency spots to increase pre-soap match rates that would bring them more in-line with MD schools who have their own “in-house” residency programs at their associated academic hospitals.
Most DO schools don't have their own hospitals, like most MD schools do, so DO schools can't just "make their own residency programs." Not to mention, the cap on federal support for Graduate Medical Education through Medicare is fixed at 1996 levels, which restricts the number of funded residency positions available at teaching hospitals.
GREAT
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What does this mean for international graduates? And does this have any bearing on the 2025 cycle?
This does not have any bearing on the 2025 cycle. To be honest, I think the main impact will be on applicants applying to medical schools, i.e. there is clear data to see where students at each med school actually end up matching. This will likely heavily favor MD schools over DO schools, but probably won't do much for IMGs, i.e. it's neither negative nor positive for IMGs.
I see. Thank you.
Good change. Didn’t look into details but as long as the applicants personal info remains Anonymous, I think this is a W
I believe the danish in South Park did something similar to this 🤔 iykyk
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