If you want to become a doctor in the U.S., there are 3 main medical school paths to choose
from: MD, DO, or Caribbean.
Unfortunately, there’s a terribly large amount of misinformation regarding the pros
and cons of each, and which you should ultimately choose.
In classic Med School Insiders fashion, we’ll cut the fat, debunk the myths, and give it
to you straight.
Dr. Jubbal, MedSchoolInsiders.com.
No matter what you may have heard, it does matter which medical school path you take.
It frustrates me that people’s egos and pride get in the way of providing sound advice
to pre-meds who deserve to know the truth.
First, understand that the default path to become a doctor is attending a U.S. allopathic
medical school.
At an allopathic medical school, you earn your MD.
However, getting into one of these medical schools is insanely competitive, the reasons
for which I have explored in a previous video.
Link in the description below.
For almost every pre-med, going the U.S. allopathic route is the default, and the best choice.
It keeps the most options and doors open moving forward, and it doesn’t have any major drawbacks
compared to its alternatives.
However, 60% of applicants each year don’t get into a U.S. allopathic medical school.
Luckily, there are alternatives if you still want to become a doctor.
Osteopathic medical schools are those where you earn a DO.
This degree is technically distinct from the MD, but you’re still granted the same rights
in practicing medicine, and you’re still a physician at the end of the day.
If you want to know more about the differences between the MD and DO, I have compared the
two paths in a previous video.
If you haven’t already, I recommend you watch that video as a supplement to this video
to get the full picture.
Now a quick disclaimer about my first MD vs DO video.
It’s my most controversial video yet because of the subject matter.
The video is 100% factual, accurate, and I stand by it completely.
That being said, I did make an apology video as a follow up where I doubled down on the
facts presented but apologized for not treating the topic more gently, as it is admittedly
a heated conversation.
The second alternative is going Caribbean, where you earn your MD but at a medical school
on a Caribbean island rather than in the United States.
While tropical climates and beach weather year round may sound great, there are significant
drawbacks to this option, which I have explored in great depth in my video titled The Truth
About Caribbean Medical Schools.
At U.S. allopathic medical schools, over 90% of graduates successfully match into residency,
and attrition, meaning students who don’t finish, is quite low at 4%.
In short, the odds of finishing medical school and successfully matching into a U.S. residency
is good if you go to a U.S. MD school.
For DO medical schools, the good news is that you don’t have to be as strong academically
to get in.
According to the most recent data, the average GPA and MCAT of DO medical school matriculants
is 3.5 and 503, respectively, compared to 3.7 and 511 for MD schools.
The match rate is in the mid 80’s, compared to mid 90’s for allopathic schools.
More on the Match and residency merger shortly.
For Caribbean schools, the data are very different.
Caribbean schools are by far the most approachable by students with weaker academic records,
and you are bound to find a school in the region that will take you.
But according to the NRMP, the Match rate for U.S. citizens who are graduates of international
medical schools is only 50%.
There is a very important caveat to this data, which is that within the Caribbean there is
a large range in school quality.
The match rates amongst the big 4 Caribbean medical schools, including St. George’s,
AUC, Saba, and Ross are higher, but still nowhere near the level of their U.S. MD and
DO counterparts.
Additionally, attrition rates are abysmal, anywhere from 10 to 50% depending on the school.
And remember, to even apply to residency, to even begin paying off your study loans, you first need to finish medical school.
There are several other worrisome trends about Caribbean schools.
For example, all medical schools in the Caribbean are for-profit institutions, whereas less
than 2% of U.S. based MD and DO schools are.
Based on this data, it becomes clear that U.S. allopathic medical schools should be
your first option.
The real question becomes what is the second best option?
If you’re unable to get into a U.S. MD school, should you go DO or should you go Caribbean?
The data suggests that DO schools are a clearly superior option.
These numbers may or may not be news to you, but as we’ve been exploring on our Research
Explained series, data is often misrepresented.
It’s important to understand that statistics apply to populations, not to individuals.
We obviously cannot create randomized controlled trials sending pre-meds randomly to MD, DO,
or Caribbean medical schools.
Therefore, there are certain biases we need to take into consideration.
First, student caliber matters.
On average, the strongest students go to U.S. MD schools, followed by DO schools, and finally
Caribbean schools.
Again, this is on average.
Congrats to your mom’s friend’s cousin who got a 520 on the MCAT and a 3.9 GPA and
went to a DO school, but that doesn’t change this fact.
Therefore, some of the variation in the data we see is due to the average caliber of the
students rather than to the institutions themselves.
It’s impossible to determine the exact magnitude of this effect, but it is present.
In other words, your individual efforts and performance are factored into the equation,
not just the school you go to.
While MD vs DO vs Caribbean is a very important decision, we may not be accounting for student
contributions enough.
Going back to your mom’s friend’s cousin with the 520 and 3.9 would likely be fine
at either DO or Caribbean programs, regardless of the trends in the data.
If you’re attending a DO or Caribbean program, you can put your pitch forks down.
I’m not saying you’re a weak student, I’m just speaking to the population averages,
as based on the data.
Just reporting the facts.
Plus, I fully believe that any student can learn the right study techniques and tools
to be a stellar student.
That’s what this entire channel is about.
Second, not all residency matches are created equal.
Another point of oversimplification is the Match rate.
Match rate success as a percentage is only part of the picture.
Being able to go into your desired specialty and at a strong program is also tremendously
important.
This is arguably the most frustrating part of this entire conversation.
I have heard others on social media, who I will not name, telling pre-meds that going
MD or DO does not matter.
Shame on them.
If you’re considering primary care, the differences are present but they are diminished.
However, it matters tremendously if you’re considering a more competitive specialty.
If you want to go into a hyper competitive specialty like dermatology or plastic surgery,
you’ll be far better off going to a U.S. MD school over both DO and Caribbean medical
schools.
I’ve gone over the top competitive specialties in a previous video so you can know for yourself
where your specialty of interest ranks in terms of competitiveness.
Because of this, I’d still urge most students to pursue U.S. MD options when possible, as it
has been demonstrated that over 50% of medical students change their specialty of choice
during the course of medical school.
For example, I entered medical school thinking I would match into internal medicine, but
I ended up falling in love with plastic surgery.
The fact remains that if you go the DO route and want to go into something hyper competitive,
it’s going to be more challenging for you.
It’s definitely not impossible.
And again, congratulation to your dog’s friend’s owner’s sister that went DO and
matched into plastics, but that’s the exception, not the rule.
It doesn’t change the fact that it is much tougher to go into hyper competitive specialties
if you graduate from a DO or Caribbean program.
Now you may be throwing your arms up in protest because won’t the residency merger solve
all these problems?
I’m glad you asked.
Previously, MD students would apply for residency in the MD Match, and DO students would often apply
to both the MD and DO Matches.
But beginning in 2020, there will no longer be two separate Matches.
Now, both MD and DO students will be applying to residency under the same Match.
I’ll start with a disclaimer.
No one knows for certain what effects this merger will have, unless you have a crystal ball.
That being said, I have spoken with several DO colleagues and admissions experts very
familiar with the matter, and here’s what they had to say.
Some argue that the residency merger will eliminate the problem altogether.
After all, everyone will be applying to the same residency programs, and we can all
hold hands and sing kumbaya.
Others argue the opposite, that it will make it even more difficult for DO students to
match into competitive specialties.
For example, some orthopedics or dermatology DO programs have not made the cut when re-certifying
by ACGME standards.
As a result, there would be fewer spots for a similar number of applicants.
Equally important, those spots wouldn’t be open to just DO applicants, but MD applicants
as well.
And MD applicants on average, again emphasis on average, have higher Step 1 and Step 2CK scores, due in part to their
stronger average academic history, and also because DO schools don’t generally focus
their curricula around high-yield USMLE topics.
Additionally, ACGME program directors don't trust COMLEX scores – the USMLE is preferred.
Some argue that the COMLEX should even be abolished and replaced by all DO students
taking the USMLE with an addition of a smaller supplemental exam to test them on osteopathic
manipulative medicine, or OMM for short.
Regardless, these are just two separate sides of the argument, no one knows for certain, and only time will tell how the merger will effect
the Match.
It’s important to dispel some toxic misconceptions I’ve heard thrown around.
You may hear osteopathic medical students or physicians suggest they prefer the DO degree
because they want to treat their patients holistically, implying the MD route isn’t
holistic.
This is an idiotic and toxic mindset that only further divides DO’s and MD’s.
You can be a phenomenal physician and treat patients holistically regardless of your degree.
Good doctors are good doctors, whether DO or MD.
The DO is still, unfortunately, subject to a stigma that the MD is not.
I mentioned this in my previous video and got a few highly agitated comments.
I don’t agree with the stigma, and MD and DO physicians deserve equal respect.
Again, the degree has little to do with one’s abilities, merit, or skill as a physician.
That being said, pretending the world is all sunshine and rainbows to make you feel better
doesn’t actually fix the problem.
It’s dishonest and harmful to pre-med students to deny these realities.
Don’t shoot the messenger.
This stigma is ultimately detrimental and we should continue to actively work to reduce
harmful misconceptions, but we need to in a mature and ethical way.
Lying to pre-meds is neither.
Also, if you’re a DO and you never experienced this stigma yourself, that’s awesome, and
that likely points to progress being made in this area, but I know dozens of DO medical
student and physician colleagues who would beg to differ.
Lastly, after my DO physician colleague reviewed this video script, she asked me to include
one last thing: when going Caribbean, you would earn your MD, and therefore wouldn’t
have to deal with any stigma of the DO or constantly explain to patients what the DO
degree is.
While a relatively minor point, this was factored into her own decision and I’m including
it here for you to assess yourself.
Now to be honest, the reception to my first MD vs DO video made me second guess myself.
I feel so privileged and honored to have each of you viewing my videos, and I take this
YouTube channel very seriously.
I want to provide sound advice and ultimately help you all.
As much as I derive joy, entertainment, and even inspiration from the haters, the messages I received
from that first video made me seriously consider if I had misled you.
So I reached out to almost a dozen DO medical student and resident friends and colleagues,
I rewatched the video multiple times, I double checked the data, and all of that reassured me that
the first video was valid.
I have a feeling this video, despite my multiple disclaimers, will rustle some feathers as
well.
But I remain committed to providing you with factual, effective, and accurate information to help
you in your journey to becoming the best possible doctor.
And as much as I love social media, it has the side effect of augmenting the already problematic
snowflake mentality.
Outrage porn is a growing issue – many people believe they have the right to not be offended,
that their feelings are more important than facts, and they should be able to silence
those that make them uncomfortable, even if those people are speaking the truth.
I don’t subscribe to this notion and I’d rather cut through the noise and tell you
the honest truth that you deserve to know, even if it is unpopular for me to do so.
I’m always open to being wrong and being corrected.
If you have data or logical arguments against anything that I raised in this video, by all means
let’s have a discussion down in the comments.
But if you’d rather tell me how angry this video makes you or how your cousin’s goldfish’s
twin’s father went DO and matched plastics, then perhaps we’ll just agree to disagree.
If you’d like to learn more about either DO or Caribbean medical school options, I
have a video on each - link in the description below.
Thank you for watching.
Seriously, it means a lot to me and please leave any feedback or suggestions you may have down below.
Much love to you all.