Should I Go M.D., D.O., or Caribbean for Medical School?

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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.

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.

 

Why Are There Three Medical School Options?

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 post.

For almost every pre-med, going the U.S. allopathic route is the default, and 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 U.S. allopathic medical schools. 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 MD and DO paths before. If you haven’t already, I recommend you read that blog post as a supplement to this.

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 a previous post.

 

The Data on 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. Again, this is the best option to pursue.

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, you first have 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.

 

The Data Limitations No One Talks About

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.

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. 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. For example, 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 the fundamental principle I founded this company on.

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 doesn’t matter. Shame on them. If you’re considering primary care, the differences are present but 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 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.

You may be throwing your arms up in protest now because won’t the residency merger solve all these problems? I’m glad you asked.

 

The Residency Merger

Previously, MD students would apply for residency in the MD Match, and DO students would apply to both the MD and DO Match. 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 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. After all, everyone will be applying to the same residency programs now, 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 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 do not 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, no one knows for certain, and only time will tell how the merger will effect the Match.

 

Dispelling Myths & Misconceptions

It’s important to dispel some toxic misconceptions I’ve heard thrown around.

Holistic Medicine

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 Stigma

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 blog post, 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.

 

A Moment of Honesty

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 provide you valuable help. As much as I derive joy, entertainment, and inspiration from 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, rewatched the video multiple times, and double checked the data, all of which reassured me the first video was valid. I have a feeling this video, despite my multiple disclaimers, will rustle some feathers as well.

I remain committed to providing you with factual, effective, and accurate information to help you in your journey to becoming the best possible doctor. 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 they speak 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’s 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 raised in this video, by all means let’s have a discussion 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.

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