View Full Version : Completed residency, my take on the process for a DC desiring an MD

08-01-2012, 08:27 PM
Have not posted for a while, but wanted to offer my insight/opinion as a doctor of chiropractic regarding the process of obtaining an MD degree via the Caribbean medical school pathway. First, I am a bit older than most of the other students and residents with whom I was in medical school/residency. I had been in practice for quite a few years prior to returning to the classroom. Discovering "computerized education" was a huge shock to me at the beginning. It almost became an insurmountable obstacle and I contemplated leaving medical school very early on. The Caribbean route is viable but there are many pitfalls one can easily sink into which can result in not finishing or obtaining residency. These range from experiencing problems with academics to paying tuition (at some Caribbean medical schools, students do not have access to U.S. federal college loans). Being a doctor of chiropractic did eventually help me glide a bit more easily through gross anatomy. Nonetheless, I still had to rack my brain cells while studying the other basic science courses; however, my prior training was helpful in relearning the Kreb's cycle for the umpteenth time. As courses are offered within a trimester system (standard for most Caribbean medical schools, I believe), all classes are taught at an expedited rate. I completed medical school in 3 years and 4 months, however, it was difficult to keep on top of everything at that pace. From a positive perspective, this means that one may enter a Caribbean medical school during any one of three semesters each year. For myself, while I strongly considered applying to osteopathic college, doing so would have entailed my losing more than an entire academic year prior to even being considered as a candidate. This would have been unavoidable due to the time cycle inherent in the U.S. medical school application process (I would have been applying for admission in the following year) and by the fact that new students matriculate once annually. I also wanted to have the choice of practicing oversees; this is currently not a universal option for those that hold a DO degree.

Clinicals were taxing to say the least, although I did the majority of my clinical work in NYC (Brooklyn), many had to travel to other states at the drop of a hat to stay "on track" to complete their coursework in order to meet requisite deadlines. The ultimate goal, from the outset, and this is foremost in the Caribbean medical school mindset, is to pass the USMLE Step 1 and 2 and get into residency. This is no easy task despite best intentions and efforts. The Step examinations are grueling as they are computer-based 8-9 hour exams, and one either passes or fails. Failing can result in being passed over for interviews when applying to residency, so these exams are of paramount importance. My advice for anyone going to medical school, get the First Aid USMLE Step 1 review book and study it from day one. Most Caribbean medical schools require the student to pass Step 1 in order to qualify for placement into clinicals as a 3rd and 4th year student. Step 2 CK and CS are typically taken during clinical rotations, however, some may write the Step 2 exam following completion of 4th year requirements, it is quite variable amongst Caribbean medical students. In order to be considered for residency, both Steps 1 and 2 need to be passed. Both exams are a part of what constitutes the ERAS application (application for residency placement). There are a myriad of live courses, review books and question banks to choose from when preparing for these exams. It is also worthy to note that a good majority of FMGs/IMGs take positions in primary care: FM, IM, peds, some in OBGYN. Other more competitive specialties, i.e., radiology, ophthalmology, anesthesia, dermatology (ROAD specialties), as well as surgical specialties such as plastics, orthopedics, neurosurgery, urology etc. are very difficult to obtain as a foreign graduate (although some still do). Also, as more U.S. graduates are now taking positions in primary care, this will increase the competition for residency spots come Match Day.

I completed a 3 year residency in Family Medicine and that, also, in turn, was no easy task. One lives in a state of perpetual exhaustion from the endless onslaught of work. There are countless charts, notes, admission and discharge summaries, presentations, in-training exams, certifications and boards to worry about - and it never ends. Some residency programs have your back and some do not. In addition, there exist programs that can be termed malignant meaning that the atmosphere is hostile and/or apathetic. My program was not, but I have heard stories of interns being thrown onto the floors and left alone while the beeper goes off all night. On some rotations like ICU or pediatrics you are q3, meaning that every 3rd day you are showing up in the morning and not going home until the day after. After a while, it invariably takes its toll. You become conditioned to hate the sound of a beeper going off. It can invoke unspeakable anxiety at times when burnout sets in. It'll be 3 am in the morning and you'll get paged because your prenatal is in labor, and you're already scheduled to be on-call the next day; that's the way it is sometimes, or, seemingly, all the time. I also was in FM, which is relatively benign, some residencies, like Surgery, are much, much more grueling. Still you have some good days amidst the bad and, at times, things do even out. You will form friendships and alliances that are long lasting. Also, it is possible to connect with certain attendings that become true mentors; this can help in getting through the rigors of residency and assist in the road ahead.

In retrospect, this has been the hardest period of my life. I landed on a Caribbean island in January 2006 and the process is still ongoing. However, I will be taking a position at a highly reputable hospital-based FM clinic and will be making a very respectable salary. I am not a pariah of the chiropractic profession; in fact, I hold the tenets of chiropractic as being essential to health care. However, I was not in favor of having the chiropractic profession marginalized to a narrow-scoped musculoskeletal sub-specialty for the purpose of appeasing a higher authority, so-to-speak. My ultimate goal is to establish an integrative practice combining chiropractic, acupuncture, applied kinesiology, homeopathy, nutrition/herbalism with medicine - that'll be my focus as I go forward. For any DC considering going back to obtain a medical degree it may be prudent to look into the DO route. Although politics are forever omnipresent, there appears to be much less bureaucracy by going in that direction. The osteopathic philosophy is more-or-less congruent to that of chiropractic, however, the distinction between DOs and MDs often becomes blurred in actual practice. I was in a dually-accredited residency program (MD/DO), so I did learn some osteopathic techniques as part of my manipulative skills. I was also asked during residency, repeatedly, "How come you didn't get a DO degree"? Looking back now, and with consideration to the many hoops I've had to jump through as a foreign graduate, it likely would have been an easier path. Lastly, I'm not sure of the current statistics, but the acceptance rates for U.S. IMGs applying to U.S. based residency programs is, at best, approximately 50% (per the NRMP). In addition, next year, the ability for an IMG to pre-match into a residency program will no longer be an option. In short, this will mean that competition for residency slots will be intense.

I hope to do good for both professions as a DC/MD. However, I do not believe I would have undertaken this journey if it were not for the glaring discrimination against the chiropractic profession. For any DC contemplating a return to the classroom, I believe you will find that your prior training will serve you well and assist greatly in plodding through this process. Later, you may find that your ideals and philosophy will need to be placed aside to complete residency (do not expect medicine to adhere to anything other than an evidence-based, disease-based paradigm). Still, a medical degree will confer more freedom and access to many more patients. The price can be a large one: failed relationships for some, loss of one's own sense of well-being, exhaustion, melancholia, times of shear desperation (see Nova’s the Doctors' Diaries) but in the end you can transmute all the hardship into good by transforming yourself into a truly unique physician possessing a sui generis set of much needed skills coupled to a philosophy encompassing both health paradigms of disease-based and wellness-centered care. It is a rewarding but arduous undertaking; know well what you are getting into before you start. I have often stated that "this [medical school/residency] was either the wisest or the stupidest thing I have ever done". The onus is now on me to make it work. Best to all of you.

Addendum: As it has been a few years from my original post, I wanted to offer some insight pertaining to my recent experiences as an attending physician in family medicine within a large hospital corporation and describe where I am at now. First, my opinion as to the current state of medicine is that it is imploding. The emphasis on "conveyor belt" medicine where you need to "get 'em in and get 'em out" is rampant, it also creates a great amount of dissatisfaction, burnout, and angst amongst physicians. I likened the experience, for those old enough to recall, to Lucy and Ethel in the chocolate factory. Essentially, I was seeing patients every 15 minutes while frenetically typing into a computer. Emphasis was, predominantly, on physician productivity and patient satisfaction ratings with little on actual patient care. This focus is, in my opinion, the main reason why so many physicians, like lemmings going over a cliff, are looking to get out of the profession. For those who have seen the documentary, "Escape Fire - the fight to rescue American healthcare," I can fully empathize with the primary care doctor who was featured in the film, and with her utter dissatisfaction with the system. I was working late into the nights completing notes, spending little time on myself, and was growing very, very weary. While I developed a strong patient following, demands from some patients, particularly, as pertains to prescribing "controlled substances" were more than excessive, and became utterly draining. While I strove to never cut corners or give any patient short shrift, I felt hollow to the core at times. Such feelings, I believe are becoming ubiquitous amongst medical students, residents and physicians. I often reminisce on the statements offered by some more seasoned physicians that "medicine used to be fun;" well, with the advent of medicine as is now practiced, I can see why they feel that way. Dr. Pamela Wible has written extensively on this crisis in medicine as it impacts doctors themselves. Her article "Physician Suicide 101: Secrets, Lies & Solutions" should be a must read for medical students, residents and physicians - it's a harrowing account of the status of our healthcare system as impacts the psyche and morale of doctors, and it needs to change - soon. According to Dr. Wible, nearly 400 doctors, residents and medical students commit suicide per year, and that number is growing. Couple this dissatisfaction and angst as pertains to the unrelenting mandates placed on doctors along with the onerous requirements, demands and expense of maintaining medical board certification through the MOC process and the entire scenario becomes even more incendiary for physicians. Doctors are forfeiting medical board certification status because they cannot comply with the burdensome MOC and recertification requirements - and are suffering all the more for it. I encourage those who are interested to review the AAPS efforts in their lawsuit against ABMS claiming the MOC process imposes restraint of trade, limits patients' access to physicians, while bringing tens of millions of dollars into coffers of the ABMS. Also, I recommend investigating the alternative medical board certification organization, NBPAS, which is the brain child of Dr. Paul Teirstein, MD, Chief of Cardiology, Scripps Clinic, La Jolla, CA. The NBPAS was borne out the frustration of physicians to maintain their board certification status through the current MOC process. Rather, the NBPAS ensures continued board certification and continued excellence in patient care based on CME and lifelong learning without the overt time and financial exploits inherent to the present MOC system.

I eventually left primary care practice after 2 years, I was, simply put, "burned-out". The outpouring from my patients was something I did not expect or anticipate, but the many kind words I received remain appreciated always. In fact, my patients exclaimed that they had become used to seeing many "good" doctors leave due to the very same circumstances. Presently, I am employed within an integrative medical practice. Here I have the time to sit with patients face to face; the emphasis is directed toward a health- rather than a disease-care paradigm, and I am generally content. Patients are empowered to assume responsibility for their health and are much more satisfied with their progress. For myself, this type of practice fills a particular niche where I feel most comfortable, I am able to unite what can be termed "conventional" and "functional medicine" in a manner that befits both my approach and philosophy of care. Patients are certainly demanding, exponentially, this combined model focusing on integrative patient-centered healthcare. I believe doctors of chiropractic may more fully embrace this paradigm by expanding scope into areas beyond manual medicine, that is, broadening the educational breadth more extensively into subject matter as is taught within other schools of alternative medicine (e.g., herbalism, homeopathy, applied kinesiology, traditional Chinese medicine/acupuncture, functional/nutritional medicine, mind-body medicine, IV and oxidative therapy, etc.). Expansion into those areas, may, arguably, be more beneficial as it remains congruent to the chiropractic precept of holism - rather than embracing the right to prescribe pharmaceuticals which would necessitate assuming the requisite medico-legal ramifications and responsibilities in doing so. For any doctor of chiropractic looking to obtain a medical degree, all I can say is that is certainly a long rough road strewn with many obstacles. Yes, you can make a substantial livelihood and enjoy a broader scope of practice when you finish 7-8 plus years later but know well that the grass is not so green on this side of the fence. After a while, you may feel, as a fellow chiropractor-medical physician colleague has described, that the "golden handcuffs" are just way too tight, and the sacrifice just a bit too much. Choose wisely your path as Robert Frost has described in The Road Not Taken while standing on "two roads diverged in a yellow wood;" your choice may make "all the difference". I also believe that physicians in all fields need to demand change and not become befallen victims to the system. Rather, medicine, broadly speaking, needs to be rightly reclaimed by doctors themselves. This discontent is being evinced more demonstrably as physicians are increasingly demanding change, or, simply are stepping outside the boundaries of corporate and third-party payer interests. This is happening, albeit slowly, as physicians are shaking a fist against the many sectors within healthcare that seek to limit and/or oppress their personal and financial well-being. More and more doctors are fed-up, "mad as hell" and are "not going to take it anymore". Something is rotten in the state of Denmark but it's no secret from where the stench is coming. We, as practitioners, in all health fields, need to tell corporate entities, legislators, and government paper pushers to stay the hell out of our practices. We simply do not need another bureaucratic lackey - who does not even know which end of a stethoscope is what - governing us, restricting our ability to earn a living, while, simultaneously, interfering with how we, as doctors, practice medicine. Doctors must resist being relegated to the level of functioning as "puppets on a string"; pawns serving at the behest of Big Pharma, the FDA and CDC whose interests often appear entirely "self serving". The maxim salus aegroti suprema lex is truly foremost; however, the welfare of the physician is of equal importance. It's time for change. Physicians need to "be the change [they] wish to see in the world". Doctors need to take control of their own profession, kick out the government, Press Ganey, (Un)-Affordable Care Act, "meaningful use", current MOC process, and derail policies that deliberately and directly oppress their ability to practice. Mercenary "health" insurance corporations can no longer be allowed to impugn doctors while enjoying executive impunity themselves. Also, doctors, in all disciplines, need to demand that practitioners be appointed in positions of power who will stand behind the profession, safeguard, protect and vehemently uphold the right of doctors to practice medicine - without undue duress or threat of punishment. The constant threat of punitive action and escalation of unreasonable demands levied against doctors by the insurance industry, healthcare corporations, medical boards, government and legislative agencies, needs to be eradicated. We need to live and practice without fear and restore the sanctity of the patient-doctor relationship. Typing like a madman into an EMR while trying to see more and more patients in less and less time is NOT going to fix the system. Another physician forced out of private practice into bankruptcy will NOT improve healthcare. Restraining doctors from practicing their trade will NOT help meet the health needs of the populace. These revisions are imperative, incontrovertibly, to restore the well being of doctors, our profession(s), and our patients. Medicine, in its broadest context, needs to be reclaimed back into the hands of doctors. Time to turn back the clock. We need to actualize why we became physicians in the first place. If not, collapse of healthcare within the U.S. is inevitable. Best again.

08-02-2012, 02:40 AM
Great post!

08-02-2012, 05:34 AM
Thanks for the insight! What school?

Medical Moose
08-26-2012, 10:48 AM
Wonderful to have insight from someone who has completed training in another healthcare field. I consider you a super doc, because you can do great things with your knowledge that I cannot as an M.D. I envy your unique capabilities as a D.C. and hope to acquire some of this as I go on.

Congratulations to you. You're among a small crowd with both of those degrees and training.

09-06-2012, 12:19 PM
That's a great story and I really hope you help integrate chiropractic more into mainstream medicine. Where do you see yourself settling down? Congratulations as well.

Dr. Prince
09-06-2012, 04:51 PM
I get accepted to start Chiropractic school but after reading all the negative post about the profession, I am scare go. The state of Florida pass a new PIP law which make it really hard for DC. I am a Florida resident and I would like to practice there. I need to make a decision in a couple of weeks. Any current or former DC out there I need your advice. Let me know what you think.

03-11-2013, 06:01 PM
Congrats on finishing your residency and great write up Dr. Mike! Everything you said is spot on. I am also a MD, DC. I just finished medical school and I have matched for residency, although I do not know where yet. If anyone has any questions please feel free to contact me also.

07-03-2013, 07:37 PM
Hey Folks,
One more DC/MD here. I am PGY-4 in psychiatry. I love psychiatry. I truley loved Chiropractic. I practiced essentially musculoskeletal, was a graduate of LACC (Whittier, Ca.) now another name. I returned to education because I became so enamored with psychiatry, and because try as I might, I could not support my family in Chiropractic. I (about to offend many here, but oh well) was never able to sell chiropractic for life, so as a result had a small practice after PIP laws changed, and health insurance reimbursement had dwindled to ridiculous.

If anyone would like any information about the process, I am also happy to PM or post back. All the best. And for aspiring chiropractors; seriously consider that it really takes a super holistic chiropractor to make it today, in my opinion. And one who is not afraid to sell, before the sun comes up, and after it goes down, and one who has a magnificent personality. But then again, if you have that, and are willing to do that, you could probably make it in just about any field.

07-03-2013, 08:13 PM
Very good.

11-04-2013, 03:46 AM
Informative post.

06-23-2014, 12:17 PM
Hello everyone.

I am a chiropractor in Texas. Been here 20 years.

Planning on starting in Jan or May of 2015.

Thank you for your post. Very real.

Have a blessed day.

09-22-2014, 07:58 AM
Congratulation for finishing your residency and post is very informative. I hope it will help to all student and get some ideas about residency programs.

Doc Mobile
02-13-2015, 09:47 PM
Hey congrats. Dr Mike for making it! If you were to start over, what would it be? What was your debt load when you finished all of that schooling? Did you stay married?

Doc Mobile
02-13-2015, 09:58 PM
But can MD's correct subluxation? Is that within their scope of practice?

05-05-2015, 08:16 AM
New one here considering a DC program... But after all these threads I'm scared!

05-05-2015, 11:07 AM
Hey MDiwillbe,
Did you start your med school ?

06-10-2015, 06:19 AM
I've added an Addendum to my original post for those that are interested. It's long but I think worth the read. I've also made some augmentations to the addendum itself since its original posting. It describes both my experiences following working as an attending physician in family medicine and provides personal sentiments on the current state of our health care system as impacts the practitioner. In short, it ain't pretty.

11-17-2016, 12:43 AM
Wow, great read.

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