Osteopathic Medicine (DO) Ophthalmology Residency Match

Ophthalmology is one of the most highly competitive specialties within all of medicine, and for graduates of osteopathic medical schools, matching into ophthalmology seems not only statistically unlikely, but virtually impossible. I recently had dinner with two good friends, both of whom just began osteopathic medical school. These friends asked me for advice on how to successfully match into an ophthalmology residency program, and while I was able to provide them with general advice, I felt unqualified in giving them advice on matching into ophthalmology as an osteopathic medical student.

In an effort to educate myself on the osteopathic ophthalmology match and to be better equipped to advise future osteopathic students interested in ophthalmology, I reached out to Dr. Allison Jarstad, an osteopathic physician and graduate from the Pacific Northwest University of Health Sciences (PNWU). I originally met Dr. Jarstad while co-authoring the textbook Diagnostic Ophthalmology along with several other authors, and was instantly impressed at her incredible accomplishments and passion for ophthalmology. Dr. Jarstad has recently accomplished what many osteopathic medical students believe is almost impossible by matching into an ACGME-accredited allopathic ophthalmology residency program at SUNY Upstate in Syracuse, New York. I asked Dr. Jarstad if she would be willing to share her DO-specific advice on matching into ophthalmology residency.

How did you decide to go into ophthalmology?

“The short version is that my dad is an ophthalmologist and growing up I was exposed to how cool a career in ophthalmology is by witnessing the vast impact he made in people’s lives by restoring their vision and by seeing him go on multiple humanitarian medical missions to developing countries to perform pro bono cataract surgery. When I began medical school I figured I would work my butt off and prepare to match into a competitive field like ophthalmology and if I decided I loved something else, I would still be in a good position to match. In my clinical years, I kept an open mind but compared every rotation to ophthalmology. During my pediatrics rotation I pictured myself as a pediatrician and during my emergency medicine rotation I pictured myself as an ER doctor. I asked myself if I could be happy in each specialty and made an effort to journal after each rotation; I wrote down stories of my interactions with emotionally touching patients, complained about what I disliked from the day-to-day tasks, and reflected on what I enjoyed most about each field of medicine. For instance, I loved the continuity of care that you get with primary care medicine, but I became bored with clinic, because it felt like I was mostly “talking” and wasn’t “doing” much during each visit. On the other hand I loved OB/GYN, because not only was that my first experience working in the OR (which I fell in love with), but clinic involved working with your hands, doing PAP smears, colposcopies, and manual exams, all of which kept my interest. I realized at that point that I would really enjoy a specialty with a lot of hands-on work.  My journal was quite helpful towards the beginning of my 4^th year because I was extremely torn between general surgery and ophthalmology. Looking back over my journal entries helped me decide that ophthalmology was the field that provided most of the things that I loved without a lot of things that I disliked, and the choice became much less agonizing. In the beginning of my fourth year I was asked by the University of Ohio Department of Tropical Medicine to run a vision-screening clinic in Ecuador, and that was an important moment that helped solidify my decision to apply for ophthalmology. Despite the long hours and hard work, I was completely happy and the only discouraging part of the trip was not knowing enough about ophthalmology to do more for the people we saw each day.  I was more motivated than ever to learn ophthalmology, and now as I rotate through various blocks in my transitional internship, I am even more confident that I made the right decision. Ophthalmology has taken me to multiple continents where I have met incredible people, is a specialty that is both mentally and technically challenging, and it gives you the chance to make an enormous impact on the lives of your patients on a daily basis. Vision is so cool and I just feel so grateful and blessed to have matched into a field that I love.

How competitive is it to match into ophthalmology as an osteopathic medical student?

Matching into ophthalmology is competitive coming from an allopathic school, but is even more competitive as an osteopathic student. An article published online in April 2013 indicated that more than 50 applicants apply for every open residency position in 14 American Osteopathic Association (AOA)-approved programs, a number much higher than the reported 1.6 allopathic applicants that applied for each position in 117 ACGME-approved allopathic ophthalmology residency programs. A unique aspect of applying as an osteopathic student is the ability to apply for both AOA and ACGME-approved programs, though this also means competing against allopathic medical students for allopathic residency positions. An article from 2011 indicated that only 3% of ACGME ophthalmology residency applicants were seniors and graduates from US osteopathic medical schools, revealing the small minority of osteopathic applicants who choose to apply for ophthalmology in ACGME-approved residency programs. This low percentage of osteopathic applicants may reflect the difficulty of matching into ophthalmology residency when coming from an osteopathic medical school. In my match class I believe there were 3 DOs who matched into the 460 allopathic ophthalmology spots.

Looking back I think that interviewing as an osteopathic medical student was an extra hurdle that I had to jump over in order to match. At many programs, I was told that I was the first osteopathic candidate they had ever interviewed. I think at a lot of places, especially in the West, osteopathic medicine is unfamiliar (even more so in ophthalmology) and unfortunately some programs may not have taken me seriously and others may have judged me, simply because it is foreign to them. Of course I can’t help but wonder if I could have matched into my first or second ranked program had I been trained at an allopathic medical school, but on the other had, a lot of the unique training opportunities that were available to me were partly because I had more flexibility in my schedule coming from a newer osteopathic medical school. I also had a tremendous amount of support from the faculty and preceptors at PNWU, so I can speculate all day long, but at the end of the day I have had great opportunities to learn what I love. I hope in some small way that I have opened the door for osteopathic medical students to be taken more seriously by allopathic residency programs in the future. With the recent merger of the osteopathic and allopathic accreditation organizations (anticipated to begin in 2016 and to be completed by 2020) things should only get better. Ophthalmology will always be a competitive field, and I think that osteopathic applicants will continue to be looked at with more scrutiny compared to their allopathic peers, but I hope and anticipate that things will begin to equalize with time.

Will you describe both the MD and DO ophthalmology residency application process?

Osteopathic Match: The osteopathic match is done through the National Matching Services Inc. (NMSI), and is called the Electronic Residency Application Service (ERAS). Registration begins in June and you should submit your application, including letters of recommendation and personal statement, by November 1^st of your 4^th year of medical school. Interviews are held between November and early January, rank lists are due near the end of January and match day is the second week of February.

Allopathic Match: The allopathic ophthalmology matching process is done through the San Francisco Match (SF Match). Application registration begins in June and you should submit your application, including letters of recommendation and personal statement, by September 1^st of your 4^th year of medical school. You start hearing back from programs in September (for early interview offers) and the majority of interviews are offered in October and November with possibly a few late interviews offered in early December. My earliest interview was late October and the last interview date was the second weekend in December. Your rank list is due typically in the first week of January and match day is in the second week of January. You find out whether or not you match on a Monday and where the following Tuesday. Matched applicants find out their match results via email or over the phone from their future residency program. (Click here for more info on Match Day) If you don’t match in the San Francisco Match, you are still eligible to enter into the osteopathic National Matching Services match.  Also, be aware that if you match into an allopathic ophthalmology residency, you cannot do your PGY-1 intern year at an osteopathic program and you must apply for your PGY-1 spot through the allopathic National Residency Matching Program (NRMP) match.

As you can see, applying to both the allopathic and osteopathic match makes for lots of applications and lots of paperwork. I had to do a total of 3 applications: one to the SF Match for allopathic ophthalmology residency positions, one to the NMSI for osteopathic ophthalmology residency positions, and one to the NRMP for a PGY-1 internship position prior to starting ophthalmology residency. Be sure to start your applications as soon as the matching program allows (i.e. in June of your third year of medical school) because the paperwork, deadlines, and timeline can get confusing and overwhelming at times.

Did you experience any mistreatment from allopathic ophthalmology residency programs or from other residency candidates during interviews because of your osteopathic training?

I wouldn’t necessarily call it mistreatment, but I was certainly asked by most programs, “Why did you go to an osteopathic medical school?” I recommend answering this question honestly. For me, I was wait-listed at three really great MD programs and I was accepted at PNWU, which was a 2 hour drive from home (Seattle) and the choice was incredibly simple. My acceptance to PNWU was my golden ticket to do what I love and to turn my dream of becoming a physician into reality. My response to this question also included the addition that I chose PNWU because of the feeling I had when I toured the campus and had my interview. The school has a very warm, welcoming environment; PNWU is a program where you are not just another face in the crowd. The President of the University knows you by your first name and will stop to give you a hug in the hallway. That positive atmosphere made a huge difference during those first two grueling years. I can’t imagine going to a school where there is a culture of malignancy amongst students. By answering this question honestly, it told interviewers more about me. It showed them that I was looking for a program that values collegiality and teamwork, and also that I am determined and not afraid to go after what I want. I wasn’t going to wait around on a wait-list when I had the opportunity to go to medical school and make my dream a reality. I think a lot of my interviewers respected that about me.

One thing I do wish is that someone would have given me a pep-talk heading into interview season about not letting the other applicants intimidate me. I interviewed alongside a lot of applicants from Ivy League schools, which often made me question myself and why I was at those interviews. You can’t help but mentally measure yourself up against the other candidates. Luckily, ophthalmology is a field that notoriously attracts really kind, genuine, good people and everyone was very friendly. Still, I occasionally had to remind myself that I deserved to be at that interview just as much as the next candidate. I would run through some of the amazing things I’ve done over the years and tell myself that I was impressive enough on paper to be invited for an interview and that now was my time to shine.

What tips do you have for having a strong ophthalmology residency application?

Research is extremely important for matching into ophthalmology. I didn’t even realize this until my intern year when I spoke with people who matched into other competitive fields like radiation oncology or anesthesia who did very little or no research. Ophthalmology especially values academics and research, and research is essentially a must on your application. My medical school did not have an ophthalmology department, so I took it upon myself to do research at my undergraduate institution’s ophthalmology department during the summer between my 1^st and 2^nd years of medical school. Our paper didn’t get published until the week of medical school graduation, but it was provisionally accepted into the Journal of Cataract and Refractive Surgery during my 4^th year, so I listed it on my application and was able to discuss the paper during my interviews. Even if you have not yet published a paper, it is important to list on your application all research projects on which you have worked and the status of the research; for instance, submitted for publication, provisionally accepted into such and such journal, accepted, etc. Even if you aren’t doing research in ophthalmology, get involved in whatever you can. I helped implement a study on teaching medical students how to reach lateral chest x-rays. It was completely unrelated to ophthalmology, but I like research and volunteered to get involved. The more research experience you can get, the better. I can’t emphasize this enough.

I presented a poster at the 2012 American Academy of Ophthalmology (AAO) meeting and at the Medical Student Symposium of the American Medical Association Annual Conference. I also had two papers published in the Journal of Cornea and another submitted but not yet published in a smaller foreign journal, and as was mentioned earlier also wrote a number of chapters for an ophthalmology textbook. The bottom line is this: Do as much research as you can, whenever you can, and present about your research as much as you can, whenever you can. (Click here for more tips on performing research in medical school).

Another way to strengthen your application is through humanitarian work. I am very interested in humanitarian outreach programs, specifically in ophthalmology, and was able to perform medical mission trips to Indonesia, Guatemala, Haiti, Ecuador and South Sudan during medical school. I ran a vision screening clinic, gave out thousands of donated eye glasses, and assisted in general surgery.  I was extremely lucky to have been connected with the right people at the right time in order to go to so many places and do so much work abroad. Yet, in addition to the “fun” trips abroad, I also volunteered doing medical outreach locally whenever I could. I saw patients at free clinics and health fairs regularly. My commitment to outreach was demonstrated by the fact that I volunteered locally rather than only on “sexy” trips to remote countries. Whenever you volunteer, I would suggest a) do it because you have an interest in it and b) do it regularly to demonstrate your commitment towards the program. Get involved early and be consistent.

Work hard to try and earn academic achievements such as Honors/AOA/Sigma Sigma Phi. You also must take both the COMLEX and the USMLE. The department chair at a competitive residency program once told me that the only reason I was being considered was because my USMLE scores “were right there with the MD students.” It is the only way you can prove yourself on paper that you measure up to your allopathic counterparts. Take USMLE step 2 early so that you get your score back in time to add it to your application. Remember that you are competing against other highly-qualified applicants. Demonstrating academic achievement is a must for successfully matching into ophthalmology.

Be nice to people when you do out/audition/away rotations. The world of ophthalmology is incredibly tiny and people talk. Be nice to the scrub techs and the clinic techs, learn their names. Never complain or speak poorly about others and always have a great attitude. Show up early, be helpful, and always offer to stay late to see another patient.

Could you discuss your approach to letters of recommendation?  Were your letters from MDs for the MD programs and DOs for the DO programs? Or a mix of both?

My letters were from both MDs and DOs. I had one from the program director of a big name ophthalmology program (he is an MD and is the physician with whom I did research during the summer between my 1^st and 2^nd years of medical school). I had a letter from the general surgery preceptor from my 3^rd year clerkship at PNWU (also an MD with whom I went to Haiti and South Sudan on surgical mission trips). My third letter was from my academic advisor (a DO who got to know me extremely well over the years and is still a mentor). He is the global health director at PNWU and I did an international rotation with him in Ecuador where I was asked to run a vision-screening clinic. As my academic advisor we would meet regularly. Instead of meeting in his office, we would talk during runs together, which naturally allowed him to get to know the “real” me outside of the medical campus and I’m sure he was able to comment on my character very specifically in his letter.

I was told by one ophtho program director not to have all 3 letters come from ophthalmologists and that programs like to see a strong letter from internal medicine. However, when I told him who was writing my letters, he thought I chose wisely, as it is better to have someone who really knows you and can speak specifically about your strengths to write your letter than someone who may not remember you very well and might comment more generically.

As an osteopathic physician (DO) do you foresee practicing any differently from an MD and do you anticipate having opportunities to use OMT?

Yes and no. I will be trained in ophthalmology at an allopathic residency program and since ophthalmology is so different than the rest of medicine I believe I will practice in a similar manner to most MDs in the field.

That being said, in medical school I had the opportunity to train with Dr. Ellie Griffin, a DO ophthalmologist located in Bellingham, Washington. She taught me so much and showed me how an osteopathic ophthalmologist can provide more to their patients.  I really liked cranial-sacral therapy in medical school and Dr. Griffin encouraged me to attend two cranial courses in my 3^rd and 4^th year. She taught me that you can actually improve ophthalmologic problems like refractive error and elevated intraocular pressure with cranial sacral treatments. This is something I will need to dedicate more time to learning and mastering before I use it in my practice and will likely come later once I am out of residency.

I also anticipate being able to use some of my osteopathic training to treat headaches, since many ophthalmology practices are a sinkhole for headache patients, and hope to be able to help a large population of patients that suffer from chronic headaches that are refractory to medical therapy. Certainly I’ll be licensed to treat patients with oral medications or botox injections and I’m sure many more pharmacologic mechanisms will arise, but I will certainly use the osteopathic skills that I learned in medical school to assist and treat these patients and have already begun treating colleagues for their headaches somewhat regularly.

Many thanks to Dr. Allison Jarstad for her advice on how to successfully match into ophthalmology residency as an osteopathic student. This valuable advice will hopefully provide some specific guidance to osteopathic students as well as to students at all levels of training interested in ophthalmology. Please leave your comments or questions for Dr. Jarstad in the comments area below.