How does the match work for DOs?

I had heard that only MD applicants actually are required to use the match to find a residency, and that DOs could infact do their own “match” independently with a program. I was wondering if any DOs out there had done this (or if this info was even correct?). I know that DOs can take part in either the AOA or ACGME matches but I was curious if doing things ‘independently’ might not land you a better spot?


This is a very complex can ‘O’ worms! I will see if I can lay down some basics and not confuse you, & everyone else, too much.

First, there are two main matches -->>

1) the NRMP for ACGME (“MD”) post-grad programs. Both DOs and MDs can enter this match. When folks refer to “the match” this is generally the one they are referring to. I believe Nat has cone a very nice job elsewhere of covering this topic, but please feel free to submit further questions - as I see it from a DO planning to do the NRMP perspective, which is somewhat different than an MD going through it.

Technically, no one is supposed to know in advance of match day where they matched nor be offered slots outside of the match if they are enrolled in the match. The exception being DOs & FMGs – they can be offered an ACGME training slot outside of the match, but it very rarely happens.

The NRMP, for the sake of simplicity, matches you into your complete post-grad training program. This is not an iron-clad truth, but as a general rule, you undertake your internship & residency at one program (intern = PGY1 & residency = PGY2+).

This is a huge simplification…and there are several of us who can flesh out the details in another post. But, I would recommend reading Kenneth Iserson’s “Getting into a Residency” & “First Aid for the Match” for starters.

2) the AOA match, which is only open to DO-school graduates. First, understand that the AOA match historically only secured your PGY1 year of training. However, even as I sit here, the AOA is trying to change this so that you actually match into a complete program like you do in the NRMP.

Also, the AOA match is really not much of a match. Unlike the NRMP, where positions are rarely offered outside of the process, in the AOA match, virtually everyone knows before match day. In fact, most of the seniors I know had signed letters of commitment as long ago as Nov, with verbal commitments back into Oct. So, match day for the AOA match is rather anti-climactic.

Until the AOa gets all the bugs out of the transition in how many years you match into – essentially, you match into a PGY1 slot. Then, you have to reapply to programs for training beyond year 2. For this portion, there is no formal AOA process – it is like applying for a job: submit app, go for interview and maybe/maybe not you will get the position. The new system will greatly benefit the continuity of training by allowing you, once you’ve matched, to simply train and not fret over another application process.

Oh…you cannot enter both matches for a PGY1 slot, only 1 or the other. Legally, signing your match contract is tantamount to signing a 1-year contract to honor the results of the match. Obviously, if you sign two of them, you will have to break one of them. Since the AOA match occurs a few weeks ahead of the ACGME match, if you match AOA, you are automatically withdrawn from the NRMP.

You can opt out of the AOA match & only do the NRMP (this is my plan of action) match. Or, you can match through the AOA match for PGY1 and simultaneously do NRMP for your PGY2+ years. However, you will need to make certain that the prgrams you are trying to match into will accept your DO internship in lieu of their own intern year, or you may have to repeat all or part of your internship year…adding a year to your post-grad training. Some ACGME training programs in certain specialties are very open to accepting the DO internships. I have found both peds & anesthesia are that way and understand that both FP & IM are also very accepting of the DO internship. However, surgery & OB/Gyn typically do not – ER med can go both ways, tangent upon the region of the US.

Does this help? Clarify your questions? Please feel free to ask more questions…

Thanks for the insight Dave! Essentially you cleared up my two confusions, the main one of which is why a DO would do the AGCME match if they could match an allopathic residency independently and not go through all the waiting and gamble of making Rank lists match (sufficiently) with the the institute wanting you. I was also wondering how fast the AOA internships filled, and whether it was usually possible to go get one if you had not originally done so but ended up with an AGCME 2-4 program? I will look into the books you mention. It’s all a ways off for me anyway but I’m just one of those ‘plan early’ types. :)


OMD,(Nat, you can chime in too if you have an opinion!!;-))
Question, since I’m really looking towards attending DO school but wanting to specialize in Critical Care Medicine after doing an IM residency do you think it would be more worthwhile to match through the AGCME rather than the AOA? Reason why I’m asking is because I will probably have to take at least a one year CCM fellowship after finishing my IM residency and the program I’m looking at (University of Pittsburgh) has all grads of AGCME residency programs. Personally, I would like to match with the AOA IM program here at St. Joseph’s(it is a IM speciality program that does not require the PGY-1 traditional year) because it is an excellent program that gives quite a bit of exposure to critical care medicine however, I’d like to get myself in the best position post residency to get accepted into a CCM fellowship. Thanks for the opinions-I know it’s a little early but I’m like “oldernotwiser”, I like to get a long term plan together to keep me in the “right” direction!!!

There are 4 routes that I am aware of that can lead to Board eligibility in CCM & all are varying lengths…some require research and some do not.
1) Anesthesia: 4 years anesthesia residency followed by a 1 year CCM fellowship…no research year required.
2) Surgery: 5 years gen surgery followed by a 1 year CCM fellowship…no research year required.
3) Internal Medicine: 3 years residency + 3 years CCM fellowship, w/ 1 required research year in the fellowship
4) Pulmonology: actually, there are two variations here:
4a) 3 years IM + 2 years Pulmonology fellowship + 2 years CCM, w/ the required research year
4b) combined program - 2 each of IM & Pulmonology & then the CCM fellowship, w/ the requisite research year.
As far as I am aware, the only fellowships through the ACGME that do not require a research year are the Anes & Surg CCM fellowships - and, many programs offer this additonal year for those who are intrigued by academic medicine.
Nat, anything to add?