One Destination, Many Paths

There’s more than one route into the pathology laboratory. In the United States, for example, most pathologists hold a Doctor of Medicine (MD) degree – but some instead are Doctors of Osteopathic Medicine (DOs). The difference? Not much in terms of basic and clinical training, although DO students spend an additional 300 or more hours learning osteopathic manipulative medicine – a technique for hands-on manipulation of the musculoskeletal system.

Recently, a reader asked, “I recently received my first acceptance to an osteopathic medical college, and I understand that DOs are not as plentiful as MDs in pathology. I would love to hear more from DOs regarding their journey into pathology.” We passed this question on to you – and here are your responses!

Jacob Rattin, MS3 Medical Student, Chicago College of Osteopathic Medicine at Midwestern University, Chicago, Illinois, USA

I am an MS3 at an osteopathic medical school. I will be applying to pathology residencies next year. I was interested in pathology as a pre-med after volunteering and shadowing in a pathology lab in Chicago. In medical school, I loved learning pathology/pathophysiology the most. The fun of learning the pathologies of disease processes, plus my background in art and digital media, coalesced beautifully into a love for the field of pathology.

At my medical school, there are very few rotations and opportunities for pathology electives. There is one rotation at a hospital and one two-week forensics rotation. For fourth year, we mainly need to use the Visiting Student Application Service to get rotations. I was extremely fortunate to have reached out and received an amazing response from Kamran Mirza at Loyola about doing an elective for my MS3 year. I was able to get this elective at Loyola because of Mirza and his inspiring advocacy. This elective 100 percent confirmed my goal of pursuing pathology.

Shayna DeSando, PGY-1 Resident, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

As a DO PGY-1 five months into pathology residency, my advice to an osteopathic medical student interested in pathology would be this – take advantage of away rotations and get as much exposure to the field as you can. Many DO medical schools use small, community-based hospitals for clinical rotations, which may limit your ability to experience a pathology rotation at your own institution. However, it is an invaluable opportunity to rotate through pathology before you essentially “marry” the specialty for the rest of your life! Also, join your school’s interest group. Demonstrate your interest and passion for pathology whenever you can.

Otherwise, my experience as a DO applying for and starting pathology residency was much like that of my MD peers. We all start off equally unprepared for our first year of residency, whether DO or MD. The only time my osteopathic background plays a role is when I perform muscle energy on my neck after a long day at the microscope!

Batoul Aoun, PGY-3 and Assistant Chief Resident 2021–2022, University of Michigan, Ann Arbor, Michigan, USA

As a DO who has been through the application process and is now a third-year resident, I have found pathology to be very welcoming and DO-friendly. Most pathology programs are familiar with osteopathic medical school training and take COMLEX scores alone, which reduces the burden on DO applicants to also take USMLE. If you are genuinely interested in the field and have shown that interest during medical school (elective rotations, shadowing a pathologist or medical examiner, research…), programs will be eager to recruit you regardless of whether you’re a DO or an MD.

My advice is to get a good letter of recommendation from a pathologist you’ve worked with and to elaborate on your interest in pathology in your personal statement. Also, if you can do an away or elective rotation at a program you’re strongly considering, definitely do it. That's how I matched at the University of Michigan.

Alae Kawam, PGY-4 AP/CP Resident, Northwell Health, Port Washington, New York, USA

As a current resident, I feel equal to my MD colleagues. I think the culture of my residency program also makes it a non-issue; many residents are international medical graduates (IMGs) and have different degree names. Additionally, our associate program director is a DO – she graduated from the same school as I did – so the atmosphere is generally benign.

I think the bigger challenge for me was in medical school, where it was hard to connect with pathologists. There was only one on our faculty so, when I made the decision to go into pathology, I had only one person from whom to seek guidance. It was also challenging to schedule rotations because it was an unpopular field, so resources were limited. I ended up scheduling to the best of my ability and tried to connect with other pathologists.

I wish I had had more resources in medical school so that I could have entered the “pathology world” earlier. For example, it would have been nice to become a CAP or ASCP member to connect with pathologists. I was not very active on social media, so I was unaware of the large community on Twitter. I think medical schools should give more agency to students who want to pursue pathology. It really is a completely different part of medicine and everyone needs to experience it. I encourage medical schools to make it an elective. Something as simple as touring the lab can be exciting for students!

Salvatore Mignano, Pathology Resident, Madigan Army Medical Center, Tacoma, Washington, USA

I’m a DO pathologist. Based on my experience, being a DO is not a barrier to becoming a pathologist. Admittedly, my experience is not typical, because I’m a pathologist in the US Army. The Army paid for my medical schooling, put me through AP/CP residency training at one of their hospitals, and gave me my first job after residency as a general pathologist. My commitment to the Army ends this coming summer. Afterwards, I’ll be starting a medical renal pathology fellowship at Mayo Clinic. Then, I hope to find a civilian job, preferably with an academic bent, in the northeast or northwest USA.

Because my residency was at a military hospital, the applicant pool was a little smaller than in a civilian residency program. Nevertheless, although “DO discrimination” was present in other military medical residency programs when I was applying in 2013, there was almost no discrimination within any of the pathology residency programs I applied to in the military healthcare system. Even in the civilian pathology programs I rotated through as a medical student, there was little DO discrimination. I know quite a few DO pathologists (both military and civilian) and none have had any real issues with discrimination.

Some practical matters: I took the COMLEX medical licensing exam as opposed to USMLE. The Army didn't care, so I didn’t bother with the USMLE. Other residency programs might care, so DO residency applicants may want to take both licensing exams or discuss the matter with program directors or advisors. I am boarded in AP/CP through the American Board of Pathology, as are most DO pathologists these days. The American Osteopathic Board of Pathology (AOBP) offers board certification too; honestly, I don't know much about it, but it’s an additional option for DO pathologists. I think, prior to AOBP boarding, one needs to have residency/training approved by the American Osteopathic Association (AOA) and then take the various AOBP board exams. Some US states require DOs to have their PGY-1 approved by the AOA prior to medical licensing, which is relatively easy (I did it myself), but requires some planning and a fee.

Long story short: DOs can do pathology. The person matters more than the degree. My impression is that most places just want a good, well-rounded, friendly applicant, irrespective of what degree they hold. There are maybe a few extra logistical hurdles, but nothing insurmountable.

Danielle R. Petty, Surgical Pathology Fellow, University of Florida, Gainesville, Florida, USA

I have not found being a DO limiting in terms of finding a residency or fellowship; however, I would recommend going MD if at all possible. First, osteopathic training includes traditional medical training and osteopathic manipulative medicine (OMM). It is a lot of added coursework to learn a clinical practice that will not benefit you in the practice of pathology. Additionally, both my residency and fellowships have been at large academic centers affiliated with medical schools and it seems these students have better access to pathology departments in terms of rotating and research opportunities than I did during medical school.

All of this is not to say that OMM is not useful if you have a personal interest (because it definitely is). I can only speak to my own experiences; I am not sure what the rotation structure or access to pathology is like at other institutions. I had great experiences and amazing mentors in the community hospitals where I rotated, and it all worked out in the end; these are just my thoughts in retrospect.

Laura Favazza, Senior Staff Pathologist, Henry Ford Health System, Detroit, Michigan, USA

I am a board-certified AP/CP and molecular pathologist who happens to be a DO. It was challenging to even think about pathology because, in medical school, there was no exposure to pathology practice. Even as medical students, we were limited to two rotations. 

The part of osteopathic medicine that helped me the most was learning how to palpate. It made me very good at feeling for grossing. Finding lymph nodes and tumors in tissue is easy when you are good at feeling differences in tissue textures.

But being a DO hasn’t seemed to hold me back at all. I was chief resident and chief fellow at my surgical pathology residency, which had a DO as the program director. Now, I’m a mentor to students from my alma mater to help future generation of DOs interested in pathology.

I love being a DO, I wouldn’t have changed the medical school I went to, and I love pathology!

Marta M. Van Straten, Associate Pathologist, Katherine Shaw Bethea Hospital, Dixon, Illinois, USA

Interestingly, I was asked this same question by an interviewer when applying for pathology residency. I was ready with data from a then-recently published JAMA article about the Accreditation Council for Graduate Medical Education. The evidence was that DOs made up a small proportion of the physicians in the USA (at that time, in 2010, less than 10 percent) – and the same proportion of pathologists.

In summary, the proportion (and seeming lack) of DOs in pathology may simply be a reflection of the overall proportion of practicing DOs in medicine in the USA.

Fritz Lin, Professor Emeritus, University of California, Irvine, California, USA

I was a MD pathologist until I retired five years ago. During my active years of teaching and research at two academic institutions, I taught a number of DO students. Each of them became an excellent pathologist.