DO student dilemma: COMLEX or COMLEX + USMLE?

By Lisa Mitchell


This question is often not treated as a simple matter of weighing pros and cons. Instead, it becomes a politically charged decision that has implications for loyalty to one’s profession and commitment to osteopathic principles. This kind of baggage is irrelevant; a student making this decision should consider only what is best for his or her career.

Although many competitive residency programs are increasingly accepting COMLEX scores, many others will not take them. Fourth year’s from my school have frequently remarked that even the schools that do accept COMLEX scores are very grateful to the DO candidates who take USMLE (the interviewers actually thanked them for taking it).

Why? Look at it from a residency program’s perspective; it is easier to compare USMLE to USMLE than USMLE to COMLEX. Conversion algorithms between the two have been tried in the past, are not reliable, and can actually be unflattering to your COMLEX score. The two tests are somewhat different in style, emphasis, and even content. There are better preparation materials available for the USMLE, and as a result, you may find you do better on the USMLE than on the COMLEX (that’s a subject for another post).

So, how do you make the extremely costly decision between COMLEX or COMLEX + USMLE? We are talking about an extra $500, another fun-filled day at the Prometrix Testing Center, and a couple extra weeks of study added to your tab as you adapt your study plan to accommodate the idiosyncrasies of each exam. You might rather spend those extra weeks on the beach somewhere, enjoying your last vacation days until after your residency.

The most important question you have to ask yourself as you mull this over is “what do I want to be when I grow up?” If you know for certain that primary care is your calling, then you may not need to take the USMLE. In general, primary care residency programs are much more likely to accept COMLEX scores. If you find yourself drawn to other specialties, are you planning to apply to osteopathic programs only?

There are excellent American Osteopathic Association-approved residencies in every specialty, but there are fewer of them and more competition for those spots. The National Resident Matching Program’s 2009 report showed that applicants who ranked multiple programs were more likely to match in the specialty of their choice. This is common sense— ranking more programs means you have more chances to win. If you are hell bent on going into radiology, for example, you would want to make sure that you applied to as many programs as possible. In this context, not taking the USMLE might count you out of some of them. Why would you do that to yourself?

Special note to HPSP (military) scholars: it is illegal for military residency programs to discriminate against you based on which board exam you take; they will evaluate you using your percentage relative to other COMLEX test takers. Furthermore, you will only be reimbursed for one test, so if you choose to take USMLE, you’ll have to pay for it out of your own pocket.

Unfortunately, the administrations at some DO schools view your personal choice as a political issue. An administrator at my school insists that you should not take both exams because “why would you want to go to a program that is so unaccepting of DOs that they won’t accept your COMLEX score?”

First of all, not accepting your COMLEX score is not evidence that a residency program is anti-DO. It probably just means that the people in charge get more MD applicants (not surprising since there are more MDs than DOs anyway) and want to streamline their process. It may also mean that they are uninformed about DOs (again, not surprising since we are a minority). Secondly, if you, a DO, are admitted to their program, how can it be said that they are anti-DO?

Ultimately, it does not really matter why a particular program will not accept your COMLEX score—if you want to be accepted to a particular program, you have to play their game.

The choice of how many board exams to take is yours alone and there is no one-size-fits-all answer to the question. It all depends on what you want to do with your career. Take a close look at the kinds of residency programs you are interested in and what their specific requirements are. If you can’t easily find the information on the internet, you can always contact the director of the residency program or alumni from your school who are at a program that interests you.

As always, please remember that you are more than a test score. Residency programs examine many criteria in evaluating your application, so if your score on either exam is not what you had hoped, don’t give up.




3 thoughts on “DO student dilemma: COMLEX or COMLEX + USMLE?”

  1. Thanks for this piece. I had this same dilemma a few years back prior to starting residency.

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