Reply turned post, COMLEX and USMLE style

A reader and fellow medical student who blogs at the Dark Autumn Hour asked me why I took both versions of the step I board exams. For most of my readers who are not medical students, especially osteopathic medical students, this question and corresponding blog post may sound like wah wah wah, but it is a huge issue in osteopathic medical schools, so I thought I would address it with an entire post.

Here is just a little background for those of you who aren’t osteopathic medical students and are reading anyway. There are two types of medical school and degree designations for physicians in the United States: D.O. (also called osteopathic) and M.D. (also called allopathic). (There are also two for dentistry: D.M.D. and D.D.S.). I am not going to get into the differences in training or controversies regarding the different designations now. Licensed D.O.’s and M.D.’s have the same practice rights in all 50 states and enter all fields of medicine.

Both medical designations have 3 parallel but separate board exams that one has to pass, step I and II in medical school and step III at the end of residency, in order to become a licensed physician. The osteopathic exam is called the COMLEX, and the allopathic exam is called the USMLE. I just took step I. I took both exams, allopathic and osteopathic.

There are many more allopathic medical schools and residency programs than there are osteopathic programs. Osteopathic students can and do apply to allopathic residencies. The opposite is not allowed. Again, not the topic of this post, but a controversy. When an osteopathic medical student is applying for a residency spot in a pool that includes mostly allopathic students at an allopathic institution, their measuring stick will be the USMLE. Some programs say they will consider COMLEX scores, and some osteopathic students have gotten residency spots with only a COMLEX score. But, in general, for many reasons, many allopathic institutions do not have any D.O. residents in their ranks. So, every osteopathic student in their second year has the option of taking the USMLE in addition to their COMLEX.

OK, here is the reply:

Isn’t that the question on everyone’s minds in the first few years of osteopathic medical school?

I took both for a few reasons. I had to take the COMLEX to finish my school’s academic requirements. However, there are no osteopathic obstetrics and gynecology residencies in my state. I find that especially pathetic, since we have no less than two osteopathic medical schools in Florida. When I first went to the ACOOG website to search residencies, I thought I was doing it wrong. But, no, unfortunately, osteopathic ob/gyn residencies are heavily concentrated in a few states, like Pennsylvania, Michigan, and New York. They might want to reconsider their search by state option, since the vast majority come up empty. (OK, I just checked out the site, and they may have removed this option.)

I am geographically limited. Severely. I have joint custody of my older son, and his father lives about one hour south of me in South Miami. There is only one ob/gyn residency within 6 hours of his house. It is allopathic, obviously. I have heard of D.O.s being accepted there in their internal med program with only a COMLEX score, but I wasn’t sure about the ob/gyn residency. I know of a D.O. student who wasn’t accepted there, and spent a year as a rotating intern, then accepted for this year. (He is probably starting this week. I need to get his contact info and pick his brain.) Another student from our school matched there, but I didn’t know her and have no idea if she took both exams.

According to APGO, 600 people applied for 9 slots there. I have also heard they grant a maximum of one D.O. slot per year, although, including the intern, there are two this year, both graduates from the osteopathic school I am attending. So, it’s going to be really competitive. I don’t want the lack of a USMLE score to hold me back. (Let’s hope a lousy USMLE score doesn’t hold me back!) I have shmoozed some of the attendings over there and plan to do some elective rotations there, so I hope I have a shot. I will unfortunately be competing with some friends from my school for what may be one or two D.O. slots.

There are a few other programs in Florida, and one in Asheville, NC, I may apply to (my husband’s folks have a house near there, but I may have to go to court to take my older son there). No matter what, anywhere I get in other than the Miami program will involve an alteration in our custody arrangement.

There are many arguments both ways about whether D.O. students should take the USMLE. Each exam costs $500 and takes about eight hours. D.O. students are educated slightly differently, and tend to do slightly worse on the USMLE than M.D. students, and a higher percentage will fail. I took both exams, and in my opinion, the USMLE questions were more difficult. The writing style, vocabulary, the question stems, and the amount of higher level thinking rather than rote memorization was dramatically different between the two exams.

Some of my classmates signed up for both exams. Some ended up taking both, and some changed their minds and didn’t take the USMLE even after paying the substantial fee. We got advice from former students emphatically pushing us in both directions.

In the end, I hope I chose best. I hope my score on the USMLE is adequate. I can always withhold my USMLE score and only present my COMLEX score, if I did better on the COMLEX, but the residency programs will see that I am withholding the score, which is pretty much saying I bombed.