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 was 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.


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19 responses to “Reply turned post, COMLEX and USMLE style

  1. Anna

    Hey there! I found your site accidentally while looking for information as to when COMLEX scores will be released. And now I’ll be probably following your blog as it seems interesting and entertaining!

    Anyway, just wanted to share that in my school (I go to Western University in California) we were specifically told that rules were recently changed and that if you take both the USMLE and COMLEX, you HAVE to report both scores when applying to residencies regardless of how well/bad you do in the USMLE.

    • MomTFH

      Thanks for the compliment and thanks for the information. I think not disclosing it is about the same as saying it was a poor score, anyway.

  2. Pingback: USMLE and COMLEX « Mom’s Tinfoil Hat

  3. Roger

    Great post. I hope that the search is going well for you! Also, after speaking with the PD at Miami last year, I’ve been told that all the DO students taken as residents in IM there have taken the USMLE. Of course he may be wrong, but that’s the official word.

    In response to whether reporting is mandatory, it is not. It is “mandatory” for you to say whether or not you took it, but not mandatory to release your score. As you say, MomTFH, not reporting is just as bad as saying you bombed. I worked last year with ERAS to try and have the rule changed, but not update on that yet.

    • MomTFH

      Thanks! Glad to see you here, Roger. By the way, did you hear that snow flurries were reported in Kendall last night?

      • Roger

        I had no idea they had flurries in Kendall! That’s crazy. We’ve had flat-out SNOW in Atlanta this year, and lots of it. Hope things are going well!

  4. Humaira

    Hi, I am thinking of joining the D.O. school in Bradenton, Fl. How much exactly does the method of teaching differ from a med school and furthermore how difficult it is to get a good score in usmle after studying in a D.O. school.

    • MomTFH

      Hi Humaira. I don’t go to the Bradenton school or know anyone who does, so I really can’t tell you much about it. Most DO students do slightly worse on the USMLE than they do on the COMLEX, which is the board exam for DO students. DO and MD educations are fairly similar, except DO students also learn osteopathic manipulative medicine.

  5. Pingback: Board scores, driving, public health and applications | Mom’s Tinfoil Hat

  6. Brody

    Great post. I also took both the exams. The COMLEX is definitely not as hard as the USMLE. The level of logical thinking and problem-solving that goes into solving a single USMLE question is on a completely different level than the COMLEX, which is largely still solvable using buzz words and memorizing information. There was not a single buzz word or question that could be solved by straight memorization on the USMLE Step 1. So fellow DO students, unless you want to study a lot more to get an MD residency, don’t bother writing the USMLE Step 1. It’s way too hard. I don’t see why it has to be so ridiculously difficult.

    • MomTFH

      I actually did much better on the USMLE Step II than the COMLEX Step II. It may have to do with different learning styles / test taking styles, or just the particular versions of the exams I ended up with. I also found the OPP questions really confusing and difficult.

  7. Al

    Wrong about dentistry. DMD and DDS are EXACTLY the same, the difference is in name only. DO and MD are more than just name differences.

    • MomTFH

      Not according to my son’s DMD or the articles I looked up. It’s a similar situation.

      • Al

        Oh really?? So you’re saying that there’s two different dental governing boards, two different board exams, two different types of schools, depending on whether it’s DDS or DMD? Would you care to explain the difference?

        • MomTFH

          There are two degrees for dentistry, offered at completely separate institutions. There are even more different licensing exams for dentists, a total of five in the United States. Just like D.O.’s and M.D.’s, the material at these institutions and in all these licensing exams are similar, and their scopes of practice are practically identical.

          I’m not sure what arguing aimlessly on a four-year-old post is doing for you.

          • Al

            Think about it. You write a blog as an aspiring physician, so other aspiring physicians can read and be informed. You then write something blatantly false, of which I point it out to you. Rather than simply doing a quick search online so you can see your own mistake and make the appropriate correction, you continue to further push it as the truth, saying things like “my son is DMD therefore it’s true”. Look, we’re not talking about a COMLEX question here, it’s a dead simple question that anyone with an internet connection can find the answer to. Yet, you continue to persevere in pushing a false answer. You’ll make a very fine and credible medical doctor, I’m sure.

  8. MomTFH

    I am credible, and a good doctor. I spoke to a DMD on the topic, and looked it up. You have not refuted the facts I just posted.

    This is nonsense. If you post any more troll-y bickering about nothing I will block you. I am so sorry you find my valid analogy troubling. Time to move on.

  9. Becky

    AL, didn’t you know? The DMD is awarded by schools governed by the Osteopathic Dental Association, while the DDS is awarded under the American Dental Association. DMD students take the Osteopathic NBDE, while DDS students take the normal NBDE. And the Osteopathic Dental Association was created by B.T. Still (A.T. Still’s little brother, no joke). So there you have it, an osteopathic path to dentistry as well. MomTFH, please set him / her straight.

    • MomTFH

      Neither organization awards those degrees – they are awarded by the dental schools.

      I already trashed one of his comments saying a “real doctor” would continue arguing with him. I wrote one parenthetical line in my entire post four years ago pointing out that there are two different but essentially equal dental degrees. That was the only mention I made, not that this was a complete parallel to osteopathic and allopathic medicinal training and licensing in the United States. I’m not sure what this fascination is in this minor analogy I made four years ago. With the tenor of these comments, I’m tempted to blame SDN.

      Please, people. It’s really not a major point and I’m missing the fascination and vitriol. I am very close to closing comments on this post.

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