As a medical student approaching my final year of school, in a few short months I will be putting together my application for residency. For all medical students, this includes writing a personal statement, gathering letters of recommendation from physicians I worked with during clinical rotations and determining which residency programs I’ll apply to—in my case, family medicine programs. However, unlike my MD and some of my DO student colleagues, my program options are limited because of a choice I’ve made. I’ve chosen to take only the DO licensing exams.  

There are two physician licensing exams in the United States—one, the USMLE, licenses students from allopathic, or MD, schools; the other, the COMLEX-USA, licenses students at osteopathic, or DO, schools. MD and DO students need only take their respective exams to become physicians. Despite this, almost 66 percent of DO students take the USMLE on top of the COMLEX-USA, leading to an average additional cost of $2,235 and 32 hours of exam time per student. We do this because many residencies prefer the USMLE when considering applicants. According to the 2022 Survey of Program Directors participating in the National Resident Matching Program, USMLE Step 1 and Step 2 scores were considered by 62 and 78 percent of program directors, respectively, with COMLEX-USA Level 1 and 2 being considered by only 48 and 55 percent of respondents. It’s unacceptable that almost 15-25 percent of program directors will not consider me for their residency program, solely because I did not take the USMLE Step 1 or 2.  

Preliminary research suggests a correlation between USMLE and COMLEX-USA scores and equations have been calculated to create a predicted USMLE score from COMLEX-USA scores for DO students. Basing my scores on these calculations and correlations, I would be predicted to have a score within the top quartile of medical students taking the USMLE, placing me as a competitive applicant for most family medicine programs. Despite this, by only taking COMLEX-USA, I have been struck from consideration by programs that only take USMLE scores.  

As a prospective family medicine resident, my chances of attending the program of my choice are greater than my peers who choose to pursue specialties outside of primary care. Many family medicine programs are not only accepting DO students, but also choose to obtain Osteopathic Recognition, making it easier for me to identify programs which are welcoming of my osteopathic education. In some specialties, such as general surgery, dermatology and anesthesiology, the pressure to take both COMLEX-USA and USMLE is exponentially greater, as DO students who do not take both exams will likely not be considered. Unfortunately, for those who do take USMLE, receiving a competitive USMLE score may still not be enough, as there are huge numbers of programs who simply do not accept or interview osteopathic students.  

As a National Health Service Corps scholarship recipient, I’ve committed to practicing primary care in a Federally Qualified Health Center after graduation. I chose to pursue family medicine because I am interested in serving all members of the community, and especially those who are most vulnerable. Given that 56 percent of family medicine residency graduates practice within 100 miles of where they completed their training, taking applications of DO students like myself out of consideration exacerbates shortages in rural and underserved areas, especially those committed to providing primary care to the underserved. Increasing access to residency programs is an issue not only for osteopathic medical students but for patients who lack access to primary care physicians.  

In the end, I’m taking only the COMLEX-USA because I am proud of the education I’m receiving at my college of osteopathic medicine. Requiring osteopathic students to take both COMLEX-USA and USMLE insinuates that the values I bring from my osteopathic education are not equivalent to those of my allopathic counterparts. With the transparency that would come from the FAIR Act, I’d be better able to understand which programs respect the experience I bring as an osteopathic medical student, my whole-person, primary care training and my commitment to working with the underserved. My future residency training will pave the way for how I practice as a physician—and I want that training to be supportive of the osteopathic principles that guide my clinical care. The FAIR Act improves fairness for DO students and allows patients to benefit from access to osteopathic physicians and their strengths across all specialties.