Throughout my education as a future osteopathic physician (DO), there has been considerable student discussion about the Match. With Match week upon us, I thought this would be a good time to reflect on my journey and some of the obstacles that I have faced along the way to obtaining residency placement. During medical school orientation week as a first-year student, I was told that competitive surgical specialties were going to be out of reach unless I built a flawless resume with a nearly perfect academic record, extracurricular experience and an excellent board score. As a second year, I watched my third- and fourth-year peers stress about getting audition rotations through VSLO (Visiting Student Learning Opportunities), which they described as their only path to obtaining a residency slot. As a fourth year now, many of my mentees express their worry about their inability to Match without an excellent audition rotation. 

These experiences may sound familiar to allopathic (MD) medical students, but they are extremely stressful for DO students. Although both types of students endure many of the same trials throughout training, previous literature has demonstrated that DO students are less successful when matching into many specialties outside the realm of primary care. With the recent merger of DO and MD residency programs into a unified Match system, DO match rates in many “competitive” fields, such as orthopaedic surgery, have been declining. In my experience, DO students are made aware of this both by their peers and their medical schools, and it is a significant source of stress for them. 

To equalize applications with our MD peers, many of my DO student peers (including myself) take the USMLE board examination series (the MD licensing exam) in addition to our own COMLEX board examinations. This is not as simple as it may sound—I had to purchase extra study materials for the USMLE, pay several extra test registration fees, drive to a testing center that was eight hours away and find housing in that location to take that examination. All in all, I spent over 2,500 extra dollars on this exam alone to make my residency application more “competitive.” Realistically, this is not attainable for many of my peers, who may not have the resources or the time to complete a second set of board examinations. 

 While there are many factors that contribute to a successful Match, academic performance and board scores are no doubt one of the most important. Even on the residency interview trail for internal medicine, a specialty that had several hundred unfilled seats after the 2024 Match, I was consistently asked about my USMLE scores; however, my COMLEX scores were never brought up. While overall DO Match success has been steadily climbing year over year, the gap in surgical and other competitive specialties has continued to widen. I believe that there are many nuances to this phenomenon, but chief among them is the unequal weighting of USMLE and COMLEX board examinations. It is a large lift for DO students to take a second series of examinations, both temporally and financially. By requiring that Medicare-funded graduate medical education programs accept both COMLEX and USMLE exam scores, the Fair Access In Residency (FAIR) Act presents a solution for this problem and is a potential means to improve the equity and efficiency of the Match process in the future.