USMLE for D.O.

[bigyihoroi]

Since many D.O. students will apply for M.D. residency spots in addition to those avaiable through the AOA, I know that many D.O. students have chosen to take the USMLE in addition to the COMLEX. My question is: do D.O. students only take step 1 of the USMLE or do they generally take all three parts of it? I heard from some D.O. students that they only need to take step one. Can anyone confirm this?

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[JonnyG]

you cannot confirm personal opinion some take only step 1 some take only step 2 some take all the steps. It is purely up to your situation. Plus you should only take it if you feel you will do well.

 

[bigyihoroi]

you cannot confirm personal opinion some take only step 1 some take only step 2 some take all the steps. It is purely up to your situation. Plus you should only take it if you feel you will do well.

Thanks for you post but it doesn't help too much. You said it's purely up to your situation. What do you mean by that? Can you give me a situation where only taking step 1 is necessary? or a situation where only taking step 2 is necessary (as described by you above)?

 

[JaggerPlate]

Thanks for you post but it doesn't help too much. You said it's purely up to your situation. What do you mean by that? Can you give me a situation where only taking step 1 is necessary? or a situation where only taking step 2 is necessary (as described by you above)?

Taking Step 1 necessary: applying to ACGME residencies.
Taking all Steps: you plan to completely disregard the AOA and practice in a state that doesn't have it's own osteopathic board which requires you to take COMLEX/be a member (err something) to get a license.
Taking Step 1 + All COMLEX: Applying ACGME, but living in a state (ie CA) with an osteopathic board.

You should ask a mod to move this to the osteo board, as the med students will know more. What I told you is probably a little off, it's what I remember from second hand knowledge on the boards. Maybe someone will come in and correct me.

 

[rkaz]

What about taking all USMLE steps and all COMLEX steps? Seems like a whole lot of extra money and effort needed, but at least then you don't have to worry about missing anything...

I'm not being facetious here, I just assume that is what I will do when the time arises.

 

[Semicolon]

What about taking all USMLE steps and all COMLEX steps? Seems like a whole lot of extra money and effort needed, but at least then you don't have to worry about missing anything...

I'm not being facetious here, I just assume that is what I will do when the time arises.

There wouldn't be a point to that since you take the third step (I don't know about the second) at the end of your residency, and you'll know whether you're in an ACGME or AOA residency.

 

[JaggerPlate]

There wouldn't be a point to that since you take the third step (I don't know about the second) at the end of your residency, and you'll know whether you're in an ACGME or AOA residency.

I think though if you're in state like CA with an Osteopathic Board, you have to take all 3 steps even if you did an ACGME residency to practice in the state. Honestly I could be off, but someone explained it in Osteo forums one time ... I wish I could remember who.

 

[group_theory]

A lot of DO students take USMLE Step 1 because they plan on applying to ACGME residency. Although some ACGME programs accept COMLEX, taking the USMLE gives you more options (to residencies that only take usmle) and also gives program a direct comparison to your MD peers (how does a 550 on comlex compare to a 220 on usmle?)

You will need to take and pass COMLEX 1, COMLEX 2-CE and COMLEX 2-PE in order to graduate.

Some DO students will take USMLE 2-CK to improve their chances or to make up for a less than stellar performances on USMLE 1. However, a lot of DO students only take USMLE 1 since many MD students will not have taken Step 2 by the time the programs are selecting candidates to interview (so Step 2 is weigh less heavily in deciding who to interview). The cost of USMLE 2-CK is roughly $500.

USMLE-2CS is an expensive $1000 test that is only taken by DO students if you have any plan on taking USMLE Step 3. It is also only located in 5 testing locations (so unless you live/rotate near one of them, plan to include travel expenses too).


You take Step 3 at some point during your residency. Many residents take it during their 1st year to get it out of the way. Many state medical boards (DOs and MDs) have time limits on how long you have to complete all the steps of your licensure exam (either COMLEX or USMLE). At this point, as a DO, you have already taken COMLEX 1, COMLEX 2CE and COMLEX 2PE. You only need to take COMLEX 3 (1 day exam, $650) and you are done. From a medical licensure examination standpoint, you are eligible for licensure in all 50 states. (some states require an AOA approved PGY1 but that is outside the scope of this thread).

There is no benefit (as a DO) to take USMLE 3. First, you will have to take and pass USMLE-2CS (see above) in addition to Step 1 and Step 2 of USMLE. Second, USMLE 3 is a 2-day $650 exam. Besides the fees, finding time during residency to take 2 days off during the workweek is very hard (unless you want to spend your vacation time). In addition, there is nothing to be gained by taking USMLE 3 in addition to COMLEX 3. Some people may take USMLE 3 in lieu of COMLEX 3. This may be an acceptable course of action however be warned that some states will absolutely insist on COMLEX and will not grant licensure even if you complete the USMLE series. These states are: California, Florida, Michigan*, Oklahoma, Pennsylvania, Tennessee*, Vermont, and West Virginia.

*willing to accept USMLE if you applying for licensure via reciprocity. USMLE not accepted if you are applying for initial licensure

To finish both COMLEX and USMLE series is also expensive - it's an additional $2150 not including travel cost ($500 for USMLE-2CK, $1000 for USMLE-2CS, $650 for USMLE 3) and 4 extra exam days (not including studying time and travel time) with no real benefits.


And of course, fees are always going up so the cost may be higher in the future.

 

[Chocolate Bear]

When this thread opened, I hoped group_theory would rain down some knowledge. Thanks for not letting me down!

 

[Bleurberry]

A lot of DO students take USMLE Step 1 because they plan on applying to ACGME residency. Although some ACGME programs accept COMLEX, taking the USMLE gives you more options (to residencies that only take usmle) and also gives program a direct comparison to your MD peers (how does a 550 on comlex compare to a 220 on usmle?)

You will need to take and pass COMLEX 1, COMLEX 2-CE and COMLEX 2-PE in order to graduate.

Some DO students will take USMLE 2-CK to improve their chances or to make up for a less than stellar performances on USMLE 1. However, a lot of DO students only take USMLE 1 since many MD students will not have taken Step 2 by the time the programs are selecting candidates to interview (so Step 2 is weigh less heavily in deciding who to interview). The cost of USMLE 2-CK is roughly $500.

USMLE-2CS is an expensive $1000 test that is only taken by DO students if you have any plan on taking USMLE Step 3. It is also only located in 5 testing locations (so unless you live/rotate near one of them, plan to include travel expenses too).


You take Step 3 at some point during your residency. Many residents take it during their 1st year to get it out of the way. Many state medical boards (DOs and MDs) have time limits on how long you have to complete all the steps of your licensure exam (either COMLEX or USMLE). At this point, as a DO, you have already taken COMLEX 1, COMLEX 2CE and COMLEX 2PE. You only need to take COMLEX 3 (1 day exam, $650) and you are done. From a medical licensure examination standpoint, you are eligible for licensure in all 50 states. (some states require an AOA approved PGY1 but that is outside the scope of this thread).

There is no benefit (as a DO) to take USMLE 3. First, you will have to take and pass USMLE-2CS (see above) in addition to Step 1 and Step 2 of USMLE. Second, USMLE 3 is a 2-day $650 exam. Besides the fees, finding time during residency to take 2 days off during the workweek is very hard (unless you want to spend your vacation time). In addition, there is nothing to be gained by taking USMLE 3 in addition to COMLEX 3. Some people may take USMLE 3 in lieu of COMLEX 3. This may be an acceptable course of action however be warned that some states will absolutely insist on COMLEX and will not grant licensure even if you complete the USMLE series. These states are: California, Florida, Michigan*, Oklahoma, Pennsylvania, Tennessee*, Vermont, and West Virginia.

*willing to accept USMLE if you applying for licensure via reciprocity. USMLE not accepted if you are applying for initial licensure

To finish both COMLEX and USMLE series is also expensive - it's an additional $2150 not including travel cost ($500 for USMLE-2CK, $1000 for USMLE-2CS, $650 for USMLE 3) and 4 extra exam days (not including studying time and travel time) with no real benefits.


And of course, fees are always going up so the cost may be higher in the future.

Just playing devil's advocate here:
So it wouldn't pay to complete both paths even if you were doing a dual accredited program? There's no upside? This is under the premise, of course, that the AOA path would be the primary series and licensing.
I can't see one but what do I know. Not much in these matters, so I thought I'd put it out there.

 

[MikeTheGipper]

Has anyone heard tha some ACGME residencies require residents to complete USMLE-2 by the time residency starts? I think I've heard of this being the case at some programs and if it is true than wouldn't that unfortunately make it necessary for D.O.'s to take the USMLE-2's in addition the the COMLEX-1, and 2's?

 

[group_theory]

Just playing devil's advocate here:
So it wouldn't pay to complete both paths even if you were doing a dual accredited program? There's no upside? This is under the premise, of course, that the AOA path would be the primary series and licensing.
I can't see one but what do I know. Not much in these matters, so I thought I'd put it out there.

Attending a dually accredited residency program only means you are eligible to take both sets of boards (ie if you attend a dually accredited family medicine residency, you can take the American Board of Family Medicine exam and/or the American Osteopathic Board of Family Medicine). As a DO, you can choose to take either one (or both) - although there is no advantage of taking both (except that you have to study for another exam, and pay fees in excess of $1000 as well as having the pleasure of trying to maintaining certification every few years by fulfilling both boards requirements )

When people say they are board-certified, they are not referring to COMLEX or USMLE but to the certification process that people do at the end of residency/fellowship (and recertify every 7-10 years).

As far as COMLEX and USMLE are licensure examination. You take these exams to be eligible for licensure. Once you finish COMLEX, you are done. I can see no advantage to taking USMLE (maybe some competitive ACGME fellowships - but I've known DOs who got into cardiology, GI, heme/onc without USMLEs)

 

[Vita]

This may be an acceptable course of action however be warned that some states will absolutely insist on COMLEX and will not grant licensure even if you complete the USMLE series. These states are: California, Florida, Michigan*, Oklahoma, Pennsylvania, Tennessee*, Vermont, and West Virginia.

I had a question about this part. Sorry if I should stupid, but are these the states that require an AOA rotating internship year? I live in TN and my mother is the director of a duel accredited program and they don't do the rotating first year. Are there different standards based on if it is only AOA or if it is duel accredited?

 

[235750]

I can see no advantage to taking USMLE (maybe some competitive ACGME fellowships - but I've known DOs who got into cardiology, GI, heme/onc without USMLEs) [/quote]

If a fellowship is in your future, why not finish all the steps for USMLE? Step 3 is one of the requirements for a lot of fellowships which include everything from cardiology and child pysch for example. Of course it depends, you have to look at the individual requirements of a program that will specify if they only want USMLE or if COMLEX is ok. I have not seen a cardiology program that will take the COMLEX, where have you seen this?

Perhaps this will change in the future, but as it stands taking all of the USLME is a good way to keep your options open. I work a few IM docs (DOs and MDs) who are trying to get into cardiology and the ones without step 3 are screwed.

Good luck!

 

[Bleurberry]

I can see no advantage to taking USMLE (maybe some competitive ACGME fellowships - but I've known DOs who got into cardiology, GI, heme/onc without USMLEs)

If a fellowship is in your future, why not finish all the steps for USMLE? Step 3 is one of the requirements for a lot of fellowships which include everything from cardiology and child pysch for example. Of course it depends, you have to look at the individual requirements of a program that will specify if they only want USMLE or if COMLEX is ok. I have not seen a cardiology program that will take the COMLEX, where have you seen this?

Perhaps this will change in the future, but as it stands taking all of the USLME is a good way to keep your options open. I work a few IM docs (DOs and MDs) who are trying to get into cardiology and the ones without step 3 are screwed.

Good luck![/quote]


Oh, snap?!

 

[DrWBD]

Perhaps this will change in the future, but as it stands taking all of the USLME is a good way to keep your options open. I work a few IM docs (DOs and MDs) who are trying to get into cardiology and the ones without step 3 are screwed.

Good luck!

I find that very surprising. Step 3 was asked for on my fellowship application but I just entered my COMLEX Level 3 score and that was the end of that. I've always been under the impression that Step 3 is a waste for a DO to take, as group_theory pointed out very eloquently.

 

[235750]

I find that very surprising. Step 3 was asked for on my fellowship application but I just entered my COMLEX Level 3 score and that was the end of that. I've always been under the impression that Step 3 is a waste for a DO to take, as group_theory pointed out very eloquently.

Like everyone else has said, I guess it depends on the program, but I copied/pasted two fellowships, one cardio and one child psych, where USLME step 3 is required. You can find a whole bunch more with the same requirements by Googling 'xxxxx fellowship'.

Which program did you apply for wanna_be_do? Did you hear good things back? The docs I work that didn't have USLME step 3s did the same thing you did, put COMLEX for USLME, but they weren't asked for an interview. Maybe they just plain sucked as applicants but...the programs specifically asked for USLME so it's a good bet that had something to do with it. As the links say, you can be a DO for those particular programs, they metion that's OK, but you need either "ECFMG Certification or USMLE Scores". I don't think they are accidently omitting COMLEX if they mention DOs. Right?

Look, I'm not trying to act like I know anything. I'm not a doctor, I'm not even in medical school yet, and wanna_be_dobut would seem to know about the process best because he/she has gone through it. But, I can read requirements posted online. They seem to be pretty straightforward, and I'm just trying to help a fellow student out

 

[group_theory]

Like everyone else has said, I guess it depends on the program, but I copied/pasted two fellowships, one cardio and one child psych, where USLME step 3 is required. You can find a whole bunch more with the same requirements by Googling 'xxxxx fellowship'.

Which program did you apply for wanna_be_do? Did you hear good things back? The docs I work that didn't have USLME step 3s did the same thing you did, put COMLEX for USLME, but they weren't asked for an interview. Maybe they just plain sucked as applicants but...the programs specifically asked for USLME so it's a good bet that had something to do with it. As the links say, you can be a DO for those particular programs, they metion that's OK, but you need either "ECFMG Certification or USMLE Scores". I don't think they are accidently omitting COMLEX if they mention DOs. Right?

Look, I'm not trying to act like I know anything. I'm not a doctor, I'm not even in medical school yet, and wanna_be_dobut would seem to know about the process best because he/she has gone through it. But, I can read requirements posted online. They seem to be pretty straightforward, and I'm just trying to help a fellow student out

Sorry for the late reply - I've been busy on service lately

Do not make the conclusion that your friends did not get interviews due to lack of USMLE. It may be the case or it may not be. There are lots of factors involved in deciding who to interview.

Some programs may absolutely require USMLE. Others do not. Just because the program ask for USMLE doesn't mean they are not willing to accept COMLEX in lieu of USMLE. Only way to know for sure is to ask the program directly. The vast majority of applicants to ACGME programs will have USMLE so often time COMLEX is an afterthought to those designing websites (which may be program coordinators, or sometimes just some IT guy working for the hospital)


As for the DOs that I personally know who have gone into ACGME fellowships - they vary from community hospital acgme programs to academic medical centers in major cities. None of them have taken USMLE 3. A few have good connections and strong research background.

 

[TexasTriathlete]

Take them both. Straight from the mouth of a trauma surgeon I used to work with, who used to be program director at an internship program at Baylor College of Medicine. And the guy has nothing at all against DO's, but said that it is just easier to measure all applicants against eacho other if they all took the same exam.

 

[DrWBD]

Like everyone else has said, I guess it depends on the program, but I copied/pasted two fellowships, one cardio and one child psych, where USLME step 3 is required. You can find a whole bunch more with the same requirements by Googling 'xxxxx fellowship'.

Which program did you apply for wanna_be_do? Did you hear good things back? The docs I work that didn't have USLME step 3s did the same thing you did, put COMLEX for USLME, but they weren't asked for an interview. Maybe they just plain sucked as applicants but...the programs specifically asked for USLME so it's a good bet that had something to do with it. As the links say, you can be a DO for those particular programs, they metion that's OK, but you need either "ECFMG Certification or USMLE Scores". I don't think they are accidently omitting COMLEX if they mention DOs. Right?

Look, I'm not trying to act like I know anything. I'm not a doctor, I'm not even in medical school yet, and wanna_be_do would seem to know about the process best because he/she has gone through it. But, I can read requirements posted online. They seem to be pretty straightforward, and I'm just trying to help a fellow student out

In order to limit confusion in this thread, let me first state that my comments are regarding USMLE Step 3, NOT the other steps. I'm also limiting my comments to fellowships, not residency.

There are many reasons why people get accepted or rejected from fellowships. Osteopathic fellowship applicants typically have a rougher time applying for competitive fellowship positions outside of the institution where they did residency, as most ACGME fellowship programs prefer US-trained MDs in their programs. There are exceptions, of course, but this tends to be the rule.

With that said, for your physician acquaintances to cite not taking USMLE Step 3 as the reason for their rejection seems dubious to me. Most DOs do not take USMLE Step 3.

If you look at the NRMP Match Data for 2008 (Table 2: 'Fellowship Appointments'), you will see that there were 221 osteopathic graduates who matched for ACGME fellowships in total through The Match.

However, looking at performance data for the USMLE in 2007 (Table 3: 2006-2007 Step 3 Administrations), only 21 DOs actually sat for the USMLE Step 3. They haven't yet put up the 2008 data but it's probably safe to assume that the numbers will not have changed dramatically.

So, if you assume all those Step 3 takers were doing it for fellowship (which is probably an erroneous assumption) then roughly 90% of DOs who successfully match into ACGME fellowships DO NOT take USMLE Step 3. As I mentioned, I did not take USMLE Step 3 and am currently a fellow.

I think your intentions are good but you should consider the consequences of your advice. Neither COMLEX Level 3 nor USMLE Step 3 are easy exams to prepare for and take. Besides having to take time off from work on test day, there is a significant cost burden to these exams in terms of both money and in time spent preparing for the tests. Step 3/Level 3 are generally regarded as necessary only for state licensing and don't carry much academic weight in my experience. Fellowship directors tend to not weigh Step 3 scores as heavily as letters of recommendation, research, your medical school, where you did residency, whether you were a chief, etc.

As group_theory pointed out, often there is no mention of COMLEX on fellowship applications just because the form/website was designed by someone not familiar with the COMLEX. As always, the best thing to do is to contact the program to ask whether or not USMLE Step 3 scores are absolutely required.

 

[DrWBD]

Take them both. Straight from the mouth of a trauma surgeon I used to work with, who used to be program director at an internship program at Baylor College of Medicine. And the guy has nothing at all against DO's, but said that it is just easier to measure all applicants against eacho other if they all took the same exam.

For a surgical residency, or other competitive ACGME residency program, taking the USMLE can be beneficial. My recommendation, based on my own experience and that of the more reliable forum contributors on the subject, is that USMLE Step 1 is usually all that is needed for the residency application. For fellowships, or if you didn't do so hot on Step 1, the Step 2 written portion may be beneficial. As I stated in my post above, USMLE Step 3 seems to be unnecessary for a DO to take.