I think that you're being a little overconscientious. The USMLE is not the end all and be all in licensing examinations. And, don't confuse achievement tests such as the MCAT, LSAT, SAT etc where higher scores = higher achievement with licensing exams that where the goal is to determine thresholds for minimal compentency. There is a ton of literature in the academic medical circles showing that higher scores on USMLE correlates little with residency achievement.
Still, because some program directors use USMLE cut-offs and may be too lazy or ignorant to develop COMLEX cut-offs, I advise DO's who are considering competitive ACGME-accredited residencies (there is really no such thing as an "allopathic" or "osteopathic" residency only different accreditation agencies such as the ACGME versus AOA) to take USMLE steps I and II for residency applications and then finish up their licensing sequence with COMLEX Level III. No one will ever care which pathway you're licensed under (USMLE versus COMLEX).
However, depending upon the state you practice, there may be real benefits to being licensed under the COMLEX as a D.O. (that is the reason it was designed in the first place). Chiefly, how you acquire and maintain your certification. In the osteopathic world, things are set up so you can essentially hit an AOA convention every 2 or 3 years, catch up with friends from medical school, and get all your CME done for that 5 year cycle. Being licensed under both pathways will likely require more time (ie $$) away from practice to keep your CME current, two separate accounting systems of CME credit, and double dues to the various professional societies that sponsor the CME. Being licensed only under the USMLE as a D.O. may create problems down the road in certain states. As the profession grows (and currently the AOA population pyramid looks like a third world country in terms of the number of D.O. students and residents in training), the COMLEX will clearly increase in stature and relevance. Similarly, things like the AOA-approved internship might also be important. Case in point: I recently interviewed for a fellowship positiion in PA. PA is one of "those states" that require an AOA-approved internship. I did an ACGME-accredited internship which would have left me out in the cold because the fellowship requires fellows to be independently licensed so they can bill for their services. To be indepedently licensed in PA require an AOA-approved internship. Luckily, I applied for approval for my internship from the AOA a couple of years ago under the "hardship rule" and got it approved....so I was okay! I never would have thought that I would be interested in a fellowship in PA 4 years ago, but I'm glad that I jumped through the obligatory hoops to make it happen.
Bottom line: Don't get suckered into thinking that "their way" is always the better way. Things like licensing examinations, accreditation standards, etc are beauracratic rigormoral that can change with the wind. Similarlly, don't cut yourself off from the AOA and the osteopathic world because you never know when it might come in handy. Yes, there are a lot of politics and shinangans in the osteopathic world, but you'll see that it is *EVERYWHERE* in medicine and worse in some specialties!
How you behave on the wards, how you treat your patients, your work ethic, and your own personal integrity will be the ultimate index of your "achievement" and "expertise" not which test you took.
