Will MD schools accept COMLEX scores?

Hi prwunecom,

I am a (lowly) MPH student and am currently torn between medical school (MD/DO) and graduate school (PhD). I am very interested in psychiatry as well as clinical neuropsychology, so am having a difficult time deciding which route to pursue. With regard to medical schools, I am leaning toward the osteopathic route because of my longstanding interest in preventive medicine and the holistic philosophy of mental healthcare.

I have contacted several residency directors at allopathic and osteopathic programs regarding COMLEX scores and most (if not all) said that they accept them. You will have to check with the programs to which you plan on applying. From what I recall, some psychiatry programs are adamant about only receiving USMLE scores.

Psychiatry is not very competitive, so MD and DO graduates rarely have a difficult time matching.

I'm curious to know about your background. Judging by your screen name, I imagine you go to UNECOM. I would be delighted to hear from you, either on this post or by PM.

Thank you!

neuropsych

 

What about other residencies than Psych? If I'm looking to be a G.P., what are the odds I have to take another 600 dollar test and age 15 years in the process due to unwanted stress if it doesn't really matter?

Of the 4500 DO's that graduate, there's really only 50%-60% of them that even apply to the DO match, which means at least 2000 of them are matching MD. Of those 2000, how many are submitting COMLEX scores?

I know that's a tough question to answer, but is the key to directly contact each residency individually...even if I'm not 100% sure what I want to do?

People have told me taking the USMLE opens more doors, but if I only apply to the MD match, I'm actually CLOSING all the DO residency doors, PLUS my 'chances' are better in a pool of 2500 DO students vs 50,000 + (counting International Medical Students) for the MD match.

Anybody, any thoughts??

 

If you're talking about psych in the DO match, something like 27% of the slots went unfilled. So I would think that statistically one's odds of matching is better in the DO match (for psych), but this is splitting hairs.

 

Many psych residencies list this information on their website. They also usually say something like, "we prefer 1st time passers.". If you're concerned simply call and ask.

 

Though this was an N of about 4 or 5, I noticed that the osteopathic students I interviewed this past year who only took the Comlex were SUBSTANTIALLY weaker applicants than the ones who had also taken USMLE independent of their board scores. No evidence for cause and effect, but I can't help but be slightly biased by it (and wonder if the applicants who weren't motivated to take the USMLE might also have just not been motivated to be decent medical students otherwise).

 

What else made them "weaker?"

 

I think the preparation for 2 tests is going to make you better on paper. Almost everyone will take both test scores. Do you really want to go somewhere they don't take it either because of ignorance or obstinance?

 

Their grades (including failures in core clerkships), their letters, their commitment to psychiatry, the superficial way they spoke about psychiatry. I remember one woman being absolutely perplexed when I asked her where she saw herself in ten years, like she'd never thought two weeks ahead about anything in her life. Things that would clearly make any candidate weaker and wouldn't exactly make us want to rank them.

 

Ah. Good. I dont have any of those problems, although I only took COMLEX 1. I'm debating taking USMLE 2 (and likely will), but didn't take 1 because I didn't want to waste the money, when COMLEX is so widely accepted in so many fields. I'm hoping to be an otherwise good applicant, with mostly A's in my clerkships, great letters, strong commitment, and a clear vision for my future. Hurray! Thanks.

 

I've never heard the point of view of a resident interviewing students that have only taken COMLEX vs those taken USMLE and COMLEX, so thank you for that perspective.

I understand there will be some inherent curiosity as to the reason why people choose NOT to take the USMLE.

I have also had students that have taken both that said studying for the USMLE actually deterred them from focusing on the COMLEX (DO students HAVE to take and pass COMLEX, but USMLE is optional). When it came to crunch time they had to choose to study more genetics/embryology/biochemistry or OMM/autonomic innervation. They were confident their COMLEX scores were worse BECAUSE of the USMLE.

Granted, my research was just an N of 2 people, but it was another interesting insight.

Thanks for the input as I continue 'trucking along' the medical school path!

 

I know plenty of MD's that think less of DO's and plenty of DO's that are convinced they receive MORE education that MD's, but that whole conversation is not for here...or anywhere in my opinion.

But I do agree; if there's a residency program I'm interested in (again, I'm kind of a G.P. guy...not looking for the cardiothoracic surgery residency at Hopkins) and they DON'T understand the benefit DO's can provide to a community, then I'm probably better off NOT going there.

I come from a town of 75,000 people and while there are plenty of successful doctors in town, I would argue that of the top 25 busiest doctors, 7-10 of them are DO's (much more than the 10% of DO's in the National Doctor Community)...and YES, I come from a WESTERN State, believe it or not.

 

That is such a bunch of crap. I'm sorry some people have decided the benchmark of motivation is to pay for and succeed is yet another standardized test. Especially in psych.
I did not take either USMLE, nor did I ever feel I should have. I got interviews at many very prestigious places, and every one of them cited my LORs, clinical grades, and PS over anything else. If you apply to psych, show your motivation to be dedicated to the field. That will take you farther. My only caveat to that statement is if you want to become some master of the universe academic. Then you might need both. Otherwise, save your money and time, and invest in something more worthwhile.

 

I honestly feel that way sometimes, too. I don't feel I need to take the USMLE to prove anything, but that could be part due to my ignorance or part stubbornness. I'm glad DO's are making more of a 'name' for themselves and hope it continues.

But I still wonder if taking the USMLE would make me, a GP in the making, more/less/or even indifferent of an applicant. I guess I'll never really EVER know the answer; I can't try both options, so better just stick to one option (whatever it be) and feel good about it, and let the chips fall as they may.

Thanks for the insight.

 

COMLEX scores are used by osteopathic residencies. USMLE scores are used by allopathic residencies.

You can ask allopathic programs to guage your aptitude and compare it the majority of their applicants who have taken the USMLE, but it seems you'd only fare better taking the actual USMLE and removing the guesswork and judgment call.

I have no problem with osteopathic programs asking me to take the COMLEX. It's their residency, their call.

 

For the record, the term GP is not used much anymore. That's the old school term for docs who only did an internship. They're being phased out these days. I'm thinking that what you actually have in mind is Family Medicine, but most Family Medicine docs would balk at being called GPs since they are better trained than the old fashioned GPs were.

As for the USMLE thing, most MD family med residencies are not super competitive but some of the best ones (the ones where family medicine residents learn to be true jack of all trades instead of just referral monkeys who refer everything cool to a specialist) can be quite in demand. Some of the residencies in desirable locations are also very competitive just because they are in a place that lots of people want to live.

As for the issue of closing doors to DO programs, well, it's not like most DO programs will hold it against you if you take the USMLE (though sure, it's possible it could happen, it would be kind of stupid for a program to do that and personally I've never enjoyed working for stupid people ).
I think it's better to have the USMLE score and not need it than to look back and wish you took it because you end up realizing the program or specialty you fell in love with will want to see a USMLE score.

 

Having once attended an interview at an MD program where one of my interviewers didn't even know what the COMLEX was, I definitely agree that I would not leave it up to the interviewers to figure it out on their own.
The only people I would recommend should avoid the USMLE would be people who know they are weak at standardized tests or have done poorly on practice tests and know they might be in danger of failing it. Certainly, failing it looks worse than never taking it in the first place.

 

Really? You're disputing that the worst candidates I interviewed last season also happened to be the DOs who didn't take the USMLE? I'm glad you have a camera in my office. Maybe I really haven't been taking my Risperdal.

 

Don't mean to hijack the thread but what do you guys think about having to take USMLE Step 2? I took USMLE Step 1, did average and am now debating if I should take USMLE 2 or not? Am a DO and hoping to aim for a west coast allopathic program.

 

But your program interviewed these people in spite of only having the COMLEX and these other potentially red flags (weak LORs, failures, etc.). Based on that, I'd think taking v. not taking it isn't too important.

At my program, we get to review the applications for people we meet at dinners/lunches. We did have some people who only took the COMLEX, so it's enough to get you through the interview door here. I can say I have trouble interpreting what COMLEX scores mean, though.

 

What would you think of a DO students who forwent USMLE 1 but had an ok score on USMLE step 2?

 

I think we interview basically everybody that come from a few schools geographically near us. That includes a DO program and a very uncompetitive allopathic program. In the past six matches (the ones of people I know), we've only had one person from the allopathic school and no people from the DO school match here.

Then again, if their career interest is "Umm, I haven't really thought about it," then maybe the major academic center isn't for them anyway.

It doesn't really matter whether my observation has any generalizability or not. What matters is that clearly in this thread there are plenty of folks, allopath and osteopath alike, who have said your best bet is to take the USMLE if you want the option of doing an allopathic residency. A little bit more cash and another day of a test is relatively speaking a pretty tiny hoop to jump through. You've already studied for the COMLEX. I'm sure there are plenty of programs who won't care either way. But if you're a second year medical student, you don't necessarily have any clue what you're going to want to do with yourself. Maybe you'll still want to be a psychiatrist after a year of doing clinical work, but maybe you won't. Maybe you want to go to a certain kind of program now, but maybe in a year you're going to want something very different. My brother-in-law killed himself while I was on my M3 psych rotation. The next day after coming back from the funeral I had to interview an inpatient with the almost identical psychopathology that he had and who looked a lot like him. I threw up after rounds. Don't you think that could have made my decision to go into psychiatry take a different route? I wasn't planning on him overdosing while psychotic, but he did.

If an extra few hundred bucks and one more day of your life at the end of your second year has any significant chance, for better or worse, of making a difference in whether you live in city X in specialty Y for 4 years and maybe a lot longer, then there's probably not a great reason not to do it other than the fact that you don't want to. And if that's the only thing you've had to do in the last 6-8 years of your life you've had to do that you didn't want to do, you've had a more blessed route than the rest of us.

Psychiatry is still an applicant's market. Other than maybe MGH, Columbia, Cornell, UCSF, Stanford, UCLA, even the other top good programs wind up interviewing some pretty weak applicants, because it's not easy to fill a large psychiatry class top to bottom with really good people, and you'd rather have somebody underwhelming but competent match than nobody at all. And just because you get an interview doesn't mean you have just as good a chance of matching as everybody else who got an interview. That's simply a myth.

I know I say things that aren't popular, but I don't think it makes sense for people to keep telling each other that so many things don't matter when they really can. People don't like hearing that your board scores, medical school, research, having your life together, etc. can matter. None of these things are ultimately deterministic, and your general story and what you want to do with your life matter and showing that you will be a safe, competent physician matter much more than any one of those things. But that doesn't mean they can't matter in a lot of situations, and it's reckless to blow these things off flippantly.

 

It's not hard to figure out COMLEX scores. 400 is passing (=180 USMLE). 500 is the mean (USMLE = 220). 600 is really good (USMLE = 235- ish). 700 is super-gunner level (USMLE = 250+). This pretty much correlates to what people wind up getting on each test. Someone who crushes COMLEX and gets a 650 will do very well 230-240 on USMLE, usually. Someone who barely passed COMLEX will barely pass USMLE.

I will fess up and say that I'm not a great standardized test taker, but still did fine on COMLEX 1. I did not take USMLE 1 (although im sure i wouldve passed and done about average) but am likely going to take USMLE 2, as I'm really much better at clinical than basic science. I also have some VERY strong LORs (including 1 saying i am better than the 2nd year psych residents from a strong academic program who rotate at this institution) and mostly A's in my clerkships. Hopefully a strong USMLE 2 showing will make up for my COMLEX.

 

Does everyone feel that USMLE 1 AND 2 are required, or is just 1 alone good enough?

 

For DO students? There's little consensus that any USMLE is required. Most of us seem to think you'd be fine with COMLEX only, with a couple dissenters. If you're super worried, one of the 2 USMLE's should suffice. Most programs that I've talked with do NOT require it and have said, "save your money." As I've said though, I'll probably still take U2...

 

I think the "most of us" might skew to osteopathic students who don't want to take the USMLE, no?

I'm sure you can get by without taking the USMLE, but it might hurt your odds and the match can be an uphill battle if you're looking at anywhere competitive, so why not hedge your bets? I applied to mostly west coast academic programs and didn't meet too many osteopaths, but those I did that I spoke to all seemed to have taken the USMLE. Apparently from this discussion, it's not standard, but it sure was with the folks I met on the trail.

 

As others have pointed out, it probably depends on your residency goals, including location and type of program. If you're applying in the midwest, maybe programs there are more familiar with the comlex and DOs in general, making the USMLE less important. For the coasts and for big academic programs, it's probably a good idea to take it. And as mentioned above, if you change your career goals, it's also useful.

As for test scores in general, though, I agree it's not such a huge deal for psych. My program is not one of the super top competitive ones, but it's probably somewhat on the higher end based on our location, and the vast majority of USMLE scores I saw were below the natural averages. It seemed like anything above 200 was OK. I've got to admit this disappointed me on some levels since I did well on the USMLEs and put a decent amount of effort into them, but I don't know.

Getting back to the DO issue, people out here where there aren't many DOs do have weird ideas about DOs, so I wouldn't be surprised if they were suspicious of the comlex. I'm from a state with a DO school and worked with a lot of DOs and OMSs in medical school, and some of the things I've heard said out here are quite puzzling. None are really derogatory, but they're still a bit ignorant.

 

You will rarely need the USMLE. If you do need it, you will probably regret going to that program.
Will it help? Yes.
Could it hurt? Yes.
If I was to analyze the cost benefit, I would not take it. You can spend that time studying specifically for your rotation. I am a firm believer that step 1 of the USMLE/COMLEX is only so important. Honing those skills at the expense of losing your clinical skills (not paying attention to your rotations) is not worth it. Now if you were going to spend that extra time in a bar, by all means take the USMLE but in general you will gain from spending that time from reading about whatever rotation you are on.

Also, do you really want to go to a program that discrimates or is ignorant of osteopaths to the extent that they dont know what the COMLEX is? Even the most competetive programs know what osteopaths are. We arent talking about Derm or radiology here.

 

Not to support stereotypes (either positive or negative) but the general consensus of what I've seen in my clerkships (and my 25 years of life) is that DO's tend to have better bedside manners and have better people skills in general. MDs tend to be more standardized test smart and research-mind oriented. I'm sure that statement is going to offend people on both sides of the spectrum, and not to say that there aren't MDs with great bedside manners, or DO's who do brilliantly on standardized tests but that's what I have observed to be the main difference (IF there is one) between people in the two groups.

COMLEX scores are only difficult to interrupt if you: 1) Don't understand the concept of standard deviation and a Bell Curve; 2) Don't make the effort the look up the mean number and standard deviation (as was said before mean 500, sd varies from year to year but is normally around 80). That being said, it would make things simpler if the COMLEX and USMLE had the same scoring system, but I think we all know the stubbornness of people will prevent that from happening.

The bizzaro world that is our eval forms has managed to land me 5 rotation grades of 88-89. Wonderful luck right?

 

That's a pretty big generalization you've got there, dude. I'm having trouble seeing how a 25 y/o medical student could make many meaningful sweeping generalizations about the bedside manners of MDs v. DOs. I'd suggest saving that type of stuff for pre-allo or pre-osteo.

As for understanding the comlex, looking up the grading scale is work. If you're program is interested in DOs, they'll probably do the work. If they're not, they don't. On the other hand, all ACGME programs are pretty familiar with the USMLE scales, requiring pretty much no work to interpret the scores.

 

It certainly is. Not saying its a sweeping generalization, its just what I have observed, take it with a grain of salt if you'd like. I knew it would rub people the wrong way, but might as well keep the thread active cause I'm sure its going to create some fire haha.

And you are correct about the second part, which is why I am going to take USMLE step 2, I don't trust people to take that 60 secs to make sure they understand my score. But that doesn't mean its a difficult thing to understand.

 

I've had a couple of those too. They're so silly and subjective. Not sure why we don't do P, HP, Honors like everyone else.

 

Not sure if your also Osteopath but I am Allopath and my school goes on a graded percent scale A, B, C, fail and I was burned a couple of times with high 80's but now that I know I matched I could less about that A vs B.

 

Dude, Manic gave you the best advice. You don't need to take the test to land a spot in the majority of residencies. Also, like already mentioned, you don't want to be in a place that doesn't look upon you as an equal. I went to a midwest school and didn't encounter any of that, but I did do an away elective at a solid East Coast program where I found the discrimination to be true. I automatically declined that interview as soon as the season started. I don't need to be in ANY program that badly. I don't care if it's the greatest school in the history of mankind.

If your dead set on an elite school, I would make sure those places take DOs first. Examples such as MGH, Longwood, Stanford, Columbia, Cornell, etc often come up as places that don't take DOs period.

I for one did not take the USMLE because I just physically couldn't sit for 2 eight hour tests in a 3 day span (I could barely sit for one). I knew whichever test I took 2nd, I would bomb. My entire prep towards both Step 1 and Step 2 was UWorld and taking practice USMLE tests. I was actually doing better on the USMLE tests than the COMLEX tests. However, since the test I NEEDED to pass was the COMLEX, I took that. If I was given the choice of taking either test to get my degree, I would have taken the USMLE...kill 2 birds with one stone and in the process not have to waste my time with OMT. Instead, I learned all those embroyology, biochemistry, and physiology stuff for no reason (my god damn COMLEX only had 4 physio questions WTF, how is that even possible on Step 1, that was my strongest subject too).


In the end, not taking COMLEX did not haunt me at all. I was ecstatic with the interviews I received this season. I matched somewhere and soon will continue my dream of becoming a psychiatrist.


One more thing...AT made a comment in another thread that applicants often think they are smarter than they are (or something to that effect). I think it's easy to think that when it's such a buyer's market that schools you normally wouldn't have a shot at offer you interviews. I think when looking for the that perfect residency, you have to know your skill set. It's not always about matching at the most prestigious school possible. Find the best combination of a program that will train you to be the best psychiatrist you can be while providing an encouraging and supportive atmosphere. That's the philosophy I used in creating my rank list.

 

As someone taking boards in a couple months I'll weigh in on what factored into my choice. I think the demographics of this board skews toward the more academic and competitive aspects of psychiatry, while (in my opinion) the lurkers may skew the other way. Of course, this is only my assumption. I think in this sense it's easy to make assumptions that all applicants may share some similar values in their career goals, which may or may not be the case.

Currently, there are 182 allopathic psychiatry programs. I'd venture to guess that roughly 1/3 to maybe 1/2 of these really ever get discussed here much from my perception (could be way off). This leaves a large amount of programs that fill every year (whether it be through match or scramble). In essence, most people aren't matching into a lot of the programs we may conjure up when we come here and think 'someone wants to match into psychiatry'. Naturally, many people will also want to land in some more competitive places, hence the fact that they are competitive. In this context then a lot of what's been said is pretty appropriate about making sure you take each opportunity to, at the very least, match up with others you're competing against.

As far as the story of the bad applicants having not taken USMLE, I'd say that using that as a screen would probably be pretty sensitive for bad applicants but not very specific. What would your thoughts of them have been had the only taken the COMLEX but didn't have multiple rotation failures, didn't have a superficial interest in psychiatry, didn't have bad letters, and had given thought to where they would be in the next ten years? Not taking USMLE is the least of these problems. Of course I'm sure you know that and were just pointing out that in addtion they didn't take it, but as I was saying senstive and not specific.

I think the biggest problem we have is that the advice isn't getting translated. I've mentioned before that if you go through the ROL threads for the past few years you'd think only 20 programs exist. I'm not saying this as a fault, just pointing out that the demographics here certainly aren't representative. In my experience, those who were comfortable enough going to a DO school to begin with are also much more comfortable not going to a huge academic center and a more comfortable in the midwest (since it's also more likely they went to school there) and/or in community programs. I'm only saying this as a generalization, since there are also obviously many DOs that want to match into bigger, more competitive programs, and on the flipside there are many at competitive MD schools that opt for a smaller program or even what isn't considered a "sexy" location.

You could tell a 6'1" basketball player entering the upcoming draft that teams are really looking for some help inside and grabbing rebounds and that would be to his benefit to showcase his rebounding and work on his post-up game. Surely, this wouldn't hurt his chances and could maybe get him a bit of praise, but let's not kid ourselves in thinking that someone is going to draft him to play power forward. If they're looking to bolster their frontcourt, they're going to draft a big guy, and not a 6'1" point guard, no matter how awesome his rebounding and post skills. If a program values a solid USMLE score and won't look upon taking COMLEX only very favorably, it's likely that the bigger uphill battle is that you're a DO -- not that you didn't take USMLE, much like our 6'1" rebounding machine. Of course taking and doing well on the USMLE will give you a better chance at these places but by how much? Our point guard friend can increase his chances of being selected higher by a team looking for a rebounder by showing his rebounding skills as a point guard, but by how much? My advice to him would be to showcase his speed, footwork, ball-handling and passing to catch the eyes of teams looking for a point guard. Afterall, he probably doesn't want to play power forward anyway. There are exceptions, obviously, as I'm sure Don Nelson wouldn't have a problem starting a 6'1" power forward.

There are a few different reasons why, as of right now, I am not planning to take USMLE step one. The first is financial. Our school budget is created for a single individual. They will not allow or approve anything above the standard budget given to each student. I've tried getting other educational loans independent of the school, but in the end it proved to be a waste of time since they required the school to approve it, but I digress. I'm supporting my wife and two children on a budget created for one person. The extra $600 is though to poney up for something that I've deemed to be of too little value for any added benefit it may bring according to my own personal goals. Due partially to my circumstances in addition to a few other factors, the programs I'm looking at aren't at big academic centers and aren't in 'desirable' locations for young single people.

Often times I hear about having "good" board scores only to later find out that what we're talking about is >210 or sometimes even >200. If it's so important to a particular program that I fork out $600 for a test where a nationally sub-par performance would be considered proving something, then no thanks. If things change, I reserve the option to take step 2. But as of now if they think, aside from everything else in my application that I'm confident of, that me not taking a test with a 200+, then I don't think we're going to be that good of a fit anyway. I understand some may disagree with this reasoning, which is why I can say I'm comfortable not being considered at these places with no sweat off my back. Again, if things change and my goals (which are largely static due to having a settled family) also change over the course of the next year, then I'll take step 2.

I guess in summary what I am saying is that there are numerous factors that can go into the decision and simply implying as a soft rule that the USMLE should be required in order to be competitive (which may or may not be the case depending where the applicant is considering applying and what their goals are) doesn't always hold true. By the same token it also can't be said as a soft rule that the USMLE is not required since, again, this depends on the individual and what they are looking for rather than having us superimpose what we personally are/were looking for. Conclusion: my belief is that it is not as much bang-for-your-buck as is being implied, since programs more anal about having a USMLE score will likely be just as anal about you being a DO graduate.

 

Gotta like the basketball analogy in March.
Maaatch Madness...as they say in new england.