The NBOME Advocates Parity for DO Applicants and Their Qualifications in GME Applications

October 2024 | Vol. 68, No. 1
Written by Renee Cree, NBOME

The National Board of Osteopathic Medical Examiners (NBOME) advocates for parity and equal opportunity for DO applicants to residency and fellowship training programs. This advocacy includes equivalent recognition and acceptance of the COMLEX-USA credential within graduate medical education (GME) to that of USMLE for MD applicants. To the extent that licensure examination scores are used as part of a holistic residency application process, COMLEX-USA scores should be considered exclusively for osteopathic (DO) applicants.

The NBOME has taken a two-pronged approach to its advocacy efforts: education and direct outreach. As part of its education, the NBOME partners with organizations including the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, the American Society of Osteopathic Medical Regulators (formerly the American Association of Osteopathic Examiners), and state medical and osteopathic medical licensing boards to inform those outside of the osteopathic profession on the distinctive yet valid elements of the osteopathic medical pathway to practice, including the purpose of COMLEX-USA and its alignment with the educational program leading to the DO degree.

As part of its outreach to residency programs, the NBOME works directly with DO students who have encountered certain programs that do not appear to accept them for visiting student clinical rotations or GME programs, those that require or strongly prefer a United States Medical Licensure Examination (USMLE) score over a COMLEX-USA score, and/or the few that charge DO students a higher fee for elective rotations. In addition, NBOME leadership meets regularly with osteopathic medical students, faculty, and leadership at colleges of osteopathic medicine (COMs) through our COM Visit Program to discuss concerns and hear feedback directly. Should you encounter a GME program that appears to be discriminating or using unfair practices, please let us know via our online advocacy form.

The NBOME will then reach out to these residency programs to learn more, clear up misunderstandings, and answer questions to foster a better understanding of COMLEX-USA. Thus far, the NBOME has reached out to more than 350 residency programs in the past 2 years— including those at Pennsylvania institutions such as Temple University Hospital and the University of Pittsburgh Medical Center— and those efforts often result in programs updating their websites to make it clear they do support COMLEX-USA and welcome applications from DO students.

Since 2022, eight specialties have released consensus statements supporting the value that DO students and residents bring to their GME programs and the use of COMLEX-USA scores as part of a holistic residency and fellowship application process for DOs. Those specialties are Family Medicine, Psychiatry, Physical Medicine and Rehabilitation, Pediatrics, Anesthesiology, Obstetrics and Gynecology, Emergency Medicine, and Internal Medicine. Of the 7,412 DO seniors who participated in the 2024 National Resident Matching Program (NRMP) Match, more than 84 percent of those who matched did so in one of these specialties.

Currently, the NBOME is working with the Association of Program Directors in Surgery (APDS) to advocate for equal opportunities for DOs applying to general surgery residency programs with COMLEX-USA scores. The APDS Recruitment Task Force has updated its guidelines for 2024-2025 to emphasize the importance of a holistic review process and to recommend the de-emphasis of numeric scores from COMLEX-USA Level 1 and USMLE Step 1 when available. These guidelines also stress the need for residency programs to transparently disclose how COMLEX-USA Level 2-CE and USMLE Step 2 CK scores will be evaluated within this holistic framework.

The NBOME is also partnering with the American Board of Surgery (ABS) and members of the American College of Osteopathic Surgeons (ACOS) to explore the correlations between performance on COMLEX-USA, the ABSITE (American Board of Surgery In-Training Examination), and the ABS board exams. This study is investigating the predictive validity of COMLEX-USA with these assessments, to improve understanding of COMLEX-USA as a part of holistic applicant review in GME.

This acceptance of DOs and the value they bring to medical and surgical specialties continues to grow. Across the country, state medical associations such as the Texas Medical Association and the Washington State Medical Association have approved policy calling for equivalent recognition of COMLEX-USA and USMLE exams in residency and fellowship program applications.

Even globally, interest in the value of DOs cannot be understated; in February of 2024, the International Association of Medical Regulatory Authorities—of which the NBOME is a member of the US delegation—recognized the equivalent competencies of US-educated DOs and their MD counterparts. This commitment to advocacy not only enhances the professional standing of DOs but also fosters a more inclusive and diverse healthcare workforce and enhanced access to care to reduce health disparities.

DO students have been very appreciative of the advocacy efforts. Percentages of DOs taking USMLE Step 1 and Step 2-CK are in decline for the second year in a row, and residency placement rates continue to exceed those of other cohorts, with DO graduating seniors garnering an 98.5 percent placement rate and DO graduates from prior years garnering a nearly 60 percent placement rate during the 2024 NRMP Match (MD seniors from US medical schools had 97.7 percent and 52.9 percent, respectively). Post-Match Week placement rates for the DO Class of 2024 was even better, at 99 percent.

These developments come at a time of unprecedented growth in the osteopathic medical profession, including in Pennsylvania with the opening of the Duquesne University College of Osteopathic Medicine and the proposed COM at Indiana University of Pennsylvania. This follows LECOM (founded in 1992 and continuing to expand) and PCOM (celebrating its 125th anniversary this year and having grown to two additional campuses in Georgia) bolstering the physician workforce in Pennsylvania and the nation with competent, caring osteopathic physicians. This is exceptionally good for patients.

For its part, the NBOME will continue to advocate for DOs and the COMLEX-USA credential in Pennsylvania and beyond in its mission to protect the public through valid, reliable, and fair assessments for osteopathic physicians.