To the Editor: COMLEX-USA vs USMLE? Irrelevant.

We should neither duplicate, divide, or unify as Ahmed and Carmody asked¹ ; rather, we should fight discrimination against osteopathic graduates. The very question of what to do confounds the issue at hand: it is not about what examinations students take; it is not about normalization or standardization of scoring; it is about program directors discriminating against osteopathic graduates.

Recent data collection reveals that acceptance of the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is irrelevant to the issue of match rate disparities for DO students, regardless of preferred specialty. The issue is not whether COMLEX-USA is accepted but whether DO students are being interviewed at all. The 2022 National Resident Matching Program (NRMP) Program Director Survey revealed the following data²: 29% of program directors never interview DOs; 49% seldom interview DOs; 28% never rank DOs; and 46% seldom rank DOs.

What do these data show if not discrimination? A closer look at NRMP data reveals that most programs consider a COMLEX-USA score even if they also require a United States Medical Licensing Examination (USMLE), making the examination standardization argument superfluous. Match rates for DO graduates by preferred specialty are lower than those of MD students with only 4 exceptions in 2022: neurology, radiation oncology, diagnostic radiology, and transitional year programs.

The match rates range from 7.5% for DO students vs 10% for MD students in dermatology, to 6.3% for DO students vs 72% for MD students in vascular surgery.^3,4  Also, despite more DO schools opening in the last 15 years to meet the need for more primary care physicians, even primary care specialties show a difference in the DO vs MD match rates.⁵  After the Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA) accreditation merger in 2015, AOA-accredited residencies no longer exist; thus, all osteopathic graduates participate in the NRMP Match unless in the military or in another specialty match such as otolaryngology or ophthalmology. The NRMP data suggest that osteopathic graduates are not receiving equal opportunities in The Match. The question of type of examination may be a smokescreen for institutions discriminating against DOs.⁶ 

The answer to the question posed by Drs. Ahmed and Carmody is none of the above.¹  Forget examinations. Instead, hold discriminatory programs accountable for their actions. Require that all programs report the number of DO and MD students they interview and rank, and withdraw funding from institutions that do not grant equal opportunities to equally qualified applicants.