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Letters to the Editor

In Reply to Gimpel

Ahmed, Harris DO, MPH1; Carmody, J. Bryan MD, MPH2

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doi: 10.1097/ACM.0000000000004135
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We appreciate Dr. Gimpel’s comments and emphatically agree with the need for equitable treatment of osteopathic physicians (DOs). Yet, we maintain that equity would be better advanced by a single licensing examination for all physicians.

It is true that osteopathic medical school curricula incorporate distinctive osteopathic principles. But licensure examinations exist to protect the public, not enforce curricular standards. Over 90% of states allow DOs to obtain licensure by completing the United States Medical Licensing Exam (USMLE), 1 and we believe that DOs who become licensed this way are just as capable of providing safe medical care as those who completed the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA).

It is also true that osteopathic manipulative treatment is not assessed on the USMLE. To us, this seems to be a more compelling argument for the National Board of Osteopathic Medical Examiners (NBOME) to offer a specific examination on this competency rather than mandate an entirely separate series. Alternatively, accredited osteopathic medical schools could simply continue to certify their students’ competency in these techniques, just as they are now being entrusted to do following the long-term suspension of the COMLEX-USA Level 2-PE.

Finally, the Commission on Osteopathic College Accreditation does require, as a condition of accreditation, that students pass the initial portions of COMLEX-USA before graduation. However, as Dr. Gimpel notes, there is substantial correlation between performance on the USMLE and COMLEX-USA. The NBOME’s own analysis found that less than 1% of students who passed USMLE Step 1 failed COMLEX-USA Level 1. 2 This concordance should be viewed as evidence that the content of COMLEX-USA is captured adequately by the USMLE and that the latter would function adequately as a stand in for the former.

The NBOME’s exams undoubtedly performed an essential function in an era in which many DOs were unfairly excluded from practice and licensure opportunities. But to maintain a “separate but equal” licensing pathway in the modern era seems duplicative, unwise, and ultimately detrimental to the goal of equitable treatment for DOs.

References

1. Federation of State Medical Boards.. State specific requirements for initial medical licensure. https://www.fsmb.org/step-3/state-licensure. Accessed April 20, 2021
2. Sandella JM, Gimpel JR, Smith LL, Boulet JR. The use of COMLEX-USA and USMLE for residency applicant selection. J Grad Med Educ. 2016; 8:358–363
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