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Letters to the Editor

In Reply to Lenchus

Ahmed, Harris DO, MPH; Carmody, J. Bryan MD, MPH

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doi: 10.1097/ACM.0000000000003834
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We thank Dr. Lenchus for his interest and agree that the de facto requirement for osteopathic medical students to take 2 licensing examinations imposes unacceptable costs on students. Although we agree in sentiment, we seem to differ on the optimal solution.

We disagree that there are no sound reasons for osteopathic medical students to take the United States Medical Licensing Examination (USMLE). According to the National Board of Osteopathic Medical Examiners (NBOME), nearly 20% of program directors do not use the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) as part of their selection process. 1 Though space limitations preclude an exhaustive bibliography, there are multiple studies demonstrating that osteopathic medical students who do not take the USMLE are significantly disadvantaged in the Match process. This practical reality has been appreciated by colleges of osteopathic medicine across the nation, which increasingly require students to take the USMLE in addition to the COMLEX-USA. 2

A more realistic solution may be for all students to take a single licensing exam. Indeed, the USMLE was created with the intention of having a single licensing exam for all physicians, regardless of their educational background. Despite initial interest, the NBOME declined to participate in this endeavor. 3

We readily acknowledge the distinctiveness of osteopathic medicine, but question whether the philosophical differences are truly so great that they require a separate measure of suitability for licensure. A minority of osteopathic medical education is devoted to osteopathic manipulative medicine (OMM), and the profession itself has acknowledged that these techniques are not a defining feature of an osteopathic physician. In fact, the American Osteopathic Association has developed a certification pathway that does not include OMM. We can therefore imagine a system in which all physicians take the USMLE for licensure with the NBOME offering a separate certification for OMM. Unfortunately, as we noted in our original letter, the financial incentives to further such a system do not exist.


1. National Osteopathic Board of Examiners. COMLEX USA for Residency Program Directors. Published 2019. Accessed October 30, 2020.
2. Rocky Vista University. Rocky Vista University Student Handbook. Published 2020. Accessed October 30, 2020.
3. Johnson DA, Chaudhry HJ. Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards. 2012. Lanham, MD: Lexington Books
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