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Licensing and Residency Requirements for Osteopathic Medical Students

Getting a license and completing residency requirements in osteopathic medicine is similar in many ways to allopathic medicine. As an osteopathic physician, you can be granted a license to practice in any one of the 50 U.S. states.

Like graduates of allopathic schools, osteopathic medical school graduates must pass a series of licensure examinations as well as complete one or more years of residency training per the requirements of the state medical board in order to obtain a medical license in that state.

The Comprehensive Osteopathic Licensing Examination of the United States (COMLEX-USA) is analogous to the United States Medical Licensing Examination (USMLE). The COMLEX has three levels:

  • Level 1 covers the basic sciences and is usually taken after the second year of medical school.

  • Level 2 consists of two parts: Level 2-Cognitive Evaluation (CE) and Level 2-Performance Evaluation (PE). These levels are usually taken during the fourth year of medical school.

  • Level 3 tests knowledge in the clinical sciences and is typically taken after the first year of residency.

COMLEX Level 1, Level 2-CE, and Level 3 are computer-based tests. Level 2-PE is a clinical skills test. More information about the COMLEX-USA is available at the National Board of Osteopathic Medical Examiners site.

DO schools usually require their students to take the COMLEX, but some DO students choose to take the USMLE as well in order to be more competitive for certain allopathic residency programs.

Although osteopathic physicians are eligible for medical licensure throughout the United States and in many foreign countries, some foreign countries don’t recognize osteopathic physicians (or do but grant them only limited practice rights).

This lack of recognition can present a problem for students who want to practice in a foreign country at some point in their medical careers, although there’s a global trend toward increasing practice rights for osteopathic physicians. If you envision practicing internationally and are considering osteopathic schools, research the policies pertaining to osteopathic physicians in the country in which you’re interested.

Osteopathic medical school graduates have two options for residency training:

  • AOA-accredited residency programs

  • Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs

To apply for an AOA-accredited (osteopathic) residency program, fourth-year DO students participate in the AOA Intern/Resident Registration Program, also known as the AOA Match. Because DO residency programs don’t have enough places to accommodate DO graduates, many osteopathic students choose to participate in the National Resident Matching Program (NRMP) match to apply for ACGME-accredited (allopathic) residencies.

Some allopathic residency programs favor graduates of MD schools, so if you’re an osteopathic student applying to MD residencies, focus particularly on programs that have a history of accepting DOs into their programs.

You can make yourself a more competitive applicant by working hard to distinguish yourself during medical school through your grades, letters of recommendation, board scores, and by doing rotations at institutions with residency programs you’re interested in to make connections there.

Note that changes are underway regarding accreditation of residency and fellowship programs. Currently, some programs are AOA-accredited, others are ACGME-accredited, and still others are dually accredited.

The AOA and the ACGME are working toward a single accreditation system for all graduate medical education programs in the United States with a proposed implementation date of July 2015. If you’re interested in osteopathic medicine, make sure you keep up with the changes by checking the AOA site on a regular basis.

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