Warning: Long Post.
Hello. I have some random questions about USMLE and COMPLEX. I won’t be applying to medical school for several more years as I have only begun to take prereqs. Forgive my ignorance but I’m somewhat confused on the licensing exams. I know students in allopathic schools (MD) take the USMLE and students in osteopathic schools (DO) take the COMPLEX and there are several steps to each.
1. How many steps are there in USMLE and COMPLEX? I thought there were only 2 steps in each. One after the first 2-years of medical school (basic sciences) and one after graduation (4th year–after clinical rotations), but I think this is wrong. It seems the Step 2 is after the 3rd year, maybe??
2. What happens if you don’t pass Step 1? Do you keep retaking it until you pass? Ditto for Step 2? Is there a Step 3?
3. When are you given the title of “doctor”–after you graduate medical school or after you pass these exams?
Personally, I’m more interested in the DO route because I’m interested in becoming a primary care physician and it seems that DOs emphasize this. (I think I will end up in either Internal Medicine or Family Practice.) I also like the idea of learning a little something “extra” (OMM) even if I never use it. However, I do not believe in limiting myself so when the time comes, I will apply to both MD and DO schools. And I’m going to wherever I get in and wherever I feel most comfortable!
4. If you are a DO, can you match into an MD residency? What about vice versa? If you go DO, do you automatically have to take COMPLEX in order to get the degree of DO? Likewise, if you go MD, do you automatically have to take USMLE to get the MD degree? It seems like the MDs have a more established residency program and match and therefore most people (MDs and DOs) want to match into an MD residency. I guess if you really want to maximize your chances for a good residency you can take both exams?? Is that possible? (Or maybe that’s insane! Well, I think the whole process is insane…but I digress).
5. Finally, the big question. Does it honestly matter where you do your residency? It seems like everyone wants a “competitive” residency (regardless of what type of doctor they want to become) but does it really matter? As long as you get good recommendations from your attendings when you’re a resident, will being in a “non-competitive” residency make it more difficult for you to find a job when you’re done?
Sorry for the long post. I hope the current medical students and docs can help me out. Thanks!
Love,
Stacy
Let’s see what I can do…
1. USMLE is 3 steps. I think COMLEX (it’s not COMPLEX but don’t ask me what the acronym stands for) is also 3 steps. You are right, Step 1 (for either) comes after completion of your pre-clinical years, i.e. the end of year 2. Currently USMLE is self-scheduled: you can choose a date. The exact timing is generally determined by your med school - mine required you to take it by June 30 following second year, so that it was done prior to starting third year rotations. I think that’s fairly typical. I think COMLEX is paper-and-pencil and therefore is given on the same date for everyone, in early June. I also think it’s two days but I’ll let someone more familiar with the DO side of things answer that definitively.
Step 2 - mine is one of a growing number of M.D. schools requiring that you pass Step 2 before graduating. In the past, it wasn’t a requirement for graduation at a lot of places and so people tended to put it off. I’m taking it soon because I heard from SO many people that your third year rotations are your best prep for Step 2, and so taking it soon after the conclusion of third year makes lots of sense. There’s a possible tactic to be played here - by taking it early, my score will absolutely, positively be on my residency applications. That CAN be a downside for some applications to competitive specialties. OTOH some people study their butts off to get a fabulous score early, to make up for a previous crummy Step 1 score. I didn’t worry about strategy; I just want to get it over with.
Step 3 is taken generally at the conclusion of the intern year and is the final step in licensing. (USMLE stands for US Medical Licensing Exam.) Jumping ahead to your question #3, you are an M.D. or D.O. when you get your degree from your medical school. You can then be referred to as “doctor” and in your intern year, you’ll write prescriptions and orders. HOWEVER, you won’t have a license to practice independently - that only comes after passing Step 3.
Steps 1 and 2 are a sort of joint venture, in that they are required for you to obtain a medical license eventually, but it is your school that has the immediate interest in how you do. So, all D.O. students have to take COMLEX 1 at the conclusion of 2d year while M.D. students must take Step 1; M.D. schools may require that their students have passed Step 2 prior to graduation. (presumably something similar is required of D.O.s but I don’t know exactly what it is.)
2. What happens if you don’t pass. At my school, when your failing grade came back to the Dean’s office on Step 1 (usually in mid- to late-July), you were suspended from your clinical rotations and given two months to study intensively and take the test again. USMLE has a limit on how many times you can take it within a certain period of time, but to be honest I don’t know how it would get to that, because your school would kick you out, frankly, before you got to the USMLE limit if you couldn’t pass.
You are behind, but not irreparably so, if you have to pause in your clinical rotations to re-study for Step 1. There’s usually a lot of leeway in your fourth year schedule so that you can make up the rotation time missed during third year, and you can still graduate on time.
3 (already answered)
4. Yes, D.O.s can match into M.D. residency programs. Find Dave Kelley’s story of getting into the Dartmouth anesthesiology program - just do a search for “Dartmouth” and you should find it pretty readily. Some M.D. programs will accept COMLEX scores but my impression is that D.O. students feel safer by taking the USMLE, so yeah, they’re taking both.
5. Matching into a residency is actually a very personal decision about how you are fitting your new career into the other important goals in your life: where you do want to live, what’s important to your family, etc. etc. There aren’t too many unemployed doctors regardless of where they did their residency so that shouldn’t be a concern.
If you go to www.aafp.org (American Academy of Family Practice), dig around a little in the student section and you’ll find a neat article that describes some of the off-beat things FP docs have done. Of the specialties, FP is definitely one that makes you hire-able pretty much anywhere.
Reading over this, I think I’ve gotten the essential stuff right but i hope folks will correct me if I’ve messed up in any of the details. 
Thanks Mary! This is so helpful. I’m hoping Old Man Dave or one of the other DOs will weigh on some of the DO questions too.
I’m going to print out the responses to this post when I get home. I just love OPM. I read SDN too but people get really crazy on those boards and so far I’ve been afraid to post anything there. <!–emo&<_
Love,
Stacy
Will do when I have time to come for air. Meanwhile, go to my journal - can be accessed via the home page - and you will some stuff there. Also, do a search on DOs &/or osteopathic medicine. Similar discussions have taken place & you might be able to answer several questions that way too. Meanwhile, take a few moments to format some specific questions for me to address & post them here. If I have a wy slow call-night like I did this past Tuesday, I will invent the time in answering them then.
| QUOTE (Mary Renard @ Jul 25 2003, 12:21 AM) |
| 1. USMLE is 3 steps. |
Howdy y'all!
Unfortunately (for me, not for Mary), there are now/will shortly be four steps to the USMLE. Starting with my class of 2005, Step II will include the Clincal Skills Assessment as a 'part B'.
The National Board of Medical Examiners, the evil bastards who sponsor the USMLE, have said that in order to register for Step III, anyone graduating in 2005 must have taken both the written and skills parts of Step II.
The NBME is purposefully not calling this CSA an extra step since many state licensing boards require passing only three steps. If they were actually honest about requiring a new test, those states would, theoretically anyway, have to pass new legislation requiring the new test. Since many state medical associations are opposed to this new test, the NBME was worried that this would not happen. Thus, Step II now has two parts instead of there being a Step IV.
Sorry for the rant. As one of the first to have to take this ~$1,000 (plus travel and lodging) waste of time, I'm still a little torqued about it.
Other than that, Mary's dead on, as usual.
Take care,
Jeff Jarvis, MS-III
UTMB
Galveston, TX
Jeff, I’m sorry, I forgot about that! (wincing as I say that 'cuz I know YOU can’t forget it) Step 2B is crap, I wholeheartedly agree. While I am grateful to avoid the time and expense, I am unhappy at how this has been pushed through despite a good bit of evidence to show that it’s completely unnecessary. 
Hi there,
Unfortunately, beginning with the class of 2005, there is an extra step (Clinical Skills Assessment or CSA) to obtaining a license to practice medicine in the United States. It will be expensive and is totally un-necessary for most American grads but you have to jump through hoops.
In Virginia, you have seven years from the time that you take USMLE step I to take and pass USMLE Step III or you have to start over again with Step I even if you passed it. Good advice is to take Step III as early as possible and get your license in some state. The CSA is not a problem unless you are Class of 2005 or later.
It is possible to be a DO and apply for MD residencies but do some homework. Some places still consider the DO less than an MD. Don't waste your time or energy applying to these programs. You can get an idea of such programs by looking at the list of current residents. Good residency programs like Mayo Clinic do not make any issue of DO vs MD but do your homework! Most good slots want you to have good grades in medical school and good scores on USMLE Step I or Comlex. You have to do some research here.
Good luck and do your best.
Natalie
Staci,
Shhhhhhh…don’t tell the nurses, but I am on-call and things are fairly quiet. Maybe I should turn my pager on, huh?
| QUOTE |
| 1. How many steps are there in USMLE and COMPLEX? I thought there were only 2 steps in each. One after the first 2-years of medical school (basic sciences) and one after graduation (4th year–after clinical rotations), but I think this is wrong. It seems the Step 2 is after the 3rd year, maybe?? |
Both exams have 3 steps - including the damnable, waste-of-time & money IIb CSA exam. Bot MD & DO students will begin enduring this add-in test for the Class of '05. I am totally against it…but that’s a whole other soapbox speach.
| QUOTE |
| 2. What happens if you don’t pass Step 1? Do you keep retaking it until you pass? Ditto for Step 2? Is there a Step 3? |
As far as official policies by the NBME (USMLE people) & the NBOME (COMLEX people), there are no limits on how many retakes you are allowed - at least as far as I am aware. However, both the medical schools & the state licensing boards most definitely have limitations. You will need to check with the individual schools as their policies vary greatly. Some do not even require taking the board exams. However, you cannot advance into the third year nor ever get a license to do a residency if you do not - so there is a de facto restriction there.
Individual state will vary too, but not as much. Most states mandate that you must pass each step w/i 4 or 5 attempts. Some states will allow as many as 7 and quite a few limit it to 3. Recently, the FSMB (Federation of State Medical Boards) recommended to all state boards that they all adopt a 3 take limit for all 3 steps. Some states have adopted this, some are considering & others are snubbing their noses citing physician shortages will only be made worse.
| QUOTE |
| 3. When are you given the title of “doctor”–after you graduate medical school or after you pass these exams? |
The MD or DO degree is a Doctoral-level degree; so you are deserving of the title “Doctor so&so” immediately upon graduation. Becoming a licensible physician requires passing all the board exams & completing post-graduate training.
| QUOTE |
| 4. If you are a DO, can you match into an MD residency? What about vice versa? It seems like the MDs have a more established residency program and match and therefore most people (MDs and DOs) want to match into an MD residency. I guess if you really want to maximize your chances for a good residency you can take both exams?? Is that possible? |
Yes, in fact about 2/3rds of DO graduates undertake ACGME (MD) residencies. The reasons are as many-fold as the number of people who choose to do ACGME programs. For me, virtually all of the AOA (DO) anesthesiology programs are either small, community-based, non-university affiliated programs which is incongruent with my career aspirations. No, I am not saying that the AOA programs are not excellent programs…I am, however, stating that their structure does not provide specific elements that I need in my training.
In general, there are tons of AOA slots, the bulk of which are directed towards primary care. There is a paucity of AOA specialty & sub-specialty programs. That is another commonly cited reason for a DO to undertake ACGME post-grad training.
At this time, MDs cannot do an AOA post-grad program. In my humble opinion, this is very elitist & just plain stupid. I also wouuld wager that w/i my practice life, most probably in the next decade, that this will change.
Taking both exams…yes, you can, if you are a DO graduate/student. MDs cannot take the COMLEX. You should be aware that you do not have to take the USMLE to do an ACGME program…I did not & here I sit at Dartmouth-Hitchcock on a dreary Sunday morning on call. There are specific situations where, as a DO candidate, it might be advantageous to take both USMLE & COMLEX, but that takes us into an entirely different topic arena - I have wirtten pretty extensively about this in my journal, see the home page for links. If you stay with your expressed desire for primary care (FP or IM), I cannot imagine a scenario where you would need to take both. Maybe with some of the ultra-competitive individual residency programs w/i the IM/FP sect - but for 95+% of the programs, it would be a waste of time & money.
| QUOTE |
| Finally, the big question. Does it honestly matter where you do your residency? It seems like everyone wants a “competitive” residency (regardless of what type of doctor they want to become) but does it really matter? As long as you get good recommendations from your attendings when you’re a resident, will being in a “non-competitive” residency make it more difficult for you to find a job when you’re done? |
The answer to this depends upon your ultimate career goals. For me, I love the politics of medicine & plan to invovle myself in policy making, hopefully at the national & state levels - eventually. Plus, I plan to either subspecialize in either critical care medicine or pediatric cardiothoracic anesthesiology. Therefore, I needed to undertake my anesthesiology training at a university-affiliated, high-volume, high-acuity, high-variety academically driven program to land the exposure, land the fellowship(s) and make the correct connections. Were I to aspire to a rural FP physician, that would be completely unnecessary.
I hope all of this helps. Reply with loads of questions. Regarding the implied question of: “can DOs do everythig an MD can do?” Yes - in legal terms & medical licensing terms, the degrees are equivolent.
Thanks to everyone for all their replies! As a pre-med, I’m so focused on just getting in to medical school so I don’t think I worry as much about the licensing exams. But, I just want to know what I’m in for later on down the road. (BTW, I’m really embarrassed–I thought there was a P in there. I thought it was COMPLEX. 
) Oh well.
I think by the time I’m in, we’ll be up to Step 506 on both exams! Step 2B on USMLE is crap. That sucks!
I have such a long way to go…I try not to think about it. I will be taking PreCalculus this fall and next spring at NVCC and then I’ll be sending in my applications to post-bacc pre-med programs for next summer or fall. Despite the debt, I want to quit my job and go to school full-time to take all the prereqs. I have a degree in journalism and have worked in publishing for the past 6 years so I’m really switching gears here. I have no idea whether I’ll end up as a DO or MD (although I don’t really care that much). I have a slight preference for DO b/c I’m intrigued by the practice of OMM but since I haven’t seen it in action yet, I don’t really know. I have to get off my butt and start shadowing some docs (both MDs and DOs)! I’m a people-person, which is the main reason I want to go into medicine to begin with, and I think I will be best suited as a family practioner or internist. I like the idea of seeing a variety of people, variety of problems, and not focusing on one specific body part or system so being a generalist appeals to me–at least in theory. Also, I like the idea of only 3 years of residency!! Sleep deprivation for 3 years as opposed to 5 years or 7 years! Who knows though? Once I’m on rotations, I may find that I love X speciality and want to be a specialize in X.
Wish me luck. Current goal = make it through PreCalculus. I hate math! Next goal = get into post-bacc program.
Love,
Stacy