There’s something very sad about the NBOME (the NBME’s osteopathic counterpart) marketing their COMLEX licensing examination with such cringeworthy desperation:

Look everyone, some people can match without taking the USMLE too!

In other news, no one is going to use that hashtag.

The COMLEX is an expensive, duplicative exam that has almost no purpose in 2023. Many DO students, especially those attempting to break into more competitive specialties, have been taking the USMLE for years. The NBOME, by stubbornly existing, is effectively taxing DO students.

Parallel residency accreditation is gone. DO students finish school and enter the same residencies as MDs now exclusively supervised by the ACGME and work the exact same jobs as MDs. While the NBOME could reasonably offer a separate small examination to test for osteopathic manipulative medicine (OMM), every year the COMLEX exists is a waste of time and money for everyone involved.

Two years ago, I wrote:

In the 21st century, I’m not convinced physicians are best served by maintaining distinct osteopathic and allopathic pathways at all. A physician is a physician, and the easiest way to get rid of the unfair DO stigma is not to make it a PR issue–but to make it a non-issue. I understand there’s a lot of history here (though much of it not so positive) and plenty of strong feelings. However, even if one buys the argument that the underlying educational philosophy is sufficiently different to warrant different degrees, that’s no justification for perpetuating a separate-but-equal system for licensure given that post-graduate training has already merged and the vast majority of states don’t care.

The eventual outcome is the same. As we all know, it’s the residency training that really makes the doctor.

The future is hard to predict.

When a large language model can pass the USMLE (see the NBME awkwardly trying to deflect), it raises valid questions about how useful not one but a series of three (!) multiple-choice knowledge assessments will be in the future. But, there is no valid argument for why the COMLEX should even exist now let alone in the future. Even if both sets of exams were to be completely pass/fail, that would theoretically remove the extra cost for DOs, but it wouldn’t justify the wasted time and energy need to maintain two analogous physician licensing pathways. Instead, the development costs of both tests could be combined and the price lowered.

If the COMLEX exists 10 years from now, it can only be as an example of status quo bias and the self-serving power of the acronym mafia.

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