Osteopathic Update January 2024

Kyle Cohen, MS, NRP, OMS-IV, Alabama College of Osteopathic Medicine
EMRA MSC Osteopathic Coordinator 2023 - 2024

EMRA and the Medical Student Council continue to advocate for osteopathic medical students. With the NRMP match numbers for emergency medicine the last couple of years declining, osteopathic medical students have stepped up and begun to fill more spots. However, there seems to be a continued bias. According to the most recent match numbers, MD applicants had a 95.3% match rate, while DO applicants had only a 91.4% match rate.1 These numbers are from NRMP in 2023, when there were 554 unfilled positions. However, they are much better in respect to equality when compared to the pre-pandemic and pre-jobs report match rates in 2019 of 88.7% for MD and 65.7% for DO applicants.2 Emergency medicine was much more competitive, but some of the increase in equality may be due to the adoption of an EMRA policy supporting the equal consideration of allopathic and osteopathic applicants in the spring of 2021.3 However, there is still some room for improvement as programs continue to include the requirement for osteopathic students to continue taking both COMLEX and USMLE for both audition rotations and residency applications.

At the ACEP conference in October 2023, the medical student council put forth a resolution to further improve the equity and reduce the bias for DO applicants.4 It was cited in the resolution that in the 2020 match cycle, DO applicants that took the USMLE in addition to the COMLEX matched at a rate of 86.6% while those that took only COMLEX were at 75.8%. With the transition of both USMLE Step 1 and COMLEX level 1 being pass/fail, it is believed that these should be viewed as equal. The resolution put forth that residency programs should accept a passing COMLEX level 1 passing score report in  lieu of a USMLE step 1 passing score report for students applying for away rotations, as well as update their VSLO page to reflect the acceptance of COMLEX score reports. While this does not address all aspects of the bias, we believe it is a huge step in the right direction.

Further support of reducing the bias was made in a statement from CORD shortly after the ACEP Scientific assembly.5 In the statement, CORD recognizes that there are undue barriers for osteopathic students applying to emergency medicine and that the COMLEX exam results should be held as equivalent to those of the USMLE, and applicants should be considered equally. While the exams are not scored the same, the NBOME provides a score concordance chart that correlates a COMLEX score range with a USMLE score range, as well as a 3-digit score conversion tool to a percentile according to the cohort of the exam.6-7

Recognition of this bias has also made its way to Congress. The Fair Access in Residency (FAIR) Act (H.R. 751) was introduced to the House of Representatives in February 2023 and was referred to the committee on health.8 The bill, as written, recognizes that the USMLE and COMLEX should be accepted as equal when evaluating residency candidates, and would require that the residency submit a report to the secretary of health and human services regarding the number of applicants from each type of program and the number of accepted applicants from each type of program beginning in 2024. While not signed into law yet, the bill continues to gain support with numerous co-sponsors.

It is our goal at the EMRA and the Medical Student Council that all medical students have equal support and representation within the field of emergency medicine. Many advances have been made over the last couple of years, but there is still room for improvement. If you have questions, concerns, or suggestions for resolutions, please reach out to the medical student council, or submit a resolution of your own.


  1. Main Residency Match Data and Reports. Advance Data Tables: 2023 Main Residency Match. National Resident Matching Program. March 2023. Accessed December 8, 2023. https://www.nrmp.org/wp-content/uploads/2023/04/Advance-Data-Tables-2023_FINAL-2.pdf
  2. Match Data and Reports Archives. Results and Data: 2019 Main Residency Match. National Resident Matching Program. April 2019. Accessed December 8, 2023. https://www.nrmp.org/wp-content/uploads/2021/07/NRMP-Results-and-Data-2019_04112019_final.pdf
  3. Policy Compendium. Section V, Policy XXIV: Equal Consideration of Osteopathic Medical Students. Emergency Medicine Residents Association. March 2023. Accessed December 8, 2023. https://www.emra.org/siteassets/emra/about-emra/governing-docs/policy-compendium-march-2023-final.pdf
  4. Sholmire A, Timmreck A, Maki B, et al. Resolution F’23-1: Improving Equity/Reducing DO Bias. Emergency Medicine Residents Association. September 2023. Accessed December 8, 2023. https://www.emra.org/be-involved/be-a-leader/representative-council/2023-fall-resolutions/resolution-f2301
  5. Advocacy & Position Statements. CORD Support of DO Applicants. Council of Residency Directors in Emergency Medicine. October 21, 2023. Accessed December 8, 2023. https://www.cordem.org/about-cord/mission--vision/advocacy--position-statements
  6. Concordance: COMLEX-USA and USMLE Score Ranges. National Board of Osteopathic Medical Examiners. February 2022. Accessed December 2023. https://www.nbome.org/news/concordance-comlex-and-usmle-scores/
  7. Percentile Score Converter. National Board of Osteopathic Medical Examiners. Accessed December 8, 2023. https://www.nbome.org/assessments/comlex-usa/percentile-scores/

United States House of Representatives. H. R. 751: Fair Access in Residency Act. February 2023. Accessed December 8, 2023. https://www.congress.gov/bill/118th-congress/house-bill/751/text?s=1&r=43&q=%7B%22search%22%3A%22H.R.+2%22%7D

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