Should DO students take the USMLE?

What's the case for taking the USMLE?

The USMLE is the exam MD students take, so it's the exam every residency program knows how to interpret. If you're applying to programs that see mostly MD applicants, a USMLE score puts you on the same scale as everyone else.

There's also a learning case. In my experience, USMLE questions demand deeper reasoning. Studying for them made me better at the COMLEX too, not the other way around.

With Step 1 and Level 1 both reported pass/fail, the numbers that matter now come from Step 2 CK and Level 2. If you take the USMLE path, plan on Step 2 CK as well. See the Step 2 CK/Level 2 overview.

Who should strongly consider it?

• Students aiming at competitive specialties. In competitive fields, DO applicants often have to do more to stand out, and a USMLE score is one more way programs can compare you directly. If you're still deciding on a field, start at the specialties hub.
• Students applying broadly to programs that mostly train MD graduates.
• Students who are undecided. Taking it keeps doors open. Not taking it can close some.

Who might reasonably skip it?

If your specialty and the programs you're targeting accept COMLEX scores without hesitation, the USMLE may add cost without much benefit. That depends heavily on the field and changes over time.

Don't guess. Look at the requirements on your target programs' websites, and ask residents and faculty in that specialty what they see in practice. Your school's advisors will also know how recent graduates have done.

Does going to a DO school change the math?

A little. The DO route opens the door to almost every specialty, but competitive fields can take extra effort. DO students' rotations also vary more, often in community hospitals without residents, which can make it harder to stand out through clinical experiences alone.

Board scores are one of the few parts of an application that compare everyone on the same terms. That's a big part of why I took the USMLE. It was something I could control, in a format every program reads the same way.

None of this means DO students are at a dead end without it. It means the USMLE is one more tool, and for some goals it's an important one.

What does it cost you?

• A second exam in each phase you choose to take, with registration fees on top of COMLEX. Check current fees on the official sites.
• COMLEX-style practice during dedicated, so the shorter, recall-heavy format isn't new. See USMLE vs COMLEX.
• The gap. Taking two full-day exams within a week is draining, and the days between are hard to use well. See the gap between exams.

The content cost is smaller than people expect. The topics are nearly the same.

If I take both, which one goes first?

I took the USMLE first and the COMLEX within about five days, for both phases. That order let me put my best studying toward the harder exam and then carry the momentum into the second one.

The caveat: don't plan to study for the COMLEX in those five days. Do that work during dedicated.

Questions to answer before you decide

Key takeaways

• The USMLE puts you on the same scale as MD applicants.
• For competitive specialties, I think it's usually worth it.
• Check your target programs and ask people in the field. Don't guess.
• The extra content is small. The extra exam day and the gap are the real cost.
• If you take both, I'd go USMLE first and COMLEX within a few days.

Everyone also asks

Do DO students need the USMLE to match?+

Not always. COMLEX is the required exam for DO students. Whether the USMLE helps depends on your specialty and the programs you want, so check their requirements and ask residents and advisors in that field.

If I take Step 1 as a DO, do I have to take Step 2 CK?+

It's a separate decision, but think about them together. Step 1 is pass/fail, so Step 2 CK is where a USMLE score actually appears. Plan both phases before you register.

Is it harder to prepare for both exams?+

The content is mostly shared, so the extra work is smaller than it sounds. The real costs are a second test day, COMLEX-style practice during dedicated, and the draining days between the two exams.