Residency Advisor
The fear that “only COMLEX = no match” is wildly exaggerated—and also…not completely made up.
Let me be blunt: only taking COMLEX will close some doors. But it will not slam the whole building shut, and anyone telling you it does is either out of date or just enjoying scaring DO students.
You’re worried you ruined your chances. That you made the “wrong call” not taking Step. That PDs will open your app, see only COMLEX, and toss it.
Let’s walk through what actually happens.
The ugly truth first: yes, some programs really do filter you out
You already know this part, but I’ll say it clearly so there’s no sugarcoating.
There are absolutely programs that:
- Explicitly require USMLE Step 1 and/or Step 2
- Say “we accept COMLEX” but still prefer USMLE and quietly rank DOs lower without it
- Use a hard USMLE filter in ERAS that your COMLEX score doesn’t touch at all
I’ve sat in on discussions where someone literally said, “We’d love more DOs, but it’s just easier for us to compare Step scores.” Lazy? Yeah. Common? Also yeah.
So if you only took COMLEX, here’s the realistic fallout:
- You’re instantly out for programs that list “USMLE required” on their website / FREIDA / program page
- You’re at a disadvantage at some competitive university programs that like neat little Step score spreadsheets
- For hyper-competitive specialties, your life is harder without USMLE, even if it’s not absolutely impossible
But notice what I didn’t say:
I didn’t say “you won’t match.”
I didn’t say “no good program will look at you.”
Because that’s just not reality.
| Category | Value |
|---|---|
| Truly COMLEX-friendly | 35 |
| USMLE preferred but flexible | 40 |
| USMLE basically required | 25 |
Where you actually stand if you’re COMLEX-only
Let’s talk real scenarios, not abstract doom.
Scenario 1: You’re a DO with only COMLEX, aiming for a core field (IM, FM, Psych, Peds, Neuro)
This is the most common worried-applicant situation.
You:
- Took COMLEX 1 and/or Level 2, did fine or decent
- Didn’t register for Step (or failed to schedule it, or ran out of time after a rough Level 1)
- Are now panicking that “only COMLEX = red flag”
Here’s what’s actually true for core specialties:
- Tons of ACGME programs are historically DO-heavy and completely comfortable with COMLEX
- Many community and mid-tier university programs will honestly not care as long as your scores are solid and the rest of your app is coherent
- Your biggest problems will be:
- Overly competitive academic centers
- Regions that are already Step-obsessed
- Trying to act like you’re competing evenly for top brand-name IM / Psych / Peds programs with MD applicants who all have Step
So if you’re going for Internal Medicine, Family, Peds, Psych, Neuro with only COMLEX and:
- You have reasonable scores (think ~550+ Level 1 and/or 2, give or take)
- You’ve got decent clinical evals, maybe some research or solid experiences
- You apply to a smart mix of programs (including DO-friendly and community)
Your match odds?
Far from dead. Genuinely very workable.
Where people get wrecked is not the COMLEX-only part. It’s:
- Applying to 25 programs all in NYC and California
- Aiming only at super academic university programs
- Acting like “I’m a DO but I’m special so surely they’ll overlook it”
They usually won’t.
Scenario 2: You’re COMLEX-only and want something moderately competitive (EM, Anesthesia, OB/GYN, some Neuro, some Path)
This is where the anxiety spikes.
You don’t want Derm or Ortho, but you’re not exactly applying to Family med either. You’re in that middle zone where:
- Some DOs do great every year
- Some DOs get absolutely crushed by the combination of Step obsession + limited spots
If you only took COMLEX and want EM, Anesthesia, OB, etc., then:
- You must be strategic and realistic
- You cannot pretend to be a generic MD applicant with Step scores
- You need to lean hard into DO-friendly programs and those that openly accept COMLEX
What I’ve seen:
- EM: some programs legit like DOs and have historically taken plenty with COMLEX only. Others basically don’t look twice without USMLE.
- Anesthesia & OB: similar split. Some community/university-affiliated places are fine with DO + COMLEX; big-name academic centers much less so.
Here’s the uncomfortable part:
If you’re COMLEX-only in these specialties and your scores are average-ish (like 500–540), and you don’t have amazing clinicals, contacts, or home-program strength…
Yeah, your risk of not matching is higher. Not impossible—but higher.
So what do you do?
You play a stats game: more applications, more DO-friendly programs, more geographic flexibility, and accept that some top-tier programs were never really available to you anyway.
| Specialty Tier | COMLEX-Only Viability | Strategy Needed |
|---|---|---|
| Family Med / IM / Peds | High | Moderate |
| Psych / Neuro / Path | Moderate-High | Moderate-High |
| EM / Anesthesia / OB | Moderate | High |
| Ortho / Derm / ENT / Plastics | Very Low | Extreme |
Scenario 3: You’re COMLEX-only and want something brutally competitive (Derm, Ortho, ENT, Plastics, Urology, Rad Onc)
This is where I have to be hard with you.
If you:
- Only have COMLEX
- No Step
- No insane research portfolio, no insane connections, not graduating from some magic DO school pipeline to that specialty
Then your odds for the hyper-competitive fields are:
- Very low, bordering on fantasy in ACGME programs
Does it happen? Yes.
Is it common? No.
Is COMLEX-only the main problem? Partially, but not entirely. Those fields crush MDs with great Step scores too.
So if you’re sitting here, COMLEX-only, aiming for Dermatology and refreshing Reddit threads…you’re not crazy, but you’re in a very high-risk situation. You’d need:
- Crazy strong mentorship
- Possibly a plan B specialty
- A brutal level of honesty with yourself about how many cycles you’re willing to burn
I wouldn’t say “never.”
But I would say: you’re playing on max difficulty with a handicap.
| Step | Description |
|---|---|
| Step 1 | DO + COMLEX Only |
| Step 2 | Core: IM/FM/Peds/Psych |
| Step 3 | Moderately Competitive |
| Step 4 | Hyper-Competitive |
| Step 5 | Apply Broadly to DO-Friendly + Community |
| Step 6 | Heavy DO-Friendly Focus + Extra Apps |
| Step 7 | Consider Step Later or Plan B |
| Step 8 | Specialty Type |
“But will programs secretly think I’m lazy for not taking Step?”
This is the part that stings.
Some PDs do think this way. I’ve heard it, you’ve seen it hinted at on forums: “Why didn’t they take USMLE? Were they scared?”
Others honestly don’t care at all and just think, “We’ve had solid DO residents for years with COMLEX only. Good letters? Good fit? Fine.”
How they interpret your COMLEX-only status often depends on:
- Whether your school historically encourages or discourages Step
- How many DOs they’ve had before (and how those DOs did)
- How desperate they are to fill spots vs how selective they can afford to be
You can’t control what they mutter behind closed doors.
You can control:
- How strong the rest of your application is
- Whether your personal statement / advisor / dean’s letter subtly contextualizes why you didn’t take Step (without sounding defensive)
- How well you target programs that don’t live and die by USMLE spreadsheets
| Category | Value |
|---|---|
| DO + COMLEX + Core Specialty | 80 |
| DO + COMLEX + Mid-Competitive | 55 |
| DO + COMLEX + Hyper-Competitive | 10 |
So what should you actually do now if you’re COMLEX-only?
This is where the anxiety usually explodes. Because you can’t go back in time and take Step 1.
You’re probably cycling through:
- “Should I cram for Step 2 now?”
- “Should I wait a year and take Step?”
- “Should I just give up on my specialty?”
- “Did I sabotage my whole career by not taking USMLE?”
No. You didn’t sabotage your whole career. But you do need to be strategic.
Here’s the honest framework I’d use if I were in your shoes, COMLEX-only, right now:
Figure out your actual risk level, not the Reddit version.
Look at:- Your COMLEX scores
- Your school’s match list in your desired specialty
- How many grads matched with COMLEX-only
If multiple people from your school in the last 3–5 years matched into your target specialty with COMLEX only, your fear is probably louder than reality.
Categorize your specialty choice.
Core? Mid-competitive? Hyper-competitive?
If you’re in core specialties, your path is stressful but not doomed. If you’re mid-competitive, you’re playing a higher variance game. Hyper-competitive? You need a backup plan.Lean aggressively into DO-friendly and COMLEX-explicit programs.
This is where people screw up.
They cling to “dream” institutions instead of loading up on realistic options. You want:- Former AOA / osteopathic heritage programs
- Community or community-university hybrids
- Programs with multiple DO residents listed on their website (stalk them, seriously)
Do not waste apps on programs publicly requiring USMLE.
If they say “USMLE required,” they’re not lying for fun. Those apps are almost always just donations.Use advisors with actual data, not just vibes.
Talk to:- Your school’s GME office
- Recent grads in your specialty
- Residents who matched in the last cycle
Ask them straight: “Did anyone match here with COMLEX-only?”
The answer to that one question is more valuable than 200 anonymous online opinions.
If you’re early enough and your specialty really values Step, seriously consider Step 2.
If you still have time before ERAS, and:- You didn’t take Step 1, but
- You can realistically prep for and take Step 2,
A good Step 2 score can rescue a lot of doors that would otherwise stay shut.
It’s not mandatory in every situation, but if you’re gunning for a mid-competitive specialty and you’ve still got runway, I’d lean toward taking it.
When does “COMLEX-only” actually become a big red flag?
COMLEX-only isn’t the red flag. The combination is.
The real problems are:
- COMLEX-only + low scores + competitive specialty
- COMLEX-only + narrow geographic limits (“only this major metro area or nothing”)
- COMLEX-only + few applications because you underestimate the risk
- COMLEX-only + weak letters or mediocre clinical evals
Program directors don’t care that much about the specific letters COMLEX vs USMLE. They care about:
- “Can this person pass our boards later?”
- “Will they work hard and not implode?”
- “Will they make us look stupid with low board pass rates?”
If your COMLEX scores are clearly passing and reasonably solid, and the rest of your app suggests you’re stable and competent, COMLEX-only is awkward, not fatal.
The uncomfortable but reassuring bottom line
You didn’t “ruin everything” by not taking USMLE. You narrowed your path. Those aren’t the same thing.
If you’re COMLEX-only:
- You’ll need to be more intentional and more humble about where you apply
- Your dream list may need to shrink and your realistic list needs to explode
- You’ll have to accept that some doors are closed—and also that some genuinely good doors are still wide open
Most DOs I’ve seen crash in the Match don’t fail because of COMLEX-only.
They fail because they misjudge how competitive they are and don’t build a smart, wide, DO-friendly list.
You can fix that part. Today.
FAQ (exactly 4 questions)
1. Is it even worth applying ACGME with only COMLEX, or should I give up and retool for USMLE first?
If you’re going for a core specialty (IM, FM, Peds, Psych, Neuro) with at least average COMLEX scores and okay clinical performance, it’s absolutely worth applying ACGME now—just with a broad, DO-heavy target list. If you’re aiming for something more competitive and you still have time to credibly prep for Step 2 before applications, then it’s reasonable to delay slightly and add Step 2. But “give up entirely for a year” is usually overkill unless your scores are weak and your specialty choice is very competitive.
2. Will programs think I’m hiding a bad Step score if I only report COMLEX?
No. If you never took USMLE, they won’t assume you’re hiding something; they’ll just see you as a DO who stayed in the COMLEX lane. The “are they hiding something?” suspicion is more common for people who took Step and don’t report it, not for those with no record at all. If you’re worried, your MSPE or advisor can lightly frame your choice (“student followed school’s COMLEX-focused licensing pathway”) without making a big deal of it.
3. Should I explain in my personal statement why I didn’t take Step?
Usually, no. Drawing attention to it can make it more of an issue than it needs to be. Unless there’s a compelling, concise reason directly tied to your story (illness, family situation, or your school’s explicit policy), it’s better to let your dean’s letter / MSPE and advisors handle any needed context. Your personal statement should sell who you are as a future resident, not be a justification essay for test choices.
4. If I don’t match as COMLEX-only, will I be permanently screwed for a second try?
Not permanently, but your second attempt will be more scrutinized. If you go unmatched, your reapplication needs a narrative shift: either stronger clinical experiences, new research, expanded geography, a more realistic specialty choice, or adding Step 2 if feasible. Plenty of people match on a second attempt, including DOs and COMLEX-only applicants. But you can’t just re-upload the same application with the same limitations and expect a different result.
Open a spreadsheet or doc right now and list 20–30 programs in your specialty that have current DO residents and explicitly accept COMLEX. That’s your starting point. If you can’t build that list, you’re not actually “doomed”—you’re just unprepared.
