Board Examinations and LicensureOsteopathic physicians are eligible for licensure in all 50 states, the District
of Columbia, other territories and areas of the United States, and many foreign
countries. Licensure is determined by each state through the appropriate
In order to be licensed as an osteopathic physician, one must:
• Graduate from an accredited U.S. college of osteopathic medicine.
• Successfully complete a licensure exam sequence accepted by a state’s
licensing board (COMLEX-USA or USMLE).
• Successfully complete one to three years of graduate medical education (varies
by individual state requirement).
Following residency training, the osteopathic physician takes certification
examinations from the specialty board that oversees her/ his particular
specialty. Board certificationis required by many hospitals for hospital staff
membership, and many health insurance companies, in order for the physician to
obtain reimbursement from third-party payers.
Osteopathic physicians stay abreast of the latest medical developments related
to their specialty training through continuing medical education programs. CME
requirements are determined by each state’s licensure board. The American
Osteopathic Association (AOA) also requires its members to complete a certain
number of CME credits to maintain board certification.
For state-specific licensure information, please visit www.docboard.org.
In addition to full licensure in the United States, many foreign countries
recognize the American DO degree and grant full licensure to American-trained
DOs who wish to practice internationally. The scope of licensure is determined
by each country.
Medical Licensure ExamsComprehensive Osteopathic Medical Licensure Exam (COMLEX-USA): The COMLEX-USA or
Comprehensive Osteopathic Medical Licensure exam is a standardized test of
medical knowledge. The goal of the exam is to assess competencyin the areas of
study related to practicing medicine. It tests the medical knowledge and
clinical skills that are considered essential for an osteopathic physician to
practice medi-cine without supervision. The COMLEX-USA includes standard test
questions, and a pass/ fail observed examination performed by the student.
The Comprehensive Osteopathic Licensure
Examination (COMLEX-USA), Levels 1, 2 Cognitive Evaluation and Performance
Evaluation(CE and PE) and 3, are adminis-tered by the National Board of
Medical Examiners (NBOME). Level I of the exam is taken after the second year of
medical school prior to the last two years of clerkship training. Level 2-CE is
taken at the end of the clinical clerkship years prior to graduating from
osteopathic medical school.
COMLEX-USA Level 2-PE is an examination developed to test physical examination
skills and is also taken prior to graduation. Level 3 is taken prior to the end
of the internship year.
COMLEX-USA Level 1 and 2 (CE and PE) are required for graduation from an
osteopathic medical college. Each of the osteopathic col-leges has its own
requirements for progres-sion through the stages of the COMLEX-USA before
The National Board of Osteopathic Medical
Examiners (NBOME) is the organization that administers the COMLEX-USA exam. The
NBOME is a separate organization from the colleges of osteopathic medicine and
has as its role the protection of the public. All 50 states in the United States
accept COMLEX-USA as a licensure exam for the practice of medicine by
To learn more about the COMLEX-USA exam, please visit www.nbome.org/.
United States Medical Licensure Examination (USMLE) Osteopathic medical students
and residents also are eligible to take the United States Medical Licensure
Examination (USMLE), which is taken by students in allopathic (MD-granting)