Applying - Advice for DO students

Updated March 2018

Navigating the residency application process is difficult for all students.  If you are an osteopathic student the process is complicated by the option to apply to both AOA (DO) and ACGME (MD) certified Emergency Medicine residencies.  

These decisions are further confused by the transition to a single residency accreditation system now in process.  All AOA programs are transitioning to ACGME certification by 2020.  And most programs are attempting to complete the transition prior to that deadline.  Each year the number of programs in the DO Match will drop as programs complete their ACGME certification.  For an in-depth and outstanding explanation you should read Ashley Guthrie's EM Resident piece published by EMRA.  

The goal of this resource will be to assist students who are navigating this decision for the 2018 match.  The particular focus will be on DO students who choose to pursue ACGME training. 

Why do DO students apply to ACGME programs?

The reasons often given by residents and rotating students who went to DO schools: 

  • The opportunity to train in larger medical centers
  • Option for three year training programs
  • Academic affiliations of the training programs
  • Larger sized programs and the stability that comes with them
  • Greater perceived opportunities for fellowship and jobs
  • More programs to choose from 

What are the obstacles in applying?

The biggest obstacle to a DO student’s application to ACGME programs is perceived competitiveness. 

EM is competitive, with more applicants than available spots.  Fourth year US seniors from allopathic schools get most of the AGME spots, with approximately 10% taken by 4th year DO students.  

Not surprisingly, to be successful in matching you need stand out as a candidate.  

The issue of bias against DO students in the selection process is very real.  Only 81% of allopathic programs will interview and rank DO students, therefore there are less programs available to apply to.  One way to maximize your application, is to look at the composition of a residency's recent classes.  If they have no DO's, your application is less likely to be seriously considered. If they have DO's, especially from your school, they are more likely to consider your application.  The EMRA Match program database can help you find programs that are training DO's. 

Be warned that some programs who give consideration to both types of students, will rank academically equal MD's above DO's.  

So how do you match?

You need to level the playing field as much as possible. The easiest way to do this is to make yourself as competitive as possible. You can not change how your school is viewed, but you can effect how you are perceived. Your goal is to allow the programs to compare you "apples to apples" with the MD students.

First: you MUST take the USMLE to get fair consideration. This allows your knowledge to be compared directly to your MD peers.  USMLE Step 1 scores >230 will help you get interviews. Scores <210 will make it more difficult for you to get interviews.

39% of allopathic residency directors, even those open to taking DO's, will be unwilling to translate a COMLEX score to an equivalent USMLE score.  I they look, they may look for a grossly higher COMPLEX score than the equivalent USMLE score.  Do not give them an excuse to discard your application.

Second: you need to rotate in two allopathic EM residencies during your fourth year and get SLOEs from each. This again puts you head to head with the MD students in a single rotation. This also shows your performance in an academic setting similar to the residencies you will be applying for. Ideally you will want two clerkships between May and September.  Rotations and SLOE's from DO residencies can be very helpful, but are unlikely to be as useful with ACGME programs as SLOE's from ACGME programs.  

While community EM months can be great learning experiences they will not assist your application to an allopathic EM residency. If your school requires them you will have to do extra clerkships in EM, and in some instances even forgo credit to gain the opportunity to advance your application.

Lastly: the letters that carry the most weight are going to come from residency program administrators.  You are looking for SLOE's written by the education leadership (Program Directors and Clerkship Directors).  Frequently these types of letters are missing from the osteopathic students application making it difficult to accurately compare them to the rest of the applicant pool.  Having these letters sets you ahead of much of your competition.


You can match to an ACGME EM residency without doing all of the things recommended - this is the playbook to let you take control of this process and proceed as an equally competitive applicant who can be a consumer in this process:
1.       Take the USMLE and score >230
2.       Rotate at 2 allopathic EM residencies, that take DO's
3.       Get group SLOE's from the Clerkship Director and Program Director
4.       Be ready to apply broadly and strategically, if your application is not above average

For more information targeted at "non-LCME applicants":


  1. Hello,

    I'm an osteopathic student. I have a great step 1 score (255+), and anticipate a step 2 score that will be pretty good as well (I'm a good test taker). My concern is that by september 15th I will have only completed 1 Allopathic EM audition rotation. I'll be about midway through my 2nd block of Allopathic EM which ends about 10 days after September 15th. My question is really two questions I guess.

    1. Is it worth waiting until the end of the second EM block for a SLOE from that institution, or is it better to submit everything on time on Sept 15th? Also if I do submit on the earliest date possible, is it at all beneficial to submit subsequent letters/SLOEs later?

    2. My second Question is in regards to #3 on your above list. Is it acceptable to get two SLOEs from one institution and have it count as 2 letters?

    Hope this makes sense! Thanks a lot for your blog, it is very informative and helpful.

    1. Jon,
      You find yourself if a common situation where a 2nd rotation will delay your application. With a rotation ending in late september you will still have a letter from that rotation arriving to ERAS by early October. That is early enough to hold a spot for that letter. You should still try to have everything you control submitted between Sept 15 and October 1st. Have a back-up letter you can designate in place of that 2nd SLOE just in case it gets delayed past the middle of October.

      You can get 2 SLOE's from one program. That is better than having non-EM letters. However, that does not get you the benefit of 2 SLOE's from different programs. The advantage of having 2 SLOE's is that the information will seem more reliable, assuming they say similar things. When programs require multiple SLOE's what they are really requiring is multiple rotations. Few programs will not look at a candidate with only one EM rotation, but there are some.

  2. how important do you think research or other extracurrics are for DO students applying ACGME? I did decent on step 1/level 1: 248/619, but i have no extracurrics outside of a few shifts at the student run clinic. the big problem is that i have to do all my core rotations at a small community hospital and the nearby residency is dominated by carribean students rotating there. the nearest residencies/research opportunities outside of that are over 1.5hrs away. should i try and volunteer somewhere i like?

    my current plan is to hopefully get 2 ACGME SLOEs, a couple honors on my core rotations, do well on step 2, and then hope for the best.


  3. I think you should separate research from other extra-curricular activities as you consider putting together your application.

    Research is important for all students interested in training at a program that emphasizes resident research. All programs will have some kind of research going on and varying opportunities for residents. Programs that require residents to do a research project (instead of just the "scholarly project" the ACGME mandates) are likely to be looking for trainees with research experience so they don't have to start from scratch with someone who has not previously been interested in research. So it depends on what you are looking for. Research done just for the sake of a med school requirement or to "check the box" (the most common type of student research) generally does not impress most program directors enough to affect your application.

    Opinions vary greatly on the value of other extracurriculars. The personal likes/biases of individual application reviewers can give enough weight to some activities to be the difference between an interview and no interview. For example: a faculty member with an interest in global health is going to be predisposed to like the application of someone with global health experience. Same for public health interventions, community service, teaching, specialty interest groups, etc. So do activities that you are interested in and apply to programs that have those activities as features.

  4. Dr. Kellogg,

    I wanted to thank you for your post! I am an OMS-1 and have been drawn towards EM after scribing for close to three years in an emergency department. As an osteopathic medical student I have been feeling more anxious and honestly scared of the match process and attempting to match at a solid EM residency. I read your recommendations above, but what else do you think can make someone standout as an applicant at an osteopathic medical school? Thank you!

    1. Some of the current advice will be outdated by the time you match, as we find out what impact the single accreditation system has on DO students being accepted into traditionally ACGME residencies.

      For a more comprehensive look (and broader opinion base) have a look at this guide created specifically for the DO student applying to EM:

    2. Thank you for the quick response! I saw you had answered another students question concerning research. Their are a view mentors at my school whose research I am interested in, however, they are not relevant to EM, nor do I plan on pursuing research later on in residency. However, since I do not wish to pursue research later on in my career, do you think it would still be worth it to do? I would most likely have a fantastic LOR and get to do something I enjoy.

    3. If you enjoy research you should do it. Certainly will not hurt your application and could help. Only caution would be to get involved with something that would hurt your ability to adequately prepare for boards and be involved with EM based opportunities and projects. As a general rule: do what you enjoy!

  5. Dear Dr. Kellogg,

    I am an OMS III and have a COMLEX score of 597. At the time of preparing for boards I did not realize just how important it was to have a Step 1 score, especially for EM. Outside of not having a Step I score, I would consider myself a well-rounded and strong applicant. I have three questions:

    1. Are there ACGME accredited programs that tend interview students with only COMLEX scores? Or is the fact that I did not take Step 1 an instant rejection at most ACGME accredited programs?

    2. If I took Step 2 and performed well, would this help negate the fact that I did not take Step 1?

    3. What do you advise that I do now that I am in this difficult situation?


    1. Many ACGME programs will interview students without a step 1, if they are a program that typically considers DO students. No instant rejection at most.

      There are some programs where you will be screened out. Those are mostly going to be programs that were not going to look at a DO applicant.

      Taking step 2 and doing well certainly could help.

      You also want to make sure the rest of your application is strong. Do not give programs a reason to not interview you. Try to do a couple ACGME EM rotations and get SLOE's.