The FAIR Act of 2025 mandates that hospitals publicly report data on the acceptance rates of allopathic and osteopathic medical school graduates in their residency programs and requires them to accept either USMLE or COMLEX scores.
Steve Daines
Senator
MT
The Fair Access In Residency (FAIR) Act of 2025 aims to ensure equitable treatment of osteopathic (DO) and allopathic (MD) medical school graduates during residency applications. Hospitals must report detailed data on DO and MD applicant numbers and acceptances to avoid a 2% cut in Medicare payments. Furthermore, programs must affirm fair consideration and accept either COMLEX or USMLE exam scores if an exam is required. This collected data will be made publicly available by the Secretary of Health and Human Services.
New FAIR Act Mandates Hospitals Accept Both USMLE and COMLEX Scores for Residency, Imposes 2% Medicare Penalty for Non-Reporting
The new Fair Access In Residency Act of 2025 (FAIR Act) is stepping into the complex world of medical training, aiming to level the playing field for doctors coming out of osteopathic (DO) and allopathic (MD) medical schools. Essentially, this bill is about fairness and transparency in who gets those coveted residency spots at hospitals.
The Data Mandate: What Hospitals Must Report
Starting with the fiscal year beginning October 1, 2026, hospitals running residency programs have a new administrative requirement: they must report detailed statistics to the Secretary of Health and Human Services (HHS). This isn't just busywork; it's a transparency push. Hospitals need to report the number of applicants they receive and the number they accept for each residency program, specifically broken down by whether the applicant came from an osteopathic school or an allopathic school. They also have to formally state that they consider applicants from both types of schools for every program they offer (Sec. 2).
The Exam Score Equalizer
This is a big deal for medical students. If a hospital residency program requires an exam score for acceptance—and nearly all do—the FAIR Act mandates that they must accept scores from either the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) or the United States Medical Licensing Examination (USMLE), based on the applicant’s choice. Previously, some programs only accepted the USMLE, which created an unnecessary barrier for DO students. This provision removes that hurdle, ensuring that a DO graduate doesn't have to take an extra, potentially redundant exam just to be considered by certain programs.
The Cost of Non-Compliance: A 2% Cut
To ensure hospitals actually follow through with this reporting, the bill includes a financial stick. If a hospital fails to submit the required residency data, their Medicare payment amount—specifically the portion related to medical education funding—will be cut by 2% for that year. That 2% penalty applies for every year they fail to submit the data (Sec. 2). For a large hospital, 2% of their Medicare payments can be a significant amount of cash, making compliance a strong financial incentive. This is the bill’s check on the system, ensuring that the reporting requirements aren't just ignored as administrative overhead.
Why This Matters to You
While you might not be applying for a residency, this bill affects the future doctors who treat you. By promoting fairness and removing arbitrary barriers, the FAIR Act helps ensure that qualified doctors—regardless of whether they have an MD or a DO—have access to training. The public transparency aspect is also key: the Secretary of HHS is required to post all this applicant and acceptance data online. If a hospital claims to consider both types of applicants but the data shows they only accept one, the public will know. This transparency creates accountability, which ultimately benefits patients by supporting a diverse and well-trained physician workforce. Crucially, the bill doesn't force programs to accept anyone; it just forces them to be honest and fair in their consideration process.