Med School Cost

Sometimes I feel like writing a post titled, "Why We Deserve To Make Over 100,000 A Year" but since it would just end up getting buried under pictures of my kids, I've decided to dedicate a whole page to this.  There isn't a week that goes by that I don't hear someone complain about the high cost of medical care.  I know it is high, way too high in my opinion.  I'm actually a proponent of reform but I get ticked off at what sometimes feels to me like the government's desire to make doctors foot the bill for health care reform.  Doctors do make quit a bit of money, but most people don't even have a basic understanding of what goes in to becoming a doctor.  Below you'll find many of the cost associate with a medical education along with the basic schedule.  It is important for students contemplating medical school to know the cost, as well as for people using the system to understand some of the hidden cost.  I'll be honest, when my husband and I started this journey we were two naive early twenty year old kids.  Eight years later, (my husband is finishing his last year of an MdPhD program) I feel like we have a little wisdom to share.

The most important thing to know about medical school in the United States is that it is a Pay To Play System.  Going to medical school is not cheap.  Even with our tuition covered because Dr. J was teaching for the University, even with him working part time bringing in a little stipend, even with me picking up odd jobs here and there, we are going to graduate with almost 100,000 dollars in student debt.  Medical school is expensive!  EVEN APPLYING is expensive!

Application Cost (and lets not even go over the fact that you have to do 4 years of college first)-
  • Required is a standardized test, the MCAT.  The MCAT cost $230.  Medical schools rely heavily on it to rank students, therefore many students chose to take a test prep.  Kaplan charges you $1200 for this privilege.  Dr. J was going to take it...but at the time we didnt' have a credit card that went up that high so he just had to wing it :)
  • Next you have to apply through AMCAS a service that gathers all your grades, letters of recommendation, test scores, and personal info.  You pay $160 for processing and to apply to one school, and than $32 dollars for every school you want to apply to after that.   We applied to 10 schools.  We know of people who applied to almost 30.  The more you apply the better chance you have of getting in, but the cost definitely add up.
  • Now previous to AMCAS  being formed medical schools collected their own fees.  Since they still have to cover processing, many charge secondary application fees.  These can be as low as $15 dollars but at most of the big name schools they are closer to $100.  Usually these secondary applications don't indicate any interest but are instead just another way of raising money.
  • If they really are interested, medical schools will request an interview.  That means you need to get yourself, drive, walk.  You also need to find a place to stay.  They will give you information about students who might be willing to put you up but the responsibility is ultimately up to you.

Cost of School 
  • Average tuition is 25,000 a year.  Our school charges something like 38,000 a year but because Dr. J has taught for the University through his PhD, work we've been lucky to have that waived.  We do have $1000 dollars a semester of fees we have to pick up.
  • Not all medical schools are set up the same.  Some have you doing clinical work from the very beginning, others like the one my husband attends work on a more shock and awe approach.  M1 had 9 or 10 classes a semester.  These are heavy science classes that 1) take so much time there is no time to work a job with a normal schedule.  My hubby was a machine.  He managed to teach a Community Health class and TA for another class while he was in this heavy class schedule.  What he did was exceptionally unusual.  Most people don't have time to work and even though he did, he'll be the first to tell you his grades took a hit because of it.  2) The classes are all science classes, known for heavy overpriced textbooks.  It was not uncommon for us to spend $1000 a semester on books alone.
  • Second year is very similar.  There are a few less classes but they are more time consuming so most people still aren't working.  Also this is the year med students have to start studying for the USMLE (the boards) or step 1 exam.  It was $500 dollars but will be rising to $550 in 2011.  Because this test score is so important to the ability to get desired residencies some people will take test preps just like with the MCAT.  At the time hubby was studying, a test prep course would have cost him over $3000.  Again that just wasn't something we could afford.  We did spend close to $500 getting access to online test prep questions and some test prep books.  It was still pricey but a heck of  a lot less than the prep course.
  • Almost immediately after finishing the step 1 students move on to third year.  Third and forth year of medical school are almost like being a real doctor.  Student now rotate through core rotations, gynocology, internal medicine, surgery, family medicine, pediatrics, and psychiatry  You than have a choice of other rotations.  Emergency medicine, Cardio, Specialized surgeries, etc.  During this time students work under the supervision of other doctors and work the same schedule.  This can be especially stressful during gynocology, surgery, and internal medicine.  During surgery hubby was gone no later than 6:30 and wasn't home until after 9.  He also worked most weekends and some nights.  Once again there is no time to take an outside job. 
  • It is also STRONGLY RECOMENDED that you participate in a few away rotations.  They give you an idea of how you like other programs and letters of recommendation for other schools are thought to be highly valued.  Applying for away rotations is mainly done through VSAS.  It cost $15 per school.  Some have secondary processing fees.  We spent about $100 applying and then $100 more dollars to the U of U for a secondary.  The cost of your away rotation is entirely on you.  You must pay to get yourself there.  You must set up housing.  Because of the short nature (usually around 4 weeks) most people see if they can just rent a room from another student.  It is a time to work, learn about the program, and try and make yourself well known and liked.  It is not the time to be hanging out with family, which is why I'll be hanging at home taking care of kids and running school carpool while my hubby does 4 weeks at the University of Utah in ICU and than the next 4 weeks in Portland at the University of Oregon Health Sciences in the ER. 
  • Before leaving medical school you must take the step 2, the second set of boards and a clinical skills test (both of these run somewhere like 8 plus hours).  We had to pay for these last week.  They cost us $1580. 
  • Finally applications for residencies are due at the beginning of 4th year.  It is all done via computer on a program called ERAS.  Your school submits to them letters of recommendation you've gathered and your transcripts.  You pay $70 to have your step 1 scores released.  You have to upload your CV in pieces, each publication, each job, each community service action has to be typed into their system.  You write a personal statement telling your chosen field, why you want them and why they should want you.  ERAS charges you something like $15 a residency to send it out.  You will apply to almost 30 residencies.  In these coming up weeks they will look over the applications and chose who they want for interviews.  They'll send out request for interviews via e-mail to more people then they actually have slots to interview.  It is necessary to respond quickly.  We know of someone who was at dinner and didn't respond to an e-mail from one of his top residencies picks for 90 minutes.  He didn't get an interview.  Because of this we bought a blackberry 9700 and had Internet put on it.  It felt like throwing money on a fire but you need those interviews.  Someone who matches gets an average of 16 interview request.  They will interview at something like 10 residencies.  The cost of this comes out of the medical students own pocket.  They will buy their flights, book their hotels, pay for their own parking.  They will be happy to do it because this is how jobs are gotten and then want a job.  (Since I originally wrote this, Dr. J has gone to all his interviews...he got almost thirty interview request and went to almost twenty.  WE SPENT THOUSANDS OF DOLLARS!!!!  I MEAN THOUSANDS!!!  The kind of money that makes me sick just to think about.  Hubby flew all over the country, stayed in hotels, here and there, had to rent cars, pay for parking, get shuttles, eat food, get to airpots.  It was extremely expensive.  The good news is...we found lots, and I mean lots of places we LOVE!  The bad thing...just more money we had to spend.)
  • After interviewing students will rank their residency choices through ERAS.  Residencies will rank their student choices.  All of this information goes into computer land and little white envelops pop out. Finally the third Thursday of March all the medical students who matched will gather together.  They get a white envelope.  They open their envelope.  They are now contractually obligated to the residency on the piece of paper they pull out.  They have no idea if it is their first, second, or third choice.  It all depends on who they liked, who liked them, and what people who may have been liked more chose to do.  Residencies run anywhere from three years (family medicine, internal medicine, pediatrics) to 5-7 (ob, surgery, etc.).  Residencies were once like indentured servitude.  They are a little better now, but just slightly.  Most residencies start out paying around 45,000 a year.  Some of the good to live places (California) may start as low as 42,000.  Some of the better paying ones (Boston) 49,000.  Laws have been passed saying residents can't work more than 80 hours a week.  I've heard some grumbling that work still has be completed even if it puts you over but we haven't gotten there so who knows.  Regardless even if you are just working your eighty, once you take you two weeks vacation you are making something like $12 an hour.  There are no signing bonuses, there do not pay to relocate you.  When you start residency you are tired, broke and the interest on your student loans is coming due, but you are a doctor!  Each year you'll get a slight raise.  Then once you finish residency, you'll take another set of boards. 
This is when you will finally start to make some real money.  You will be contributing.  Employing nurses and office staff.  You will be supporting the economy by paying for electricity, building buildings, buying office supplies, medical equipment, computers, fish tanks, and paying for malpractice insurance, paying off lawyers who sue you.  People will grumble about how you make too much money and you should just want to help people.  I'm married to one of those people who thinks you should just want to help people.  He tells me all the time "Sweetie is isn't about the money."  And sometimes I think he is right, but then I remember the debt hanging over our heads (ironically a good portion of it was spent on insurance for our family both medical and dental), the scrimping, the saving, the going without.  This is when I think, well maybe it isn't completely about the money but when it comes to going to medical school it certainly is!

Just a few crazy AMA stats...
156,456-the Average Education Debt held by the 2009 Graduating Class
79% of graduates have debt of at least 100,000
58% of graduates have debt of at least 150,000
87% of medical students carry outstanding loans

Oh med school, how I won't miss you :)


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