Soon-to-be MS1, Tricia Pendergast joins us on the blog to discuss the costs that premedical students may face while applying to medical school and the debt they may incur BEFORE medical school. She also includes comments from other pre-medical students, medical students and physicians collected from the Twitter community on their experiences with the application process.
“Medical schools want us to gain clinical experience before applying…but hospitals won’t hire you without a certification. You’re left with jobs that don’t pay much, forcing you to work more. I worked 40-60 hours a week at night in the Emergency Department as a scribe, and a bartender and went to class during the day. I was told by my organic chemistry professor that I was smart, but not disciplined enough. I was spread so thin.”
- Skylar Erickson, Medical School Applicant
The effects of medical school debt are documented in the literature; debt drives decisions about medical speciality and location of practice, adversely affects medical student well-being, disproportionately affects African-American students, and is reported as the primary deterrent to a medical education by prospective minority applicants, however there is a paucity of discussion and literature about the costs incurred by prospective applicants before the increasingly competitive application process.
Half of the nearly 100,000 applicants who applied to medical school last year were unsuccessful. As the number of applicants increases, up more than 35% since 2002, more is demanded from prospective candidates. Applicants are expected to not only graduate from an undergraduate institution with a transcript inclusive of intensive writing classes, a breadth of liberal arts education, and upper-level science coursework, they are also expected to demonstrate a commitment to service, leadership and research, and score well on the Medical College Admissions Test (MCAT).
“I remember thinking that the MCAT course was too expensive…taking a prep class was almost a requirement to be competitive.”
- Dr. Katie Noorbakhsh
The MCAT is a standardized exam designed to assess problem solving, critical thinking, and core concept knowledge. I began studying for the exam in August of last year. I was working full-time as a Clinical Research Coordinator (CRC) in a large academic institution for a couple dollars more than minimum wage. It was my first job since college where I was offered health insurance, and I was thrilled to be able to move out of my mother’s apartment. There were two other pre-medical CRCs; one lived with her parents and worked part-time so she could dedicate fifteen hours per week to studying for the MCAT, the other lived with her boyfriend in order to split rent with someone.
“After graduation from college, I moved home and worked two jobs (one to gain medical experience, one for fast money) for two years to save for the MCAT and applications. This process is so exhausting and financially stressful.”
- Valerie Voce, Medical School Applicant
I was intimidated by the cost of preparatory courses ($1600-$11,000), books, and practice examinations. I was making too much money to demonstrate academic need in the eyes of the Association of American Medical Colleges (and therefore qualify for discounts on MCAT preparation materials and examination fees) but was uncomfortable handing over the $315-$370 examination fee and $2,000 for an online course that didn’t even include personal tutoring. I was making about $38,000 and needed to make less than $36,420 to qualify for fee assistance from the AAMC. Even though I lived alone and independent of any financial support from my parents, the Fee Assistance Program does not draw distinctions based on dependent tax purposes, and I was required to submit my parents’ tax information as proof of financial support.
I was at a crossroads. I could use the worn MCAT prep books my physics teaching assistant offered me ($50 for the lot), watch the free Khan Academy videos, and pay for the AAMC’s practice exams $35 at a time. I could beg, borrow, and steal through the most important exam I had taken to date.
I started seeing instagram advertisements for Kaplan and Princeton Review in late fall (“higher score or your money back,” they boasted). Thoughts about the prospective applicants who could pay, or ask a parent to pay, $2000 for the classes were taking up a substantial amount of real estate in my head. A soldier does not enter into battle clad in only half their armor, why would I spare any expense in preparing for this crucible experience? After all, my practice exam scores had plateaued around the 45% percentile (well below what I needed to gain acceptance), and I had just signed up for a new credit card. Charging $2500 was financially feasible, but was definitely not financially astute. I weighed what was prudent for me, my credit score, and my financial future, and what was necessary to achieve my career aspirations.
“I didn't qualify for application fee waivers since I had a job at the time of applications. I moved in with my girlfriend who had a much better paying job. We were able to afford applications and interviews with our two salaries.”
- JJ Liebow, Feinberg School of Medicine M4
“I took a year off after college and worked because I couldn’t pay for applications. I applied late in the cycle because I didn’t want to lose money if my MCAT score was bad.”
-Dr. Courtney Hanson
The American Medical College Application Service (AMCAS), the centralized medical school application clearinghouse, requires an initial $160 payment, and $39 for each subsequent medical school. The cost to apply to ten schools is a little over five hundred dollars, twenty schools costs one thousand dollars. I charged another $1500 to the $2500 mentioned above (it was now approaching $3000 with interest). Then came the secondary applications. Often sent out either automatically to all applicants or after preliminary screening, the cost of secondary applications differs by school, ranges from $45 to $150, and is only waived for those who qualify for the fee assistance program.
“I had to work 30-40 hours per week in graduate school to save up for the MCAT, which limited the number of interviews I could afford to go on.”
- Joshua Niforatos, Case Western Reserve University School of Medicine M5
I spent $4,500 on the MCAT, primary applications, secondary applications, and a suit for interviews. My credit card points lasted two flights and half a rented car, and after ten interviews, I was approaching $7,000 spent in under a year. Those who qualify for application and MCAT fee assistance programs receive no stipends or support with travel.
There is a quantifiable relationship between the number of interviews attended and possibility for acceptance. If a particular applicant applies to fifteen medical schools, at which she has a 7% chance of acceptance, she has a 66% chance of at least one acceptance. If that number climbs to twenty medical schools, her chances at acceptance rise to 77%, twenty-five schools puts her at 84%. This assumes she can afford to complete every secondary application sent to her and attend every interview to which she is invited. It’s a numbers game, and one that is rigged in favor of those with financial means.
“Without reduced application fees and a grant from my undergraduate institution for application and interview expenses, I wouldn't have been able to apply to medical school. Even with the support, I couldn't attend all the interviews I was invited to.”
- Courtney Klein, University of Michigan M3
“I cancelled interviews because it was so expensive to get there and required time off of work I couldn’t afford.”
-Dr. Courtney Hanson
Despite myriad recruiting initiatives, minorities, women, immigrants, and LGBTQ+ individuals are still not effectively represented in the physician workforce, disparities that prevent patients from receiving optimal care. It is possible that diversity initiatives within healthcare have fallen short because the socioeconomic challenges faced by underrepresented medical students have not been sufficiently addressed. Medical schools’ affirmative action policies primarily target race, ethnicity, and sexual identity, and place little emphasis on an applicants’s socioeconomic status. A key strategy in closing the gap in health discrepancies is building a physician workforce that reflects the demographics of the patients it serves. It follows, then, that recruiting physicians from less advantaged backgrounds would have the same result.
Please note, some comments have been edited for clarity and brevity.
For more on #PhysicianFinances and debt, check out this article "Confessions of a 31 Year-Old with 1 Million In Debt."