Mira Shahin, medical student<\/cite><\/p>\n [N]o other…job in the modern world requires you to pay\u2026$2000 dollars up front just to apply.<\/p>\n It\u2019s an unacceptable predicament. And this year, it\u2019s sent a ripple of reforms through the medical education community. Specialties such as ob\/gyn have broken away to create their own lower-cost application. The Association of American Medical Colleges (AAMC) has restructured is application fees and added more financial aid. All eyes are on the 2024-2025 application cycle to see if they succeed at cutting costs. Early reports show application expenses are trending down \u2014 but maybe not enough.\u00a0<\/p>\n Residency application costs start with the United States Medical Licensing Examination (USMLE) Step 1 and Step 2 exams. The two board exams cost $670 each, and more if you\u2019re an international medical student. Most students take the second board in the summer before their fourth year.<\/p>\n Then, in the last week of September, the AAMC opens its Electronic Residency Application Service (ERAS). In years past, the first 10 applications cost $99. The next 10 were $19 each. Applications 21 through 30 were $23, and every application after 30 was $27.\u00a0<\/p>\n Cedric Mutebi, MD, a first-year internal medicine resident at Northwestern Medical School in Chicago, spent $1500 applying to 60 programs in 2024 \u2014 a few more than average because he was trying to couples match. And that\u2019s for a less competitive specialty where everyone gets a spot, he emphasized.\u00a0<\/p>\n Meanwhile, Ashton Amos, DO, a first-year surgical resident at West Virginia University applied to well over 100 programs in 2024 and spent several thousand dollars in fees.\u00a0<\/p>\n \u201cAs a DO, we have to apply to more programs because not every place is as accepting of DOs,\u201d Amos said. The highly competitive nature of surgical specialty and the fact that she also was trying to couples match significantly added to her number of applications, she said.\u00a0<\/p>\n Although there have always been costs to apply to residency, the amount students were spending on the application portion really started to skyrocket 8 years ago, said Gabrielle Campbell, chief services officer at the AAMC.\u00a0<\/p>\n Ninety-three percent of students match<\/a>, but the residents applying still outnumber the available spots. Students are afraid of not matching, afraid they won\u2019t be able to finish training and pay off impending medical debt, Campbell said. So, to cover their bases, they started applying to more programs. And year after year, each class of applicants felt the need to out-apply the class before them.\u00a0<\/p>\n \u201cA lot people [ahead of you] would say this is not the time to save money. This is your future. Apply to more,\u201d Fabian Jimenez, MD, a third-year thoracic surgery resident at the University of Florida, said. \u201cIt became an arms race of who could apply to the most places, go on the most interviews.\u201d\u00a0<\/p>\n Although application costs are exorbitant, they certainly aren\u2019t the end of residency expenses.\u00a0<\/p>\n On top of paper applications, students pursuing the most competitive specialties must pay for away rotations. Away rotations serve as a sort of residency audition. Students go to an institution where they one day hope to match and spend a month or so rotating as a sub-intern.\u00a0<\/p>\n You\u2019re trying to \u201cshowcase your skills, talent, and belonging,\u201d Michael Megafu, DO, an orthopedic surgery resident at the University of Connecticut, said. Three to four away rotations are recommended, but Megafu did six. He had to cover short-term housing and living expenses at all six placements.<\/p>\n Fabian Jimenez, MD<\/cite><\/p>\n It became an arms race of who could apply to the most places, go on the most interviews.<\/p>\n \u201cYou\u2019re paying double rent during that time, and everything costs more because you don\u2019t have anything,\u201d Amos, who did five away rotations, said. And sometimes the hosting institution requires additional tuition and malpractice coverage.\u00a0<\/p>\n Then, in October, interviews start. One silver lining is that COVID-19 normalized virtual interviews, said Alyx Porter Umphrey, MD, a neurooncologist at Mayo Clinic in Arizona and co-founder of ElevateMed, a nonprofit that provides mentorship and scholarship to fourth-year residents from underrepresented backgrounds.\u00a0<\/p>\n Several specialties, such as internal medicine, ob\/gyn, and ophthalmology, have agreed to virtual-only interviews to promote equity. But some specialties and programs that have reverted to in-person interviews. These on-site visits often give programs and candidates a better chance to interact, but they leave students on the hook for flight costs and sometimes lodging. Depending on location and the number of interviews a candidate takes, expenses can mount quickly.\u00a0<\/p>\n Tack on $80 transcript fees here, a $70 match registration there, and $15 dollars for every away rotation application and extra fees for couples matching: \u201cIt feels like you get nickeled and dimed across the process,\u201d Mutebi at Northwestern said.\u00a0<\/p>\n The exorbitant cost of application season exacerbates existing inequities, clearly favoring students from financially privileged backgrounds who can pay for the many additional applications and travel to every offered interview.<\/p>\n The AAMC has come under scrutiny<\/a> for allowing high costs to continue and profiting off of the sharp rise in application numbers. According to Campbell, the fees pay for a number of medical student services, such as the technology behind ERAS, information security, the Residency Explorer tool, and the Careers in Medicine Program. Still, student advocates argue that with soaring application numbers, AAMC had more than enough margin within its $120 million annual revenue to lower costs before 2024.\u00a0<\/p>\n This year, the American College of Obstetricians and Gynecologists took matters into its own hands and launched an ob\/gyn-specific application system called ResidencyCAS. Through the platform, students interested in ob\/gyn can apply to their first 18 programs for $99, then $18 for every additional application. Preliminary data showed that 100% of ob\/gyn programs switched to ResidencyCAS in its inaugural year. And in early October, Emergency medicine announced<\/a> it would follow suit and partner with ResidencyCAS to build its own application platform for 2025-2026.\u00a0<\/p>\n Cedric Mutebi, MD<\/cite><\/p>\n It feels like you get nickeled and dimed across the process.<\/p>\n The AAMC also made some significant application changes for the 2024-2025 cycle. They offered new cost structure: $11 per application for the first 35 applications. Then the fee goes up to $30. The organization hopes this will be more affordable and limit the number of applications students submit. AAMC also expanded fee assistance in 2024 to 4100 people who will get 60% off up to 50 applications.\u00a0<\/p>\n On top of new pricing structures, students are seeing cost savings this cycle thanks to program signaling. A strategy used by both ERAS and ResidencyCAS, program signaling gives students a set number of signals they can use to let a program know it\u2019s one of their top choices.<\/p>\nBusiness News A Costly Dream\u00a0<\/h2>\n
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