The Total Cost of the USMLE Journey Until Matching a Residency

Exam Fees

• USMLE Step 1: The registration fee for Step 1 is approximately $975. Additionally, if you're an international medical graduate (IMG), there's an international test delivery surcharge which can range from $180 to $220 depending on the test location.
• USMLE Step 2 CK: The cost for Step 2 Clinical Knowledge (CK) is around $975, with a similar international surcharge of $180 to $220 for IMGs.
• USMLE Step 2 CS: Although Step 2 Clinical Skills (CS) has been temporarily suspended, it previously cost about $1,580. This fee might be replaced by alternative assessments in the future.
• USMLE Step 3: Step 3 costs around $895. Unlike the previous steps, this is typically taken during residency or shortly before.

Additional Fees

• ECFMG Certification: The Educational Commission for Foreign Medical Graduates (ECFMG) certification, essential for IMGs, costs approximately $160.
• USMLE Transcript Fee: Each time you apply to a residency program through the Electronic Residency Application Service (ERAS), you will need to send your USMLE transcript, costing $80.

Study Materials

• Textbooks and Review Books: High-quality textbooks and review books like First Aid for the USMLE Step 1, Kaplan lecture notes, and USMLE Rx can cost between $200 to $500 for all steps.
• Online Question Banks: Subscriptions to question banks such as UWorld, Kaplan Qbank, and Amboss are crucial for preparation. UWorld subscriptions for Step 1 and Step 2 CK typically cost around $399 for a 6-month subscription each.
• Review Courses: Enrolling in review courses such as Kaplan, Becker, or Doctors in Training can significantly enhance preparation but can also be costly. These courses can range from $1,000 to $4,000 depending on the length and comprehensiveness.
• Practice Exams: Practice exams like NBME practice tests for Step 1 and Step 2 CK are around $60 each, and taking multiple practice exams is highly recommended.

Travel and Accommodation

• Travel for Exams: Traveling to test centers, particularly for IMGs who might need to travel internationally, can add significant costs. Flights can range from $300 to $1,500 depending on the origin and destination.
• Accommodation: Staying near the test center often requires booking hotels. For example, a 2-3 day stay in a mid-range hotel can cost between $100 to $300 per night.

Residency Application

• ERAS Fees: The Electronic Residency Application Service (ERAS) charges based on the number of programs applied to. For up to 10 programs, the fee is $99; for 11-20 programs, an additional $16 per program; for 21-30 programs, an additional $20 per program; and for more than 30 programs, an additional $26 per program. The total can easily exceed $1,000 depending on the number of applications.
• NRMP Fees: The National Resident Matching Program (NRMP) registration fee is $85, with additional fees for ranking more than 20 programs.

Interview Costs

• Travel: Traveling for residency interviews can be one of the most significant expenses. Domestic flights within the US can cost $200 to $500 per trip, while international flights can be much higher.
• Accommodation: Interview season often involves staying in multiple cities, which can result in hotel costs ranging from $100 to $300 per night, depending on the city and the length of stay.
• Miscellaneous Expenses: Additional expenses include meals, local transportation (such as taxis, rideshares, or rental cars), and professional attire for interviews. These can add another $500 to $1,000 to the total cost.

Opportunity Costs

• Lost Income: During the period of intense study and the application process, many candidates are unable to work full-time, resulting in lost income. This is particularly relevant for those who may be supporting themselves or their families during this period.
• Time Investment: The time spent preparing for exams, completing applications, and attending interviews could otherwise be used for gaining clinical experience or earning an income.

Hidden Costs

• Visa Expenses: For IMGs, visa expenses can add up. Application fees for visas like the J-1 or H-1B can range from $160 to $1,000, including SEVIS fees and premium processing fees.
• Credential Verification: Additional costs might include credential verification and translation services if original documents are not in English. These services can cost several hundred dollars.
• Health Insurance: For those studying or applying while not employed, maintaining health insurance can be an additional cost. Monthly premiums for health insurance can range from $100 to $500 depending on the coverage.

Total Estimated Cost

• Approximate Total: Summing up all these expenses, the total cost of the USMLE journey until matching a residency can range significantly based on individual circumstances but typically falls between $10,000 to $25,000. This estimate includes exam fees, study materials, travel and accommodation, application fees, interview expenses, and other hidden costs.

Tips to Manage Costs

• Budgeting: Start with a detailed budget and stick to it. Track all expenses meticulously to avoid unexpected financial strain.
• Scholarships and Grants: Explore scholarships, grants, and financial aid options available for medical students and graduates. Some institutions and organizations offer financial support specifically for exam preparation and application processes.
• Cost-Sharing: Consider sharing accommodation and travel expenses with peers who are also preparing for the USMLE. This can significantly reduce the overall cost.
• Job Opportunities: Look for part-time or freelance work that can be balanced with your study schedule. This can help mitigate the opportunity cost and provide some financial relief.
• Utilize Free Resources: Take advantage of free study resources and online forums. Websites like Reddit, USMLE forums, and social media groups can provide valuable information and study materials at no cost.
• Discounts and Promotions: Keep an eye out for discounts and promotional offers from review course providers and question banks. Many offer discounts for early registration or group enrollments.

By understanding and planning for these costs, medical students and graduates can navigate the USMLE journey more effectively and with fewer financial surprises. Balancing preparation, budgeting, and strategic spending is key to successfully managing the financial aspects of this crucial step towards a medical career in the United States.