Engineering senior Ryuji Arimoto is on the tail end of the stressful cycle of medical school applications. After multiple rounds of online applications and 10 interviews, he’s finally started to receive acceptances.
But Arimoto’s hard-earned acceptances have come at a cost. Factoring in testing fees, his primary and secondary applications to 40 different medical schools and the travel costs of interviewing at schools across the country, Arimoto estimated he’s already approaching $10,000 in total expenses, and he hasn’t finished the process yet.
“That’s an obscene amount of money,” Arimoto said.
The pricey application process begins with the Medical College Admission Test, or the MCAT. According to Arimoto, many students take a prep course, which can cost a few thousand dollars. The test itself costs over $300, and it’s not uncommon for students to take the MCAT several times.
Second-year University of Michigan Medical School student Vy Tran, a first-generation college graduate who identifies as someone from a low-income background, said even though MCAT preparation is expensive, she took a course to make sure she was setting herself up for success.
“Medical school is a huge process,” Tran said. “You want to do everything you can, you don’t want to be cheap on these things.”
Next come the primary applications. Primaries are streamlined so students submit a single application package through the Association of American Medical Colleges’ online service. Students who applied this past cycle paid $170 for the first school and $40 for each additional one. For the 2019-2020 cycle, students applied to 17 schools on average, according to the AAMC.
If a student meets the qualifications for a medical school, they’ll be asked to submit a secondary application answering school-specific questions. The cost of secondaries varies, but Arimoto said it’s often around $100 per school. The U-M Medical School charges $85. After secondaries, Arimoto said his total application costs were already in the range of multiple thousands of dollars, not including MCAT-related fees.
“Secondary is a cash grab,” Arimoto said. “Obviously, you don’t need a hundred dollars from every single applicant for them to send you, what, two essays?”
Without family support, Arimoto said, he would have been in financial distress at this point in the cycle.
“Even before my interviews started, I would’ve just been drained monetarily,” Arimoto said. “There would have been no question about that.”
Steven Gay, assistant dean for admissions at the U-M Medical School, said though secondaries are expensive, the school-specific aspect makes sense.
“Every school has its own secondary, and I think that’s very appropriate,” Gay said. “Just like students are looking for certain things in schools, we should be attempting to get the best students to succeed in our curriculum, to become the type of physicians we feel it’s our mission as an institution to create.”
Gay acknowledged the cost of secondaries, noting the U-M Medical School does try to alleviate it by offering fee waivers to students who reach out and demonstrate need. In addition, Gay said when the University began accepting a “people skills” test called CASPer as part of medical school applications, the Office of Admissions did not raise secondary fees, recognizing that students were now paying to submit those scores.
“We’ve worked to keep our secondaries lower in terms of the top institutions,” Gay said.
There are also some scholarships available through the AAMC. For instance, Tran said she was able to get 15 or 16 schools worth of primary and secondary application fees waived, covering all the schools she applied to.
As a final step, qualified applicants hear back from medical schools with interview invitations. Arimoto said someone who applies to 20 schools might expect to get five interviews if they’re fortunate. The travel costs are not reimbursed.
“If you’re lucky enough to get interviews, they don’t pay for your interviews,” Arimoto said. “If you have to fly out to California from Michigan, it’s like $500, and then you have to buy a hotel, that’s $200 a night, and if you have to spend two nights there, then you’re already at a grand for one interview.”
Gay said medical schools have some ways of mitigating the cost of attending interviews. Schools in similar locations may try to coordinate interview dates so students only have to make a single trip. In addition, Gay said the U-M Medical School works to provide interviewees with more affordable housing, food and transportation options, as well as travel reimbursements for some applicants.
“We tend to give travel reimbursement for our students who are low-income so that it’s not an issue to travel,” Gay said. “We have an extensive program where students can stay with other students on their visits and aren’t paying for places to stay.”
Tran received a $200 reimbursement from the University to support her interview. She also tried to offset travel costs by grouping interviews in similar locations.
“I tried to group my interviews together,” Tran said. “There are things like that that you can do, but that being said, sometimes you don’t have that choice because the school will pick a date for you.”
Tran said hearing back from the University of Michigan, one of her top schools, by early October spared her the cost of additional interviews. In addition to seeking out schools that offer a quick turnaround, she said applicants should think carefully about what schools are truly a good match, rather than just applying to as many as possible.
“There are some people who don’t need to apply to that many, and there will be people applying to schools that are not a good fit for them,” Tran said. “Just think about what the school’s values are.”
Gay echoed Tran’s sentiments, noting the “one-size-fits-all” primary application, which allows prospective medical students to apply online to dozens of schools at once, may encourage people to apply to more schools than necessary. He said applicants should narrow down which schools actually match their interests. For instance, some schools might better prepare students for medical research, while others might fit students aspiring to become primary-care physicians.
“Part of applying to medical school, just like applying to undergrad, is the onus of when it’s easy to apply to all of them, you just apply to all of them,” Gay said. “There is responsibility on the student to be an informed consumer with some discretion, saying, these are actually the things I want.”
Gay said increasing the number of schools one applies to doesn’t necessarily improve the chances of getting an interview. Medical schools have specific criteria, so Gay said applicants need to be honest with themselves about what schools they are likely to be accepted to.
“The application process isn’t a lucky thing,” Gay said. “Students do the very best they can to prepare themselves to be the best candidates for medical school. But once they have done that, it’s important to assess what you look like as a candidate and have others with experience frankly assess what your candidacy looks like.”
One thing medical schools can do to help applicants make educated choices, Gay said, is to be open with pre-med advisers and prospective students about what requirements and values they’re looking for in an applicant.
“All of us, as medical schools, should be transparent in our processes,” Gay said. “We should be very open with letting students know how we are trying to assist them, knowing that finances can be a significant barrier to the application process. But students, equally, should work hard to pick schools they feel they have not only the best opportunity of getting into but fit who they wish to be.”
Arimoto, who applied to 40 schools — an above-average number — said he’d already accepted that going into medicine would put him into debt. The cost of applying and interviewing seemed almost insignificant compared to the overall cost of becoming a doctor.
“Trying to go into healthcare in general is just such a ludicrous business in itself, in that, even though this seems like a ton of money, you compare it to the tuition of a school, and it’s minuscule,” Arimoto said. “For example, if you want to attend Harvard Medical School, per year the amount of money that you’re going to pay is around $95,000. And they don’t hand out any merit-based scholarships.”
Tran said it’s important to be financially savvy when applying to medical school, noting people do find ways to handle the cost. For instance, Tran worked all through college, accruing savings, and also managed to graduate from college relatively debt-free. She said these factors prepared her for applying to — and paying for — medical school. Still, Tran said she recognizes how stressful the costs associated with medical school are and understands the solutions people find are not always easy.
Tran added she’s considered different ways medical schools could make application costs less of a barrier.
“I especially advocate for people of low-income backgrounds or first-generation students like myself,” Tran said. “I support myself; I still have to support my family during this process. I feel it should not be a deterrent of medical school.”
Arimoto said if anything, the expense of becoming a doctor has made him sure this is the career he wants to pursue.
“I feel like that also allowed me to think in a way that may be more genuine towards the field,” Arimoto said. “It’s like, ‘Okay, I actually want to do this, I’m giving up a lot, but even with that on the table, I still don’t want to do, for example, research or engineering. I still want to do this.’ It provides a little bit of conviction.”