The Price of Match Day

About Our Research

Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high impact analyses. For example, Medscape’s Medical School Experience Report 2src24 found that

• About 47% of med students expect to leave school with $2srcsrc,srcsrcsrc of debt.
• About 8 in 1src said that income was important in their choice of specialty.
• About 39% worry about their future financial burden.

“My fees alone were close to $25srcsrc just to submit my applications,” Watters told Medscape Medical News.

Her Tulane career adviser encouraged her to apply to more programs, which come with a higher price tag, to increase her chances of matching into an “uber competitive” specialty, neurosurgery, she said.

Applying through the Electronic Residency Application Service (ERAS) costs $11 for each application for up to 3src programs, but three times more, $3src an application, for over 3src programs. Watters applied to nearly triple that number.

The AAMC, which manages ERAS, changed its application fees for the current recruitment cycle to reduce student costs, simplify the pricing structure, and encourage students to apply to fewer residencies, relieving programs inundated with applications. The cost of applying and interviewing for medical residencies varies by specialty and program location, AAMC reported.

As of late February, Doctor of Medicine candidates submitted an average of 58 applications across all specialties, the AAMC reported. Doctor of Osteopathic Medicine candidates submitted an average of about 73 applications across specialties, and international medical graduates, nearly 125 applications.

Pushing Virtual Interviews

The AAMC continues to recommend virtual interviewing to reduce applicant costs.

“I was actually relieved when I found out that pediatric residency interviews would all be virtual this year,” said Meghan Murphy, who is finishing her studies at the Idaho College of Osteopathic Medicine in Meridian, Idaho. “However, it wasn’t long before I discovered the other fees involved in this process. The costs associated with ERAS, transcripts, and even small expenses like interview technology piled up so fast.”

While most of his interviews were virtual, Jeremy “JP” Scott applied to 189 residency programs to increase his chances of landing a position as an international medical graduate (IMG) from the United States. “I spent a little over $5srcsrcsrc.”

Scott is a fourth-year student from Ross University School of Medicine in Barbados who completed his clinical rotations in the US and is applying to residencies from Maryland. He believes IMGs, whose match rates tend to lag behind their American peers, have to apply to double or triple as many programs as most US graduates and be flexible about their specialty choices to increase their chances of matching.

In 2src24, 67% of US citizen IMGs and about 59% of non-US citizen IMGs matched, according to the National Resident Matching Program, which oversees the match process. Meanwhile, nearly 94% of US graduates matched, National Resident Matching Program reported last year.

A few specialties require or highly encourage away rotations as part of the application process.

Robert Lloyd’s most considerable residency recruitment costs stem from two out-of-state rotations required for those pursuing emergency medicine. The hospitals at which he rotated send letters of review to be considered with his application. “It’s the most important part of the application,” said Lloyd, who is finishing his studies at the University of New Mexico School of Medicine in Albuquerque, New Mexico.

He estimated that he spent $6srcsrcsrc on travel, housing, and related expenses to rotate at programs in Detroit, Michigan, and Sarasota, Florida, for three months over the summer. His interviews were virtual, but he also spent about $2srcsrcsrc on applications to 75 programs. His advisers recommended that he apply to more programs than most students because it took him an extra year to graduate due to a family loss.

Watters believes she spent an additional $45srcsrc on three away rotations. The Society of Neurological Surgeons recommends neurosurgery candidates include two evaluation letters from external internships in their application.

Adding to Student Debt 

Although Watters’ interviews were in person this year, a shift from pandemic practices, she believes visiting programs is advantageous. “Seven years is a long time to spend somewhere you’ve never visited but also rather expensive.”

She said most of her interviews lasted two days. “So that’s generally a flight, a hotel room for an evening, any Uber, taxi, or car rental fees, plus any food or beverage not provided at the interview.”

The fees associated with applications and interviews create an “unnecessary financial strain,” Watters said. In addition, students also have to pay for exams, study materials, residency navigator tools, and other expenses.

Many of the fees are paid with student loan money if medical students don’t have an alternative source of income, she said. “The true cost then is compounded over time as you work to pay back the loans you utilized to pay these fees, something I think most medical students don’t really conceptualize because we are so worried about just having a [residency] job come July.”

Watters estimates she’ll graduate med school with about $45src,srcsrcsrc in debt compounding at about an 8% interest rate after paying down her undergrad debt and consolidating her loans through the Public Service Loan Forgiveness program.

Murphy is also concerned about her debt load, which she estimates at about $5srcsrc,srcsrcsrc. “After close to four years of medical school tuition, fees, and living expenses, my student loan balance is incredibly daunting, and the cost of applying for residency just adds an additional dimension of stress,” she added.

“While I understand some of these costs are necessary, it felt so discouraging that I had to worry about budgeting carefully, when my focus really should have been on finding the best program for my future.”

Lloyd has a different view. “Generally, I think physicians do well enough to pay off their student debt.” He said he began medical school with $15,srcsrcsrc of debt, estimated now at $25src,srcsrcsrc. “I’ve not looked at it recently. I’ll look at it soon to figure out…what the future looks like in terms of debt.”

Ways to Save 

AAMC advises students to develop a strategy for managing recruitment-related costs before they incur them.

Watters recommends planning ahead as much as possible, trying to drive if you’re able, maximizing flight points, hotel points, and credit card deals. “I wish more programs offered hotel discounts or comped an evening, for example, as I found that very helpful, as well, and a large incentive to prioritize an interview.”

She believes she was savvy about her away rotations. “I used every connection I had to lower costs, including staying with alumni from my alma mater who were gracious and requested little to no rent at two of my aways.” She thinks some people who have to complete these aways may have to pay rent at their away rotation while maintaining their rental/mortgage at their home institution. Watters subleased her place to save money. Transportation is often another expense, if you don’t bring a car.

Murphy said she also tried to cut costs when possible. “One of the biggest ways I saved money was being selective about the number of programs I applied to. I took the time to research each program carefully and only submitted applications to those where I felt I would be a strong fit.”

She also took advantage of free mock interview resources from her school and didn’t buy new clothes for interviews. “Every little bit added up, and while the process was still expensive, these small decisions helped keep my costs as manageable as possible.”

Scott was also particular about where he applied. “I only sent applications to residencies that had a history of accepting IMGs to their programs and in areas that I had a connection,” either having lived there or being familiar with the area. “For the handful that I had in person, most were in driving distance.”

If You Could Turn Back Time 

Watters regrets not calling upon her Tulane alumn network more for housing during in-person interviews. “It wasn’t something I thought of ‘til the end of interviews, but most alums will host a student for free for an evening while you’re interviewing in a city that they live and work in.” Or they’ll help connect you with others who can assist, she said. In hindsight, Watters said she’d drive to more interviews instead of fly and ride-share more with other applicants to resident meet-and-greet dinners and the airport.

Murphy believes she should have budgeted further in advance, “as having some money set aside ahead of time would’ve made the costs feel more manageable.… I’d focus on prioritizing the essential costs while being more mindful of the extra purchases, which are not always necessary.”

Looking back, Lloyd realizes he could have applied to fewer programs. “I ended up getting twice as many [interviews] as I needed. I probably could have saved $5srcsrc. It’s hard to know how many interviews I’d get offered.”

On the other hand, he wishes he could have visited more of the programs he applied to of his top three or four choices, to see if they were a good fit. He only visited the programs he rotated through because he was too busy fulfilling school requirements to take advantage of tour opportunities when they were offered.

“It would probably have cost $3srcsrcsrc but I would have done it.”

For more tips on managing expenses during the matching process, visit the AAMC’s reports on the costs of interviewing and applying to medical residencies.

The American Academy of Family Physicians also offers a sample budget worksheet to help students keep track of their spending.

Roni Robbins is a freelance journalist and former editor for Medscape Business of Medicine. She’s also a freelance health reporter for The Atlanta Journal-Constitution. Her writing has appeared in WebMD, HuffPost, Forbes, New York Daily News, BioPharma Dive, MNN, Adweek, Healthline, and others. She’s also the author of the multi-award–winning Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.