There are a million and one reasons why people might decide to pursue residency training in the United States (we go through a long list of these in our online course), but there is usually 2 major things that hold people back from taking that leap:

• The hassle of taking all those extra exams
• The cost of trying to make the transition
  

While we talk about the extra exams elsewhere on our site, in this blog, I’m going to drill down into the second of those and explore the question; how much does applying for residency training in the United States cost?

Now, I’m not here to sugar coat things or persuade anyone that they should move to the US. While it’s something that I decided was best for me (see my ‘Why I left the NHS’ blog for more details), I have no vested interest in recruiting others to follow in my path. My goal, with LibertyMedics and with this article, is to give people the most thorough possible understanding of what the transition process is like.

To that end, I wanted to make this article the most detailed breakdown of ALL the costs involved that is available anywhere on the internet (or anywhere I could find from a few Google searches… but the internet’s a big place so who knows!)

Different Types of Expenses

When people think about applying for residency, the cost that immediately comes to their minds is the exams. They’ve heard through the grapevine somewhere that it costs a grand to take the USMLE, and that’s usually enough to create a sense of financial apprehension. Understandable! Well… you may not thank me for letting you know that there are actually a whole lot more expenses involved if you’re considering the ENTIRE process from registering on the ECFMG website to actually beginning your job as a doctor in the US.

In this article, we’re going to go through the following category of expenses, organized chronologically as you will be facing them:

• ECFMG, exams, resources
• Electives
• The Match
• Visas
  

So, let’s get cracking.

ECFMG, Exams, Resources

There’s going to be a lot of numbers coming your way, and also a lot of acronyms. We’re not going to slow down too much along the way to explain things like what ‘ECFMG’ is in too much detail in this article. Here, it’s ‘all about the Benjamins’ (bit of U.S. slang for you). But, in do check out the relevant sections in our online course for a micro-detailed explanation of everything we mention here.

Disclaimer: all costs listed in this article are current as of January 2020. They are subject to small changes (e.g. between 2016 and 2020 the Step 1 exam became roughly $100 more expensive… inflation, eh?)

So, when you decide that you’re definitely going to embark on the journey to US residency training, the first step on that journey is to register with ‘ECFMG’ - the organization that is in charge of coordinating the entry of IMG (international medical graduates) into the US healthcare system. A quick search on their website, some paperwork to complete, and bam, you’re done.

• ECFMG online registration: $135
  

Great! So you’ve been given your ECFMG ID after your registration, and now you want to book a ‘test period’ for your USMLE Step 1 (a 3 month block of time in which you plan to take the exam). You panic, get cold feet, warm then slowly over a few weeks, and then decide to bite the bullet and commit.

• USMLE Step 1 Exam:  $940 + $195 (EU)   (this additional surcharge varies based on the country in which you’re taking the exam, so check your rates for any non-EU countries online)
  

Our wallets are feeling a little lighter already, right? Well, it’s not over yet! They call it ‘Step 1’ for a reason unfortunately… because there’s other steps right after it! Realistically, before you apply for residency training in the US as an IMG, you really want to have done the next 2 exams as well to make you a strong applicant. Let’s add these.

• USMLE Step 2 CK Exam: $940 + $220 (EU)
• USMLE Step 2 CS Exam: $1580 (no additional charge here because everyone has to do it in the US!)

UPDATE 2021: The USMLE Step 2 CS has now been discontinued indefinitely. This means that the cost associated with this is not currently required. We are leaving the number and calculations here in place for now, but will remove this in the coming months once the next steps are clear.

Wow. We’re really making it rain here with all those dollar signs! But, let’s not forget, taking exams requires preparation, and preparation requires a combination of textbooks, question banks and online videos, each of which come with a price tag.

What exactly our recommended resources are, how to make the most of them etc. is all covered in our online course, but for now, take our word for it. It’s going to cost around about this much:

• Textbooks/ videos/ question banks for ALL Step exams combined: $1100
  

So, who’s been doing the math? (We have)

ECFMG, Exams, Resources Grand Total: $6005

Electives

For those of you who haven’t yet heard about electives, they are basically ‘away rotations’ that IMGs should STRONGLY consider doing at US based hospitals in advance of their application for ‘The Match’. Although these are essential to a strong application, they can come with an eye-watering cost. The vast majority of electives available at US institutions come with a ‘tuition fee’, meaning that you pay them handsomely for the honour of going in at 5am and helping them do their work (what a racket!) Sadly, these institutions know how desperately IMGs need this US clinical experience, and the prices are only increasing by the year.

Although each hospital has its own varied costs for 1 month electives, we are just giving a ballpark figure for the tuition fee to help give you guys a sense of the anticipated cost.

Tuition fee: $1000-2000 (minimum)

Now, don’t forget, most IMGs try their best to do at least a 1 month clinical elective, and ideally 2 x 1 month electives if possible! That means both flying to and from the US, and actually living there for 2 months, with the associated accommodation and living costs involved.

Flights + Accommodation: $4000 (at least $1k on flights, $1.5k on accommodation for around 2 months, and $1.5k for living costs for around 2 months)

Electives Grand Total: $5500

The Match Application

At this point, we’re still trying to figure out how they’ve made us pay them over $5k to do their work for them for 2 months. But we have to shake it off, because it’s now time to actually apply for ‘The Match’. If you thought they’d been creative up until now in squeezing money out of you, get a load of this! They make you pay for both an ‘ERAS token’ (like an ‘entry ticket’ to The Match), and then separately an ‘NRMP ID’ (a separate ticket to use at the end of the process to actually be submitted into the matching algorithm). They also make you pay to electronically submit your USMLE transcripts to programs (what’s wrong with the old PDF upload I hear you ask…? It’s free.)

ERAS Token: $130

NRMP ID: $85

USMLE transcript: $80

Then it comes time to actually applying. Now, theoretically, you are allowed to apply to EVERY program in the entire country from every specialty if you choose to do so. We go through whether this is a good idea in our course (Hint: it’s not), but the cost of actually submitting the application to different programs is proportionate to how many programs you apply to, and how many different specialties you apply to. We explain how exactly these costs break down in the course. But, because of this, the expenses to consider here vary greatly. We are going to use an example of an IMG who applies to just one specialty e.g. Internal Medicine, and applies to around 100 programs.

Applying to programs: $1400 (minimum)

You’ve submitted your application, and hooray! You’ve got some interview call backs! But this also means having to fly to and from multiple different institutions (because you’re LibertyMedics superstar applicants, of course, and have a bunch of fantastic interviews lined up). Again, the costs of the ‘interview trail’ vary greatly depending on how many callbacks etc. but we are giving numbers for someone who has 15 interviews, 10 of which require separate flights (i.e. can group some together geographically hopefully, and all needing at least 1 night of accommodation.)

Interview Trail: $2000

The Match Application Grand Total: $3695

Visas

Fast forward, it’s the end of March and you are in tears. Not because you’ve seen your bank balance and didn’t know minus numbers could be so big. But because you’ve found out you’ve Matched in your dream residency program!!

You wipe the tears, you message LibertyMedics to tell us the great news, and THEN you call your parents to tell them too.

Now, it’s immigration time! If you’re a US citizen or green card holder IMG, then you don’t need to worry about this part (we’re all jealous and resent you, just so you know…) The rest of us will need typically one of the following 2 types of visa to train in the US: the J1 visa, or the H1b visa. Each of these visas has its own set of pros and cons which we discuss in detail in the course, but in terms of cost, they break down roughly as follows: J1 visa $560, H1b $500 - $1000. We’ll use a lower end estimate for our calculations below.

Visa Grand Total: $550

Adding it ALL together

You’re probably wincing at this point and wanting me to stop, but we have to add it all together so forgive me.

ECFMG, Exams, Resources Grand Total: $6005

Electives Grand Total: $5500

The Match Application Grand Total: $3695

Visa Grand Total: $550

OVERALL GRAND TOTAL: $15,750

(without the USMLE Step 2 CS this will now be $14,170 from 2021 onwards)

Don’t Lose Hope!

Unless you are the child of Russian oligarch or Saudi prince, the chances are, that number is looking pretty daunting right about now. I said at the beginning, I don’t want to sugar coat anything. For so many applicants, each one of these costs comes as a horrible surprise as they work their way through the process, and some unfortunate people end up stranded and unable to continue on the journey because they hadn’t anticipated and budgeted for this. That’s why I think it’s so important to be clear and transparent about it from the outset.

However, don’t despair. While that number looks massive, and basically no medical student or junior doctor would be able to afford it as a lump sum, it doesn’t come as a lump sum! I have put all these figures in front of you at once right now, but that entire process we breezed through about actually happens across the span of at least 2.5 years for most people. I know death by a thousand cuts is still death… but the way the expenses come along are often in thousand dollar chunks every 3-4 months. If you know finances are going to be an issue, you can extend the gaps between things like exams even further to help with budgeting.

Also, the projections for things like electives and interviews do vary greatly; some people get lucky and do an elective without a tuition fee (we explain in the course), you may have the majority of your interviews in New York in one month and can save on 4-5 flights because of it, and you may just be someone who is great at living frugally and can drive down that living cost expenditure.

And hey, if all this talk of $15k application costs has you down, I encourage you to check out our article explaining the salaries that US physicians make… it might make this an easier pill to swallow!

How can I find out more about moving my career to the U.S.?

If you want to find out more about how a doctor/medical student from India, the UK,  Pakistan, South America etc. can actually go about moving their career to the U.S., we can help. We've produced the most thorough, A-Z, step-by-step guide on the process of international medical doctors moving to the U.S. that we've seen anywhere. Check out our 'How To Make It In America' course for more details, including an in-depth discussion of all of the other most common 'pros and cons' of moving your career to the U.S. We also provide insider tips and advice on how to ace the USMLE exams (all 4 of them), to secure electives and make the most of those, how to get incredibe letters of recommendation, the entire 'Match' application process, as well as visas and immigration advice!

CLICK HERE:
HOW TO MAKE IT IN AMERICA COURSE