Factor in these 4th Year Medical School Costs
Written by Andrew Woods
Anyone who has persevered through the first three years of medical school has likely done so by paying attention to the “4th year best year” mantra. Fourth year arrives and for most of us, it means no more shelf exams, no more board exams in medical school, easier rotations and our eyes shift towards residency. What is often overlooked though are the significantly higher costs associated with fourth year. My goal here is to cover some, not all, of the costs that may not be thought about until they come due. So, let’s dive in!
1. Away Rotations: The Best, Most Expensive, Part of 4th Year
Before the COVID-19 pandemic, July through December was affectionately known as “audition season.” These were unique months filled with medical students crisscrossing all across the country, exploring programs and locations they were interested in for residency, all while living on friends’ couches, in hotels, or Airbnb’s. Unfortunately, this was eliminated entirely for the Class of 2021 and heavily restricted for the Class of 2022, but as we continue to move through the pandemic, the medical education system has begun returning to its old ways.
When budgeting for these rotations, I recommend taking the following into account:
· Travel: are you going to fly, or can you drive there? Tip: if you can drive there, you save on a cost discussed below!
· Lodging: do you have friends or family in the area that you can stay with, or do you need to find a hotel/Airbnb? Tip: reach out to the program to see if a resident has a room for rent!
· Transportation: how are you going to get around while on the rotation? Is every component of the rotation at one location? If so, can you walk there from your lodging, or do you need to drive there? Driving might have parking costs or tolls, but if you flew to the rotation, are you going to rent a car or just use ride sharing options?
· Food: do you have access to a kitchen where you’re staying? Does the hospital have food available or discounted food options?
· Miscellaneous Costs: does the rotation have exclusive requirements? Some of those that I ran into were N95 mask fitting, additional background checks, unique lab titers, specific requirements for equipment, and fees paid directly to the away program.
2. Application Fever: To be part of the problem or not to be, that is the question!
“Application fever,” cleverly coined by the great Sheriff of Sodium, Dr. JB Carmody, describes the self-perpetuating issue of medical students applying to more residency programs with each subsequent year. The Association of American Medical Colleges provides a nifty little table to help calculate what your fees will be. In my opinion, it is important to look at yourself as an applicant, compare that to the match data available through the National Resident Match Program (NRMP), and have an honest discussion (in your head or with others). For myself, I took into account that I was applying to Physical Medicine and Rehabilitation (PM&R), that my family had specific needs that had to be met over my residency years, and that I had a red flag that could deter some programs. In all, I applied to 39 programs, which was about 9 below the average within PM&R from the data released by the AAMC this year. Having that discussion with yourself will help guide your own decisions, but the cost of application bloat is something to factor in.
3. COVID-19 Induced Interview Changes: Are they here to stay?
This is likely the golden question everyone wants to know moving forward. The COVID-19 pandemic brought residency applications into the virtual world, which in turn greatly diminished the costs associated with interviews. Before the pandemic, applicants would have to fly to their interviews, get a hotel for a night or two, and then repeat that many times over. In the virtual format, all of those costs were eliminated and applicants now just needed a laptop and a solid internet connection to interview all around the country. I will give this advice under the presumption that this format continues, so my best advice is to get a cheap ring light and microphone (I don’t get any kickbacks from those links, that is just what I used!), a good Internet connection, find a part of your home you can be undisturbed, and crush those virtual interviews! Depending on where you live, it could be worth it to look into upgrading your internet for a couple of months to ensure there are no connection issues, but every program I interacted with had backup plans in case there were problems.
4. You’ve Matched, Now Figure Out How to Move There!
In my opinion, the greatest hidden cost associated with fourth year is actually the one everyone is most excited about: moving to your new residency program. Student loans are intended to cover a student’s school and living expenses while they are enrolled. As we have detailed above though, there are so many hidden expenses that the last semester student loans get stretched so thin, and many forget that your official start date with your new program isn’t until July 1st, and so the first paycheck doesn’t hit your bank account until a couple weeks after. One of my friends had a horror story where they didn’t get their first paycheck until the middle of August due to an accounting error…talk about stress inducing! The magnitude of the moving costs are obviously dependent on how far you are having to move and how much you are having to bring. Should you be stretched too thin, it may be useful to reach out to the program you matched at to see if they offer any moving assistance or if they have small in-house loans that you could possibly tap into.
5. All the Other Stuff that Doesn’t Fit
I could likely continue rambling about how expensive fourth year is, but for the sake of us all, these are some additional fees that I could think of or were brought up on Twitter and Instagram that may apply to you: board examination fees, VSAS/VSLO fees, extra fees for couples matching, academic conferences that you may choose to attend, registering for the NRMP Match, ECFMG certification fees, and my personal favorite: PAYING JUST TO BE ALLOWED TO GRADUATE and pay for or rent regalia.
At the end of the day, the medical education system is designed to squeeze blood out of a stone, and unfortunately students are the victims. So let us hope that the pandemic has allowed us to look more creatively at the financial demands on students and implement solutions to alleviate some of the stress.
**Andrew is currently a 4th-year medical student and the advice provided throughout this post does not reflect the official stance of any organization that he represents or participates in. Engage with Andrew on Twitter @TheAndrewWoods.
