In this blog post I will go over the financial implications of being a pre-medical and medical student coming from and being in a lower social economic class (SES). In 2019 both my husband and I applied and were accepted into medical school, but little did we expect that the financial complications and trauma would occur before our loans were even due to be paid back after medical school. In fact, financial insecurities disproportionately affects students from low-income communities and underrepresented students in medicine because they have less financial assistance from family to subsidize their medical education and living expenses. I will start by talking about the cost to apply to medical school as a married couple, the extra costs no one talks about during medical school, and the financial disaster we experienced when I had to take an unexpected leave of absence (LOA).
"As I once again receive an email regarding not paying rent yet this month, and have another late fee added, I am reminded of the financial inequities that plague the medical education system. Medical school IS NOT created for individuals of lower and middle social economic classes. Even though we are provided the ability to take out federal loans for school and living expenses they are not easily accessible nor enough to live. In fact we are given living expenses which are about 250% of the federal poverty level."
Finances for Pre-Medical Application:
Just to Apply to Medical School: $5,000 - $10,000+/person
MCAT exam is $325 (each time you take it)MCAT Practice Tests, Resources, Class, and/or Tutor - Starting at $200 minimum2023 application fee is $170 for the first school and $43 for each additional SchoolSecondary Applications: $75-$150 per schoolSchool Transcript Sending FeeLetter of Recommendation Sending FeeApplication Review Editing Service and/or Mentorship - Starting at $300 minimumSuit for Interviews - $200 minimum
Our Total Application Cost Combined ~ $20,000
Each of us took MCAT Twice, did a virtual self paced MCAT class, and used an Application Review & Editing Service
56 Total schools applied to66 Primary Applications Sent = ($43 * 64 schools) + 170 +170 = $3,09250 Secondary Applications Sent = on average $100 * 50 ~ $5,00024 interviews offeredDid 13 interviews (11 out of state) ~ flight, transportation and sometimes hotel stay for $1000 total, but sometimes we had the same interview or stayed with students which helped decrease the cost
At the end it was worth it because we were waitlisted at 6 positions and accepted at 7 medical schools!
Things we wish we knew while Applying to Medical School:
There is a Fee Assistance Program for the Application Service that we were not aware we qualified for.
Sometimes you can ask schools to waive the costs of secondary applications
It is best to start start saving during college because $10,000 on Credit Cards gets really expensive to pay back (average annual credit card interest rate in 2022 is around 16% and you rarely have enough money in your living expense loans to pay them off during med school.
Here is a website by Blue Print on How to Reduce the Medical Application Costs
Medical School "Living Expenses"
Average Cost of "Living Expenses Loans" (per Rush Website in Chicago)
Monthly Living Allowance: $2,450
Rent, utilities, etc. = $1,457 per month Transportation (car repairs, insurance, registration, gas, etc) = $380 per month Miscellaneous (food, entertainment, moving expenses, clothing, medical care, pet food, etc.) = $201 per month
--> Groceries & food = 50.25/weekEducational Resources & Exam fees (left over) = $412 per month
For the ~10 months you are "in classes" you are given: $29,000/year (yes not given money for holiday or term breaks if greater than 4 weeks in a row!)
This means a single medical student who takes out 100% of loans for living expenses without any parental financial $$$ support is at around 250% of the Federal Poverty Level Annual Income
Educational and Academic resources: Many students ended up purchasing the majority or all of these resources once they realized their peers were receiving benefit or an advantage. These resources for the first two pre-clinical years include Sketchy ($800), Pixorize ($400), Boards&Beyond ($400), Amboss($500), Pathoma ($120), Complete Anatomy ($150), and a First Aid book ($50). In total, the cost of unexpected academic resources would be $2,4020 per student. Of course there were ways for some students to acquire some of these resources without paying, but technically that is against the code of conduct.
Health Insurance: ~$5,660/year per Rush Website
Fall: Aug-Dec: $1,861.00Spring: Jan-April $1,369
Summer: May-July: $2,430 (based on above number)
80% percent coverage for most in-patient services, including hospitalization and surgery, as well as outpatient services like office visits, mammography, laboratory tests and X-rays. This means you pay 20% of all procedures up to your $6,000 out of Pocket
$20 co-pay for generic and $50 co-pay for brand-name prescription drugs ($80 co-pay for brand-name drugs when the generic equivalent is available)
If you ever want to increase your living expenses disbursed you can fill out this form (every school has one) which allows you to increase the loans for purchase of a computer or tablet, plane tickets, and medical expenses.
***The most recent example of difficulty dealing with financial aid living expenses is that this month we will not receive our loans until at least October 15th, but rent was due on the first of October. The date of when you receive your next paycheck doesn’t matter to landlords because they expect being paid on a certain date.One might say “oh you knew this for months, why didn’t you save up?” But the reality is that no one knows the exact amount that will be given each time nor for how long it will last until a couple days before disbursement-including the very own financial aid department
See recent blog Post Surviving the Taboos of Medical School to see more in detail information about finances and paying back medical school loans
USMLE STEP 1&2 Preparation Expenses:
NBME Practice Exams: $60 each (Usually take 5-6 of them during each preparation)
Each time you reschedule the exam it costs $50-$100 depending how close the exam date is
Sometimes there are no exams available in your town, so you have travel (sometimes by plane~$200 total) and stay the night before at a hotel or Airbnb (~$150/night)
After continuing to struggle passing the practice exams I was given access to tutors from a professional tutor company (3-6 hours). If I had paid out of pocket, this tutor would have cost over $300/hour which there was not a single possibility we could afford that.
If you fail STEP, you have to pay the full cost all over again: $645 plus the practice exams, plus any renewal of UWorld or other virtual studying materials
When it came to academic success, some students paid for private tutors especially for the board exams. Since I was experiencing academic struggles and consistently scored in the lower percentiles, I was provided tutoring by my school for “free” by a student in the upper level classes.
To note, we just found out that the reason they are unable to give us exact amounts is because they provide different amounts to different individuals. A new piece of information is that if one takes four weeks of "elective time" to just study for STEP2 (or take time off), you are not provided living expenses financial aid for that month. This then puts you a month or more behind the income expected.
During COVID, we realized that there were multiple concerning challenges of living at our current Chicago home. During the initial weeks of remote education, our internet connection went down. This led us to have to take our summative exam at one of the proctor’s homes. Since internet was still down and Comcast said our neighborhoods upload speeds were not a priority to fix, we were living in a zip code with lower SES, we were forced to drive to our parent’s home in Colorado. However, there were 5 adults including one adult with special needs living there which made living at the home near impossible in regards to studying, doing remote classes, and taking proctored exams.
Once the internet was back up in our home in Chicago we drove back. Our upstairs neighbors were also forced to stay home with their loud young children which made it difficult to study and take virtual proctored exams. We also used our living room as our office, and was on the first floor and facing a very busy street. Being back in our Chicago home 24/7 led us to be impacted by and witness multiple crimes and homicides directly outside our front window. The loud noises and recent frequent crimes have made it difficult to study and take our exams. The increase in crime activity in front of our house during COVID prevented us from walking outside with our dogs or for a quick respite. These stated reasons greatly impacted our mental and physical health during COVID as we did not feel safe nor had access to a quiet area to study.
Therefore during our second year of medical school we decided to move to a safer and quieter location which was also more expensive. The new home was on the second and top floor, had more reliable internet connection, and was in an area with lower crime activity. Additionally, the home had a separate office for my husband and I so we could each take our exams and do our classes in separate areas. The proctored reviewers did not like it when we had previously take our exam in the same room, as we had done previously when our desks were both in the living room.
Since we had to end our lease early we had to pay $750 to break our lease, a $3,125 deposit, the first months’ rent of $2,105, and movers for $756. This equated to needing an unexpected $5,000 which we had no available loan living distribution to use. Thankfully, we each applied to our school's COVID emergency funding of $2,000 which helped us pay for these expenses. Moving is always expensive and it is difficult to plan for, so it is a significant disadvantage to individuals who rely fully on loans.
Check out my full Financial Trauma blog post
Leave of Absence (LOA) Expenses:
Check out the full blog post here.
In June 2021, I had to take a LOA because of my medical and mental health disability which prevented me from being able to pass my practice STEP1 exam in the time the school provided. This resulted in Financial Aid requesting back over $7k in expenses that were already distributed and we were planning on using to pay for living expenses. Unfortunatly, this resulted in my husband selling his wedding/medical school watch and computer in order to pay back the school. I had to pay for the continuation of my Health Insurance (~3,00) because it is the only health insurance that would cover the needed medical appointments and medication. I also applied for and was accepted to receive Medicaid. This decreased the costs of my physical therapy (PT) from $30 copays to $0 which I need to go to every week. It also decreased the costs of some of my medications, therapy, and doctors appointments.
Financial resources we have used and highly recommend:
One can increase the $$$ of living allowance you receive for computer/tablet purchases (once), flights home (2 times per year), and medical costs (contacts, copays, medicines, etc). Each school has their own form to fill out so contact your financial Aid Department. Rush's Request to Increase Loans
Food stamps (SNAP) Application if you have NO family financial support or external income is under 250
Food Banks and More Food Support
LasagnaLove: Make or receive a huge Lasagna from someone in the community
Medicaid Application- decreased costs of medical care, ER visits, and medications
Chicago Utilities Support
WIC Application: If you or your partner is pregnant or having a young child
Is there anything else you would like to know? If so send me a message and can contact me here. I hope you consider signing up for my monthly emails where I share educational virtual events, trauma-informed resources, and more blog posts.