When Jamieson O’Marr ’18 started applying for medical school, he made an Excel spreadsheet to keep track of all the schools he was applying to. At the bottom, he kept a tally of all the costs he was incurring — just so he could keep track.

A little under a year later, the application costs have added up to over $8,000. And O’Marr said he was still not done applying.

“It quickly adds up to be a really expensive process, and it’s not something that they [tell you] that you should really be aware of,” O’Marr said. “No one says that you should probably have five to 10 thousand dollars if you’re going to apply to med schools.”

Every year, hundreds of students from Stanford apply to medical school. Many students say that the costs of the application process alone catch them off guard. While some aid exists, many students worry about the fees’ impact on lower-income applicants and diversity in the medical field.

“It’s so inaccessible, it’s not even funny,” said Rebecca Bromley-Dulfano ’18, who applied to medical school in the 2018-19 cycle.

The costly process

The application costs start even before students officially apply to medical school, with the Medical College Admissions Test (MCAT), which almost all prospective medical students are required by schools to take.

Bromley-Dulfano didn’t pay for MCAT classes, and neither did O’Marr. But if a student chooses to do so through test-prep companies like Princeton Review and Kaplan, the classes can cost upwards of $1,500. On top of that, the registration fee to take the MCAT costs $315.

“It’s a lot of burden to place on a student,” O’Marr said.

Then, the application process itself begins.

Multiple students said that by the time they began applying to medical school, their parents had stopped financially supporting them, meaning they bore all the costs incurred.

“My parents are not really financial players in my life anymore,” Bromley-Dulfano said, adding that her parents helped her only minimally with expenses in the past year, covering only about 5 percent of her costs.

The official application process starts with a primary application containing a student’s personal statement, similar to the Common Application used in undergraduate admissions. The same version is sent to all schools a student applies to. This primary application, submitted through the American Medical College Application Service (AMCAS), costs $170 for the first school and $39 for each additional application.

In the 2018 cycle, medical students applied to an average of 16 schools, according to the Association of American Medical Colleges (AAMC). Bromley-Dulfano applied to 15. O’Marr applied to 24. Nick Quach ’19 applied to 20. A student like Quach applying to 20 schools would pay nearly a thousand dollars in primary application fees.

Then, after the primary application fees come the secondary application fees: Nearly every medical school will send a secondary application that asks school-specific questions, much like the supplementary application for undergraduate applications. The secondary fee can range from $80 to $100, depending on the school. If a student applies to 20 medical schools and writes secondary applications for all 20, that amounts to an additional $1,600 to $2,000.

After all the applications are sent in — most students submit around late August or early September — the interview process begins.

“Interviews are likely to be a lot less numerous than secondaries, which is good,” Bromley-Dulfano said. Good, she qualified, in the sense that the less interviews one has, the less costs they incur. Receiving fewer interviews, however, can create further stress for students anxious about their prospects.

If a student gets an interview, they are expected to pay for their flight, transportation and, in some cases, food and lodging. O’Marr made 11 round trip flights during the interview process, mostly to the East Coast. He incurred $3,221 just in travel costs.

On top of flight costs are the small, miscellaneous expenses that come along the way — buying a formal suit for interviews, or getting lunch in an airport restaurant, or taking Ubers.

“It all adds up,” O’Marr said.

The medical school application process contrasts to many other graduate and Ph.D. programs, which typically place less financial burden on students. Universities will often try to “wine and dine you,” said Christina Kohlmann, who is applying to a graduate medical program with an application process similar to medical school. Many Ph.D. programs will pay for flights out for interviews and house students in hotels.

Bromley-Dulfano took about eight flights for interviews, also mostly to the East Coast. She said that she ended up shuttling between East and West more than she should have and wished she had known sooner about her ability to negotiate the dates of her interviews.

She spent around $1,600 on travel. Her total cost of just applying came to over $4,000.

“That sucks to say out loud,” she said.

How students cope

To help alleviate costs, the AAMC offers a fee assistance program for low-income students. It reduces the registration fee of the MCAT to $125 and waives the application fees for the first 20 medical schools the student applies to.

Katie Wang, Stanford’s director of upper division advising and pre-professional programs, said pre-med advisors are also useful resources for students worried about financial barriers.

“Financial considerations do come up at many points in the pre-med path,” she said. “We have a page on our pre-med Canvas site dedicated to ‘Financial Resources’ to help address some common questions and point students to resources.”

According to O’Marr and Bromley-Dulfano, medical schools themselves also usually help applicants find housing with students on campus so that they do not have to pay for hotel costs. And UCLA Medicine paid for O’Marr’s flight to the campus. But this was an anomaly compared to the norm, he emphasized.

“I started asking about midway through [the application process] if [schools] would give me any financial assistance for flights or traveling, and there wasn’t for a lot of them,” he said.

Bromley-Dulfano said she chose to take a gap year instead of applying to medical school during her senior year largely because of the high cost of applying. According to Wang, students taking at least one gap year before applying to medical school “is now the norm, both for Stanford undergraduates as well as applicants nationally.”

“Once I finally in senior year realized what was going to be involved, I was like crap — I’m not ready [and] I’m not going to be able to afford this,” Bromley-Dulfano said.

Bromley-Dulfano and O’Marr both said they think medical schools can do more to help students during the application process.

“Med schools will talk about wanting to be champions of diversity and inclusion, but then not acknowledge at all that people who are probably most impacted by this are people who have multiple marginalized identities and can’t get into the door,” Bromley-Dulfano said.

The data shows that low-income students are indeed having a hard time getting through the door. Research from the AAMC shows that about three-quarters of medical school matriculants come from households with incomes in the top 20 percent of America or higher.

O’Marr also pointed out that when low-income students go through the application process and make it into medical school, the cost — both of applying and of actually attending — can often push them towards high-paying specialties and away from working in under-resourced areas in need of doctors.

“Some people will want to feel like they need to have the financial security that a specialty provides,” O’Marr said.

The financial strains complicate an application that students said can already be tricky and opaque, and that makes it hard to know whether you’ll get into school at all.

“It’s like playing a game you don’t know the rules to, and the stakes are your future,” Quach said.

But despite its costs, for many pre-med students, the end goal is worth it. That’s how O’Marr felt when he found out in March that he got into two medical schools.

“So I’ll be going somewhere next year, and I don’t regret it in the slightest,” O’Marr said. “If you know medicine’s the path for you, it will all be worth it in the end.”

Contact Adesuwa Agbonile at adesuwaa ‘at’ stanford.edu.