Gearing up to apply to residency is one of the most exciting, yet nerve-wracking times in medical school. At this point, you have likely either decided on a specialty or at least narrowed down your choices and are getting ready for application season. Aside from gathering your letters of recommendation and updating your CV, the overall costs of applying to residency are also very important to consider during this time. With this blog post, we hope to give you more insight into the costs that come with the residency application cycle so that you are able to go into your 4th year as prepared and informed as possible.
The overall cost of your ERAS application depends upon the number of programs and the number of specialties you apply to. Per specialty the cost breakdown is as follows:
Further, another important consideration is for those applying to specialties that require a separate preliminary position, as both preliminary internal medicine programs and transitional year programs each count as a distinct specialty when calculating ERAS costs. Next, we will go through some more specific examples to give you a better idea of ERAS application costs and how cost can vary between specialties.
The average cost of applying to residency varies dramatically based on competitiveness of your chosen specialty, geographic preferences, and number of specialties you decide to submit applications to. Let’s break down some specific examples to give a better idea of overall ERAS costs:
First, let’s discuss the cost of applying to internal medicine residency. In the 2022 ERAS cycle, the average MD candidate applying to internal medicine submitted 35 applications. This comes to a total ERAS fee of $609. The same year, the average DO candidate applying to internal medicine applied to 59 programs, which comes to a total ERAS fee of $1,233. Finally, the average international medical graduate applying to internal medicine submitted 99 applications, which comes to a total of $2,273 for their ERAS application.
Contrast that with the average MD candidate applying to dermatology. The average number of dermatology applications submitted by an MD candidate is 87, which comes to an ERAS fee of $1,961, but remember that the vast majority of dermatology programs are advanced programs such that applicants also need to submit applications to preliminary positions. Data on preliminary programs is limited; however, 2022 ERAS data shows an average number of 15 transitional year applications submitted by MD candidates. The ERAS fee for transitional year programs comes to $184, and combining that with the dermatology advanced application fee that gives a grand total of $2,145 for all ERAS applications submitted by the average MD candidate hoping to go into dermatology. This fee would further increase if the applicant also decided to apply to internal medicine preliminary positions in addition to the transitional year positions for their PGY-1 training. Other specialties that require a separate preliminary year application include radiology, PM&R, and sometimes anesthesiology and ophthalmology, though both anesthesia and ophthalmology programs are trending more and more towards being categorical rather than advanced.
Finally, let’s discuss the costs of applying to a residency in general surgery. The average MD applicant submits 57 applications, coming to a total cost of $1,181. The average DO candidate submits 68 applications, and the average international medical graduate submits 72 applications, which comes to a total of $1,467 and $1,571 in ERAS fees, respectively.
When thinking about application costs, keep in mind that some students applying to competitive specialties might elect to also apply to other, less competitive fields as a “backup plan.” This would be a great thing to bring up to mentors who can take time to give you a realistic picture of your application competitiveness and potential backup plans if the need arises. Of course, in the case that you will also apply to a backup specialty, make sure to add those costs to your budget as well.
One silver-lining of the COVID pandemic has been the transition to a virtual interview format. The vast majority of interviews in both the 2021 and 2022 Match were virtual, which saves a huge amount of money that is normally spent on airfare and hotels to get to interviews during the season.
Another cost that can arise is to get your official professional headshot to go along with your ERAS application. Check with your medical school, as sometimes schools will arrange a photographer to take these for 4th year students. If not, you can either elect to take this photo yourself, have a friend or family member take it for you with a professional background while you are in professional dress, or go find a photographer (likely also the most costly option).
While preparing to apply to residency, there are a number of ancillary costs often not initially considered that come up as well. For example, the system used for ranking programs, the NRMP, is separate from the ERAS system and must also be registered for while applying for residency. The cost of registering for NRMP is $85. There is also a late fee of an additional $50 if you register after January 31st, so try to register while filling out your ERAS in the summer or fall so that you can avoid the extra fee and go ahead and include your NRMP registration number on your ERAS applications. One other extra fee related to ERAS is the one-time USMLE transcript fee of $75 to send your board scores to programs.
When it comes time to rank programs, a total of 20 programs may be ranked in the R3 system before an extra fee sets in. See the couple match section below for a breakdown of NRMP rank order list fees when ranking more than 20 programs (or program combinations for those couples matching).
Finally, as you gear up for your 4th year of medical school, make sure you are budgeting wisely and thinking ahead for what all is to come. Towards the beginning of the year, away rotations can also cause a major financial burden between finding accommodation for the month and preparing for away rotation applications, which may include costs for background checks, BLS recertification, application fees, and travel costs. While it can seem really far off in the midst of residency applications and interviews, many of us tend to make a big move to start residency as well. It is important to know that often you will not receive your first residency paycheck until a month or so after you have started, so try your best to keep those moving costs in mind as well when budgeting for your final year of medical school and the transition to residency.
There are a few important cost considerations to know about when applying for the couple’s match. First, the NRMP registration fee of $85 that was mentioned above increases by an extra $45 for those applying for the couple’s match. Typically, those applying for the couple’s match tend to also apply to programs more broadly in hopes of getting more interviews in overlapping geographic areas, so keep that in mind as well when thinking about and budgeting for the costs of applying to residency.
Also, within the NRMP ranking system, after the initial 20 ranked programs, each program or program combination has an additional fee per rank. For programs after the initial 20 included, each additional program ranked costs $30. For the final rank order list, after 100 or more ranks, there are additional fees. The fee is $50 for 100-150 ranks, $100 for 151-200 ranks, $150 for 201-250 ranks, and finally $200 for 251-300 ranks. You may rank a total of up to 300 programs or program combinations.
Residency Application Money Saving Tips
While a lot of the residency application process can seem out of our control, there are certainly a few ways to try and control the costs associated with applying to residency. First, like so many other things in medical school, make sure to start this process early and dedicate time to researching programs. There are many programs out there, and you want to do your best to apply to the ones that will be a good fit for you and your career goals as much as possible. This is the time to utilize your mentors and get their input. Take some time early on to really think about what you want out of a program — are you looking to become a clinical researcher and embark upon a career in academia? Then you might want to look for more academic programs. Or are you looking to eventually join a private practice in the community? Then more community programs might need to make it on your list. Once you have researched programs and decided what your goals are, review both your list of programs and CV with a trusted mentor or two to decide how to move forward and optimize both the number and types of programs you decide to apply to. Mentors are invaluable sources throughout the application process, and since they have likely guided students before you as well, they will be able to provide a lot of insight and guidance into deciding how many programs you need to apply to so that you can also prepare financially for this process.
While the past few application cycles have featured virtual interviews, it is still unclear whether programs will return to in person interviews at some point. If so, it will be important to be cognizant of travel costs to minimize them as much as possible. Try to book interviews in the same area within the same week to avoid having to buy multiple flights to one geographic area. Tap into your medical school’s alumni network and your own contacts to try and save on accommodation costs. If possible, see if there are interviews you have within driving distance so you can save on airfare. Lastly, while more time consuming, some credit cards can have generous travel perks, especially if you use them to pay for your hefty ERAS fees and can cash in on travel reward points throughout the interview season to offset some of the costs.
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