The Cost of Our Medical Licensure Complex

You could see the frustration in his eyes as he spoke to his fellow resident.

"I had to fork over eight hundred and thirty five dollars," he said slowly in a disgusted tone, "... and that doesn't even include the $300 state license fee we have to pay later...."

So much for starting our EKG conference on time.

The comments continued. No one could understand why medical school licensure has become so expensive in the US. I thought I'd look into what medical students can expect to pay these days for licensure since it had been a while since I had gone through the gauntlet. Here's what I found out:

A good overview can be found on the Wikipedia website. I'll direct readers there who want specifics as a starter. What I was more interested in were the sheer numbers of organizations and people involved in this process of verification of credentials and managing a series of tests that have become known as the US Medical Licensure Examination (USMLE).

First, there is the National Board of Medical Examiners. Then there's the Federation of State Medical Boards. Then there's the Education Commission for Foreign Medical Graduates. And let's not forget the Foundation for the Advancement of International Medical Education and Research, whom the US medical students support, in part, so tests can be administered to foreign medical students in an effort to advance international medical education and research. It's a veritable cornucopia of testing services for the whole world!

So no wonder the resident was frustrated. He's been paying into an industry that's getting quite expensive: over three thousand dollars expensive.

How can that be?

Well, the toll is paid gradually by medical students and residents - it's easier to pay in "steps," it seems. Here's the breakdown for 2011:

USMLE Step 1: $525
USMLE Step 2, Clinical Knowledge (CK): $525
USMLE Step 2, Clinical Skills (CS): $1120 (Oh, if you're not from Philadelphia, PA, Chicago, IL, Atlanta, GA, Houston, TX or Los Angeles, CA, then please add hotel and transportation fees, since this part is offered only in those cities.)

... and then you have to check with you local state licensure board for the fees associated with USMLE Step 3. For Illinois (pdf) (from where the disgruntled voices rose):

Fee for Continental Testing Services, Inc.: $105
Fee to the Federation State Medical Board: $730
Total USMLE Step 3 Fee in IL: $835

And that doesn't include the later $300 IL state medical licensure fee to be paid later. (Other states are likely to be different)

Which leads to the Grand Total for licensure for an Illinois-based US medical student today:

$3,305.

This on top of how much medical school debt?

No wonder the resident was upset.

(Good thing I didn't mention his upcoming board certification fees.)

-Wes

In the mail: "Dr. Wes, internists aren't 'fleas' any more, they're the dogs from which the fleas suck."