Tuesday, August 09, 2011

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:


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.)


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


rlbates said...

Seems to me the cost of your school tuition should cover the required USMLE tests, but then someone wouldn't get their cut.

david said...

cheaper than becoming a licensed architect. and an average architect pays a higher percentage of their yearly salary to student loan debt.

Tim Hulsey, MD said...

"Oh, you rich doctors! Everybody knows you'll make a fortune and live a life of liesure, golfing three times a week with no headaches or concerns, sleeping like a baby, flowing through life on a slipstream of money! Quitcher bitchin'!"
No! Really! That's what many people think!

Anonymous said...

are those tax-deductible? p.s. I don't think you live a life of leisure

Tim Hulsey, MD said...

Anonymous said...
"are those tax-deductible?"

When you're in training, it's difficult to come up with that amount of cash. I don't think they are any more tax deductible than my textbooks were in medical school.

"p.s. I don't think you live a life of leisure"

But many people do.

Anonymous said...

As a recent resident who forked over >$3000 for two sets of boards a few months ago (why did I decide to be double-boarded?), I would like to point out that every penny that I make over my resident's salary in my "real job" will go toward paying my student loans. Good thing I didn't go into medicine to play golf and not work. Like most of us, all I want to do is take good care of patients.

Tim Hulsey, MD said...

With the cost bubble of higher education, only the wealthy and a fortunate few top scholars will be able to attend professional schools. Some of us less academically endowed students who came from poorer backgrounds can deal with patients well and practice good medicine, but would be culled out by the exorbitant cost of medical education, today. It was difficult enough to see studentswhom we all thought would make good physicians culled out by grades, but to see it done economically doesn't bode well for the future of medical care in this country. I remember well, as a resident, having to buy a pair of loupes (glasses with built in magnifying lenses). I closed my eyes, forked over the cash, and hoped I would be able to eat the rest of the month. "It ain't easy doin' what we do!" Maybe that's why we get $40,000 for those amputations Obama talked about!