Applying to Medical School (3) : The True Cost of Attending and the “Sunk Cost” Fallacy

This post has been sitting in my “drafts” for quite some time and, honestly, I still probably wouldn’t have gotten around to writing it were it not for my upcoming review of my 2021 Financial Goals…

As I have shared with some of you who have written to me privately by email, at this time, I have decided not to pursue medical school. I have gone back and forth about this decision for YEARS, however, coming to terms with a few things has gotten me to a place of mostly contentment with this decision. A few things…

The few things mostly have to do with my motivations and desires. While these are enmeshed and overlapping, I will do my best to pull these apart here:

1) Sunk Cost – I think part of my motivation to continue down this path had to do with the sheer amount of time and money I had invested in this endeavor. Beyond just the upfront course costs, there was also the missed year of professional earnings, retirement savings, and accumulating student loan interests that resulted from me returning to school full time to take premed courses. When you make that sort of investment of your time and money it is difficult to walk away. Unlike if I had pursed a graduate degree or had been working, walking away was made more difficult because I felt like I had nothing to show for that time. I still feel this way. However, I have also come to realize that this “sunk cost” cannot be a primary motivator.

2) True Cost of Attending – One of the great things about being an older premed is that physicians don’t feel obligated to give you the “rah, rah, you can do it” pep talks. Instead, many of them were brutally honest about the “true cost” of a career in medicine, and how much more complicated that choice becomes for someone in their 30s. PRIOR to the pandemic, I talked to happy physicians who were supportive and encouraging, but I also talked to miserable physicians who talked to me about the constant sacrifice of time, happiness, and money that the study of medicine requires. While I think it is possible that I could have been one of those happy physicians, especially if I found a way to make medical school cheap, I realized that I was not willing to make the other sacrifices…at least not at this point in my life. For a long time, I think when I would have these thoughts I would just attribute it to me being a lazy person. I’m not a lazy person. Instead, I’m making a different choice about how to spend my energy, talents, time, and money.

3) Service to Community
– I turned to the pursuit of a career in medicine just before I graduated from graduate school. My own recent interactions with health professionals and my research on the reproductive care of black women made me passionate about ameliorating healthcare inequities. My academic work in graduate school had also left me feeling like “my feet didn’t touch the ground.” What did it matter if I could have erudite conversations with my fellow graduate students…how did that improve the lived experiences of anyone? While I don’t think the answer to that question is important to everyone, it is important to me. And it will continue to play a large role in shaping my professional work. However, medicine is not the only way to be of service to my community.

4) Stimulation
– And finally, prior to going to graduate school I was working a corporate job. While the pay wasn’t bad (seriously, I made more money at 26 without a master’s degree than I did at University B), I was constantly bored and unchallenged. I loved graduate school and was convinced that medicine would provide me with a way to continue being stimulated, while also being of service to others, and eeking out a decent living. As I concluded above, I realized that there are also other ways to do this that don’t require investing 7+ years of my life in additional education and training at the cost of many other things.

Okay. That’s most of it. Almost all of it. People in my life have had different thoughts about my journey with medicine and their influence on me was more or less significant at different points. When I made this decision, I didn’t talk to anyone about it. Didn’t ask anyone for their opinion. Didn’t solicit advice. At the end of the day, this is my choice and I’m the one who has to be comfortable with it. And, for the most part, I am. There is a chance that some of this contentment has to do with me finding an alternate path to achieving much of the above (I told y’all before that I’m a planner) but that is for another post.

Applying to Medical School (2) : The Cost of Applying

The cost of applying to medical school can be financially prohibitive for many. Even if the Association of American Medical Colleges (AAMC) grants an applicant a fee waiver, which is honored by almost all medical schools, applicants still have to shell out for the MCAT (medical college admissions test), and costs associated with interviewing.

I am fortunate to be employed by University B, full time, so I will not qualify for a fee waiver. But before we get to the costs associated with actually applying, lets first discuss the costs necessary for me to become a qualified applicant.

Premed Cost

Prerequisite Coursework – A small number of medical schools across the nation (less than 10) have eschewed firm prerequisite course requirements in an effort to diversify the academic backgrounds of applicants (someone who studied music theory might have an equally interesting mind as someone who studied biology). However, most medical schools still require you to complete eight (8) courses in the basic sciences to be eligible to apply: biology+lab (2 semesters), inorganic chemistry+lab (2 semesters), physics+lab (2 semesters), organic chemistry+lab (1 semester), and either a second semester of organic chemistry or biochemistry. Additionally, some medical schools require a semester of statistics or calculus.

While it would be possible to calculate how much I have spent in the past, making myself an eligible candidate, I think it would be much more pertinent to the purposes of this blog to calculate how much it has and will cost me since I started my premed journey here.

As of January 1, 2021, I still needed to complete four courses to gain admission to most medical schools (although, not all coursework needs to be completed at the time of application…more on that later). For the spring 2021 semester, I am taking organic chemistry+lab and physics+lab. The classes plus associated college fees for this semester cost me: $1,324.00. However, because I work for University B, which has a very flexible employee tuition reimbursement policy, I will be reimbursed for the full cost of tuition ($780.00) which means my out-of-pocket cost for the coursework will end up being the $544.00 in college/university fees. Not…terrible. If only college were as cheap the first time around…

Universal Applicant Costs

While the cost of prerequisite coursework varies by where, when, and how you complete it, the following costs are universal for all applicants to U.S. allopathic medical schools unless you have a fee waiver.

MCAT – The Medical College Admissions Test is required by all American medical schools and many non-American medical schools. The importance of this exam in the application process cannot be overstated and it is a make or break for most applicants. The costs to take the MCAT and have your scores shared with the American Medical College Application Service (AMCAS) is $320.00. This does not include the cost of test prep services which are pretty ubiquitous to the medical school applicaiton process.

AMCAS – The American College Application Service is an application service required to apply to almost every medical school in the United States (except Texas as they have their own service and Puerto Rico). There are two sets of cost associated with this service:

1) Primary application fee – “Most medical schools use the AAMC’s American Medical College Application Service® (AMCAS®) to process applications. Through this service, you are able to submit a single set of application materials and have them sent to the schools you specify. The 2021 application fee is $170 for the first school and $41 for each additional school.” – Pulled straight from their website, cause why both restating it? It is important to note that most applicants to medical school apply to between five (5) and ten (10) schools.

2) Secondary application fee – “The majority of medical schools require a secondary application. Those fees range in cost.” Again, ripped from the site. The cost of a secondary applications generally ranges from $50.00 to $100.00.

Interviews – Assuming you make it through these hurdles, traditionally, most medical schools have required an in person interview. This can be a very expensive process if you are applying to medical schools out-of-state, or even across state, due to the costs of flight and hotel stay. Most medical schools for the 2020-2021 application year moved to a virtual interview process which significantly decreased the cost of interviewing. It is my hope that they don’t entirely eschew this process for the upcoming year.

So…yea. A lot of red. The cost of applying to medical school isn’t going to be cheap. However, I am determined to be as frugal as possible, and to cashflow the entire process. In an effort to try and keep myself “honest” about what this process is costing me, I plan to keep a log on this post that I will consistently update.

AfroPenny’s Medical School Application Costs

1/1/2021Prerequisites – organic chemistry + lab and physics + lab($1,324.00)

Applying to Medical School (1) : “(Debt) cannot be a disqualification for ambition.”

This post should have appeared on January 8th, but between my hope and ambition for the new year and today, a lot has happened. I’ve also been a bit rundown from work, and organic chemistry is trying to kick my a** just two weeks into the course.

This post was originally going to be titled, “Why I am applying to medical school.” Yea, I know, not particularly creative. But as so often happens when I begin writing a post, something happened. The something that happened was actually a fabulous someone and that someone’s name is Stacey Abrams.

I have always thought Stacey Abrams is kind of amazing. Stacey Abrams is the kind of chick you have to be if you are an educated, black, single, childless woman in your 30s and you don’t want your family to constantly, not so subtly mention the fact that you are an educated, black, single, childless, woman in your 30s. I kid, I kid…not really. After losing the Georgia gubernatorial race to then Secretary of State Brian Kemp, Stacey vowed to create organizations to combat, often racialized, voter suppression practices that had long been a part of Georgia’s complex political history. And she did. Her efforts are currently being lauded locally and nationally for increasing voter turnout in Georgia.

Overall, she is just really an amazing chick. She also has a pretty amazing resume that is chock full of early and consistent achievement. Which is why I was shocked when my internet stalking turned up a 2018 Fortune op-ed, penned while she was running for governor, where she admits to being in more than $200,000.00 of debt ($50,000.00 in back taxes owed to the IRS and $170,000.00 in credit cards and student loans). To say that I was shocked is an understatement. However, because Stacey Abrams is Stacey Abrams, even in a moment of extreme vulnerability, or perhaps because of it, she was able to offer the kind of insight that allowed me to set down a bit more of the shame I associate with my debt, and start dreaming again:

I am in debt, but I am not alone. Debt is a millstone that weighs down more than three-quarters of Americans. It can determine whether we are able to run for office, to launch a business, to quit a job we hate. But it should not—and cannot—be a disqualification for ambition (Abrams, 2018).

If you have read the post, “Stupidity. Reason. Qualified stupidity. The post where I explain how I got here,” then you know that after completing my graduate degree for FREE99, I decided I wanted to apply to medical school, and promptly took out ~$30,000.00 in student loans. Convinced that somehow this was different because I’d be able to go to medical school for free (rural state school and state scholarship program) and I’d be able to easily pay it back. Right.

So I spent the next year as a full time student, taking most of the prerequisites for medical school, and barely scraping by financially with a part time job. The school was very rural, and most of the time I was miserable, scared, and lonely. By the end of that first year, I had credit card debt I didn’t have the means to pay off and no real desire to return to campus in the fall. So I bailed. I took a job in a field for which I was qualified and took off to the other side of the country. Between then and now, I paid off the credit card debt, paid down some of my student loans, and generally found myself on much more stable financial footing. My premed textbooks and notebooks tucked away in my living area TV stand, never quite able to bring myself to throw them away…

It was after reading Stacey’s story, and that quote in particular, that I realized I was disqualifying myself. I decided because I made some poor financial choices in my formative years that I no longer had the “right” to dream or to want more. Somewhere, towards the end of 2020 as I sat on my couch and chatted with C over email, I decided to stop doing that. I’ve decided the only thing I have to do is to make prudent financial choices that don’t jeopardize my financial future. I think I can do that, AND apply to medical school. In another post, later today, I will break down the expected costs of applying to medical school, including what I’ve shelled out thus far.