Medical school application costs may prevent students from lower-income backgrounds from entering the profession of medicine, wrote authors in a review published in the New England Journal of Medicine.

Although attending medical school is often prohibitively expensive for students from disadvantaged backgrounds, some schools have begun to offer need-based scholarships that cover most if not all costs of tuition. However, no such forms of assistance exist to aid students with the application process. The Medical College Admission Test (MCAT) has a $315 fee, and many students pay substantial costs for practice examinations or preparatory courses. According to a 2018 survey of students matriculating to medical school, median spending on secondary applications and interviews was $1200 and $650, respectively. Further, 33% of responders reported spending $2000 or more on secondary applications, and 30% indicated that they spent $1500 or more on interview-related expenses, including airline tickets, hotel bookings, and taxi fees. Authors also noted that approximately 19% of applicants in any given year are reapplying, meaning they often must pay these expenses multiple times.

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These costs may contribute to the demographic disparities observed among medical school applicants, authors wrote. In 2018, just 9% of applicants identified as black, 10% as Hispanic, and less than 1% as American Indian or Alaska Native. Just 5% of applicants come from the lowest household-income quintile (≤$24,000 annually), while 25% report an annual family income of $250,000 or more. While programs exist to reduce application costs — including the Fee Assistance Program (FAP), which reduces the Medical College Admission Test’s cost and waives up to 20 primary application fees — the authors assert that further measures must be taken. FAP, for example, fails to supplement interview-related costs and itself has a rigorous and confusing application process. Low-income applicants may be “deterred by the complexity of the FAP application,” which requires parents’ tax returns, W-2 forms, college financial-aid letters, and other documents.

Authors suggested that medical schools adjust their policies to improve inclusivity. The Association of Medical Colleges could limit the number of schools to which each applicant may apply. With such a cap, wealthier students would have less of an advantage over low-income students. Further, medical schools themselves could begin to invite secondary applications only from students they found to be strong candidates for admission. Currently, most medical schools invite all applicants to submit secondary applicants, incurring extra costs for those who do not progress to the next stages. Finally, authors endorsed the use of virtual interviews over in-person interviews to reduce travel and hotel fees. Many top law schools already do so, and for schools not ready to adopt virtual interviews, regional interviews could be conducted through alumni networks.

While need-based financial aid is a significant step toward accommodating students from disadvantaged backgrounds, it does not assist those unable to apply at all. The authors endorsed rigorous efforts to challenge current application procedures and “diversify…the medical profession.”

Reference

Millo L, Ho N, Ubel PA. The cost of applying to medical school – a barrier to diversifying the profession. N Engl J Med. 2019;381:1505-1508.