Money matters

Navigating the costs of OMS IV

Interviews, tests, away rotations: The costs of fourth year add up quickly. Planning ahead is key to saving money.


The last year of medical school might seem like a time to exhale. After all, you’ll soon be out of school and into the real world, living out your dream of life as a doctor.

But some challenges still lie ahead, including years of residency, where you won’t make much money and will see your medical school debt continue to accrue interest.

The fourth year of medical school is also filled with hurdles. During this time, you need to take some key—and expensive—tests. You also might have to pay for plane tickets and multiple nights in hotel rooms as you interview around the country in hopes of landing the perfect residency.

These costs can add up fast. Fail to plan well, and you could pile up debt that will weigh you down as you begin a new life.

To get ahead of these expenses, start budgeting for them well before your final year of medical school, says Steven Jorden, director of student financial services at A.T. Still University-Kirksville College of Osteopathic Medicine in Kirksville (ATSU-KCOM), Missouri.

“It pays to strategically think about your goals—and what it will take to achieve them—before your first semester of your fourth year,” says Jorden, who is also chairperson of the American Association of Colleges of Osteopathic Medicine’s (AACOM’s) Council of Student Financial Aid Administrators.

Keeping test costs low

Taking important tests is among the biggest expenses of a student’s final year.

Such tests include the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX) Level 2-CE and Level 2-PE and the United States Medical Licensing Exam (USMLE) Step 2 CS or Step 2 CK.

Jorden says your first step to cutting costs is to decide which tests you need to take. Osteopathic medical students must pass all first- and second-level COMLEX testing prior to graduation. But you might not need to take the USMLE as well.

“Taking only the exam you need is one way to keep expenses lower,” Jorden says.

If you decide to take multiple exams, try to take them close together. “Scheduling the exams for the same week can help reduce travel costs,” Jorden says.

While COMLEX Level 2-CE testing is available at Prometric testing centers around the country, the Level 2-PE testing is available only in suburban Philadelphia and Chicago. USMLE testing is available in many locations.

Again, planning ahead can save you money. Make sure to lock in travel plans well ahead of testing. Doing so often means you can get a lower airfare. You might also reduce lodging costs by skipping a hotel room and opting for something on Airbnb instead, Jorden says.

Cutting the cost of the match process

Interviewing for residencies can be another big added cost—perhaps the largest of all—of a student’s final year. A 2014 study found that these costs vary by specialty, with a “range exceeding $12,000,” according to the Texas Medical Association.

A majority of students spend $1,000 to $5,000 when interviewing for residencies during the match process, a 2016 study published in Academic Medicine found.

You also might pay fees to the Electronic Residency Application Service (ERAS).

As with taking tests, advance preparation can save you big money when interviewing for residencies. It’s also important to think of the long-term future when planning your interviews.

Jorden urges students to think about where they would like to be in 10 to 15 years. Then, take a step back and map out a step-by-step approach on what is needed to get there.

“Each individual will have her own path, and should focus on what works best for her own situation, not on what others are doing,” he says.

For example, if your goal is to pursue family medicine or another field that is less competitive, going on fewer interviews makes sense, and will help reduce unnecessary travel costs.

“Students pursuing a more competitive field may benefit from interviewing at more places,” Jorden says.

If you need to travel to many interviews, make travel arrangements early so you can keep costs lower.

Stay focused on your future

Other fourth-year expenses might include everything from the cost of away rotations to having to secure a new, professional wardrobe. Creating a budget and staying within it can help prevent your spending from getting out of control.

As you budget for your final year of medical school, Jorden urges you to keep the focus where it belongs most: Squarely on what is best for your future. The choices you make in the fourth year of schooling can have an impact that reverberates throughout your career.

“Deciding in advance what you want to specialize in, figuring out what is required to achieve your goal, and making arrangements as early as possible will put you in a better position when you need to begin paying back your loans,” he says.

Further reading on fourth-year issues
For more on these issues, read the following articles:

Your COMLEX questions answered

How to finish medical school with less debt

Match Day: Tips on the match process from newly matched students

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