Step 1 Exam: $535. Soapbox: $0.

Exams exams exams...they are never-ending in medicine.  It is currently exam week for Hubby...he is taking his second final  exam as we speak/write/read.  He had one final last week, this one today, and he has his final final of the semester on Friday.

Speaking of exams:  It's official - June 16 is the Day of Doom...also known as the day that the Hubby will take the Step 1 Board Exam.  That's number 5.1, in case you're curious...or if you really want to know all of the details about the agonizing eight hour long, 322 question exam, the gory bits can be found here

Ready for my soapbox?  (I'm not going to lie - I got much more fired up writing this out than I was just thinking about it.  You'll probably be able to tell.  Anytime I try to make a point with validity, I include lots of links.  This is a link-filled post).  All medical students have to take the Step 1 test to continue their medical education.  They are already paying up and out the waazoo (yes, the waazoo) for tuition, books, supplies and equipment.  By the time the Step 1 rolls around, the average med student is in upwards of $70,000 in debt (continually thanking Jesus for the combination of employment and in-state tuition resulting in our red number being below that average).   No one is ever going to opt out of taking the Step 1 because of the cost.  It's not like they have a higher price tag on the Step 1 to weed people out - these folks taking the exam are already in it for the long haul.  I can completely understand that the MCAT should cost a bit more, so that not every Joe Schmoe tries to take it.  But everyone in medical school is going to take the Step 1 regardless of what they charge for it.  And I'm fairly certain that the people running the USMLE have realized this and are taking advantage of it.

The Step 1 Exam costs $535 to take.  When the Hubby told me this, I nearly had a conniption.  He actually tried to rationalize it to me (leading me to believe that school is *potentially* brainwashing him), saying first that another $535 doesn't matter in the grand scheme of things, and second that they have to pay for all of these questions to be written, people to administer the tests and process the results, etc etc.  

We should pause for a moment.  In 2009, there were 40,298 students who took the Step 1 Exam.  At $535 a pop, that equals out to a cool $21,559,430.  Oh. My. Hockey Stick.  Seriously?  Seriously.  Over $21.5 million dollars. Where in the world does all of that money go?? 

[Warning: the following section contains math.  Secondary warning - I'm not very good at "the maths."  If you find an error, I will blame my calculator.  But please don't double check for me (Father), just pretend with me that I did it all right].

There are 322 questions.  Of these questions, 20% are not graded - they are the newly written "test questions" for the following year's exam (I am using this information based off of what the Hubby has been told).  The other 80% of the questions that are actually being graded were previous years' test questions, meaning that only 64 questions out of the 322 have to be written any given year.  We'll guess that they have 50 different versions of the Step 1 - I am completely making that up, but 50 versions sounds good to me.  If you paid each question writer a thousand dollars for writing their one question (64 questions for 50 versions at $1000 per question) that is a total of $3,200,000 for writing the test questions (which is pretty generous considering that the people writing these questions will be the brightest of the bright and should know the subject like nobody's business).  If we divided that out by the number of students taking the test (40,298), the question writing portion of the exam comes out to $80 per student.  

Okay - so the test has all of the questions written.  Somebody has to update the computer program from last year.   We'll let each test-taking student pay that programmer $10, or a total of $402,980 for creating the test.

Now we need a location to take the test.  I have no idea what a reasonable sitting fee should be for a computerized exam, but we'll just ballpark $40 (or for the Hubby's class of 200, a $8,000 income for the testing center).  If 25 students take the exam in a sitting and it requires 2 people to proctor the exam - one per 12.5 students - each making $20 an hour for 8 hours, their wages would total $320.  Multiply that by the 8 sittings it would take for the entire class to take the exam, and we reach a total of $2,560 in proctor wages.  I would assume that the students would not do more that $5,440 worth of wear and tear on the computers/chairs/building??

We're up to $130.  Now the students have taken their test.  It's computerized.  That means as SOON as they take it, the computer knows the results.  No one has to do anything to grade them...that's the beauty of a computerized test!  We'll need a couple of statisticians to figure out all of the worthless percentages.  How's $10 per test sound?   ($402,980 for the statisticians).

I guess someone does have to notify the schools of their students' scores.  I would bet an intern could click the mouse and do that.  We'll pay her/him a generous salary of $1 per test-taking student ($40,298).

Now, here we are: questions written, computer program updated, test proctored and graded, percentages/stats figured and scores sent to schools ...all for $141 per student.  We've come to just over a quarter of the initial cost.  A total of $5,658,178 as opposed to the $21,559,430 currently being grossed from the test taking fees. 

Will someone please explain to me into whose pockets that extra $15,877,412 appears?  Couldn't we practically bring clean drinking water to the world for that amount of money?

What are your thoughts on this?   Am I missing something, or is the USMLE just a complete money-maker?  I know nothing will change, and that the prices will just continue to increase, but still.  It truly is the principle of the matter.  Let's rob these kids who are already up to their eyeballs in debt out of an extra $394, just because we can.

Soapbox complete,


  1. Oh my gosh... I loved every minute of this. I'm a math nerd...but I didn't take the time to check your numbers. It all sounded 100% reasonable to me. :)

    I would love to hear someone's reason on why this test is so freaking expensive. We should probably add in the additional cost of study guides as, at least in my case, the hubby knows he's paying ridiculous amounts of money so he has to do good on the test. Not to mention the enormous amount of pressure that these exams bring...

  2. Ummmm Derek's cost $900.00!!!! So around $500 is sounding amazing right now!! And tell me about it! They are just so understanding and sweet to students- not!! Grrrrrrr.

  3. Ummmm Derek's cost $900.00!!!! So around $500 is sounding amazing right now!! And tell me about it! They are just so understanding and sweet to students- not!! Grrrrrrr.

  4. Yeah... we just dropped over $700 for the test/materials, and this lady is not a happy camper. (Sorry family you're all getting homemade cookies for Christmas, and by cookies I mean one each). :P

  5. UGH, I feel for you and completely agree. Just wait till you get to step 3, which really appears to be a money-making scheme since by this point (graduated from medical school and over a year into residency) I'm pretty sure we no longer need the USMLE assessing our doctors... the residency programs see their skills firsthand and can take care of that, thank you very much. I've done my share of ranting - Peter always told me "it's an investment," which can be helpful perspective, but I'm ready for some returns :)

  6. It SUUUCKS, right? Wait until he's an intern taking step 3 and paying for his license. $1300 later... It's a racket, I tell you. I try my best to remain positive by continuously telling him, "There IS an end to this. We will not be in this financial bad place forever." Over and over. On repeat.

  7. I personally was annoyed most by Step 2 CS, where you have to travel to one of the test centers (there are only 5 in the country, our closest one was 400 miles away!) for a test that lasts barely a couple hours, and basically tests your ability to speak english. Awesome. Money well spent.

  8. I adore this post!

    I am seriously going to throw up the next time I hear "It's an investment" or "In the grand scheme of this"... From test prep materials to the tests to the... oh, just wait until MS4 year- $2000 to apply to residency programs for us. ALL you do is look at the screen which has a list of all programs, click which ones you want to apply to, hit send, and it was $2000!! Good shoes because 'they are an investment', new suit because 'its an investment'... ok, I'll quit... but hang in there- wish I could tell you it will get better ;0)


I adore your comments, thank you for taking the time to share your thoughts with me! Don't forget - if you don't have your email address visible on your blogger profile, I won't be able to respond directly to you via email.

[Super-sweet reminder to family and friends: please refrain from mentioning the Hubby's name, school or our city. Thanks ;)]