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Saturday, August 28, 2010

The Economics of USMLE, from the Exam to Residency.

 (The article is taken from "Another Road to Residency" compiled by class of 2003 and 2004 of Agha Khan University, Karachi Pakistan. The currency rates have changed but the basic info still applies.) 
Let’s face it. One of the most critical factors which alters one’s course of life is the issue of finance. Admittedly, the entire process of getting into a US residency is on the expensive side. However, if you end up matching, the money spent becomes quite insignificant in the long run. Allow me to demonstrate. Before I do so, I’ll tell you in advance that a lot of the terms used in this chapter will be unfamiliar. This chapter has been placed here only to give you a sense of proportion. Later, you may need to refer back to this chapter frequently when you’re in the process of planning (e.g. your trip to the USA).

Step 1:-            $805
This is a sum of the examination fee ($685) and the ‘International Test Delivery Surcharge,’ that is, the fee for giving this exam in Asia ($120).

Step 2 CK: -            $815
                Likewise, $685 + $130

Step 2 CS: -            $1200

Applying at ERAS: -        $290 (for 30 programs)
                $540 (for 40 programs)
                $790 (for 50 programs)

Applying at NRMP: -    $90 (for single applicants)
                $105 (for each participant of the couple match)

Applying for B1 visa: -    $100

Air Ticket to Islamabad: -    $120 (return ticket)

Air Ticket to USA: -        $1400 (return ticket)
This will vary with the city flown to and the airline used.

Greyhound Ameripass: -    $589 (for 60 days)
$898 (for 75 days) (a combo of a 45 and a 30 day pass)
                $958 (for 90 days) (a combo of two 45 day passes)

Public Transport: -        $300
I took a survey regarding public transport expenditure. Five people responded. The figures I received were: 100, 110, 200, 300, and 400. The width of the range is dependent on the total length of stay in the USA, the number of cities visited and the presence of relatives and friends in cities visited. I have advised a safe maximal amount to keep aside (for the careful spender, of course).

Food: -            $300
I took a survey regarding food expenditures. Five people responded. The figures I received were: 60, 100, 150, 200 and 1000! The width of the range is dependent on the total length of stay in the USA, the number of cities visited and the presence of relatives and friends in cities visited. If you’ll be staying with someone, not only will you be fed, you’ll frequently be given food to take along with you on your next trip. Hence, a cost cut. Of course, luxury can bump up the score manifold. So, there can never be an upper limit. I write $300 as a safe maximum amount to keep for a person who is careful with his / her pocket, yet does not compromise on his / her consumption. You may not spend all of it, but, it’s better to be safe than hungry.

Hotel Stays: -            $300
Again, this is a maximal amount to keep aside. If you plan well, you should not have to spend a single cent on accommodation. AKU grads (and others too) are everywhere. However, if you ever have to, a single night’s stay makes a serious dent in the budget ($100 approx). Again, better safe than homeless.

Buffer: -            $500
Of course, you must realize that you are not Hercules. You can fall ill. You can get hurt. You may need to get an urgent flight. Else, a number of things may happen which you cannot foresee. Although you will probably have some extra money on hand if you use the figures which I have quoted above (for food, hotel & transport), you should still maintain a further margin in case of emergencies.

Approx. total (thus far): -    $6810
This is for a single applicant applying to 30 programs and getting a 60 day Ameripass.

The remaining cost depends on the type of visa which you intend on applying for:

H1B: -
    Step 3: -        $625
    Health License: -    $170
    Attorney: -        $1000
USCIS: -        $685
    Premium Process: -    $1000
    Total: -        $3480
This fee may be far less than the above quoted amount as some institutions offer to pay for some combination of the above fees (not including the Step 3, of course). Furthermore, the exact fees will also vary from state to state (again, not including the Step 3).
J1: -
    + Health License: -    $170
PMDC Renewal: -    $5
    ESVP Application: -    $200
    SEVIS Fee: -        $100
    Total (Max.): -    $475

Other expenses may occur while communicating with the residency program after the match. These are variable (usually negligible) and hence unaccounted for.


Applying for H1B/J1: -    $100

Air Ticket to Islamabad: -    $120 (return ticket)
                This is for the H1B / J1 visa interview.

Air Ticket to USA: -        $800 (one way ticket)
This will vary with the city flown to and the airline used.

Thus, the grand total cost of the entire process of getting into a US residency is:

J1 applicants: -        $8300

H1B applicants: -        $11300

Now let’s look at earnings!

To take some rough averages, a resident earns about $40,000 per annum. After cutting taxes, the resident is left with about $2,500 per month. Now, one can EASILY save $500 a month if one is single. One can actually save much more if one is careful with how they spend. Even if one is a spendthrift, the income is still quite plentiful. Anyway, let’s assume that one saves $500 a month. The full cost of a J1 resident will be covered in less than 18 months. The full cost of a H1B resident will be covered in less than 24 months.

If the resident has a non-earning spouse to support, that resident is likely to save close to zero. However, if the spouse is also a resident, expect to be able to live on one salary, that is, a saving of $2500 per month! In the latter case, even if both are H1B residents, the entire cost will be covered in 9 months!

Although this article will serve to inform you of the involved costs and how much money you should take to the USA, it is meant to serve as a consolation. Many people see all their money trickling into the system and just wonder. They convert hundreds of thousands of rupees to mere thousands of dollars and just wonder. The point of the above text is to show that your money is being invested wisely. Eventually, you will pay for yourself (if all of the above was done on loan). And after paying for yourself, an extra $500 is an extra Rs. 30,000. Not bad for money sent back home to Pakistan. It feels good to move from ‘supported’ status to ‘supporting’ status.

Of course, there is the gamble of the visa. There is no guarantee that you’ll get your visas, etc. when you need them. Admittedly, people have had their contracts cancelled due to prolonged FBI clearance, etc. However, only a small percentage of AKU graduates are held back due to visa issues. Indeed, the figure may vary from year to year, but the proportion is always very low. When gambling, one always weighs one’s chances before one starts. Know this: your chances are very good – do play them.

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