The USMLE is a Fucking Rip-Off

Hoover  15 Nov, 2006  Medical School

The National Board of Medical Examiners (NBME) is responsible for the licensure exams including Steps I and II of the USMLE. These exams are ripping medical students new assholes on a semi-regular basis.

Steps I and II Clinical Knowledge (CK)
Step I and II (Step II CK) are multiple choice exams that cover information learned in medical school. Step I deals with the first two years while Step II has a more clinically-oriented approach to questions. The cost of each exam is $455. This doesn’t include any of your typical study materials such as review books, question databases, or courses.

Now, these exams are typically taken at a Prometric testing center. This is the exact same testing center where you can take your CompTIA A+ Certification Exam for $158.

Now, what’s with the big discrepancy? You’re using the exact same testing facility, with the exact same computers, and the exact same proctor. Yet, taking Step I or II CK costs you $297 more.


Does it cost that much more to hire question writers for Steps I and II? Maybe, but I honestly don’t think it justifies a near $300 difference per person for taking the exams. Does it cost more to score the exam? Nope, that is done electronically. How about costing more for score reporting? Again, this is done completely electronically.

Here’s how it works: Whenever you take your Step I or II exam, you sit down at a computer and enter your “candidate ID number” to start the exam. The question database is queried, and 50 random questions (for Step I) or 46 random questions (for Step II) are delivered for that specific block.

This isn’t top-secret internet technology we’re talking about here. Your fucking email is delivered to you in the exact same way. Once the questions are written, they peacefully reside inside the database until some poor unsuspecting medical student is picking away at its insides trying to come up with the correct answer choice. Given any changes in treatment regimens or diagnostic tests in regards to the latest studies will probably earn these questions a swift edit - but completely re-writing them most likely doesn’t happen.

Step II Clinical Skills (CS)
Step II CS is a pretty new exam (my class was the first one to take it for graduation requirements), and I honestly believe it was designed to weed out those medical graduates who can’t communicate effectively with patients. In this exam, you spend all day dealing with “standardized patients” while diagnosing and working up very basic medical problems.

Here’s the kicker: This piece of shit costs $975. Nearly a grand so I can go role-play with some “standardized patient” who is trying to make some extra beer money.

Rescheduling fees are an added bonus.

“If you cancel more than 14 calendar days before (but not including) your scheduled test date, there is no fee to reschedule. If you cancel during the 14-day period before (but not including) your scheduled test date, your fee will be $150 when you reschedule. If you miss your scheduled testing appointment without canceling, your fee will be $400 when you reschedule.”

Wait, there’s more. This doesn’t include any travel expenses. Step II CS is administered at select locations throughout the US, and there are only 5 testing centers available. These centers are Atlanta, Chicago, Houston, Los Angeles, and Philadelphia. If you aren’t going to school remotely close to any of these testing centers, you’re shit out of luck for a cheaper exam.

You’re going to have to pay to travel to one of these testing sites, pay for a hotel room, and then pay for food. That’s on top of the $975 that you’ve already shelled out to take the damn thing in the first place.

The NBME is giving it to medical students pretty hard - and without any kind of lubrication. Making a profit is great, but these guys are cleaning up at the expense of medical students who are often strapped for cash to begin with. Step II CS is the NBME’s newest venture to quietly pad their pockets while hiding behind big words such as “licensure” and “medical competency.”

If a one month subscription to USMLE World costs $90, it shouldn’t cost 5 times that much to spend 8 hours taking an exam using the exact same technology. I guess if you want to get the most bang for your buck while taking Step II CS, make sure to wash your hands. This will help keep you from failing this joke of a test and can save you $975 in retake fees.

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19 Comments so far »

  1. Anonymous said

    February 12 2007 @ 6:15 pm

    Such words of wisdom right there. I was unaware of there only being 5 testing sites…wow. that’s truly shitty. keep writing man, ur blog is hilarious

  2. QCOMDRJ said

    February 12 2007 @ 6:16 pm

    Yes, you must wash your hands. And you must tell the patients your name.

    Also, offer them water if they are coughing.

    You know, stuff that has nothing to do with the actual practice of medicine, and more to do with touchy and feely.

  3. chris said

    February 12 2007 @ 6:16 pm

    by now, i’m pretty used to it. same deal with the SAT, the MCAT, and all 3 parts of the medical boards. so the question is: what can we do?

  4. Hoover said

    February 12 2007 @ 6:17 pm

    Chris, that’s a great question. Unfortunately, there’s not much we can do I don’t think.

    The NBME pretty much has a monopoly on the exams, and I don’t see that changing.

  5. Anonymous said

    February 12 2007 @ 6:17 pm

    Hey,

    AASVB is killing us too with the NAVLE (vet equivalent of your USMLE)

    We get these retarded questions like “you are driving while on vacation and come upon a deer hit by a car how should you put it down a) tire iron b) baseball bat c) suffocation d) exsanguination or e) all of the above”

    What kind of question is that?

    I think it’s a conspiracy.

  6. Hoover said

    February 12 2007 @ 6:18 pm

    “a) tire iron b) baseball bat c) suffocation d) exsanguination or e) all of the above”

    Haha, nice. That is a crazy question. They’re all out to get us.

    I sometimes wish that I had went to vet school instead of med school. I was actually planning on applying to vet school before I got a wild hair up my ass that tricked me into the hell known only as medical training.

  7. premedtim said

    February 12 2007 @ 6:18 pm

    I don’t look forward to having to deal with the financial rape of med school…by the way, I just made a blog today and linked to you. More people need to be aware of crap like this, keep posting.

  8. Anonymous said

    February 12 2007 @ 6:19 pm

    you are an idiot, straight up. the cost likely goes into the physician who spent time coming up with and verifying the test questions. again, you are an idiot. maybe you should stop whining and try to become a real doctor.

  9. Panda Bear said

    February 12 2007 @ 6:19 pm

    Bull. Step II CS is a scam. It’s unnecessary and at a 1000 bucks a head, somebody is making money. The standardized patients get 15 bucks an hour.

    The over-riding philosophy about a lot of these things is, “They’re already borrowing 200K, what’s a thousand dollars more.

  10. QCOMDRJ said

    February 12 2007 @ 6:20 pm

    CS is absolutely a rip-off. Why else would they force all of the US medical students to go to one of 5 centers, and make us take a test that 99% of us are going to pass? When I went, fully 3/4 of the people there were FMGs, and taking it again. It is an English proficiency exam, nothing else. Why did they force us to take it? Because they blackmailed the deans of the medical schools. Made it a “professionalism” thing. And then they took a survey of AARP people about whether or not they thought the whippersnappers needed to take an exam that shows how good they are.
    I hate it, but there is nothing we can do. They are making a killing off of us. Worst part? That the letterhead saying you took it says ECFMG. I am not an FMG, and I think it is an insult to make me pay $1000 and not figure out what kind of student I am.

  11. Anonymous said

    February 12 2007 @ 6:20 pm

    http://www.nytimes.com/2006/11/27/business/27richer.html?

  12. Anonymous said

    February 12 2007 @ 6:21 pm

    link

  13. Hoover said

    February 12 2007 @ 6:22 pm

    Excellent article anonymous. That just goes to show you that I’m not all full of shit like some people who read this blog may think.

    As stated in this post, it really is all about the Benjamins in the end, and I think this article reinforces that mindset.

    Thanks for link. I might make a post about it so that more people might see it.

  14. Anonymous said

    February 12 2007 @ 6:23 pm

    how should you put it down

    a) tire iron
    b) baseball bat
    c) suffocation
    d) exsanguination
    e) all of the above”

    Hey, I got this question on the USMLE last year except it was in reference to an ICU gomer whose family had withdrawn care!!

  15. Hoover said

    February 12 2007 @ 6:23 pm

    @premedtim - Thanks for the compliments and the link! I look forward to checking out your blog.

  16. Anonymous said

    February 12 2007 @ 6:23 pm

    yeah, and when some randoms complain about doctors’ salaries being too high, you should just refer them to this blog. unfortunately, most people lack the brainpower to even imagine that there’s all this BS going on.

  17. medstudentitis said

    February 12 2007 @ 6:24 pm

    I’m so glad we don’t have to take the USMLE here in Canada. A few of my friends who wanted to apply to US residencies took it and I couldn’t believe how expensive it was. As if your tuition wasn’t high enough already.

  18. Anonymous said

    February 12 2007 @ 6:24 pm

    How about you write another post already. You make life worth living.

  19. Brad S said

    June 24 2007 @ 11:10 pm

    How should you put it down:

    a) tire iron
    b) baseball bat
    c) suffocation
    d) exsanguination
    e) all of the aboveā€¯

    Classic! By the way, what’s the answer? I’d go with exsanguination, just so some other bastard has to clean it up!

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