Med School Hell – The USMLE is a Fucking Rip-Off

This post is raw and holds nothing back. If you’re uncomfortable with vulgar language, please turn back.

November 15, 2006
By: Hoover

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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.

Are you convinced to leave medicine? If so, you may feel like you are alone. You may feel clueless about what to do next. However, quitting medicine could turn out better than you have ever thought possible. And here is why you should get out …

This article is part of Hoover’s Med School Hell series. Med School Hell reveals the crazy truth about the crappiness of the US medical education and healthcare system … while making you laugh so hard, you’ll crap in your pants.

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