FAQ#14: Being an average medical student with financial difficulties

This was an email I received from M a while back. One of the first challenge to overcome when deciding to take the USMLE is self-doubt. The second challenge to overcome is the concern that their dreams are more than what their finances can handle. The third challenge to overcome is to forget all the anecdotal evidence of those who have failed while remembering those who succeeded.

Dear Dr. Jamie,

Hello. I've researched on USMLE and came across your blog. You are truly aspiring! I am a Malaysian medical student, studying in XXX.

I am wondering if you think I should apply for USMLE, given that my syllabus back in XXX is more of a problem-based learning system (and not lecture based)? I am always worried that my medical knowledge is not on par with the rest of my fellow classmates. Furthermore, I am not exactly the top scorer of my class. I dedicated a lot of my time studying, but will only score fairly (sometimes just passing, sometimes above average). Even so, do you think I should take USMLE? 

I know you mentioned that with time & motivation, one could compensate for the lack in memory & intelligence, but I'll be starting clinical rotations at the start of January, and I am quite worried I would be burnt out after my rotations and wouldn't dedicate as much time as I should. 

I wasn’t a top student as well when I started out with my USMLE journey. During my first two years of medical school, looking back at the percentile, I was actually below average. In my second year, I decided that I really wanted to go to the U.S. I started focusing 60-70% of my time in medical school studying for the USMLE. I realized that having good scores would get me a ticket to the U.S. I also realized that scoring well in medical school doesn’t mean much. In the end, anyone who passes, top scorer or not, gets to work as a doctor in Malaysia. However, doing well in the USMLE will allow me to get immediately into a specialization training program in the U.S. Fast forward many years later, I was thankful for the decision I made back then. While the top scorers in my medical school are still waiting for the government to offer them Masters position (which has more to do with connections, duration of service and racial quotas than merit), me, the below average student, is going to start subspecialization training.

Like you've mentioned in your blog, financial issue is a big factor and would deter us from taking the exam..it is indeed true. As an international medical student, I am paying alot more than the locals and other government sponsored students. I am worried that if I take the exams, my results would not be as good (below average/fail) & would make me feel that I've wasted my money. Or even if I did well in USMLE, I might not secure a spot in residency as well. My lecturer emphasised that it is getting tougher and tougher each year and not everyone could successfully matched in their residency program. I knew of a Singaporean senior who achieved 270 in USMLE Step 1 and still did not match. 

Not everyone would match. In terms of foreign applicants, there are around 12,000 each year, and you have to be better than 50% of them in order to match. In addition of USMLE scores, getting a position also depends on interview skills as well as specialties, which you choose. In the U.S., everything is almost transparent. Every year, the match statistics are released, and it reveals valuable information such as the number of applicants, probability of matching based on score and so on.

Looking at the chart below, you can see that for Foreign-trained physicians, the number of applicants has been around 12,000 per year. The probability of matching remains the same at around 50%, meaning that if you are in a class of 10, you will have to beat the other 5 to match.

This is another chart, which shows the probability of matching based on USMLE scores for a NON-US medical student in light green. I scored 240++, and I stood an 80% chance of matching. After receiving my Step 1 results, I immediately started my Step 2 CK preparation and also made more detailed plans to get into the U.S.

The reason I'm interested in USMLE is because there are more and more medical students all over the world, with very limited training slots/internships/residency places. Like everyone else, medical school is expensive and I am paying a large sum for tuition fees & cost of living. Inevitably, I would like to have a good job prospect to repay my student loan, etc. but I'm really worried about my future and the direction I'll be heading. Please kindly advice and I am sorry to bore you with such a long email.

Around 6-7 years ago when I made the decision to head to the U.S. I took the gamble and studied hard for the exam to improve my odds of matching. I knew that nothing was a 100% and no one can guarantee my entry into a training position. I justified paying for the exams by thinking that the cost of the USMLE process is peanuts compared to the cost of my medical school. However, the difference between being able to enter the U.S. specialization system and entering the Kementerian Kesihatan Malaysia workforce is huge.

If one of your main hesitation to take the USMLE is due to financial reasons, I would suggest that you consider taking one of the steps first. If you do really well in that step, take it as a sign that you should proceed with other steps. If you do poorly in that step, then stop your pursuit of the USMLE but be satisfied to know that at least you have tried.