What's so stressful about
beginning medical school?
Even before entering medical school, potential students have already entered a zero-sum game.
start >
Just applying to medical school comes at a cost.
Try to guess how much...
continue >
continue >
Preparing for the MCAT: There's more to the cost than sitting for the exam
It is not just the MCAT that bears a significant cost. The application process itself costs more than many people would assume.
In 2025 the cost of the MCAT was $335, with many students taking the tests multiple times. Due to the importance of scoring well and above average, many students invest in MCAT prep courses or materials costing anywhere between $300-$3000. Students, on average, spend between $2000-$3500 for preparation and sitting for the MCAT.
continue >
(Le, 2025)
How many applications did prospective students turn in during different times periods?
2006
2024
1960
1960
2006
2024
Prospective students applied to 3 or more schools
Prospective students applied to 1 or 2 schools
Prospective students applied to an average of 18 schools
continue >
(Eley & Slavin, 2023)
Osteopathic medicine takes a holistic approach, using manual manipulation alongside diagnosis, medication, and surgery. Osteopathic schools train doctors of osteopathy (DOs).
Allopathic medicine focuses on diagnosis and counteracting pathology through the use of medication and surgery. Allopathic schools produce medical doctors (MDs).
+ info
+ info
continue >
(Fiorino, 2025)
MDs and DOs
Both MDs and DOs are licensed medical practitioners in the United States. Allopathic and Osteopathic medical education consists of four years of education, the first two being pre-clinical years taking place in the instution , followed by clinical rotations across several major specialties.
continue >
(Fiorino, 2025)
The American Medical College Application Service (AMCAS) is used for applying to allopathic schools.
The cost in 2025 was $175 for the first school and $45 for each additional school.
continue >
(Le, 2025)
The American Association of Colleges of Osteopathic Medicine Application Service (AACOMAS) is used for applying to osteopathic schools.
The cost in 2025 was $195 for the first school and $50 for each additional school.
continue >
(Le, 2025)
The major exception to these two primary application services is the Texas Medical & Dental Schools Application Service (TMDSAS) which is used by Texas residents or by those applying to schools in Texas. As of 2025, TMDSAS had a flat rate of $220 regardless of how many schools are applied to in Texas.
continue >
(Le, 2025)
Secondary application fees
Once a school has received a primary application, most schools send a secondary application with school-specific questions and essays for applicants to write. Along with these secondary applications come additional fees, somewhere between $75 - $150 each. Without submitting the secondary application and corresponding application fee, applications are not considered by schools.
continue >
(Le, 2025)
Many schools also implement situational judgement tests beyond the MCAT: Electronic assessments
Along with Casper is the Duet, a no-cost game used to match values of the applicant with those of the school.
The Casper is a 90-110 minute online assessment used to assess the soft skills necessary in ethical and personal dilemmas. The cost for this test is $60 for the first school and $16 for each additional school.
continue >
(Le, 2025)
Following the secondary application, students are often invited to interview in person or online.
This is an additional cost.
continue >
Travel costs
If interviewed in person, there are costs associated with flights, boarding, transportation at the location of the school, and meals while visiting. Whether in person or online, students will want to look their best, and many buy a new wardrobe for this occasion.
continue >
(Mehta, 2025)
Once a student is accepted, most schools require students to pay a non-refundable deposit. Many, but not all, schools will allow this deposit to go toward tuition.
Students may pay multiple deposits while in the decision-making process to make sure they have a seat at their preferred school if they receive offers from secondary choices first.
These deposits vary from $100 to $1500.
continue >
(Le, 2025)
A lot happens prior to medical school beginning. Medical school itself is a stressful adjustment for both allopathic and osteopathic students alike.
Subjects, or “blocks” change from anatomy, biochemistry, pathology, pharmacology, physiology, and microbiology. In a matter of weeks students, are expected to change their learning style to a more self-directed manner of learning. The expectation is multiple hours of learning outside of the classroom, with some suggestions being more than 25 hours per week.
This intense academic load often leads to stress, anxiety, and burnout.
The volume and pace of the material is rapid and dense, with little redundancy in what is learned.
(Fares et al., 2016)
continue >
Curriculum Differences
DO students attend additional hours for training in Osteopathic Manipulative Medicine (OMM), a unique aspect of osteopathic training focused on manual manipulation of the human body to treat ailments. This coursework is added to the existing biomedical expectations, not replacing them.
continue >
(Jin et al., 2026)
Assessments
Because of the rapid pace of medical school, assessment is frequent in the form of block exams, quizzes, and anatomy practicals. These tests can impact progression or class rank. Some experts believe this pattern of constant evaluation contributes to chronic rather than episodic stress.
(Fares et al., 2016)
continue >
Remediation and dismissal
Students are expected to maintain a high level of performance in the pre-clinical years. Failure to maintain such performance can result in:
Dismissal is usually the final step after repeated academic failures, though it can also occur when a student repeatedly demonstrates unprofessional conduct or violation of academic integrity policies.
- Remediating a course or courses to demonstrate knowledge and proficiency
- Repeating a year to fill necessary information gaps
- Dismissal from the institution
The student remains responsible for financial debt incurred, even if they must attend additional classes or do not complete their education.
continue >
Remediation and dismissal
Students are expected to maintain a high level of performance in the pre-clinical years. Failure to maintain such performance can result in:
Dismissal is usually the final step after repeated academic failures, though it can also occur when a student repeatedly demonstrates unprofessional conduct or violation of academic integrity policies.
- Remediating a course or courses to demonstrate knowledge and proficiency
- Repeating a year to fill necessary information gaps
- Dismissal from the institution
The student remains responsible for financial debt incurred, even if they must attend additional classes or do not complete their education.
continue >
The Interpersonal-Psychological Theory of Suicide
Acquired capability of suicide
Thwarted Belongingness
Perceived Burdensomeness
Repeated exposure to injury and death can foster an acquired capability of suicide, and early toxicology knowledge may help explain physicians’ elevated rates of suicide by self‑poisoning.
Students may feel a sense of burdensomeness, specifically related to the financial debt incurred to attend school.
Students may feel thwarted belongingness because of the competitive nature of medical school or because of progressing through school at a different pace of peers. Friend groups may be broken up because of remediation, repeating, or dismissals.
(Lynch et al., 2022; Makhija et al., 2025; Solibieda et al., 2021)
continue >
All these stressors serve as unique factors that could result in a student’s risk of death by suicide, but stressors do not end when time in the classroom ends. Following time in the classroom, students face continued, different stressors.
continue >
<< Post-Quiz >>
continue >
continue >
continue >
continue >
continue >
continue >
continue >
continue >
References
Baniadam, K., Elkadi, S., Towfighi, P., Aminpour, N., Sutariya, R., & Chen, H. C. (2023). The impact on medical student stress in relation to a change in USMLE Step 1 examination score reporting to pass/fail. Medical Science Educator, 33(2), 401–407. https://doi.org/10.1007/s40670-023-01749-4
Buckvar-Kelts, L., Ludwig, A., & Chen, H. C. (2023). The view from the medical school dean's office. In A. Kalet, & C. L. Chou (Eds.), Remediation in medical education: A mid-course correction (2nd ed., pp. 251–265). Springer International Publishing. 10.1007/978-3-031-32404-8 Eley, D. S., & Slavin, S. J. (2023). Medical student mental health – the intransigent global dilemma: Contributors and potential solutions. Medical Teacher, 46(2), 156–161. 10.1080/0142159x.2023.2279909
Fares, J., Al Tabosh, H., Saadeddin, Z., El Mouhayyar, C., & Aridi, H. (2016). Stress, burnout and coping strategies in preclinical medical students. North American Journal of Medical Sciences, 8(2), 75. https://doi.org/10.4103/1947-2714.177299
Fiorino, A. (2025, July 30). The Difference Between M.D. and D.O. Degrees. U.S. News & World Report. Retrieved Feb 28, 2026, from https:////www.usnews.com/education/articles/the-difference-between-md-and-do-degrees
Guerrasio, J., Chou, C. A., Tariq, S., & Jones, L. (2023). When the prognosis is poor: Documentation, the law, and when and how to give up. In A. Kalet, & C. L. Chou (Eds.), Remediation in medical education: A mid-course correction (2nd ed., pp. 488–512). Springer International Publishing. 10.1007/978-3-031-32404-8 Jin, R., Sandella, J. M., Gross, G. A., Dawley, M., Boulet, J., Mao, X., & Wang, Y. (2026). Effect of COMLEX-USA Level 1 pass/fail score reporting on student stress, test preparation, and performance. Journal of Osteopathic Medicine, Advance online publicationhttps://doi.org/10.1515/jom-2025-0032
References
Lynch, T., Bathe, V. C., & Jobes, D. A. (2022). The content of patient-identified suicidal drivers within CAMS treatment planning. Archives of Suicide Research, 28(1), 411–417. 10.1080/13811118.2022.2151958 Makhija, H., Davidson, J. E., Lee, K. C., Barnes, A., Choflet, A., & Zisook, S. (2025). National incidence of physician suicide and associated features. JAMA Psychiatry, 82(5), 451–458. 10.1001/jamapsychiatry.2024.4816 Mehta, S. (2025, May 30). How Much Does Applying to Medical School Cost? MedSchoolCoach. Retrieved Jan 8, 2026, from https://www.medschoolcoach.com/how-much-does-applying-to-medical-school-cost/ Mills, L. M., Stenfors, T., Duffy, M., Young, J. Q., Boscardin, C., ten Cate, O., & O’Sullivan, P. S. (2024). “When you’re in it, it feels like it’s everything”: Medical students’ experience of failure and remediation in the United States and the Netherlands. Academic Medicine, 99(11), 1254–1259. 10.1097/acm.0000000000005845
Moore, K., Williams, S., & Thomas, L. (2023). Trainee well-being and remediation. In A. Kalet, & C. L. Chou (Eds.), Remediation in medical education: A mid-course correction (2nd ed., pp. 223–236). Springer International Publishing. 10.1007/978-3-031-32404-8
Solibieda, A., Rotsaert, M., & Loas, G. (2021). The interpersonal–psychological theory of suicide in medical students: Comparisons of individuals without suicidality, ideators, and planners. International Journal of Environmental Research and Public Health, , 11526. 10.3390/ijerph Tackett, S., Jeyaraju, M., Moore, J., Hudder, A., Yingling, S., Park, Y. S., & Grichanik, M. (2022). Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams. BMC Medical Education, 22(1), 16. https://doi.org/10.1186/s12909-021-03055-2
What's so stressful about beginning medical school?
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Transcript
What's so stressful about
beginning medical school?
Even before entering medical school, potential students have already entered a zero-sum game.
start >
Just applying to medical school comes at a cost.
Try to guess how much...
continue >
continue >
Preparing for the MCAT: There's more to the cost than sitting for the exam
It is not just the MCAT that bears a significant cost. The application process itself costs more than many people would assume.
In 2025 the cost of the MCAT was $335, with many students taking the tests multiple times. Due to the importance of scoring well and above average, many students invest in MCAT prep courses or materials costing anywhere between $300-$3000. Students, on average, spend between $2000-$3500 for preparation and sitting for the MCAT.
continue >
(Le, 2025)
How many applications did prospective students turn in during different times periods?
2006
2024
1960
1960
2006
2024
Prospective students applied to 3 or more schools
Prospective students applied to 1 or 2 schools
Prospective students applied to an average of 18 schools
continue >
(Eley & Slavin, 2023)
Osteopathic medicine takes a holistic approach, using manual manipulation alongside diagnosis, medication, and surgery. Osteopathic schools train doctors of osteopathy (DOs).
Allopathic medicine focuses on diagnosis and counteracting pathology through the use of medication and surgery. Allopathic schools produce medical doctors (MDs).
+ info
+ info
continue >
(Fiorino, 2025)
MDs and DOs
Both MDs and DOs are licensed medical practitioners in the United States. Allopathic and Osteopathic medical education consists of four years of education, the first two being pre-clinical years taking place in the instution , followed by clinical rotations across several major specialties.
continue >
(Fiorino, 2025)
The American Medical College Application Service (AMCAS) is used for applying to allopathic schools.
The cost in 2025 was $175 for the first school and $45 for each additional school.
continue >
(Le, 2025)
The American Association of Colleges of Osteopathic Medicine Application Service (AACOMAS) is used for applying to osteopathic schools.
The cost in 2025 was $195 for the first school and $50 for each additional school.
continue >
(Le, 2025)
The major exception to these two primary application services is the Texas Medical & Dental Schools Application Service (TMDSAS) which is used by Texas residents or by those applying to schools in Texas. As of 2025, TMDSAS had a flat rate of $220 regardless of how many schools are applied to in Texas.
continue >
(Le, 2025)
Secondary application fees
Once a school has received a primary application, most schools send a secondary application with school-specific questions and essays for applicants to write. Along with these secondary applications come additional fees, somewhere between $75 - $150 each. Without submitting the secondary application and corresponding application fee, applications are not considered by schools.
continue >
(Le, 2025)
Many schools also implement situational judgement tests beyond the MCAT: Electronic assessments
Along with Casper is the Duet, a no-cost game used to match values of the applicant with those of the school.
The Casper is a 90-110 minute online assessment used to assess the soft skills necessary in ethical and personal dilemmas. The cost for this test is $60 for the first school and $16 for each additional school.
continue >
(Le, 2025)
Following the secondary application, students are often invited to interview in person or online.
This is an additional cost.
continue >
Travel costs
If interviewed in person, there are costs associated with flights, boarding, transportation at the location of the school, and meals while visiting. Whether in person or online, students will want to look their best, and many buy a new wardrobe for this occasion.
continue >
(Mehta, 2025)
Once a student is accepted, most schools require students to pay a non-refundable deposit. Many, but not all, schools will allow this deposit to go toward tuition.
Students may pay multiple deposits while in the decision-making process to make sure they have a seat at their preferred school if they receive offers from secondary choices first.
These deposits vary from $100 to $1500.
continue >
(Le, 2025)
A lot happens prior to medical school beginning. Medical school itself is a stressful adjustment for both allopathic and osteopathic students alike.
Subjects, or “blocks” change from anatomy, biochemistry, pathology, pharmacology, physiology, and microbiology. In a matter of weeks students, are expected to change their learning style to a more self-directed manner of learning. The expectation is multiple hours of learning outside of the classroom, with some suggestions being more than 25 hours per week.
This intense academic load often leads to stress, anxiety, and burnout.
The volume and pace of the material is rapid and dense, with little redundancy in what is learned.
(Fares et al., 2016)
continue >
Curriculum Differences
DO students attend additional hours for training in Osteopathic Manipulative Medicine (OMM), a unique aspect of osteopathic training focused on manual manipulation of the human body to treat ailments. This coursework is added to the existing biomedical expectations, not replacing them.
continue >
(Jin et al., 2026)
Assessments
Because of the rapid pace of medical school, assessment is frequent in the form of block exams, quizzes, and anatomy practicals. These tests can impact progression or class rank. Some experts believe this pattern of constant evaluation contributes to chronic rather than episodic stress.
(Fares et al., 2016)
continue >
Remediation and dismissal
Students are expected to maintain a high level of performance in the pre-clinical years. Failure to maintain such performance can result in:
Dismissal is usually the final step after repeated academic failures, though it can also occur when a student repeatedly demonstrates unprofessional conduct or violation of academic integrity policies.
The student remains responsible for financial debt incurred, even if they must attend additional classes or do not complete their education.
continue >
Remediation and dismissal
Students are expected to maintain a high level of performance in the pre-clinical years. Failure to maintain such performance can result in:
Dismissal is usually the final step after repeated academic failures, though it can also occur when a student repeatedly demonstrates unprofessional conduct or violation of academic integrity policies.
The student remains responsible for financial debt incurred, even if they must attend additional classes or do not complete their education.
continue >
The Interpersonal-Psychological Theory of Suicide
Acquired capability of suicide
Thwarted Belongingness
Perceived Burdensomeness
Repeated exposure to injury and death can foster an acquired capability of suicide, and early toxicology knowledge may help explain physicians’ elevated rates of suicide by self‑poisoning.
Students may feel a sense of burdensomeness, specifically related to the financial debt incurred to attend school.
Students may feel thwarted belongingness because of the competitive nature of medical school or because of progressing through school at a different pace of peers. Friend groups may be broken up because of remediation, repeating, or dismissals.
(Lynch et al., 2022; Makhija et al., 2025; Solibieda et al., 2021)
continue >
All these stressors serve as unique factors that could result in a student’s risk of death by suicide, but stressors do not end when time in the classroom ends. Following time in the classroom, students face continued, different stressors.
continue >
<< Post-Quiz >>
continue >
continue >
continue >
continue >
continue >
continue >
continue >
continue >
References
Baniadam, K., Elkadi, S., Towfighi, P., Aminpour, N., Sutariya, R., & Chen, H. C. (2023). The impact on medical student stress in relation to a change in USMLE Step 1 examination score reporting to pass/fail. Medical Science Educator, 33(2), 401–407. https://doi.org/10.1007/s40670-023-01749-4 Buckvar-Kelts, L., Ludwig, A., & Chen, H. C. (2023). The view from the medical school dean's office. In A. Kalet, & C. L. Chou (Eds.), Remediation in medical education: A mid-course correction (2nd ed., pp. 251–265). Springer International Publishing. 10.1007/978-3-031-32404-8 Eley, D. S., & Slavin, S. J. (2023). Medical student mental health – the intransigent global dilemma: Contributors and potential solutions. Medical Teacher, 46(2), 156–161. 10.1080/0142159x.2023.2279909 Fares, J., Al Tabosh, H., Saadeddin, Z., El Mouhayyar, C., & Aridi, H. (2016). Stress, burnout and coping strategies in preclinical medical students. North American Journal of Medical Sciences, 8(2), 75. https://doi.org/10.4103/1947-2714.177299 Fiorino, A. (2025, July 30). The Difference Between M.D. and D.O. Degrees. U.S. News & World Report. Retrieved Feb 28, 2026, from https:////www.usnews.com/education/articles/the-difference-between-md-and-do-degrees Guerrasio, J., Chou, C. A., Tariq, S., & Jones, L. (2023). When the prognosis is poor: Documentation, the law, and when and how to give up. In A. Kalet, & C. L. Chou (Eds.), Remediation in medical education: A mid-course correction (2nd ed., pp. 488–512). Springer International Publishing. 10.1007/978-3-031-32404-8 Jin, R., Sandella, J. M., Gross, G. A., Dawley, M., Boulet, J., Mao, X., & Wang, Y. (2026). Effect of COMLEX-USA Level 1 pass/fail score reporting on student stress, test preparation, and performance. Journal of Osteopathic Medicine, Advance online publicationhttps://doi.org/10.1515/jom-2025-0032
References
Lynch, T., Bathe, V. C., & Jobes, D. A. (2022). The content of patient-identified suicidal drivers within CAMS treatment planning. Archives of Suicide Research, 28(1), 411–417. 10.1080/13811118.2022.2151958 Makhija, H., Davidson, J. E., Lee, K. C., Barnes, A., Choflet, A., & Zisook, S. (2025). National incidence of physician suicide and associated features. JAMA Psychiatry, 82(5), 451–458. 10.1001/jamapsychiatry.2024.4816 Mehta, S. (2025, May 30). How Much Does Applying to Medical School Cost? MedSchoolCoach. Retrieved Jan 8, 2026, from https://www.medschoolcoach.com/how-much-does-applying-to-medical-school-cost/ Mills, L. M., Stenfors, T., Duffy, M., Young, J. Q., Boscardin, C., ten Cate, O., & O’Sullivan, P. S. (2024). “When you’re in it, it feels like it’s everything”: Medical students’ experience of failure and remediation in the United States and the Netherlands. Academic Medicine, 99(11), 1254–1259. 10.1097/acm.0000000000005845 Moore, K., Williams, S., & Thomas, L. (2023). Trainee well-being and remediation. In A. Kalet, & C. L. Chou (Eds.), Remediation in medical education: A mid-course correction (2nd ed., pp. 223–236). Springer International Publishing. 10.1007/978-3-031-32404-8 Solibieda, A., Rotsaert, M., & Loas, G. (2021). The interpersonal–psychological theory of suicide in medical students: Comparisons of individuals without suicidality, ideators, and planners. International Journal of Environmental Research and Public Health, , 11526. 10.3390/ijerph Tackett, S., Jeyaraju, M., Moore, J., Hudder, A., Yingling, S., Park, Y. S., & Grichanik, M. (2022). Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams. BMC Medical Education, 22(1), 16. https://doi.org/10.1186/s12909-021-03055-2