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Rising Costs Without Rising Match Rates: Orthopedic Surgery Application Spending Before and After the USMLE Step 1
Sahil Garg1, Kyle Jamar2, Carson Keeter2
1The Steadman Philippon Research Institute, Vail, Colorado; The Steadman Clinic, Vail, Colorado.
Journal of Surgical Education
|August 6, 2026
Summary
Orthopedic Surgery applicants do not improve their match success by spending more money. However, the transition to a Pass/Fail United States Medical Licensing Examination (USMLE) Step 1 exam has increased average applicant spending.
Area of Science:
- Orthopedic Surgery
- Medical Education
- Residency Match
Background:
- Orthopedic Surgery is a highly competitive medical specialty.
- Limited research exists on the financial aspects of the residency match process.
- Understanding applicant spending is crucial for evaluating match dynamics.
Purpose of the Study:
- To analyze trends in applicant spending and match rates in Orthopedic Surgery from 2017 to 2025.
- To assess the financial impact of the USMLE Step 1 Pass/Fail transition on applicants.
- To determine the relationship between spending and match success.
Main Methods:
- Retrospective analysis of self-reported financial data from the Texas STAR database (2017-2025).
- Included costs: ERAS fees, travel, housing, food, and second-look expenses.
- Statistical analysis compared spending between matched/unmatched and scored/Pass/Fail cohorts, adjusting for inflation.
Main Results:
- No significant difference in average spending between matched ($7063) and unmatched ($6984) applicants (p=0.80).
- Average applicant spending significantly increased from $6684 (scored era) to $7625 (Pass/Fail era) (p < 0.001).
- Match status was not associated with application cost in either era (p=0.20).
Conclusions:
- Increased spending does not correlate with higher Orthopedic Surgery match success.
- The USMLE Step 1 Pass/Fail transition has led to an approximate $941 increase in applicant costs.
- Applicants may expect to spend around $8000 on the application process.