Fourth Year, and the Summer With No Income

Part of The Training Years. The last year of medical school costs several thousand dollars, and then there is a gap of two to three months between your final loan disbursement and your first residency paycheck. That gap is a cash crisis for anyone without a family backstop, and it arrives on schedule every single year.

The short version

Two separate problems, and the second one is worse.

Fourth year has its own bill: exams, applications, away rotations, and a match fee. Several thousand dollars, spread across a year in which you're still borrowing.

Then the money stops before the money starts. You graduate in May. Your final loan disbursement was months earlier. Residency pay usually begins in late July or August, with the first paycheck sometimes two weeks after that. In between you sign a lease in a new city, pay a deposit, move, and eat, on nothing.

Both are manageable if you see them coming. Neither is if you don't.

What fourth year actually costs

Figures below are for the current cycle and change annually; the point is the shape rather than the total.

Step 2 CK. $695 for the exam.¹ Prep on top, and most people buy something.

Step 3. $955, and although most people take it during intern year rather than fourth year, some take it earlier.¹

ERAS applications. $11 each for the first thirty programs in a specialty, then $30 each beyond that.² The tiering matters: a list of forty programs isn't four-thirds the cost of thirty, it is roughly double. Applying to two specialties doubles the base again.

Transcripts. Around $80 to send your USMLE transcript, plus your school's own fee.²

The Match. $85 to register with the NRMP for up to twenty ranked programs, then $30 per program beyond twenty. Registering after the January deadline adds $50, and the couples match adds $45 per partner.³

Away rotations, if your specialty expects them. The application fee is the small part. The real cost is four weeks of rent in another city while you're still paying rent at home, and getting there.

Interviews. This is the one piece of genuinely good news. Residency interviews are now largely virtual, which removed what used to be the largest single line on this list. Budget for a decent camera position and a shirt, and for the occasional in-person second look.

Add it up and a straightforward single-specialty cycle runs a few thousand dollars. A competitive specialty with a long list, two away rotations, and a couples match runs several times that.

The gap, which is the real problem

Here is the sequence, and it's the same every year.

Your last loan disbursement is scheduled against your last term of enrollment, so the money arrives in the spring at the latest. You graduate in May. Your residency contract starts in late June or July. Payroll runs monthly or every two weeks and the first paycheck typically lands in late July or August.

So the gap is eight to twelve weeks with no income and no more student loan, and it's the most expensive stretch of the whole decade, because it contains:

a security deposit and first month's rent in a city you're moving to,
the move itself,
a car, or getting one there,
state licensure and DEA registration paperwork,
board review materials for intern year,
and eating, for three months.

For a student whose parents can float them for a summer, this is an inconvenience. For a student who has been the one sending money home, it's the moment the plan can actually break, and it's the reason a small number of people arrive at residency having borrowed at credit-card rates to get there.

What to do about it, in order

1. Ask your school's financial aid office in the fall of fourth year, not the spring. Ask exactly two things: when is my final disbursement, and does the school have an emergency or bridge fund. Many do, they're quiet about them, and they're usually first-come.

2. Understand what a residency-and-relocation loan is before you need one. They exist specifically for this gap. They are private, credit-based loans, so everything in Can You Actually Get the Money? about underwriting and cosigners applies. They are also genuinely rare: about 1% of graduating students carry one, at a median of $7,250.⁴ Read that number twice, because it means two things at once. Most people don't need one. And the ones who do are borrowing about the size of the gap described above.

3. Save from your last disbursement deliberately. It costs nothing and it solves the problem outright. Your spring disbursement is calculated to cover your living costs through the end of enrollment, not through August. If you can hold back even a portion of it for the summer, you have solved the problem yourself, and you have to decide that in February rather than in June.

4. Ask your program when the first paycheck actually lands, and whether they offer a signing advance or a relocation stipend. Some do. Nobody volunteers it.

5. Time the lease. A start date of 1 July costs you a month of rent before you're paid. If the program starts on 20 June, ask whether a 15 June start on the lease is possible, and ask about short-term options for the first few weeks.

The FLI version, which is the reason this page exists

If you're first-generation or low-income (FLI) and the one who has been sending money home, this summer is the hardest scheduling problem on the whole path, because it's the one stretch where you have neither a loan nor a salary and the obligations don't pause.

Name it to your family in the winter, not in June. A conversation in February about three months with no income is a planning conversation. The same conversation in June is a crisis. Being a Breadwinner AND a Premed is about the earlier version of the same problem, and the same principle applies: the people around you can usually adjust if they're given time, and can't if they aren't.

Working through the gap is possible but small. Some graduates pick up a few weeks of work between graduation and orientation. It's real money and it isn't much of it, and it competes with moving. Don't build the plan on it.

And this is the last hard stretch of its kind. From your first residency paycheck onward, money comes in every month for the rest of your working life. That isn't a small thing to be able to say to someone who has spent a decade with none of it.

What belongs to other pages

What lands in your account once the paychecks start is A Resident's Paycheck. What the loans do during the training years is Loans, in Plain English and The Personal Finance Crash Course. The application-cycle bill four years earlier is What It Costs Just to Apply, which is the same shape of problem at the other end. If you are weighing a dedicated research year, its costs are a different shape and are in The Year That Costs an Attending's Year.

Three things to remember

Fourth year has a bill, and the ERAS tiering means a long list costs much more than a short one.
The gap is eight to twelve weeks with no income, and it contains a deposit and a move.
The fix is a decision made in February, about how much of your last disbursement to keep for the summer.

References

Application, examination, and match fees are set annually and change every cycle. Disbursement schedules, payroll dates, and the availability of bridge funds or relocation stipends are set by your school and your program and differ substantially. Confirm all of it with your own financial aid office and your program coordinator. This is educational information, not financial advice. Last reviewed: 2026-08-06

USMLE examination fees for 2026: Step 1 $695, Step 2 CK $695, Step 3 $955. Federation of State Medical Boards and USMLE. https://www.usmle.org/apply-exams · https://www.fsmb.org/step-3/step-3-application-fees/ ↩ ↩²
ERAS application fees for the 2026 season: $11 per program for the first 30 in a specialty and $30 per program beyond that, plus the USMLE transcript fee of $80 and the school's own transcript fee. University of Washington School of Medicine residency application cost summary. https://education.uwmedicine.org/career-advising/applying-to-residency/application-costs/ ⟳ ERAS fees are set per season; verify the current season's schedule before budgeting. ↩ ↩²
NRMP Main Residency Match fees: $85 registration covering up to 20 ranked program codes, $30 per additional code, a $50 late registration fee, and $45 per partner for the couples match. https://www.nrmp.org/intro-to-the-match/match-fees/ ↩
Residency and relocation loans are carried by about 1% of graduating students at a median of $7,250. AAMC Medical Student Education: Debt, Costs, and Loan Repayment Fact Card for the Class of 2025, October 2025. https://store.aamc.org/downloadable/download/sample/sample_id/652/ ↩