If you’ve been on the internet recently, you might have seen doctors around the world celebrating Match Day. It’s when medical school graduates find out if they got into a US residency program. But here’s the thing: the journey to matching costs a lot of money.
We asked two Nigerian doctors who got matched to break down what it means to match, the steps involved, and how much Nigerian doctors spend to secure a US residency.
But first, let’s explain a few things:
What Does It Mean to “Match” as a Nigerian Doctor?
- Matching means securing a spot in a US residency program, a crucial step after medical school for doctors who want to specialise and earn more.
- Without it, you remain a general medical practitioner or a medical officer.
- Residency is where doctors get hands-on training in their chosen speciality, and it typically lasts 3-7 years, depending on the field.
- Doctors become medical consultants after completing their residency program.
The USMLE: Your Ticket to Residency
- The United States Medical Licensing Examination (USMLE) is a three-step exam for every medical graduate, including Nigerian doctors, who want to practice in the US.
- It qualifies them for the foreign ECFMG certification.
- Passing a foreign licensing exam is non-negotiable for any doctor looking to practice abroad.
- It’s like a conversion process for your medical degree, and the USMLE is required to apply for US residency programs through the National Resident Matching Program (NRMP).
The Three Steps of the USMLE:
- Step 1: Can be taken after your second year of medical school.
- Step 2 CK (Clinical Knowledge): Usually taken in the final year of med school or after graduation.
- Step 3: Taken after ECFMG certification, typically during or before residency.
Nigerian doctors can take the first two steps as undergraduates, while Step 3 is done after starting clinical practice.
What It Cost Me to Match Into a US Medical Residency at 24
Dr Timilehin Okeya, 24, UNILAG Medical Graduate
I officially became a doctor in January 2025 after completing my medical degree at the University of Lagos. I haven’t started practising yet, but on Monday, March 17, I got matched into a US residency program to specialise in Emergency Medicine.
The journey to this point started in September 2021, just as I resumed my fourth year of medical school. That was when the US Medical Licensing Examination (USMLE) announced a major change—Step 1, which had always been a scored exam, would now be graded as simply “pass” or “fail,” starting from January 2022. This meant that Step 1 scores would no longer be disclosed to residency programs.
Before this change, Step 1 was the most important part of a residency application, especially for international medical graduates like me. Residency programs heavily relied on it to compare applicants, and a high score could make you stand out. The pass mark was 194/300, but anything above 240 was considered competitive.
For U.S. medical students, this change wasn’t as big of a deal since they were already studying within the system where they’d apply for residency. However, for international students, it was a huge disadvantage. We lost one of our biggest opportunities to prove we were just as qualified. With Step 1 now pass/fail, residency programs could no longer use it to rank applicants, making Step 2, which was still a scored exam, the new deciding factor.
At this point, I wasn’t even sure I wanted to practise in the US. However, a senior colleague who had just taken the USMLE advised me to take the Step 1 exam before the change made things even more competitive. So, I bought the UWorld study materials in September and started preparing.
Unfortunately, I wasn’t fully prepared to take the Step 1 exam when the grading system change took effect in January 2022, so I took it right after my fourth-year MBBS exams in March 2022.
Getting funding for the process
My family played a major role in ensuring I could go through with the matching process. My parents had started saving for my exams in 2021. At the time, a dollar was exchanged for around ₦415, and Nigerian banks allowed up to $4,000 (₦1.6m) per quarter in foreign exchange transactions.
By March 2022, when it was time to pay for my USMLE Step 1 exam and US clinical rotation, we exchanged approximately $4,000 to cover the estimated expenses. Convincing my parents wasn’t easy, but they trusted my judgment and saw the bigger picture. Once they committed, it became a major thing we were doing in the house; everyone in the family invested in making it happen.
Taking the USMLE Step 1: $2,369
I prepared for Step 1 alongside my 400-level exams, which made that year the toughest of my time in medical school. Step 1 was my first real exposure to the US medical system in terms of studying, and it was intense. Luckily, my best friend Raphael Eloka, who also matched into a Radiology program, was preparing at the same time. So, it wasn’t as tough as it would have been if I were the only one in my class doing it.
Step 1 is an 8-hour exam with 7 question blocks, each lasting an hour, plus an additional hour for breaks.
The exam covers the basics of medicine, similar to what we study in our second and third years of medical school in Nigeria, with a few additional courses. The challenge is that their questioning style and curriculum are completely different from ours. So, if you’re taking it while in school, you’re essentially studying two different systems at once. It’s tough but doable.
There were no exam centres in Nigeria, so I travelled to Ghana to write it at a CBT centre. Here’s what it cost me:
- ECFMG Registration Fee: $150
- Step 1 Exam Fee: $1,150
- Study Materials: $469
- Flight & Accommodation Costs to Ghana: $600
Total: $2,369 ≅ ₦983,135 (March 2022 naira rates).
I had done enough practice exams to feel confident that I’d pass, and I did. I was very ecstatic.
Immediately after my exams in March, I had to do a one-month elective clinical rotation before moving fully into my 500 level.
I could have done my rotation at a hospital in Lagos, but completing a clinical rotation in the US would significantly boost my chances for the matching process. And that’s exactly what I did.
Medical Rotation in the US: $2,200
UNILAG partnered with Northwestern University Hospital in Chicago, allowing students to do clinical rotations there for free. My best friend Raphael and I were the only two Nigerians selected out of many applicants.
I’d confirmed my selection while preparing for the Step 1 exams and had already received my US visa. So, after the exams, I travelled to the US for my rotation. This was still March 2022.
The rotation was my major turning point.
Medicine in the US was nothing like what I was used to in my previous rotations as a medical student in Nigeria. Resources were abundant, robotic surgeries were a thing, and as students, we were actually allowed to assist in procedures. It was a completely different level of learning, and I knew that this was where I wanted to train.
Regardless of what happened, I decided I would commit to the process, write all the subsequent steps, and do everything I needed to qualify for a residency program in the US.
The rotation was a very challenging experience, but it also gave me the opportunity to network with other Nigerian residents — connections that later became instrumental in my matching process.
Although the clinical rotation program was free, I had to cover other expenses:
- US Visa: $500
- Medical Insurance: $250
- Flight & Travel Costs: $1,200
- Cost of Living in the US (One Month): $250
Total: $2,200 = ₦913,000 (March 2022 naira rates).
Taking the USMLE Step 2: $2,219
I started preparing for my Step 2 exam during the eight-month ASUU strike in 2022 and took it just before my 500-level MBBS exams in October 2023.
By then, the naira had jumped from ₦415 to ₦747 per dollar, an 80% increase from the rate we exchanged in 2022.
Step 2 was easier because I was already familiar with the exam structure. I knew how to manage my time, balance studying with school, and handle the pressure. Honestly, anyone who has made it past their first two years of medical school is already in the top 1% — with the right guidance, you can ace any exam.
I had to travel to Ghana again to write Step 2 at a CBT centre. Here’s what it cost me:
- Step 1 Exam Fee: $1,150
- Study Materials: $469
- Flight & Travel Costs to Ghana: $600
Total: $2,219 ≅ ₦1.6 Million (October 2023 Naira rates).
I passed my Step 2 exams with a score of 244 out of 300 and received my results in two weeks. With that, I was ready to start applying for the match process.
The Match Process: What it cost to apply to 66 residency programs
In September 2024, during my final year of medical school, I applied for residency in the US through the National Resident Matching Program (NRMP). My CV was strong, but I needed to improve my chances, so I secured another free, short clinical rotation.
This opportunity came through a Nigerian doctor, Dr. Nsikak, whom I connected with on Twitter. She had matched into Emergency Medicine, the same speciality I was interested in. I reached out, and she agreed to mentor me. I got the clinical rotation opportunity through her at Lehigh Valley Health Network (LVHN) in Pennsylvania.
To make the most of my trip, I also attended an Emergency Medicine conference around the same time.
Cost of Rotation & Conference
- Travel & accommodation for rotation: $1,765
- Visa application for rotation: $500
- Conference fees: $450
- Living expenses for 3 weeks: $500
- Total: $3,215 ≅ ₦4.9 million (September 2024 rates).
Applying for the Match
Residency applications are expensive, and I had to be strategic.
- ERAS Token ($165): To start my residency application, I needed to register on the Electronic Residency Application Service (ERAS), the official platform for submitting applications. The ERAS token is a one-time fee to open an account and access the system.
- Occupational English Proficiency Test ($400): Since I studied medicine in Nigeria, I had to prove my English proficiency by taking an approved test. This test is mandatory for international medical graduates applying for residency in the US.
- ECFMG Pathway 6 Certification ($900): This ECFMG (Educational Commission for Foreign Medical Graduates) certification is required to verify my clinical skills and communication abilities meet U.S. medical standards.
- Application to 66 residency programs ($1,600): Every residency program requires an application fee. The more programs you apply to, the higher your chances and the higher the cost. Since I had a limited budget, I could only afford to apply to 66 programs out of 300. Most international applicants are advised to apply to 150+ programs to boost their chances, which costs around $4,000, but I took a leap of faith.
To ensure I applied strategically, I researched and networked with hospital residents I met during my clinical rotations and medical conferences. I spoke with doctors who had matched in previous years, learned about the hospitals and residency programs they got into, and used their advice to refine my list. I focused on programs that sponsored visas and had a track record of accepting international graduates.
Out of 66, I got eight interviews and was successfully matched into a residency program. My residency starts in July 2025.
Total Cost for the Match Process
- Match Application: $3,065 ≅ ₦4.7 million (September 2024 rates).
- Grand Total: I spent $12,668 altogether, which was around ₦13 million at the time, but at today’s exchange rate, it’s valued at ₦19.4 million.
The hardest part of the journey was the uncertainty, financial strain, physical stress and mental gymnastics. It was exhausting and one hell of a marathon. Completing the process requires a lot of grit and mental fortitude, but if you can endure it, it’s worth it.
I’m grateful I don’t have to deal with student loans that take a massive cut of many US medical residents’ income. Residency salaries range from $60,000 to $80,000 a year, which is decent, and the earning potential is even better post-residency.
What It Cost to Apply to 95 Residency Programs
Dr Mariam Bello, 28, General Medical Practioner (₦400k/Month)
I currently work as a general practitioner at a hospital in Lagos, but on Monday, March 17, I got matched to a US residency program to specialise in internal medicine.
It’s been a long time coming. I earned my medical degree from Afe Babalola University (ABUAD) in 2020, completed my medical house job in 2022 and finished NYSC in 2023. The next step in my career was residency, but I didn’t want to do it in Nigeria. So, I got a job as a general practitioner while preparing for my USMLE exams on the side.
At first, I considered the UK route. I took the IELTS English test and planned to register for the UK PLAB exams, which would allow me to practice as a medical officer in the UK. But I missed the application window in 2022. I took that as a sign to pivot to the USMLE instead. Besides, PLAB would only make me a medical officer in the UK; I’d still have to apply for residency later.
I wanted to go straight into residency.
Everyone said the USMLE was complex and expensive and that I should take the “easier” UK route first. PLAB exams would have cost significantly less than the USMLE, with two parts totalling £1,271 (≅ ₦2.5million).
But I had already made up my mind. When I told my parents about my decision in 2022, they agreed to support me financially.
My USMLE Journey
I started preparing for the Step 1 exam in May 2023, but I found the study materials abstract, so I paid an online tutor $85/month for six months. In December, I travelled to Ghana for the exam, took it, and passed.
If I had a US visa, I would have travelled for clinical experience to increase my chances. However, the cheapest voluntary rotation I could find cost $2,000 for four weeks. It was too expensive to ask my parents for, considering my other expenses. In March 2024, I found an alternative: tele-rotation and completed a two-month online clinical rotation with an endocrinologist in Oklahoma for $250/month.
By June 2024, I had moved on to Step 2. Preparing was easier since I was already familiar with the system. However, I only had three months to study because that was the latest I could take the exam and still apply for residency that year. I sat for Step 2 exams in August 2024 and scored 232 out of 300. It felt disappointing because I had aimed for 260, and a score of at least 240 is generally recommended to boost your chances.
I even considered not applying for residency again that year because the application window was just a month away in September. But thanks to my support system — friends and family who encouraged me, I pushed through.
The Match Process
I applied to 95 residency programs in internal medicine, got three interviews and eventually matched into one.
Cost of residency applications:
- $11 per application for the first 30 programs → $330
- $30 per application for the next 65 programs → $1,950
- Total → $2,280
- Grand Total → $8,405 (USMLE Exams & Match process).
- This was approximately ₦12.9 million (September 2024 rates).
Residency interviews are less about what you’ve done and more about how well you sell yourself. They want a compelling story.
One of the programs that interviewed me liked my volunteering experience. For others, it’s research publications, high Step 2 scores, or strong letters of recommendation from consultants. In my case, I believe my recommendation letters, volunteering experience, personal statement, and how well I presented myself in my CV and interviews made the difference.
My residency starts in July. After everything, I can finally say it was worth it.
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