Medical School in the USA 2026: MD vs DO, MCAT, Costs, Duration

In the United States, medicine is a graduate degree. Unlike in most countries, you can't start medical school straight from high school. You first earn a bachelor's degree, take the MCAT, apply through a centralized application service, and then spend four years in an MD or DO program. Residency follows, and only then can you practice independently.

The path at a glance

Medical school itself is four years. With undergraduate study and residency, most US physicians spend a decade or more in training after high school.

MD vs DO

The US trains two kinds of fully licensed physicians.

Students at both LCME-accredited MD programs and COCA-accredited DO programs are eligible for the USMLE. There are 48 accredited colleges of osteopathic medicine teaching at 75 locations in 36 states.

In the 2026 Match, 93.5% of US MD seniors and 93.2% of US DO seniors matched to a first-year (PGY-1) position. Both degrees lead to residency in every specialty. Some highly competitive programs still differ in how often they take DO graduates. Look at program-level data before you decide.

How to choose:

• Philosophy and fit. If a hands-on, whole-person approach and osteopathic manipulative treatment appeal to you, DO schools may suit you.
• Career goals. For primary care, both routes are well established. For highly competitive specialties, research each program's history with MD and DO applicants.
• Exams. DO students who want to keep all doors open often take both the COMLEX-USA and the USMLE. That adds workload.
• Application strategy. Many applicants apply to both MD and DO schools in the same cycle.

Prerequisites

There is no single required major. Most schools expect coursework in biology, general and organic chemistry, physics and biochemistry, often with English, mathematics or statistics, and psychology or sociology. Requirements vary, so check each school.

Beyond grades, schools look for:

• Clinical experience, such as shadowing, scribing, EMT work or volunteering in healthcare settings
• Service to others, especially to underserved communities
• Research, which is important for research-heavy schools and MD-PhD programs
• Leadership and teamwork
• Letters of recommendation from faculty and supervisors

The MCAT

The Medical College Admission Test (MCAT) is run by the AAMC and required by nearly all US medical schools. It has four sections:

The total is the sum of the four section scores and is centered on 500. There is no penalty for guessing. The three science sections each get 95 minutes and CARS gets 90 minutes. Total seated time, with optional breaks, is about seven and a half hours.

MCAT preparation tips:

1. Take a diagnostic under timed conditions to find weak sections.
2. Make CARS a daily habit. Reading comprehension improves slowly. Practice a few passages every day.
3. Use official AAMC practice materials for realistic difficulty.
4. Build stamina with full-length practice tests.
5. Plan your test date so scores arrive before you submit applications.

What score is "competitive" depends on the school. Look at school-level data rather than general rules of thumb.

Applying: AMCAS, AACOMAS and the cycle

US applications run through centralized services:

• AMCAS (American Medical College Application Service, run by the AAMC) for most MD programs
• AACOMAS (run by AACOM) for DO programs. You complete one application and choose which colleges receive it
• TMDSAS for public medical schools in Texas

The 2026–2027 AACOMAS fee is $198 including one college, plus $60 for each additional college.

A typical application cycle:

1. Spring: MCAT done, personal statement drafted, letters requested.
2. Early summer: Primary application submitted. Applying early matters, because many schools review on a rolling basis.
3. Summer: Secondary (school-specific) applications with essays.
4. Autumn to spring: Interviews, often including multiple mini-interviews (MMIs).
5. From autumn onward: Acceptances, waitlists and a final decision.

Common application mistakes:

• Submitting late in the cycle
• A generic personal statement that doesn't explain why medicine
• Too few or too similar schools on the list
• Weak or late letters of recommendation
• Thin clinical experience

Costs and debt

US medical school is expensive:

Cost of attendance includes tuition, fees, health insurance and living expenses. Your actual cost depends on the school, in-state or out-of-state status, location and scholarships.

Ways to reduce costs:

• In-state public schools usually cost less for residents.
• Need-based and merit scholarships from schools
• Service-commitment programs, such as military scholarships or public health service programs, which pay costs in exchange for years of service
• Loan repayment and forgiveness programs tied to working in underserved areas
• AAMC fee assistance for MCAT and AMCAS costs, for eligible applicants

A sample premed timeline

There is no official schedule. A common pattern for a student who wants to start medical school right after college:

Many applicants now take one or more "gap years" to strengthen clinical experience, research or finances before applying. That is common and does not count against you if you use the time well.

Is medicine the right path?

Before committing years and money, test the decision:

• Shadow physicians in several specialties. You will see the daily reality, not the TV version.
• Work in a clinical role. Scribing, EMT or medical assistant work shows you patient care up close.
• Talk to residents. They can describe training honestly, including hours and debt.
• Compare other health careers. Nursing, physician assistant and other routes lead to patient care with shorter training. See the NCLEX-RN guide and the jobs outlook.

Inside medical school

Years 1–2 (preclinical): Foundational sciences, often taught by organ system, plus early clinical skills. MD students usually take USMLE Step 1 around the end of this phase. See the USMLE Step 1 guide and How to Study for Step 1.

Years 3–4 (clinical): Core rotations (internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, family medicine, neurology) and electives. Students take USMLE Step 2 CK during this phase. See the Step 2 CK guide. In year 4, students apply for residency and take part in the Match.

DO students follow a similar structure with the COMLEX-USA series, often alongside the USMLE.

Practicing questions from day one makes Step 1 far less stressful. You can try free Step 1 questions on the MediFlow USMLE Step 1 course page and use the app on the go.

Residency and beyond

After graduation, physicians complete residency. The 2026 NRMP Main Residency Match offered 44,344 positions, a record. Residency length depends on the specialty: shorter for primary care fields, longer for surgical specialties. Fellowships add subspecialty training.

For long-term job prospects, see Physician and Nurse Jobs Outlook in the USA.

For international students and graduates

• Studying in the US: Some MD and DO schools accept international applicants, but many don't, and federal loans are generally for US citizens and permanent residents.
• Already a doctor abroad: You don't repeat medical school. The route is ECFMG Certification, USMLE and residency. See IMG Pathway to US Residency.
• Considering nursing instead: See the NCLEX-RN guide.

A note for Canadian students

Canadian students often apply to both Canadian and US schools. Some US schools treat Canadian applicants like other international applicants, while others consider them more like domestic applicants. Policies differ by school. The MCAT is used by most medical schools in both countries. For licensing exams, remember that from 2025 the USMLE counts examinees from Canadian schools together with non-US examinees in its performance data, which matters when you compare published pass rates.

Checklist for applicants

• Bachelor's degree on track with prerequisite courses
• Clinical, service and (where relevant) research experience
• MCAT taken with time to spare before applications
• School list built from school-level data
• Personal statement and letters ready by spring
• Primary application submitted early in the cycle
• Secondaries returned quickly, interview preparation done
• Financial plan: cost of attendance, aid, scholarships