For people who are thinking of a career in medicine

This is an Article by Helen Barkan - Ayka's Mom

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Not only “young people” can go to medical school: I was accepted at 31, and in my Dartmouth class there was a woman in her 40s, and in the class above us, a man in his early 50s. So all is possible.

Most of you already have excellent advice from your college premed counselors. But I might as well carry on about what it takes. I will try to be succinct.

Like with any endeavor, you have to consider three questions:

1. Why do I want this career?
2. Do I have what it takes?
3. What do I do if I do not get in?

If your answer to 1 is “I want to help people,” then forget it right away. Medicine is a craft and an artisanship, not unlike plumbing or accounting; it is a professional guild like any other, only it takes longer to train. If you are fascinated by the spectacle of the human body and mind, by disease, by potential cures, by science, then maybe medicine is right for you.

Before you invest in this idea, you have to be reminded that the prestige afforded to “The Doctor” is long gone, and practicing medicine in America is more and more difficult every year, due to bureaucracy, litigiousness, and decreasing remuneration. There is also an increasing burnout rate. Over 400 physicians in the US commit suicide every year. This is almost twice as many as in any comparable profession: lawyers, scientists, businessmen. Wonder why? I have purchased a text called Physician Suicide Letters on Kindle. It makes for depressing reading.

Next, 2. To get into medical school, you need to finish a 4-year college in America and have a bachelor’s degree — it does not have to be in the sciences, though it cannot be a BFA — and a set of requirements: usually a year of calculus, a year of physics, a semester of biology, another one of general chemistry, two semesters of organic chemistry, and an expository writing course. Your science GPA needs to be 3.2 or higher. Many medical schools use this number as a cutoff, which is not very smart, but so it is. You also need a reasonable score on the MCAT, the medical college admission test, which you start preparing for in your junior year and take early in your senior year, before you apply. MCAT cutoffs are murky, but over 505 is a must. Studying for the MCAT is simple and even pleasant: you buy as many question sets as you can, on paper or on screen, and do them an hour a day. The unpleasant part is scoring yourself and going over what you did wrong, but it is necessary. That is how you find your areas of weakness and bang at them, even with a textbook, if needed. If you are one of the older applicants, years out of college, a commercial preparatory course like Kaplan may be very useful.

You also need recommendations from your professors, but only if they are superb: a lukewarm recommendation is a killer. So when you ask for a reference, ask specifically: are you able to provide me with a very good one? Only ask professors who know you well. For college students, there is usually also a summary letter from your school’s premed advisor, but an older student can still use that service.

Research: it is optional. Very few students clone a protein or publish in Cell as undergraduates. It would help, for sure.

Community service: only if it is real. Admission committees have a wary eye for someone who did a perfunctory visit or two to a nursing home or a hospice, just to have the resume buffed. It is very obvious when community service or medical charity is real or contrived. It is also not required.

Kids — sorry, students — who worked their way through college get an additional merit point, as opposed to those rich ones who played tennis on Saturdays, after the student work-study folks served them eggs and bacon.

Given that you did well on the MCAT, your GPA is respectable, and you don’t sound like a broken record who wants to help people in your personal statement (the best personal statements are unrelated to medicine and describe a bright experience, like getting on the varsity team, or planting trees with grandpa) — consider money. $$$$. Alas. Very few medical schools give scholarships, and those go to absolutely superb and highly promising future scientists and leaders. If you are just plain good and average, you will be about $300K in debt after you are done with medical school. State schools cost less, but can actually be harder to get into, for that reason. Can you do it, money-wise? Do you want to do it? You will not be earning decent money until you finish your 3, 4, or more years of residency, and even then, new doctor salaries are unlikely to be over $150K a year, unless you are a dermatologist, an ENT, a neurosurgeon (EIGHT years of residency), or something like that.

If you still want to give it a go, do some research online on admission rates and average scores of several med school matriculating classes (there are about 150 medical colleges in the continental US, and the average class size is about 100 students), then split your applications like you did with college: “reach” or “dream” schools — no more than a couple; “solid” schools, which are good and where you have a chance — no fewer than 6 or 7; then about 10 “blanket” schools where you are sure you will get admitted. It is not worth applying to 50 schools, and it is expensive: you pay at least a couple of hundred dollars per application.

Do your papers and wait for an interview invitation. Remember: med schools only invite those they are sure they want, so the interview is a bit of a formality, but an important one. It is more for you than for the school. You mingle with current students and with the faculty; you try to get the feel of the place and the town: after all, this is where you might spend your next 4 years of life. However, do your homework on the med schools prior to the interview: you will be asked “why us,” and silly stuff like “how do you see yourself 10 years from now,” and more. Be personable, ask questions about the program, and also see if the current students look happy or glum.

Now, the hard one, 3: some people will not get in — over 60% of applicants will not make it. The numbers schools give are deceiving, because they cite acceptance rates with a bias, but I don’t want to get into that. Suppose you have not had a single interview, or were waitlisted and dumped. What do you do?

You can try again. Find a meaningful job, spend a year improving your scores, if you think they can be improved, and apply again. However, two times is enough. If you missed twice, chances are you will not get lucky the third time. I have seen sad people in the Kaplan preparation course; they keep trying and trying, sometimes for several years, before they give up.

What are other options for those who failed to get into a US medical school?

1) DO, or chiropractic school. It is less competitive and cheaper, and the education is virtually identical to MD programs, with some nice extras thrown in: manipulations. If you do well, you can go to a regular residency after DO school, and you will be somewhat disadvantaged when applying, but minimally. I know DO orthopedic surgeons, neurologists, and dermatologists. It is something to consider.

2) An offshore school, like in Hungary or Ireland, Mexico, or the Caribbean. Admission is pretty much guaranteed, the fees are minimal, and you later take the regular boards and apply for residency in the US. The obvious disadvantage is travel and being away, plus being at a competitive disadvantage compared to American medical graduates — initially. Later, it all evens out if you do well.

3) Consider a different field; it could be medical or paramedical. Nursing is a possibility — there is a huge shortage of nurses, and there is a road to NP (nurse practitioner), who is independent. PA-C, ditto: certified physician assistant. Various technologists — US, EEG, MRI — are also in demand: they earn good money, and they have a relatively short and cheap or free training to endure.

If you have any questions, I am here to answer them. Good luck and godspeed.

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