How to get into medical school

Sep 22 2010 Published by under Medical education, Medicine

First, this piece is not a how-to guide for getting into medical school; the title is a shameless ploy.  But I use this ploy for good, and not for evil.  Through conversations with a number of non-medical colleagues, I've been forced to think a bit more about premedical and medical education.  A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and publicly examine the educational arc that turns undergrads into doctors.

Dear Pal:

I am an academic scientist at a university where I often teach and advise premedical students. I can't tell you how many kids come in to my office for advising sessions saying they want to go to medical school and then get upset that Yes, they really have to take Organic, Calc AND Biochemistry. Then it turns out that they got a D in one semester of intro Bio and Physics and are holding down a solid 2.3 GPA. WTF? I'm not going to tell them the can't go to med school (there may be places they can get in, for all I know), but last I checked it was kinda tough to get into med school.

Should I bother with the reality check? I kinda feel like that isn't my job.

Let's step back and examine the mechanics of becoming a doctor.  Becoming a doctor is a hard, long, expensive road.  Most practicing physicians have had four years of undergrad, four years of medical school, and at least three years of residency (and significantly more training for subspecialists).  In the U.S. the average medical school debt burden is about 156,000 USD.   That is somewhat above the average yearly salary for a primary care physician.  Paying back these loans has a non-trivial effect on quality of life and on specialty choice.  Given the hard work, the time, and the debt, no one should go into medicine unless they really believe they will enjoy it.

That's not something that's easy for an eighteen year old to figure out, but spending time with doctors and with patients is a good start.  Before I applied to medical school, I spent some time at a pediatric urology clinic at a major university hospital.   That experience help solidify my interest in medicine, but I've met others for whom these experiences have pushed them in the other direction.  But evaluating your own desire to enter a lifelong profession is always going to be an educated guess.  When you're 19 years old, it's impossible to know what the future may bring, but you should at least do some soul searching and gain some experiences that would help lead you to a good decision.

Once an undergrad has arrived at a (hopefully well thought out) decision to pursue medicine, they have some serious work ahead of them.  As my correspondent discovered, there are some adolescents who do not quite get the idea that prerequisites are required.  Medical schools usually publish their admission requirements online, so no one can plead ignorance.  Whether or not you agree with the standard premed coursework, it still has to be done, and done well.  The statistics on medical school admissions are clear: if you have lousy grades or lousy MCAT scores, your chances of getting into medical school are minimal.

Something noted by a number of my colleagues is that some medical students seem to approach pre-medical education as a checklist: get good grade in organic chemistry; volunteer in lab; help sick people at homeless shelter.  There's nothing inherently wrong with this, as long as the student realizes that there is a reason for these activities beyond gaining admission to medical school.  But they must also be cognizant of the future responsibilities they are taking on.

Just as I have little sympathy for a premed student who doesn't want to complete the required coursework, I have little sympathy for the common TA complaint that, "those pre-med gunners only care about the grade and don't really care about redox reactions."  It would be terrific if all pre-meds loved all science,  but sometimes it is enough understand the material enough to do well.  That is a minimum, and as an undergraduate advisor, I do think it is your responsibility to tell a student early on that, like it or not, medical school admission comes with a rigorous set of required course work, and that this course work must be done well to have any reasonable hope of being admitted to medical school.

No one likes to hear that they aren't progressing well toward a desired goal, but if you want to pursue medicine for the right reasons, and cannot succeed in the required coursework, there are other vocations that are both interesting and altruistic.  There are also resources available at most universities to help students who aren't succeeding.  I would rather help someone alter their dreams while they are young.  While an undergrad advisor shouldn't tell a student they can't be a doctor, they can show them the stats and tell them they are unlikely to get into med school.   If the student is still committed, then they need to make every effort to improve their grades to become competitive.

17 responses so far

  • proflikesubstance says:

    It is also pretty important that the realize that 'getting in' is not the end goal and that they are committing to years of hard work just to get to the point where they can practice their desired vocation. It's not like binge dieting to get to a certain weight - without change in lifestyle, these students are not going to be able to hack it even if they manage to get into med school.

    • PalMD says:

      Yes. This.

      The checklist approach isn't bad in and of itself but students must remember that they are committing to an ethically, financially, and energy-demanding life, one that will require---absolutely require, not just as an ideal, but on paper---continuing, rigorous education.

    • Vicki says:

      Actually, it sounds like it is like binge dieting: if they stop once they reach the labeled endpoint (med school admission, or a given weight) they won't have what they wanted (being a doctor, or staying at that weight).

  • Dorothea says:

    This is a great post. I will have to consider adapting it for academic librarianship.

  • JM_Shep says:

    I agree. It is much better to tell an undergrad, as early as possible, what they will need to do to accomplish their goals. That way they have plenty of time to take some classes to find something else that will work better for them if they don't think they can make it through to med school, or they have plenty of time to make sure they do well in the areas they need to get into med school.

    I also had to laugh and smile when you said this: “those pre-med gunners only care about the grade and don’t really care about redox reactions.” The same goes for most biology students. I never liked chemistry, organic or otherwise, but I had to pass it to graduate, and I wanted a good grade. On the other hand, my coworker who got his degree in biochem decided to double major in chemistry because he liked the requisite chemistry classes better. You could also replace "redox reactions" with anything regarding physics or math, or maybe even English...

  • Dr. Dredd says:

    Ah, this brings back memories. My overall GPA and science-course GPA were in the mid-3's, but my MCAT scores were.... average. I mean, 8 Verbal, 9 Chem/Physics, 10 Bio. Exactly national average, which was the kiss of death where I went to college. Needless to say, I sweated it (and applied to a LOT of schools), but got in. As a practicing primary care physician almost 20 years later, I wonder if it was worth it, but I digress.

    I guess what I'm trying to say is that if one part of the application is somehow deficient (e.g. grades OR MCAT or extracurriculars), you can probably make it work if you really beef up the rest. If more than one part is deficient, it's probably a no-go.

  • JustaTech says:

    So what about those of us who want to go into health-related fields? I stopped seriously considering med school when I was in high school; I just don't have the temperament for medicine. What I really want is Public Health. So I work the lab jobs I can get and apply for an MPH and Master's of Epi at the only local school, where I was told that right now they are only interested in applicants who already have some kind of doctorate. And that just makes me want to scream. You already have a PhD, MD, DDS, DVM! Why can't I have this little master's?

    And in this economy, none of the city or state agencies are hiring. Unless you already have an advanced degree. It's a vicious cycle.

  • Dianne says:

    Hmm...I got a C- in a physics class, held a barely respectible 3.x (where x represents a number I don't remember) and still got into medical school. The physics class in question was the advanced mechanics class and was considered a way over the top thing for a non-major* to take. Also I seem to think my MCATs were pretty good, though I don't remember the numbers. Slightly higher than average for people admitted to med school I think, but by no means stunning. The moral being, you can take some risks, take classes that aren't easy for you, explore options, and still get into med school. Or decide to do something else, if that turns out to be the right answer for you.

    * I was considering physics at one point. Come to think of it, I think it was that class that eventually made me decide it wasn't for me.

  • Nathan Myers says:

    Those C students can be come Homeopaths, or cable installers. There's something out there for everyone.

  • csjoshi says:

    Hey. I got to agree with that. Over here in Singapore where we have a british system, the mechanics are a little different. I wrote my own little guide here ( http://csjoshi.blogspot.com/2010/03/quick-and-dirty-guide-to-getting-to-med.html ) when my juniors started bugging me for advice. Maybe your Asian/English readers might find it useful!

    Cheers
    csjoshi

  • Emily says:

    I agree with your post, insofar as it addresses those that have not fully, intellectually or emotionally, accepted the academic challenges incorporated into the path to getting a medical degree. However, as my experience has mostly been with the "pre-med gunners that only care about the grade and not about redox reactions," I wanted to speak a little to your points on this -- since they are the majority of people that, because of the way the current system work, actually DO get into medical school and become doctors.

    I think it's just patently wrong to assume that someone who has thought it through and is approaching the medical requirements as a checklist is going to realize "that there is a reason for these activities beyond going to medical school." I'm not saying that thinking of the requirements as a checklist necessarily prevents this behavior -- I know of many that were able to strike this balance -- but it definitely does not PROMOTE a cognizance of the greater responsibility that you will be taking on as a physician or even encourage basic respect of your classmates (and teachers), who might be enjoying their basic science classes, perhaps even the redox reactions, and not want their class/studying/labtime be taken up by a pre-med arguing with the professor over a point or two on their grade, or complaining about how the class curve is going to screw with their GPA, or trying to get the TA to spend all their time with them to try and make their lab score better.

    I don't happen to think that the above described behaviors make people better doctors, but they are the common by-product of this demanding pre-medical curriculum that we consider necessary to master before one can enter medical school. So, I do think that we need to acknowledge that the pre-medical curriculum as it stands is a convention. As a science major, I would never have given up my basic science knowledge for the world, but I am unsure whether all of my classmates necessarily had to go through the same training. Given the "gunner" and grade-focused personality that it can encourage, I feel that it is a major contributor to why the US has so many subspecialty surgeons and so few primary care doctors and psychiatrists.

    Some schools have started offering programs that waived the pre-med requirements for those that demonstrate sufficient dedication towards becoming doctors early-on (http://www.nytimes.com/2010/07/30/nyregion/30medschools.html), and have found that more of these students tended towards psychiatry and primary care. I feel that more schools need to reexamine their assumptions about what constitutes an adequate premedical preparation. Because if "adequate" is all you need to become a good doctor, there does not seem to be the need for the GPA arms-race encouraged by the competitive medical school admissions process!

  • BB says:

    @JustaTech, my younger daughter like you wants a career in public health rather than medicine.
    There are schools that grant the MPH without the professional degree (the one at the university I'm associated with does). Also, depending upon what you want to do in public health, some schools offer a MSc or DrPH program that parallels the MPH. Talk to people at your local school and see if there isn't a progam there for you.

  • JJM says:

    Pal wrote "[I] have little sympathy for the common TA complaint that, “those pre-med gunners only care about the grade and don’t really care about redox reactions.” "

    In my experience, the ones that seemed likely to be accepted in med school were not the ones that were annoying. The TAs are usually bothered by the hopeless cases. I recall (when I was a chemistry professor) one excellent student who decided to go to medical school between his sophomore and junior years, and I teased him about becoming one of those. He said he didn't like them, either.

    Joe

  • Mark says:

    Hello,
    I recall my days as a premed. I was just studying for the grade and did not give a @#t about the actual learning. My goal was to just get into medical school, graduate , then finish residency, then practice. I wanted to make the most money I could. In a field where most doctors work extemely hard, I worked twice as hard as anyone. Looking back now, I wouldn't change a thing. I believe that going into medicine for the money is a perfectly legitimate reason for becoming a physician.
    Mark

  • kende says:

    Mark,
    I hope your not in my area! I truly feel sorry for you. Monkeypox, I agree. I love medicine, I am a paramedic who will be a physician someday, soon!