The medical school admissions rant that must be written

The BBQ Pit
1

Well fuck, here we are approaching the end of my third round of medical school admissions. I’ve been trying desperately to gain entrance to a medical school for the past three years. I’ll spare everyone the details of my past and application, but I’ll simply say that I perceived my application (this year) to be extremely competitive and of course I think that I deserved a spot in an MD program, specifically a spot in my state’s only medical school. Also, let’s define some parameters about what I feel the med-school admissions process should be: fair to people with varying socioeconomic backgrounds, transparent, and ultimately capable of selecting candidates that will make good doctors. I’ll concede right now that this isn’t an easy task and I don’t envy med-school admissions offices for their charge. And, now with three cycles of MD admissions under my belt, I’ll share my personal opinion on medical school admissions being a bunch of bullshit.

Let’s begin with a discussion of cost. The MCAT costs $200. The AMCAS application (required common application) costs $200. Every school you apply to is $100-130 thereafter. If you get a chance to interview at a school it might cost from $200-500 in travel costs to attend that interview. It’s not cheap. Successful applicants typically apply to nearly 18 schools. Ridiculous. To maintain some semblance of fairness to people without the means to make this number of applications, AMCAS offers a fee waiver for 10 schools for individuals with combined personal and parental incomes less than about $37,000 dollars. And the offspring of two full-time janitors are now privileged? Anyway, out of some (apparently) outdated sense of fairness, I decided to restrict myself to 10 applications because that was the number offered by the AMCAS fee waiver. In retrospect I think I should have applied to almost twice that number to bring myself in line with the typical number of applications by successful applicants.

Also, despite the fact that I applied at least six-weeks ahead of primary-application deadlines, I paid AMCAS $200 and waited 12 weeks for them to attribute every single undergraduate class at CU-Boulder to the fall semester of 2005. And then tell the schools that I screwed up the primary application. And, of course, because my application was sitting in a warehouse in Washington D.C. for 12 weeks, I had to obtain extensions from two schools for my secondary applications and scramble to submit the rest on time.

Moving on: one might presume that the individuals running medical school admissions offices would not be complete screw ups. You would be wrong. In fact, if I had to guess, I would state that medical school admissions office hold a rather inordinately large proportion of complete screw ups. Take Emory for example, every contact with their office revealed that they’d love to hear whatever I had to say in writing, but unfortunately the admissions inbox contained a backlog of over 2,000 unread e-mails.

Similarly, UCSD, Drexel, and Wake Forest all assured me that I was in their, “interview pool,” or “hold for interview,” but eventually I received e-mails informing me, ‘ooops, we ran out of time! Better luck next year!’ Granted, this isn’t exactly pure fuckupism, perhaps it’s just a nicer way of stating that they consider me nominally appropriate for an interview, but in that case it’s an unfortunate lack of transparency on the part of the admissions offices. This isn’t Harvard undergrad admissions where secretive machinations need to be at work to select for the crème with a certain je nois se qua and keep out the, “too Jewish” (actual comment on a Harvard candidate from an interviewer in the 1980’s). Instead, I think a simple formula of GPA, science GPA, MCAT, and hours in clinical and research experience should guide admissions. So why does the process involve so much hand waiving about leadership and humanism supposedly divined via interviews? Why do I get e-mails like this from admissions deans?

“Thank you for letting me know of your continuing interest in our school. I will be sure to note it in your file for our committee. There is not much I can tell you in terms of strengthening your likelihood of acceptance from the alternate list, as you are a very strong candidate already.”

Seriously, what the hell does that sentence even mean? And this gets to the most exasperating aspect of the late stage of this process, the infamous, “alternate pool.” No, it’s not a list. A list would imply an ordinate ranking of candidates and by extrapolating from historical trends in how many offers were made to people on the alternate list and one’s position on the list one might actually be able to make reasonable predictions on the likelihood of eventually receiving an offer from any of these schools. I’ve actually had admissions officers tell me with a straight face that, “everyone in the alternate pool has an equal chance of getting in.”

Jeebus H. Christ on a cracker, am I actually to believe that upon every e-mail that a school receives from a candidate declining a spot at the school, the committee gets together in the bat-cave to carefully mull over producing a “balanced” medical school class with an appropriate number of golfers, former scientists, tuba-players, neo-conservatives, and people with “life-experience” in chaining themselves to trees? Puh-lease.

And the only redeeming aspect to any of this? Last Thursday I received an e-mail beginning, “I am truly delighted to offer you a place in the 2007 entering class of the Temple University School of Medicine.”

Thank god.

Seriously.

Temple was my fourth choice among the schools I interviewed at, and I still hope to hear back positively from my local school; “you are going to be on the bubble.” Nonetheless, it is hard for me to express the apprehension turning to despair every time I checked my e-mail for the past three months, simply hoping that somehow I would be seeing an e-mail from a school making an offer. With every passing day over the past seven years I have grown more and more certain that medicine was the best career option for me. Knowing that I’ll have the chance to study and practice it is a joy unparalleled in my life.

The only advice that I can provide to others is that med-school admissions is an expensive, stochastic and time-consuming process. Apply early, apply widely. Start donating plasma now.

2

I wrote this rant in 1986. However, at the time I was taking a course in college in Medical Anthropology and for the final paper we had to “take an Anthropologic view of the American medical system”. With the kind of screw you disdain reserved only for a frustrated senior in college, with a broken leg and on crutches from January to May, who had applied to 21 Medical Schools, and was currently admitted to none and on the alternate list at 11, I proceeded to pour out all of my frustration in an excoriating expose of the medical school admissions process. It was returned to me with a single comment:
*I hope this isn’t true-A * .

A week before graduation I did get into medical school, and now I remind you of an old joke:

Q-What do you call the person who graduates last in his class from the worst medical school in the country?

A-Doctor.

Let me be one of the first to congratulate you. From here on it’s downhill (in more ways than one :)).

-Psychobunny, MD

3

Good job, threemae! The lack of transparency is incredibly annoying, and present not just in med school but also in undergrad admissions. Whenever I see an admissions official vapidly spouting nonsense about “unquantifiable factors,” I hear “plausible deniability.” Fortunately, I won’t have to be in your position for another…two years. Ack.

4

This is why I keep telling people to apply to graduate school. You get roughly the same amount of sleep, but you’re paid to be there (in many fields, anyway) and the application process is way easier.

Glad to hear it worked out though.

5

But now you’re in! I had to apply twice, which isn’t so bad these days. But I also had to take the MCAT twice because my first set of scores expired which sucked. After I got in I spent a very satisfying afternoon going through all the paper I had stacked up from the process (MCAT review notes, umpteen drafts of my personal statement, copies of every secondary app I submitted, etc) and tossing it all in the recycling bin. Very freeing. I highly recommend it. Now I’m coming up on residency applications which I’m sure will be just as bad.

6

I’m glad you got into a school you wanted.

This is the same thing we go through on job hunt, only without the extra application fee costs. You just never know whether they’ve even read your credentials before sending you the canned, “Thanks for applying. Go piss up a rope.” I have a folder full of those canned replys just for the amusement factor. Amusing because I’m working, of course.

7

great rant, and congrats on getting into Temple. If you need info on Philly, send me a PM.

8

My cat’s name is Mittens.

Congrats, threemae!

9

As someone planning on applying to grad school next year, just reading that made me nervous.

Congrats on the admission, though! What a relief. I hope my inevitable ranting next year has a happy ending too.

10

Congratulations threemae!

I hope (I guess…) to be going through this in the next 5 years or so, and I’m terrified.

And in the interest of keepin’ it Pitty…

I’m a non-trad student. I didn’t decide for sure I wanted to be a doctor until I was 24. I had a crazy period in my early adulthood and my previous college transcripts are not good.

I work to support myself, and have for years. I finally now have a good enough job that I can afford to work only 24-32 hours a week. That job is in a hospital, working with doctors, nurses, lab techs and most importantly patients.

I watch the doctors and nurses on the floor and I know who the good ones are. Even if they are hard to work with for me I can tell which ones are good with their patients. I’ve had 5.5 years of patient care experience.

I see premed students, and some of them frighten the hell out of me. They’re becoming doctors because someone told them they should, and they’re incredibly anal-retentive. They’re maintaining 4.0 in all subjects. I could do that, if I worked harder. But I still manage to keep my job, some semblence of a social life, and a 3.7 cum. GPA.

And it fucking kills me that I might not have a good chance because of that 3.3 I got in 2nd quarter Gen Chem. Or some other random part that looks bad on paper but has nothing to do with how good I’ll be as a doctor.

And the money - the MCAT prep. The applications. The flying. They want you to come into med school with no credit card debt (because you can’t work) but how the fuck am I supposed to afford that shit without getting scurvy from eating Top Ramen all the time?

Aiiiiiieeeeee!

11

Congratulations!

The med school admissions process makes more sense when you realize that at least half of med school applicants are insane. They are single-minded and excessively driven. If the admissions people were more open about why they pick some people and not others, the next year’s applicants would tailor themselves and their applications to that supposed ideal. What they really want is for you to be your own person, rather than a walking padded resume.

I don’t know how many times I heard my pre-med friends talk about doing this thing or that thing just to look good to the med school admissions people. I figured–correctly, for the most part–that I would be better off seeking out activities that really interested me instead of ones that looked good.

(The most extreme example: I knew one girl who majored in Chemical Engineering even though she hated it, because she heard that 100% of the CE graduates who had applied to med school in the last four years had gotten in. I tried to point out the obvious fallacy, but she would have none of it. Last I heard, she was a very happily employed chemical engineer.)

The high cost of subsequent submissions is for the same reason. If each additional school were $10, you’d seriously have a lot of kids (with the help of their parents, and probably some expensive middleman services) applying to every medical school in the country. It’s horrible to penalize the non-insane applicants (i.e., you) for that, but I’m sure the application service people sleep well at night on their giant piles of money.

If it makes you feel better, the residency match is designed specifically to avoid this sort of insanity, and while it has its own issues, it’s remarkably streamlined and bullshit-free. The medical licensure process, on the other hand…it’s easier to apply to be the next Pope than to be a physician in the state of KY, even if you’re not already Catholic.

12

If it makes you feel any better I’m also a non-traditional student with less than perfect grades and I got in. You just have to tailor your admissions process to where you think you can get in rather than your dream school. Good MCAT scores to counteract the grades will also help.

13

Stochastic is the ideal word to describe this process. In its defense, I’ve heard that none of the measurable quantities in your med school application predicts how you will do in med school or residency, so couple that with the high ratio of applicants to positions and you can see the dilemma faced by the admissions committee.

This doesn’t excuse the viciousness of the system, however. I don’t think that the admissions people are really that incompetent (although it is rumored that med school administrators tend to be failed academic physicians), rather that the severe asymmetry of power leads to predictable behavioral patters – basically, inhumane treatment. This is reinforced by the desperation and psychotic single-mindedness of many of the applicants.

And what makes it even worse is that admissions is really the only barrier to becoming a doctor – after that, there is essentially nothing preventing even the most incompetent from practicing medicine (and boy have I met some scary med students). This gives applicants even more incentive to do anything it takes to get in.

The flip side is that now that you’re in, you’ll never again have to worry about whether you’ll get to your goal. You may not end up precisely where you’d like, but you will be able to practice medicine for certain. Even better, you’ll never again have people treat you like a dog.

14

And see, this is the assumption I’ve been operating on - that if I do what I like, do reasonably well, and cut out as much bullshit as possible (ie, be my fabulous self) that everything will come together.

Why can’t there be a different system for the non- (or less- ) insane applicants? Why?

15

Well, other than your spouse and patients and the insurance gatekeepers and …

Nah. They pet the dog.

:slight_smile: (Actually I love being at work. At home no one cares what I have to say.)

Admission is somewhat random. There are more qualified people than there are positions. Higher grades beyond a certain point does not predict a better doctor. Higher MCATs don’t. So the better schools really are looking instead to create a diverse class of qualified people. One of my classmates was a poetry major. (His coop notes always ended with some poetry too.) We had an accountant. Of course we also had the hardcore science wonks. And there was me going “How the Hell did they let me in?” Best advice: do the science and math you need to do but otherwise find a true passion and follow it. It will show and you will stand out.

-Always happy to have been in the middle third which was 90% of the class.

16

Congratulations on getting into med school.

I’m convinced it’s all just a big weed out process anyhow. If you aren’t willing to pay for the application fees, the MCAT-prep courses, travel, etc, then they figure you aren’t committed. It’s kind of like how they throw scientists/pre-meds into general chemistry the first semester of year one - if you can’t make that then you’re not cut out for the field.