Applying to Medical School

This past week I spent in New York City, meeting with faculty and students and, in general, getting no sleep. It was great. It was “revisit” weekend at Cornell, where accepted students come and visit the school before picking the school they wish to attend this fall. Since many people reading this are not in the field, and I get asked often about the application process, I will give a brief recap of the medical application process:

1) Pre-reqs: As many know, most medical schools require the following: 2 semesters of Biology, 2 semesters of Chemistry, 2 semesters of Physics, and 2 semesters of Organic Chemistry. This is the core of what is required. I think some schools require random other things (notably math), but these are the main courses needed to study medicine. If you are applying, pick up a recent copy of “Medical School Admission Requirements” (MSAR). This book gives a full page on everything about each school, from MCAT scores to size of class to how grades are given and what percentage of students are accepted. As you will learn, name of school and rank don't mean as much as you would hope, so reading about each school is very important in choosing one. Where do you want to live? What type of people do you want to be around? What was your MCAT score? Are you interested in being in Academic Medicine? In general, if your goal is to do primary care practice, I would say save money and go to your state school. However, if you plan to be in Academic Medicine to some degree OR want to go into a very competitive specialty, then go to a "big-name" place (Stanford, Harvard, Cornell, Penn, Hopkins, etc). That being said, going to a school somewhere makes it more likely you'll do residency in that area (NE, Cali, etc). So consider that. Also, try to look at "match lists" of where students do residency. While it is true you can "match" from any school, it is MUCH easier to match at a big-name place if they have a relationship with your school. In other words, board scores and grades are the same, one kid is from Hopkins, which has always given us great students, and the other kid is from South Carolina Medical School, which we've never had a student from. In filling my house staff at the hospital, I'm going to go with what I know is a quality product. Also, there are MD schools and DO schools (Medical Doctor vs. Doctor of Osteopathy). While I do not have room to give the whole history here, suffice it to say that DO's are legally granted the same practicing rights as MD's. DO schools were originally formed by an MD with the idea that medicine should be more holistic and focus on the whole body. It was a good idea, but DO school has become the "less competitive" degree over the years. MCAT scores, GPAs, etc are significantly lower in DO students. In turn it is more difficult to match to a competitive specialty if you get a DO. However, if your goal is family medicine, it probably won't matter.

2) MCAT: At some point, every applicant must take the Medical Colleges Admissions Test (MCAT). This test, originally designed to cut down on the attrition rate in medical schools, now allows schools to admit a select group of students. In the 1920’s, 1st year medical students were failing at an alarming rate (attrition was as high as 50%). The first MCAT version was implemented in 1928, and by the 1940’s attrition was down to under 8%. Today’s MCAT has 4 timed sections: Physical Sciences (Chemistry, Physics), Verbal Reasoning, Writing Sample, and Biological Sciences (Biology, Organic). PS, VR, and BS are all scored from 1-15 (low-high). These are then combined to give your total score. The writing sample is graded J-T (low-high), but is not really looked at unless 1) it is really low, or 2) you are applying to a Canadian medical school. Score wise, the exam is graded on a bell curve. So the average score per section is around 8. The average total score of all people that sit for the MCAT is about 24. The average student that gets into medical school scores about a 30-31, depending on the year. In general, the lower end of the spectrum for MD schools have average MCAT scores around 27-28, while the higher-end of the spectrum are schools that have an average of 34-35. In general, you probably will not get into medical school if you have a 26 OR less than 8 on any one section. Also, if you score 34-35, then you can apply to any school in America, as many of the other factors will now become important. In other words, 34-35 is around 95th percentile, so if you score between 35-45, the chances of schools "caring" about your MCAT goes way down; it is the difference between 95th and 99.99th percentile. Most students should study 300-500 hours for this exam, and many students will be forced to take it more than once. There are numerous practice exams on AAMC's website. In fact, if you are curious, you can go take MCAT 3R on the AAMC website for free. Good luck! This is considered by many to be the hardest part of getting in. Personally, I would recommend using "Examkrackers" study books. I by no means had a great SAT score (1250), but studied for 2-3 months and managed a 34 on the MCAT. Again, it's my "n of 1" experience, but I have also tutored many MCAT students with Examkrackers and now have many students in different medical schools.

3) “Other experiences” matter. Schools like to see that you are involved in things besides studying. Who wants a doctor that is very smart but knows nothing about the world and thus cannot relate to patients? Also, medical schools look for shadowing experiences that “validate” your interest in medicine. (How do you know you want to do medicine if you’ve never been around it?) Although there are no requirements, applicants should try to get meaningful experiences that they can talk about during an interview. (Consequently, “meaningful” experiences generally help the applicant begin deciding on specialty and school best for that.) Try to shadow a range of physicians and pick the physician's brain as you shadow about current medical problems. Don't be afraid to argue - they are people just like you! Just make sure you are polite and diplomatic about your views; and always back your views up with DATA! (In other words, don't argue unless you really can back it up; but it's ok to have an opinion and discuss it.)

4) Research experience. Although not a pre-req, many schools like to see some involvement in research, as the job of a physician is at the very least to keep up with the cutting edge research in his/her field. Try to spend at least one summer in a research lab. Really get to know the research so that you can meaningfully talk about it. Also, try to get a poster presentation out of some part of the research. Also, the lab PI could be a very valuable letter of rec.

5) AMCAS application. The applicant will apply via a computer-system two summers before matriculating (so apply summer 2009 to begin fall of 2010). On this application, you basically give curriculum vitae or resume. You also write a personal statement and list all grades, schools, experiences, etc. At this point you also check which schools you will be applying to. (I applied to 17 schools at this point.)

6) Secondary applications. Each school will get your application and then request that you fill out a “secondary” specific to that school. These range from one simple page to 6 long essays. (I filled out 12 secondary applications.)

7) After this, you send in recommendations from professors and physicians. If you are unsure as to how good the letter of rec will be, find a different person to write it! These letters of rec should be full of comments as to how outstanding and unique you are. A great letter of rec won’t get you in on its own, but a lukewarm letter could sink you.

8) Now you just wait on an interview. Interviews are from September to March. Interviews are extremely fun. This is usually a whole day where they take you around the school and all the major facilities, hospitals, etc. You also usually get to meet other like-minded applicants and students and get a “feel” as to whether you would like it there. (I received invitations to and took interviews at 10 schools.) Although it is hard, try to relax and have fun with interviews. You should also come prepared with questions about the school – you should interview them as well. Also, pick up a copy of the “Pfizer Medical School Manual” by Mike Magee. Use the potential interview questions in this book to prep.

9) You then wait for acceptance/rejection/waitlist letters. (I was accepted to 7, waitlisted at 2, rejected at 1.)

10) By mid-March most programs have decided whom they are inviting to come to school.

11) By mid-May applicants must decide on a program to attend.

12) Between March and May, applicants attend “revisit” weekends to decide where they would like to attend school. Not all schools have revisit, but many of the high-ranked schools that know their accepted students have more than one acceptance usually do so. (Last year I attended UCSD and Cornell revisits.)

13) Don’t forget that many students move off waiting lists and into schools between May and August.So, this past week I was in NY for Cornell’s revisit (and to look at housing). I will write more on the actual interviews I took last year in the next segment, as those experiences were full of humorous moments and interesting perspectives on schools.

This is by no means an exhaustive list! Please feel free to email me with other questions!