Do not let what you cannot do interfere with what you can
Where to Apply
Applying to medical school is a highly competitive process, where the
demand outstrips the number of
available seats in U.S.
schools. The odds are even higher for nontraditional students. In 1998-1999, the
overall acceptance rate was about 42%. For applicants age 32 and older, the
acceptance rate was 26%. While this may partly be due to age discrimination, GPA
and MCAT scores seems to be the primary predictor.
Most students apply to about a dozen medical schools. The general rule is
that the less optimistic you are about your chances for acceptance, the more
schools you should apply to. I applied to about 24 programs in the Mid-Atlantic
area that have a strong primary care emphasis, interdisciplinary research
programs, and associations with other universities.
Estimating Your Chances
Getting into medical school is a complicated, and at times, a subjective
process. So it’s hard to estimate your chances of getting accepted. However,
many medical schools won’t even consider your application unless your GPA and
MCAT scores are above a certain threshold. Because of this, the most important
factors for getting into medical school are your GPA and MCAT scores.
To be in a realistic position, you should be in line with the average MCAT
scores and GPA for other matriculants, which is about a 3.6 GPA and 30 MCAT.
Check out the following link for
more details directly from AAMC. Note that less than 5% of students who enter medical school have a GPA of 3.0 or
less, and most of them probably have extenuating circumstances which offset
their low GPA. For example, a low GPA may be offset by a high MCAT score. If
your grades are below the averages listed here, you may want to consider ways to
improve your standing, which I discuss under the Second
Average MCAT scores and GPA for
Matriculating Medical Students in 1999.
Selecting a Medical School
State-funded medical schools where you are a legal resident should offer the
best chance of acceptance. In 1998, 27% of applicants matriculated at in-state
schools. These schools tend to reserve 90 percent or more of their seats for
in-state students. Any nonresidents accepted usually have exemplary credentials.
Private schools are another option. Do not disregard them because of higher
tuition costs. These schools are more financially independent and are not under
the same restrictions as state funded schools. Because of this, some will cater
to students who do not meet the qualifications of public state schools.
Other considerations are whether you will have to relocate, the urban/rural
character of the school, curriculum options, or special programs. Some schools
may give preference to students in the same general part of the country, such as
the Mid-Atlantic area. Find a characteristic you are interested in, such a
strong primary care emphasis, strong research programs, or associations with
Refer to the Medical School Admission
Requirements for detailed profiles on U.S. medical schools. In addition, the
AAMC has an online list
of medical schools in the U.S. and Canada.
Foreign Medical Schools
If you can’t get into a U.S. or Canadian medical school, you may want to
consider a foreign program in South
America, the Caribbean, or Europe. A person who does this is considered an FMG
or IMG (foreign/international medical graduate). The most important issue is whether you’ll be
able to practice medicine in the U.S. after you graduate. This means passing the
USMLE and getting into an AMA-approved residency in the U.S. When you visit a
school, talk to the admissions committee, current students, and former students
about their pass rate on the USMLE and find out what percentage of their
students get into AMA-approved residencies. Compare this to the success rates of
schools in the U.S. you looked at. In addition, some of these programs have very
sparse living conditions, so make sure you know what you’re getting into. Going
strictly by the numbers, only about 50% of IMGs will pass the USMLE, and of
those who pass, only about 50% will get into a residency in the U.S. This
amounts to a success rate of 25%, if you attend medical school in another
country. And if you are successful, you most likely will be limited to a community residency
program (as opposed to an academic program), which means your ability to get
into a competitive subspecialty or fellowship will be limited. These
numbers are the same for IMG students born in the U.S. as well as those who are
Doctor of Osteopathic Medicine (D.O.)
may be a reasonable alternative to becoming an allopathic Doctor of Medicine
(M.D.). Osteopathic doctors are the legal and professional equivalent of medical
doctors. They reportedly have a more holistic view of medicine, and with 50% of
them specializing in Family Medicine, a stronger primary care
focus. Osteopathic medical schools tend to look beyond the pure numbers, so they
have a reputation for being more receptive toward nontraditional students. The
average age of entering osteopathic students has been 26 years, which is higher
than the average of those accepted in allopathic medical schools (24 years old).
The main disadvantage is having to educate your patients and colleagues to the
fact that a DO is the equivalent of an MD. So if you have a strong ego or you
are overly sensitive to prejudice, this may not be a good choice. Another
consideration is that D.O. students
have a lower first-time pass rate on the USMLE (91% for M.D. students versus 72% for D.O.
students in 2003), and that it may be tougher for D.O.’s to get into competitive allopathic
residencies. There are several good books that describe what osteopathic
medicine is. I list a couple
on my web site, one
written by two osteopathic physicians (to give you an insider’s view), and the
other written by someone outside the osteopathic community (which may be more
Physician Assistant and Nurse Practitioner
Some older applicants may consider Physician
Assistant (PA) or Nurse
Practitioner (NP) programs as an alternative to medical school. They require
only 2 years of training, instead of the 7 or more years it takes to become a
doctor. There is no doubt that PA’s and NP’s provide an important function. Just
be careful that you become one for the right reasons. If you enjoy working in an
ancillary role with limited autonomy and responsibility, then becoming a PA or
NP may be the right decision for you. The PA’s and NP’s who develop a
proficiency outside the basic skills of a physician, or who provide niche services
that are not economical for a physician to perform, seem especially satisfied
with their career choice.
However, if you feel that becoming a PA or NP will be a shortcut to being “just
like a doctor“, you may be making a mistake. In whatever specialty area you
work, there will always be significant limits on what you know and on what you
are able to do. As a PA or NP, your clinical responsibilities will always be
under the direction of a physician, you likely will only be able to diagnose and treat the more basic cases, you
won’t be able to become board-certified in the various specialties, you won’t be able
to perform surgery, and you will have significantly less earning potential. Of
course, there’s nothing wrong with having limited knowledge of medicine or a
limited role in patient care. But you’re setting yourself up for failure if,
deep down inside, you really wanted to be a physician.
Another thing to consider is that “experience does not equal competence”. Even after working in the field for several years,
a PA or NP probably won’t know as much about medicine as a first-year resident, and will
often have to defer to residents and physicians in many clinical situations.
Note that a PA or NP with several years experience may sometimes have more
confidence that a first-year resident, but will still lack in competence.
In my program, second-year residents are routinely called upon to supervise PA’s
and NP’s. Remember that it takes years of rigorous and formalized education to become a
physician, with most doctors training for around a decade. For example, a
physician who specializes in Internal Medicine will never magically become a Cardiologist just because he/she
practiced medicine for several years. The same is true in other fields —
someone with a BS in Biology and some work experience doesn’t automatically
become a Biology Professor without the formal training of a PhD program, and
possibly also post-doctoral training. In the same way, a PA or NP, with
only 2 years of formal training, can never equal the competence of a physician
without the 7 to 15 years of rigorous and formalized training that he/she lacks.
You may want to consider other alternatives to both allopathic and
osteopathic medical school. Several alternative professional organizations are
exist. Before you make a final decision, you should weigh
the pros and cons carefully. On the plus side some of these program may be
easier to get into, less intensive than medical school, or have a philosophy
that you believe strongly in. However, you will always be a minority in a health
care field that is dominated by allopathic medical doctors (M.D.’s). In
addition, some of these alternatives are controversial because they
are based on anecdotes or untested theories, and can sometimes hurt their
patients by discouraging them from seeking legitimate medical care. Finally, be wary of alternative
fields that claim with cult-like fever to have unique insights into medicine
that medical doctors do not understand.