20 January 2008

When should I "give up" on applying to medical school?

I was speaking with a group of undergraduate pre-med students who asked me when I thought someone should “give up” on seeking admission into medical school. My first inclination was to say that if medical school and medicine is your “dream” you should never “give up”. I thought a bit about what might be behind the question and I thought it might make a good essay topic for my blogs.

I have never been a person who dealt in “shoulds” in terms of what might be the best situation for anyone’s life and life pursuit. If you want something and if really desire something, then pursue that “something” and make sure that you are in the best possible situation to achieve your goal. Any realistic (and the emphasis here is on realistic) goal is achievable in taking small steps daily toward it. Certainly, you cannot possibly reach anything if your are not moving “toward” it.

The pursuit of admission to medical school and medicine is a bit like having more than 100 pounds to lose. You have to be consistent with your work on a daily basis or you are not going to see results. This means that everything “counts” and you can’t afford to “slack” or you won’t reach your goals. Your undergraduate work is an opportunity to set yourself up with solid and disciplined study skills that can take you into medical school and beyond. It is also an opportunity to learn how to learn and master coursework. Just as daily exercise and diet modification will lead you closer to losing that 100 pounds (ounces at a time), daily preparation/study and mastery of your coursework will lead you closer to your goal (one semester at a time).

As you have probably heard, this is not a “sprint” but a “marathon” and like a marathon, you can’t just lace up your running shoes and expect to finish a 26.2 - mile race without some daily training and preparation. If you are not comfortable with long-term goal achievement, then use your undergraduate to obtain the characteristics that will make you comfortable with long-term goal achievement.

Overcoming difficulties
There are plenty of physicians out there who didn’t start off strong as an undergraduate. Perhaps they had some maturity problems or perhaps they just didn’t have the academic skills for the pre-med coursework but the important thing is that they kept their goals in mind. If something is not working for you in terms of getting your coursework mastered, then change it.

You can decide at this very minute -even if you are on the verge of dismissal- that you are going to turn your academics around “by any means necessary”. The process of doing this “turn-around” can be a huge asset in terms of making you competitive for medical school but you have to be successful. Just thinking about getting your academics together (like dreaming about losing 100 pounds) won’t make it happen but taking some active steps toward changing your methods will get results.

Many students have gone from extremely low undergraduate performances to getting themselves competitive but the process is not easy or short. Again, it’s back to the daily and consistent work with constant checkpoints to make sure that you are keeping on track. Enlist the assistance of any study skills courses at your school; enlist the help of peer tutors; enlist the help of a good academic adviser. In short, get help from any resources that you can find. Often, your school’s counseling service can help you identify resources at your school that can help you. You have to take the first steps and be willing to make some changes. Why not make the changes because what you are doing is either successful or it’s not?
Just remember, undergraduate “GPA damage control” is a long and expensive process. If you know this going in, then you can prepare yourself for the long haul. Again, medicine is not a sprint, it’s a long-term goal.

There are some things that are very, very difficult to overcome. I place things like academic dishonesty, felony convictions and substance abuse problems. Most medical schools, even if you are sitting there with a uGPA of 4.0 and an MCAT of 45, are not going to be very interested in you with these things in your background. If you have a substance abuse problem, get it taken care of long before you anticipate entry into medical school. There are excellent substance abuse programs out there and you can’t hide from your problems forever. Medical school on any pharmaceutical substance (other than pharmaceuticals prescribed by a physician within the guidelines of established medical practice) is expensive and heading for a crash either physically or legally. Neither of these are things that a prospective medical school would like to deal with. In short, take care of what you need to take care of and educate yourself so that you can handle life without drugs of any kind. If you “think” you have a problem with tobacco, alcohol, uppers, downers and any other illicit substances, then you have a “problem”. Get your “problems” solved as soon as they are identified.

Living in the “Real “World
You are going to read (and hear) stories out there about John or Jane X who got into Medical School A or B with a GPA of 2.5 and an MCAT or 20. Those John and Jane X’s are very, very unlikely to be real people. The average uGPA for medical school matriculants in 2007 was around 3.65 and the average MCAT was around 31. This means that the further from those average on the low side that you are, the lower your chances of admission. Admission to medical school with a uGPA of 2.5 is not impossible but it is improbable since the uGPA averages have been increasing every year. Get your uGPA as high as you can period. Get the highest MCAT score that you can period.

There are also folks out there who would believe that if you are an URM (Underrepresented Minority) in medicine, that you can get into medical school with drastically lower GPAs/MCAT. This is simply not the case because you have to have something in your application that shows you are capable of mastery of a challenging medical curriculum. If you are a URM and far below the uGPA/MCAT averages, then you likely don’t have a competitive application. Do what you have to do, to make yourself competitive and be prepared to take some years to get this done. I don’t care what your ethnicity/race is, you still have to be able to get through medical school if admitted. Admission is no guarantee that you will complete medical school. If you uGPA/MCAT is low, get yourself competitive by whatever means you have at your disposal.

But when do I “give up”?
You must answer this question for yourself. Preparation, application and matriculation in medical school is a very expensive process. How much time and money do you have? If you are a re-applicant, what you have you done to significantly improve your chances of admission? Just reapplying to medical school to “show them that you really, really want this” is not enough. You have to make some improvements on your application before you spend that money to reapply. Again, take a realistic look at what might have kept you out and get it improved.

If your application didn’t work this year, rework everything that you can rework before you submit for a future year. If you are reapplying to the same schools, you especially need to change and improve everything about your application that can be changed. Get fresh letters of recommendation, rewrite your personal statement (I don’t care how wonderful you believe it is, it didn’t work) and take more coursework if your uGPA is very low. Retake the MCAT if that is holding you back. (Beware though, retaking the MCAT and scoring lower can be a death blow). What ever you do, be sure to make it an improvement and not a change for the worse.

Looking at other career options
Some people believe that if they explore other career options such as physician assistant, nursing or physical therapy, that they are somehow giving up their dream. Nothing could be further from the truth. Explore other careers and have a realistic appraisal of how competitive you are for those careers. You may find that one of those careers better suits you in the first place from the standpoint of time of schooling to what your actual interests/motivation for medicine might be.

I am not advocating for anyone to seek to be a physician assistant, nurse or physical therapist because they “couldn’t get into medical school” but I am advocating that you should have a career back-up that you can love and pursue. You may not be competitive for physician assistant, nursing or physical therapist or you may not be interested in these great careers but you can’t make an honest decision without career exploration first. You may find again, that these careers are a great option for you and a better option than medicine.

Parting thoughts
Finally, be willing to let any of your advisers take a long and hard look at your competitiveness for medical school. If you don’t get in, get input from any and every excellent resource that you can find. Your goal is success on reapplication and you want to do everything that is within your grasp to ensure your success. Only you can tell when it’s time to move on to another career option and it’s YOUR life to live as you wish. Enlist any and all help that you can to get what you both need and want out of life.

The pursuit of becoming an excellent physician is a long goal. There will be people along the way who will tell you what you “can” and “cannot” accomplish. If you know yourself, and have faith in yourself, you know that you can accomplish anything that you want. You have to be willing to “run your own race” and take care of your own “needs”. There are as many routes into medical school as their are medical students.
If you should decide that you don’t want to pursue medicine, then that’s the best decision for you. Don’t let your life’s dream be anyone’s other than your own. It takes a fair about of courage to stand back, take a realistic appraisal of where you are and make the decision to move on to something else.

The other thing to consider is that getting into medical school does not have an age limit. Just because you decide not to continue with the pursuit next year does not mean that you can’t do something else and revisit medical school application three, four or even ten years down the line. As long as you have the desire, the stamina and are willing to earn competitive credentials, then give yourself a couple of years to decompress before you dive back into this process. If something doesn’t “click” for you in 2006, it might “click” in 2009 because you are a different person with a different perspective.


raven said...

Hi:-)..i really like to read your blog and absorb all the information--you are very helpful! My questions doesnt really pertain to giving up on med school but since I didnt see a way to email you, I wanted to ask if you have a blog on prepping for the USMLE Step 1. I would really appreciate it if you do just happen to have some fantastic info just waiting to be posted. Id really like to know what Qbank to use.

Drnjbmd said...

I am actually working on some things for USMLE prep. I will have them up shortly.

Anonymous said...

Hi Dr. NJBMD! I've been a follower of your blog ever since I started medical school this past year. Love your posts! In regards to school, I've been continually reminded of how much material I forget as I move from one class to the next (we're on a block schedule). I've been doing a moderate on exams (passing but no honors) and I was wondering if you had any words about how normal this is. I guess my question is, does the material you learn in the first two years really start sticking once you study for boards or start your clinical years, or is there something I should be doing to ensure I remember everything (occasional review or such). Also, any interesting words or advice on getting the honors mark would be helpful. Keep it up with the blog! Thanks

Drnjbmd said...

To anonymous:
It is perfectly normal to forget some of the material as you move from block to block. The good thing is that if you have learned the material in the first place, you can review it later (Board study) and your memory will be refreshed. The more times you review something, the more insight you will have into that "something".

Medical school is professional school and as such, there is very little difference between those who are passing and those who are getting honors. As long as you are mastering the material and passing your coursework, you are meeting the requirements to become a physician.

Don't get too "hung up" on your grades but challenge yourself to do your best in terms of mastery of the large amount of information that you must conquer. The good thing is that the more you study, the better your study abilities become.

If you pass, congratulate yourself and strive to improve on the next block keeping those things that work for you and discarding those things that don't. Also, don't get "hung up" on striving for a competitive specialty if you don't know what you want to do. Most people who wind up in Deem and others, figure this out when they have had some experience this type of specialty.

If you are in your first year (and you are set on a competitive residency), you have plenty of time to figure our how to get your academics into the competitive range for second year.

If you are not aiming for the most competitive specialties, then keep passing and doing your best. Those grades will come but mastery of the material is always your best strategy.

Anonymous said...

Hi I really enjoy reading your blog, I find it very helpful and inspiring. I'm sorry to bother you but I just wanted to ask you if there are any advice you can give me on what I can do to improve by mcat scores. I am graduating senior and have no where to go due to by low mcat scores. To be honest I got an 18 the first time and a 21 the second time and these scores are with mcat preparations scores. I am not very bright but I have really good work ethics, but somehow I feel like hard work does pay off for the mcat because no matter how hard i study for the mcat I still can't beat this test but I do okay in school with a 3.87 GPA. I just don't know what I'm doing wrong, the mcat is the only reason that is preventing me from going to medical school. I am planning to take it a third time in April and I really hope to do it right this time. Currently I am trying to apply for this post bacc program for a masters in biomedical science, it's mainly for those who wishes to reapply to medical school. The most difficult section for me is verbal and passages in the sciences sections, I just don't know why I feel like I know so much contents and as for verbal I practice and practice but still no improvements. Any suggestions how on how I can improve my studying will greatly be appreciated it. I just know that there is nothing else I would rather do than to go to medical school so as much as I am terrified by the mcat I am going to keep retaking it until I get a good score. Thank you so much again for all of your help.