06 January 2011

I can't (and maybe don't want) to get into medical school

Medical school has been the ultimate dream profession for many people (or their parents) for many years. In some cultures in this country, only four professions exist; medicine, law, dentistry and engineering. If a person didn't get into one of those professions, then they were seen as a professional failure in the eyes of their parents. For some unfortunate students, not only are they not going to enter one of those professions, they are not interested in the subject matter or practice of one of those four professions. Almost weekly, a parent will enter my office stating that they will "disown" their child if I don't "let" them into medical school. Many of these students will say that they have little interest in the sciences (unacceptable to the parents who are paying tuition bills) and even less interest in medicine. When questioned closely, many of these undergraduates will reveal that their parents would never "allow" them to seek other professions and that medical school is the only choice.

In today's climate of grade inflation and very high tuition costs, the sheer magnitude of maintaining the medical school matriculant average undergraduate GPA of 3.7 is a burden that many are not able to carry. For some students, a very poor freshman year can mean the end of being able to get that uGPA into the average range let alone a competitive range. For others who might enter university poorly prepared in math and science because of attendance in a poor secondary school, getting their academics off to a strong start and keeping them there may be problematic. Along those lines, I encountered a young Latina woman who was valedictorian of her secondary school class (inner city). While she had maintained a very strong academic record at her secondary school, the quality of instruction was extremely poor.She would be the first in her family of very hard-working immigrants whose dream was for her to become a physician so that she could come back to the neighborhood for practice. This was a huge burden for this young lady who was determined not to let her family down. She came to our university will poor study skills, poor reading skills and deficient math skills. He school had no IB or AP courses and offered few academic courses that would prepare her for becoming a biology major in preparation for medical school.

During her first semester, she proceeded to achieve a 2.0 GPA which lead to much discouragement and frustration. When she came to my office for assistance (she was in danger of losing her full-ride scholarship), I immediately contacted the school administration to allow her to shore up her academic skills before proceeding to lose her scholarship. She had determination and discipline but lacked guidance in being able to navigate the academic world (common in many students who are the first to enter higher education). She was allowed to spend the next semester working on basic writing, reading and math skills. Fortunately, she has and always had very strong problem-solving skills which is why she sought assistance when her performance was working in the first place. While she hadn't failed any courses, those "C" grades would not be enough for medical school.

In the next semester, she excelled in her academic remediation. She was able to make great strides and shore up her deficiencies. She learned to put her drive and determination into her studies but she also learned that she was not particularly interested in science and math. Over the course of the remediation semester and summer, she became interested in psychology which she pursued with vigor over the next fall semester earning a 4.0 GPA for that semester. Her reading and writing skills were excellent along with a very strong interest in studying her population in terms of achievement. In short, her interests lay not in medicine but in helping her community and those in her community to be able to achieve in the academic world. She went on to earn a degree in psychology and entered graduate school to earn a Ph.D in psychology. While her family was not happy, she continues to research, study and write articles which have been the cornerstone for closing the gap in Latino achievement in academia. Her most recent achievement was tenure in her department at the state university where she teaches. In short, if medical school is not your dream, all of the drive and push from your parents and family will not provide what you need to get into medical school and practice well in medicine.

Another undergraduate student had come from a family where his mother and father were both physicians. He freshman and sophomore years had ended up netting a uGPA of 2.5. He loved the university life and spent many hours with his fraternity brothers working on extracurricular activities. His father brought him to my office so that I could "talk some sense into him" before he destroyed his future. After a tumultuous weekend with his parents, this student returned to my office resigned to "dig in" and get his work done. As we calculated what he would need to do in order to raise that uGPA, he said that he just didn't have that kind of drive. He said that he would "do his best" because he didn't want to let his parents down. He said that it didn't help that his brother was in medical school and was very critical of his undergraduate performance.

Over the next couple of semesters, his academic performance improved but not enough for him to get his cumulative uGPA above 3.2. He became more and more discouraged. At one meeting, he expressed interest in looking at other careers besides medicine. He decided that he would look into becoming a physician assistant which didn't take as long but would enable him to have a career in health care. While his family wasn't pleased with his choice, after making the decision not to pursue medicine, he was better grounded and had more direction. He finished his undergraduate degree in biology with a cumulative GPA of 3.5 and entered a masters program in physician assistant studies. Today, he loves his job and loves that he can travel while practicing his craft.

I do not advocate trying to become a physician assistant because you can't get into medical school but it is a profession that is worth exploring if you have a strong interest in the practice of medicine but can't spend the minimum of 7 years above undergraduate school in order to enter the profession of medicine. In terms of love of their work, physician assistants have the highest job satisfaction in healthcare and earn a very strong salary which is quite appealing for people who have families whose needs won't allow an additional four years out of the workforce. In terms of academics, the same strong academic skills in reading, writing and math are needed by a PA that would be needed by a physician. I would also caution that the academic achievement to become a physician assistant is just a bit lower than what is needed for medical school with the average uGPA of the PA class that entered our state university being 3.6. In short, getting into PA school isn't that much easier than medical school but the training is shorter which is appealing to many people who have an interest in medicine but do not want the long training period.

Other careers worth looking at are anesthesia assistant which is a physician assistant who does anesthesia and perfusionist. The training programs for this profession are quite competitive but as with PA, the job satisfaction is very high. Anesthesia assistants work with anesthesiologists and provide anesthesia care in a variety of settings. This particular profession seems to attract people who have no interest in nursing and going the CRNA route but have a strong interest in working the operating room environment with anesthesia. The perfusionist runs the heart-lung machine (and extra-corporeal membrane oxygenator ECMO) which is used during cardiac surgeries such as coronary artery bypass grafting or valve replacement. If ECMO is used in a nursery, it is the perfusionist that maintains that machine too. Perfusion technologists earn a very high salary and enjoy very good job security. There are a limited number of perfusion technology schools (and training slots) in this country but for many people who find that medicine is not for them, perfusion technology can be a very good healthcare profession.

For the undergraduate who has applied to medical school more than twice, the chances of getting into medical school will not increase and are likely to decrease. Just reapplying is not enough to achieve admission as whatever kept you out in the first place has to be corrected and upgraded. Every year, the medical school matriculant average goes up along with the matriculant average score for the Medical College Admissions Test (MCAT). To continue trying to raise an otherwise undistinguished uGPA (graduate doesn't count) with one class here and there is a long and expensive process. One poor year as an undergraduate can be overcome but multiple drops and repeats of the pre-med courses (especially organic chemistry, calculus and general physics) do not bode well for medical school admission success. There are just too many medical school applicants out there who have completed their studies without drops and repeats. There are also many applicants who have very competitive uGPA/MCAT scores who will be admitted ahead of those who have a less distinguished record. No amount of research or extra curricular activities will off set a poor uGPA; nor will a high MCAT score do the same. In short, the admission process into medical school is long, unforgiving and quite expensive with little guarantee of success in any given year.

Multiple retakes of the MCAT with final scores less than 30 are going to be problematic for many who desire to enter medical school. One retake of the MCAT if you were ill (or severely distracted) is warrented but several mediocre scores with no or a 1 point improvement will no work will. Not releasing scores on more than one retake with mediocre scores is not a sound practice either. Students who have a less-than-distinguished academic record can't expect to "ace" the MCAT and get into medical school. This is why it takes both strong academic achievement and a strong MCAT in order to achieve admission success. Medical schools want to accept students who show evidence (by undergraduate achievement and scores on the MCAT) that they are able to master a very competitive curriculum. It is far from a certaintly that once you are accepted into medical school, that graduation will happen. In short, medical school is a very strong academic challenge that many of the strongest students find daunting at first. It takes a consistent and high level of scholarship to achieve the performance in medical school that is needed to become a physician. Also keep in mind that USMLE (United States Medicial Licensing Exam) steps are not retaken which means that multiple retakes of exams such as the MCAT do not bode well for USMLE success.

If you find that you are not successful in gaining admission into medical school, you need to do an objective and thorough inventory of why your application didn't work. After your inventory, you need to figure out how and what you can upgrade that will ensure successful admission. If you are on a waitlist, I strongly advise getting the application together for reapplication for the next year as soon as possible with updates and reworking of things such as your personal statement. In the intervening time, upgrade anything that is within your power to upgrade and apply early (exceed every deadline). If you didn't get any interviews or waitlist, then your application need a thorough upgrade (might take more than one year). If you can't upgrade your uGPA (t0 a competitive range) significantly in one or two years, you likely either need to look into a Special Masters Program for credential enhancement (if you enter one of these you need to do well) or look into another profession. Getting a Masters of Public Health (MPH) isn't going to offset a poor uGPA or MCAT nor is entering a Ph.D program as most medical schools require that you complete any graduate work that you start.

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