The following guest contribution was written by Locus Potus, who writes for the blog Hybrid Vigor.

Dear Friend/Family/Colleague:

You are receiving this letter because someone you know is about to apply to medical school. The entire lengthy process is riddled with intricacies, misperceptions, variables, and unknowns that make it unlikely you realize the full extent of what this person is about to do. I’m sure that you will try to empathize over the next year, but some things in life must be lived to be understood. Even my own knowledge base, seasoned over a long application cycle and qualified enough to enter medical school this fall has already become outdated with changes to the MCAT and the application process. Nonetheless, I will try to inform you as best I can.

A pre-medical student is born the instant they make the decision to apply to medical school. For most, this happens years before they ever start filling out application forms and taking tests. Making good grades is an obvious undertaking, but they must also be significantly involved in extracurricular activities, all while befriending busy professors to write raving letters of recommendation. All this extra work makes them an “average” applicant. Thus, for the pre-med you know, the application process began long ago.

The initial step in applying to medical school is the Medical College Admissions Test (MCAT, pronounced “em-cat”, not “em-cats”). For most people, this test is prepared for months beforehand, often utilizing expensive test-prep classes (>$1000), and on top of a full work/school/life load. Like most standardized tests that can be studied for, it does little to measure actual intelligence, but does reflect baseline knowledge in the sciences and reading comprehension needed for medical school, particularly in the first year. There is a weak correlation between MCAT score and USMLE scores (the licensing exam for MD’s) and even less predictability with being a good doctor. The full details of this 8-hour monstrosity could fill pages, but suffice it to say that the test itself is needlessly long (one quarter of the test, the writing portion, is generally not considered by medical schools), expensive (>$250), and just another “weed out” step in narrowing down the applicant pool into only the most studious and determined applicants. In my day, the exam was only held twice a year, leading to a great amount of anxiety on test day, but thankfully it is now being offered multiple times per annum.

Assuming your acquaintance has made it this far in the process and taken the test, next up comes the actual application mediated through the American Medical College Application Service (AMCAS) beginning in June, the year before they are to start med school. This is the pre-med’s first official foray into the needless bureaucracy that is the American medical system and a continuation of the expensive journey into medical school. All coursework and activities must be meticulously detailed in the AMCAS application. As this information will be sent to schools in a standardized format, pre-meds will strive to polish their resumes as best they can. More importantly, however, the AMCAS also collects a personal statement, also known as the application essay, which asks the question “why are you interested in medicine.” Herein lies one of the greatest challenges facing any aspiring physician – to put into words a lifetime of experiences that led them to pursue their career path. The personal statement can make or break an application, especially for the “average” applicant since there are thousands of others who likely have the same exceptional grades and activities. Using the cliche “I’ve always wanted to be a doctor since my parents bought me a Playskool doctor set” might as well be asking for a rejection because the admissions committee sees hundreds of these essays every year. No, this essay must be special. It must reflect who they are as a person. It must grab the reader’s attention and compel them to offer the writer an interview. Not surprisingly, finding a unique way to say “I want to help people” can be difficult. It will take a long time to write, with multiple revisions and criticisms. If your applicant is on the ball, it will be completed before AMCAS even begins to accept applications in June. Whatever you do, don’t question why they are spending so much time/stressing on an application because this step weighs heavily on the rest of their careers and lives. Applying early is a crucial advantage in a cutthroat process, where any edge should be employed.

Before hitting the Submit button on their internet browser, pre-meds must select their list of medical schools. Unlike college, where everywhere basically teaches the same material in the same way, each medical school has a distinct personality and should really only be chosen after some consideration. US News and World Report rankings is not the best of guides, as they are based mostly on revenue from research grants, not necessarily educational practice. Different schools will appeal to different applicants based on their interests. It is difficult to say one school is “better” than another, especially given that all Allopathic medical schools require national certification. In this regard, there are only varying degrees of good.

Although your pre-med may be very smart and accomplished, applying to the very top schools is not always a wise investment. Most applicants to every school will come from the top of their classes nationwide. No, Harvard will not accept them just because everyone says, “she’d make such a great doctor and she’s SOOO smart!” Even a 4.0 GPA and a high MCAT score is no guarantee to any medical school, many such applicants find themselves applying again in the next year (especially if their personalities are unappealing during the interview). The list of schools must also be chosen prudently because each additional school costs $30. I applied to an average number of schools, fifteen, which cost me approximately $500. In return for this exorbitant fee, which you must pay, AMCAS will check your transcript for accuracy (that applicants enter themselves) and send all the information in a nice, neat electronic file to each medical school. That’s right, for about an hour’s worth of work on their part and minimal production time/cost, they take what most student’s can save over an entire summer - but I digress and this fee pales in comparison to the next step in the application process. Did I mention that AMCAS processing takes about a month (if you’re early)? If your pre-med’s spirit and bank accounts are not exhausted by now, they soon will be.

Once AMCAS finishes their part, medical schools will begin collecting the primary applications and processing them in what amounts to another month of waiting. Mind you, each school will do things differently (see above about researching schools), but most will be willing to offer you their own, secondary application, for an additional fee of course. For each school selected in the AMCAS, pre-meds can expect to pay anywhere between $50-$120 for the pleasure of writing additional essays on exciting topics like “Why do you want to be a physician?(yes, they ask it again and heaven forbid you put the same answer as your primary application)”, “What makes you special?” or “Why do you want to come to School X?”. If they’re lucky, they’ll be able to recycle essays between schools, but expect lots of long nights and stress while they come up with answers that must not only be well-written, but sound original and fresh. If they applied to 15 schools like I did, it becomes very time consuming and expensive for this step alone (~$2000).

In another long pause after the frenzy to return secondary applications – remember, early is better – pre-meds will try to recover some lost money and time. Soon, interview season will be upon them. Don’t expect any particular reason why or when school’s schedule interviews. As I mentioned before, even excellent applicants don’t get interviews everywhere. An application may sit at a school from July to January the next year, presumed as a rejection, only to be called up for an interview. The logic behind each medical school’s admissions decision to interview (and accept) is a well-guarded secret. If you haven’t noticed odd behavior already, your pre-med will likely to obsessively check their email accounts every couple of hours/minutes for any word from schools. Small letters in the mail are generally rejection letters, get used to the sight of them arriving even if they’re a “better-than average” applicant. (Note: sometimes schools will offer interviews via snail-mail, but they will usually accompany an email).

A brief commentary on chances of admission: It is important for you to remain realistic during the application process. Making it any step beyond the secondary application is an achievement. A few exceptional students will be very fortunate in the process and garner numerous invitations and eventual acceptances. This is not the norm. Almost half of all applicants nationally will not be accepted anywhere and more applicants are applying every year. Many applicants get only a few, if any, interview invitations. At any medical school, expect only 1 in 5 applications on average to get an interview. Of these, only 1 in 3 or 4 will be accepted, for an overall acceptance rate between 3-10%. It may be tempting to stop worrying after receiving interview invitations, its not over until you see an acceptance letter in hand. In each of the waiting periods, be patient and supportive, but don’t assume that an acceptance is coming, chances are against them.

Assuming your pre-med is lucky enough to get an interview invitation so begins another round of expensive and time consuming preparation. Interviews are usually done on the pre-med’s own (you stay at home) and in proper business attire (more $$$). The cost of tickets and hotel can cost hundreds per trip. In these nerve-wracking situations, they can be expected to answer questions like “Why do you want to be a doctor (yes, they ask it again)” or “Tell me about yourself.” Unfortunately, there is a high degree of variability in interviews – some interviewers are nice, while others can put on a full-out grilling session, even at the same school. This is another reason why applying is often called a “crapshoot.” Applicants must prepare themselves to answer questions about medicine in general and also weaknesses in their application without sounded too rehearsed, although they are likely to have answered the same questions everywhere they interviewed. The day can be long or short, depending on the school, but almost always awkward formal – it’s a face to face meeting with the competition. However, they can be fun as pre-meds are usually Type A personalities with interesting backgrounds or else they wouldn’t have made it this far. Interviews are generally extended from September to February, don’t read too much into the timing.

Some schools will start accepting students soon after they start interviewing and are known as “rolling admissions schools.” Others, like many of the top schools, will make their applicants wait until March 15th to hear if they are accepted, waitlisted, or rejected, known as “non-rolling admissions.” Some schools will not even send any kind of notification at all, leaving many pre-meds to wonder indefinitely. In perhaps the worst kind of torture this process can put you through, a pre-med can be put on the waiting list of the school they want to attend and held in limbo until the first day of school. At any given moment, even well into next July or August and after plans have been made to attend another school, a student may be accepted off the waitlist. Therefore, a pre-med applicant may never really know where they are going to school up until the day they actually attend somewhere – often over a year after they initially submitted their primary AMCAS application. Don’t expect definitive answers from your pre-med since there are many things to consider like cost (including financial aid with its own application process), location, and teaching style. I hope at this point you are beginning to understand my initial statement above regarding the complexity and strain involved in the application process.

If your pre-med does get accepted to medical school – any medical school – they are to be thoroughly congratulated. They beat the odds and the thousands of people clawing for a spot. A common trend these days is for applicants to take a few years off before school to add another dimension to their application. I highly recommend this approach for students because it gives them a chance to live life and get a break from school before the onslaught of med school itself.

After all this expense, effort, and drama, the “pre-med student” evolves into a “med-student.” Keep in mind that most pre-meds and med-students have a marginal knowledge of actual medicine. Even after medical school, we’re not very qualified to practice medicine on our own until after years of residency. So, hold off on your impulse to start asking questions about that burning sensation you’ve been meaning to see a real doctor about. Also keep in mind that the progression to medical student and eventual doctor is not a guarantee of financial success. Medicine is not what it used to be. The bureaucracy and hoops to jump through only continue during a physician’s career, which is probably why they make us do it when we enter the profession – they want to see if we are willing to put up with it. Many doctors will graduate with six-figure debts, live modestly, and lead stressful lives well into their 30’s and 40’s - something to consider before advocating a hand in marriage to any future doctor. Many experts agree that our healthcare system is in disrepair. Due to absurd insurance rates and frivolous lawsuits, physicians are leaving their practices in droves, resulting in a deepening healthcare crisis. Physician’s wages are determined by a pencil pusher at an HMO and may decrease with a change in US policy. Despite this bleak market outlook, pre-meds will still strive at great lengths to enter into medical school.

My strongest advice is to not assume too many things and to be patient with your pre-med during the application process. Ask questions and be prepared for uncertain answers. They will need your support through it all and even beyond. The stresses of becoming a doctor are great. Medical students have some of the highest depression rates among any profession. After all the drudgery, conformity, and expense, the original, bright-eyed, and optimistic person you know may be gone. I can only hope that I don’t go that way myself.

This letter is by no means comprehensive and maybe a little dated, but I doubt that much as changed in a year. I hope it serves as a primer for one of the most difficult years of anyone’s life – many people would agree that the hardest part about medical school is getting in. As a further resource, I recommend the Student Doctor Network forums as a place to ask for more information. Many applicants, including myself, have relied on this site while applying, especially when most of the people around me didn’t fully understand what was going on.

Good luck to you and your pre-med.

Sincerely,

Locus Potus
Nom de plum

Popularity: 11% [?]

One of the things that they never mention when you are getting ready to go to medical school is what residency is about. Some people have ideas about what residency is, and some people are completely clueless. You can usually find these people on SDN with about 3 posts asking something like “How do I become a neonatologist”. That being said, the schools just sort of assume that you know what you are getting into. They have long sessions devoted to helping you get your ERAS (residency application) set up, your NRMP (matching service). They don’t mention what happens after you match (or if you don’t).

After you match or scramble, your residency position of choice sends you a packet of information that you have to fill out. If you have ever tried to join the military, the paperwork is basically the same. Some states are ridiculous about what they want, others noticeably less.

First, you have to apply for a limited license, so that you can practice as a resident. Each state has their own form for this, but they all have the basics. One state in particular has you list every single job you have ever had, along with all schooling, any periods where you weren’t in school or had a job, and probably your thoughts if you would like to put them on paper. They also make you go down to the local jail so you can be fingerprinted (twice!) at the same processing center as the other drug dealers. Sometimes you get to stop in the middle of yours so that they can take care of people with less patience than you. Sometimes you get spit on too.

You will also require at least 2 photographs of yourself, which, while not hard to get, are still a pain. Plus, you must pay for these things with either a cashier’s check or money order, because if anyone knows who it is that has bad credit, it is the future doctors of your state. Not that you didn’t already check them through NCIC with the whole fingerprinting thing. You also have to explain any and all criminal procedings, including but not limited to speeding tickets in excess of $100 (I’ve never had a ticket that cheap, who out there has?) Then you will need a state tax form (if you have state taxes), a federal tax form, a hospital code of conduct, a school of medicine (if so affiliated) code of conduct, a hospital confidentiality statement (HIPAA), employment eligibility verification form, a licensure policy, a Controlled Substances Act form, a USMLE/COMLEX policy (must take Step III by certain date), signing up for PALS, NALS, ACLS, ATLS, and last but not least, a hospital health screening form.

The screening form cracks me up, because it is the same form they use for the janitor apparently. One of the questions asks if you have or ever have had diabetes, then has in parentheses “sugar disease”. The really bad places don’t even give you envelopes for this stuff, and the extremely bad ones make you print out everything from an online site, but don’t tell you about it until an email shows up 2 weeks after the match. Not that I’m bitter or anything.

Last but not least of these is your “contract”. I put it in quotations so that you know that it really isn’t a mutual agreement as much as it is a mandate. You can either do what this piece of paper says, or you can not have a job and not apply for the match for the next 3 years. Seems about fair. Thankfully Congress prevented us from suing the NRMP over anti-trust issues by giving them a special exemption.

Not to dissuade anybody though, because it isn’t any different anywhere else you go. The biggest pain is that you will get to fill out all of this paperwork each and every time you start working at a new hospital. However, you can negotiate the terms of the contract after you are out of residency.

Popularity: 77% [?]

From MDAlien

Greetings from the glorious time of life referred to as the third year of medical school/the breeding ground of antisocial personalities. I’m presently in the midst of my surgery rotation after having done IM, neurology, EM, family med, psych, and OB/GYN.

The following is exactly how I felt during an evening at the end of my day. Don’t try to say you will never sound as angry, cynical, or crazy as this. I didn’t think I would either, but trust me, it happens.
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There was a time when I was a nice person. I vaguely remembered that time, but after the 14th hour of being at the hospital, I’m sitting in the ICU - waiting for the attending to finish his stupid story about the fish he caught that one time that was ‘this big’ – and a horrible thought crosses my mind. “We still have 4 more patients to round on . . . “

I drop my eyes to our patient census and skim the list. There is Mrs. Smith, 85 YO WF w/COPD, CAD, CHF, past MI, recent ileostomy. Look she has pneumonia and she’s on a vent. Even better, she hasn’t been conscious for a week, lived in an ECF, and her family left her full code. Mrs. Smith is on three different antibiotics, which aren’t doing anything to budge her raging sepsis and she’s on the dobutamine drip that seem to not be raising her BP the least bit. Our other three patients are in pretty similar sad shapes. They are all going to die.

Then the next horrible though crosses my mind, ‘can’t these fricking people just die so I can go home already?” Yes, I did just wish some innocent grandma to die because her terminal illness is ruining my day. All of our efforts are completely futile in her case, but when she starts coding tomorrow, I’ll have to go with the team to attempt to save her. Which will put us even further behind on our ever growing census. Thanks dumb grieving family for putting ME through this.

Now I glance at my resident who is still nodding at the stupid story. I’m so annoyed with you that if I had an uzi I’d be gunning for you. Why the hell haven’t you let me go home? The med students don’t even see the ICU patients because this is our surgery rotation. I’ve been here doing nothing for two hours. I can’t write orders, I can’t see patients by myself, and the patients we are seeing I don’t even round on. You aren’t teaching me – no, pimping isn’t teaching – and since you’ve ignored my existence except when I failed to give you that imaginary crucial bit of info the attending scooped you on, why am I still here?

Attending, if I shot the resident, you’re next. Stop telling the fucking story and let me leave. You didn’t bother to show up here until after 7pm to round on your patients, and I know your last surgery ended at 4pm because I was there. I was that med student who held the retractor for two hours that you periodically yelled at for not being able to identify random things in a body cavity that I was too far away to even see beyond my retractor. Don’t you dare start whining about how much harder you worked in residency before the 80 hour work week. In case you haven’t noticed, the 80 work week is a joke and I was here 100 hours last week. So fuck you and shut the hell up.

You know, the hospital doesn’t have metal detectors to use on the staff. I look around at the members of my team and try to figure out which one of us are going to snap, go postal, and start mowing down the patients and the oh-so annoying nurses. Who has been abused the most? The other med student who is getting treated like shit for stating he wanted to go into peds? Or maybe the intern that was left in charge of 50 patients alone while the residents went to the OR and is about to getting it for not knowing Mr. L’s latest potassium. What the hell, it’s totally going to be me, the sweet innocent seeming seething ball of rage that I am.

One hour later, we are sent home and reminded to be back before 5am tomorrow. Thanks, like I’m going to forget that since it means I’ll be heading to bed immediately upon getting home. I see people coming out from dinner at the local resturaunts and I hate them for having real lives. I debate briefly about whether I can hit some of them in the crosswalk and get away with it. Probably not, but prison seems like a good alternative to going back to the hospital tomorrow.

As I finally get ready for bed, I think back about how much I hate the hospital and how awesome it would be if it got hit by an asteroid or something between now and when I’m supposed to be there. Then I have the horrible thought – in the event of a natural disaster, I would have to stay at the hospital even longer.
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**MDAlien would like to point out that most of the anti-social feelings went away after she got off the service – except those toward the attending. No patients were harmed or mishandled in the survival of that rotation. **

Popularity: 22% [?]

The following is a guest contribution from GeekDoc.

It’s a bitter sweet time of year for med school hopefuls. Those who are applying find out whether or not they’ll be going to medical school in the fall. Tears of happiness, tears of joy, tears caused by your disappointed mother throwing her shoe at you for getting a 29O instead of a 45T on your MCAT., become a normal part of your everyday life. I just wanted to reach out to my friends and say, I know what you’re going through; I feel your pain. I wish someone had explained the process in terms that I’d understand. Hopefully this will act as a beacon of “truthiness” for future pre-meds.

For Future Applicants:

The application process is every bit the dog-and-pony show that you imagine it to be. It starts with a four year struggle to out pace every hardcore science geek on their own turf. You spend every waking minute trying to distinguish between Cys and Trans, E and Z, Cocci and Baccili, only to realize that 100 of your peers will probably know this better than you come test day.

The lucky few who do manage to maintain their sanity while spending every waking minute studying, lose it when they realize that they have to write several essays demonstrating how they did not spend every waking minute of the last few years studying, but rather took the time to “help people”

And isn’t that why we all wanted to become physicians in the first place? To help people? And by people, I mean people other than your mom and dad who will probably spend the next few years introducing you to their friends as “this is my Son (or daughter)….the doctor”.

For the few who manage to be talented enough to strike a balance between spending every waking minute studying, and delivering children in a refugee camp in sub-Saharan Africa to compensate for that A- you got in Organic Chemistry, may be lucky enough to be invited to an interview. It’s the interview that people long for, a chance to set themselves apart by professing their undying love for the school, medicine, and if need be, their interviewer.

If your act strikes the right chord with the right people, you may be part of the small group who receive a big matte yellow envelope in the mail, screaming “Congratulations, You’ve Been Accepted!!!”.

So, my friends, don’t worry to much about the application process, we all go through it. Think of it as a right of passage, a chance to become part of the medical brotherhood. It’s a necessary evil, a show that we all take part in.

Popularity: 4% [?]