Friday, March 28, 2014

A college junior wonders if she will get into med school



[Email abridged and edited.] A 21-year-old married woman, who is a junior at a large public university, has always wanted to be a doctor. She had some family and mental health problems (panic attacks, depression) which have affected her grades. She has a current GPA of 2.8, but when recalculated by including grades in repeated courses and deleting the poorer grades as her college allows, her GPA is 3.3. She and her husband have a combined $24K of student loan debt.

She feels very strongly that her family and mental health are no longer issues and is getting A's in science courses that she previously did poorly in. She says, "I seriously feel like a completely different person. I feel capable of getting good grades. However, people keep telling me that I might not even make it into med school because of my low GPA. The thing is though I don't care what I have to do. I am so passionate about learning and helping people. My dream has been to work and eventually have a free clinic on the side to help people who can't afford healthcare. That's why I'm in this. But is there a chance I can even get in? I know that's what I want, but people (peers, degree advisors, and my anatomy professor) keep bringing me down."

This is a very difficult question to answer definitively. I really can't speculate on your chances of being accepted to medical school. Your level of commitment is outstanding.

There is one missing variable—your MCAT scores.

You may want to take the MCAT at the next available opportunity. Great scores would be encouraging. Poor scores would seal the deal. You would have to move on to something else.

Your combined debt is low and you are young, both of which will allow you to spend a little extra time beefing up your GPA.

If you are thinking about applying to offshore medical schools, please do some research. As US medical schools expand their classes and new schools open, there will be fewer residency positions for offshore graduates. If you look at Table 1 on page 2 of the 2013 match data for International Medical Graduates (IMGs), you will see that 2420 US citizen IMGs failed to match to a residency position. It's only going to get worse as I noted here.
Have you considered another option such as becoming a physician assistant? The path is shorter, and PAs are becoming more and more autonomous. It might help you to look at a post of mine from a couple of months ago on "Ask Skepticalscalpel" called "Should I be a nurse practitioneror a doctor?" Read the many comments because they are pertinent.

I hope this is helpful to you. Check back here for comments as they are often more useful than what I write.

32 comments:

  1. As SS recommends, you might want to consider alternate tracks. If you really want to learn and to help people through providing medical care, PA, NP, and RN tracks can enable you to achieve that mountaintop more easily (i.e., cheaply, quickly) without as much baggage (i.e,, debt, years of neglecting your family) at the end of the climb. Losing that baggage may make it easier to offer the free clinic on the side when you've reached your goal.

    If you're still convinced you must be a physician (and not another type of healthcare professional), you might have other reasons for that of which you're not yet aware. That doesn't make it a bad idea to pursue, but before you invest 7+ years and hundreds of thousands of dollars in this career move, you may want to be sure you know why you're doing it.

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  2. I've had many of peers who were determined to get into Medical School, and did. You have every chance of doing what you want to do, and don't let anyone tell you otherwise.

    The only advice I'd give is this: While you can make a huge difference in a person's life being a doctor, it's not (in my opinion) the best way of helping people. It's a lot of "other" work that needs to be done, and the various pressures that come with a doctor can leave you disillusioned. If you want to help people, there are other options for you - so even if you don't get into med school, don't abandon that dream.

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    1. I apologize for the delay in posting this comment. For some reason, I was not notified of it automatically. I appreciate your comments and hope that our student notes them too.

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  3. Those college course marks would be considered very low for an American med school. As SS said, your MCAT results become very important. If they are at the top end, then you can argue that your college grades were not reflective of your abilities; if they are mediocre, then that argument is not persuasive.

    Other attractive attributes may trump low scores. Chief among them would be coming from a disadvantaged minority.

    You may want to look into D.O. schools. Their applicants tend to have lower college and MCAT scores. They also tend to be very expensive. The last D.O. student I talked with was paying higher tuition than a Stanford med student.




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  4. I might be doing some bad research, but when it comes to PA vs Physician I personally feel like Physicians have a better outcome. They get payed a lot more and they can eventually specialize and not have to work long hours. Please tell me if I'm completely wrong in my thoughts. I know that there may be more PA spots opening in the future and that their salaries may rise, but is there anything they aren't allowed to do? What's the big difference between them?

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  5. Anon, thanks for commenting. DOs will be included as equals to MDs by 2015 regarding the status of their education.

    Pre-med, You need to read the comments in the link to the other post of mine. Here it is again: http://askskepticalscalpel.blogspot.com/2013/12/a-woman-asks-should-i-be-nurse.html. Although MDs can earn more than PAs, PAs can start paying off their smaller student loan debt much sooner. They also can specialize. Many do. Unlike MDs, PAs mostly work fixed shifts. MDs tend to take more call and have less ordered lives. You should talk to some PAs.

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  6. I wanted to mention that while the school might let you delete and replace grades to a 3.3, the AMCAS does not if I remember correctly, instead averaging it. A 3.0 GPA would be difficult to work with, and I would think mental health could be a red flag with some adcoms, though certainly not all and there is a chance that they could see it as overcoming adversity. MCAT could be the great equalizer, but odds are against you. I'd love to hear more about your motivation of why specifically an MD is the degree for you.

    A PA could definitely do good work, have a good lifestyle, and volunteer at free clinics on the side, perhaps even taking leadership positions for events or days. With 24,000 in student loan debt currently and the debt of medical school and extended training period, it would be a long time before you could "own" a free clinic.

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    1. That's an interesting point about the GPA. Where can that be verified?

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    2. The AMCAS application used for applying to allopathic schools does not use grade replacement for repeated courses when calculating your GPA; both the original course grade and the repeated course grade will be used in AMCAS GPA calculations. What this means is that grade replacement policies that may apply at your undergraduate college or university – such as the “Extended-X policy” at Indiana University – are irrelevant to the way that AMCAS will calculate your GPA for your medical school application. If you plan to apply to allopathic medical schools and you are considering repeating a course, you should be aware that both the original grade earned in the course, as well as the grade earned when you repeated it, will be used in calculating your GPA’s on your AMCAS application. For example, the effect on your overall GPA of retaking a 5-credit hour course and earning an A in it is the same effect as if you took a different 5-credit hour course and earned an A in it. - via http://hpplc.indiana.edu/medicine/AcademicRecordandGrades.shtml (however, I just Google searched, this is a global policy, not just for Indiana students)

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    3. Anon, thank you for the detailed response about the AMCAS. It is very helpful.

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  7. Speaking strictly from a PA student perspective - I don't necessarily agree with the sentiment that PA (or NP, or RN, or whatever else) is the easier or better path for this young women. If she truly wants to be a physician for whatever reason, I highly doubt she'll be happy or satisfied in other professions. I chose physician assistant because I want to be a PA, not a doctor...for many reasons, this profession and career path is a better fit for me and I never considered applying to med school. The vast majority of my classmates and PAs I've worked with feel the same way. As a student representative on our admissions panel, I've met applicants who applied to PA school because their med school plans didn't work out or because they thought it would be an easier path. One common interview question is "why PA and not MD or NP?" You need a strong and convincing answer to that question. Even if these applicants didn't come outright and say it, it would be apparent they didn't have any true passion for the profession itself and those applicants tended not to be looked at favorably by the admissions committee.

    In addition, with her current GPA, she would also have difficulty gaining admission to a PA program. CASPA (our centralized application) does not account for grade replacements and calculates all grades into GPAs. The minimum GPA and science GPA for many schools may be listed as 3.0 or 3.2, but when there's over a thousand applicants for 40-50 spots at one school, you need to have a much higher GPA to be competitive. Not to mention most schools require at least 1000-2000 hours (or more) of hands-on patient care clinical experience prior to applying. Not volunteering, not scribing...actually touching and talking to patients. PA students tend to be slightly older - some have completely different careers for many years, some worked for a few years after undergraduate to gain clinical experience. Very few come straight from undergrad. The PA curriculum is so fast-paced and so intense that students need prior clinical experience and knowledge to succeed. My GPA was barely average among applicants and even with 6000+ hours of patient care experience as an EMT and medical assistant, it took me two application cycles to be accepted. I knew I wanted to be a PA and was willing to do whatever it took...including taking extra classes, improving my test scores, and continuing to gain clinical experience. It still wasn't easy.

    My advice to this young woman - if you're truly committed to the MD (or DO) path, then you need to commit to doing everything in your power to improve your chances. It's not impossible, but it will be a difficult journey. If you can show you do have the ability to succeed in difficult science courses, and have competitive test scores, and continue to improve your resume through research and clinical experience and service, AND are able to articulate your passion for becoming a physician, I believe you can gain admission to a program eventually. It may take a few years and lots of effort, but I'm a firm believer in that if you make your commitment evident, adcoms will take that into consideration. I'm proof of that. I think of my MD friend who applied to med school for three cycles with no success (a low GPA and average MCAT scores). He had all but given up on his dream and started a non-medical job when he was accepted off the waitlist two weeks before school started. He's now in his residency and doing very well..but was very close to giving up on medicine completely.

    As others have said, if you want to make a difference as a healthcare provider, remember there are many ways to do so besides being a physician. It's up to you to research different professions and decide if another career path may be a better fit.

    Whatever path you decide on in the future, I wish you the best of luck! Keep your head up.

    ...my apologies for the long post. All of the above is just my own opinion! :-)

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    1. Thanks for the reality check. You covered a lot of ground and what you say seems reasonable.

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  8. I'm a practicing PA and before PA school I applied to med school---twice.

    I ended up getting in the second time around, but I chose the PA path instead because it made more sense pragmatically and better suited my ideals.

    That said, I think you are fighting an uphill battle getting into med school, and I think you may have a good case of delusion on what medicine is actually going to be like. As pre-meds we were all full of hope and idealism but short on reality. Any MD or PA will tell you that you don't REALLY know what you like and dislike until you are actually out there in the game seeing patients 10-12 hours a day. Medical school is a long and costly road, and it will stress you and your family immensely at times. PA school is not much different, just shorter.

    And after that, working full time AND having a free clinic AND having a family....is really a pipe dream. You are living in TV-land I'm afraid. I'm not telling you that you CAN'T do it, I'm just telling you that's an unrealistic expectation.

    All that aside though, we really cant prognosticate on your chances with so little info. With a 3.3 GPA the X-factor is going to be your MCAT score. Personal/research experiences are great, but at the end of the day you need to break the minimum scores to even have a chance. 5 years ago when I was applying I had about the same GPA as you--a 3.45. I needed a MINIMUM of a 30 on the MCAT to even have a chance, and that was 5 years ago. With a sub-30 you might be able to get into a DO program, which is fine, but there are some drawbacks.

    Personally I wouldn't even consider an offshore program---you will be in tremendous debt and have fight tooth and nail to get an adequate residency. I think it would be a very unwise decision, both financially and career-wise.

    Where there is a will there is a way; and if you are motivated enough you can EVENTUALLY get into med school. But I'm not sure you realize the cost, the time, the family burden, and the burnout you will have to endure to become a physician. If patient care is really your passion, then save yourself $100k and 4-6 years and go to PA school. You cup will runneth over with patient care and you'll be able to have a more sane lifestyle in the short-term.

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    1. Jaqen, Thanks for the comments and another dose of reality.

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  9. another important factor that is missing aside from your MCAT is your race. certain minorities are under-represented in medical schools so that may allow you some give in terms of GPA. I don't know how good of a strategy it would be to speak about family/mental health issues. I remember when I was sitting in an admissions meeting and a kid from ivy league university undergrad came up, but had admitted to hx of alcoholism. we talked about how important it was not to judge based on medical illness but topics of risk of recivdism came up. ultimately, he was denied. my opinion is that US medical schools want to reduce risk when accepting applicants.
    in my opinion a better approach instead of telling them about family issues/mental health problems is to talk about your struggles and how you overcame it. one comes off as "making excuses" and the other way shows character/triumph over adversity type stuff. I personally love reading "Rudy" type stories and will root for the underdog.
    this applicant needs to demonstrate how they are a better candidate than someone from the same type of school with a 3.7 GPA. they will need a hell of story and be of the right ethnic background.
    you can guarantee yourself easy rejection letters if you talk about your hx panic attacks

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    1. I apologize for the delay in posting this comment. For some reason, I was not notified of it automatically. That's too bad because it is a really good response that I hope our questioner takes note of.

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    2. thx. I thought u didn't approve of the post because I mentioned race as a selection criteria.

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    3. I am supposed to be notified of every comment by email. Yours and another comment above did not come through. I have no idea why. I will pay more attention to the alternate pathway which is a list of comments inside the Blogger program.

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  10. I would add emphasis that offshore med schools are a really, really bad idea. I do see some successful, good doctors who went that route, but less than half get into a US residency. With American MD and DO schools now expanding, the residency spots - in any specialty - will become less for IMG's.

    For most of these students, they have wasted 4 years of their youth preparing for a job which they will never get, while piling up 200k of debt. Offshore med schools are a scam.

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    1. Sadly, I think you are correct. I agree that it's going to get worse for IMGs.

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  11. Hi from one of the pre-health advisors at a small, moderately selective liberal arts college.

    My experience in recent years is that PA isn't much of a fallback plan for a student who wants an MD/DO program. The GPA needed to be competitive is nearly as high, the list of courses is sometimes longer, and the required hours can be a deal-breaker for someone who wants to go straight out of college.

    Pharmacy might be a better fit in terms of the grades the student has currently, but she'll need to have the courses required (again, more than MD/DO), too.

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    1. Thanks for your very pertinent comments. I hope the woman who wrote the question sees them.

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  12. I think that in the current economy, there is a big attraction to having a practically guaranteed job with a good income for life. But, we really don't know how all this shakes down 10 years from now.

    For physicians, the vast expansion of student slots in MD and DO schools will mean less of job security, or even getting a job in the first place.

    PA's are in a golden spot right now. They are in high demand, they are very smart, and they often deliver much of the medical care. For example, in ortho practices I have seen, anything not involving cutting is handled by the PA.





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    1. Agree. Many orthopedic practices are run by PAs. The docs just do the carpentry.

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  13. About race in the selection process:

    It plays a major part, despite the reluctance to talk about it.

    Some years ago, I was on faculty at the school which was ordered not have racial quotas in a landmark Supreme Court case. Instead, we had a "special considerations" admissions subcommittee.

    So at least in some cases, we systemically accept low MCAT's and college marks.

    BTW, the current American medical student body is 23% Asian-American, lumping IndianAmericans and ChineseAmericans together.

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    1. That's interesting. I wonder which school it was.

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  14. Here is my take on med school acceptances:

    We have no idea about which students will be great doctors. So we pick them for intelligence. We can't say that out loud of course, so we go with GPA's and MCATs. which are proxies for IQ tests.

    Is high IQ needed for clinical competance? I don't know. Nobody does. But, that's what med school admission committees look for.

    Related to another thread, the prejudice against American offshores grads, even if they score high in board tests, is because their GPA's and MCATs have locked them in as not very smart.

    It is prob. not the best system, but that's the reality right now.






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    1. You may be right about the prejudice against offshore grads, but I think the fact that their schools are less prestigious plays a role.

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  15. I would guess Regents, University of California v Bakke. which is considered one of the most important Supreme Court cases in the past 50 years.

    There were many subsequent stories, including that Dr. Bakke (a former aerospace engineer) became a mere anesthesiologist in Minnesota, while his more colorful colleague practiced as an OB in LA central. Unfortunately, the latter lost his license for incomperance. He died after getting shot while buying an ice cream.


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  16. Years ago, as a younger and dumber doc in a less PC era, I joked that that my med school had affirmative action for Jews and Asians (I am AsianAmerican). I stopped when I found that some of the hospital staff actually believed me.

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  17. There are some great comments already. The poster above who mentioned that retaking classes does not replace your grade for MD apps is correct, but I missed it if anyone mentioned, DO apps do allow grade replacement, that allows a bit more ease to correct those earlier errors.

    MD schools have been growing as have the # of DO schools, the number of US grads vying for residency each year is increasing, making it more and more difficult to succeed in a Caribbean Med School. If you were my daughter I would say don't do it.

    A great resource for advice is http://talk.collegeconfidential.com/pre-med-topics/
    there are pre-meds, MD students, parents of students, residents, attendings, program directors and there is usually good solid advice. Another site is student doctor network forums, but it tends to be rather intense and over the top, with a GPA below 3.5 you will mostly be told not to bother.

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    1. Thanks for the link. It may be of some use to our young student.

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