Medicine From The Trenches

Experiences from medical school and residency.

When Do I “give up” on medical school?

Introduction

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.

“Should”

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 you are not moving “toward” it.

Long-term

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. You can’t “let up” or you will find yourself behind quickly. 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 and stay with the changes that you have made. You also have to be willing to let go of your “ego” if it is keeping you from achieving your goals. Either your study (and mastery methods) work for you or they don’t. Everything in medicine is about new experiences and incorporation of those new experiences into your knowledge base. You can begin this process as an undergraduate and make this process as familiar as a comfortable pair of shoes.  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. If you find yourself in need of  “damage control” take action immediately and not when you find yourself in a situation that is too deep to “dig out of”.

“Deal-breakers”

There are some things that are very, very difficult to overcome. These “deal-breakers” are where 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.

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20 January, 2008 - Posted by | application, failure, medical school admission, medical school preparation, reapplication to medical school

69 Comments »

  1. Hi drnjbmd –

    I am not sure if you still curate the comments on these threads or not, but if so, I was wondering if you could give me some advice on applying to medical school.

    I graduated with a BS in Biology & Psychology. My uGPA is mediocre. I got a 3.6 overall, and took 18-21 credit hours a semester on top of playing an ncaa div. I sport. As a freshman and sophomore, my grades were not very good. I scored very low in Organic Chem. I brought my grades up during the latter half of my time as an undergraduate. I went to graduate school for an MS in Biology. I obtained a 4.0 in my studies, and enjoyed the research I was doing very much. I wrote my thesis and published a first-author paper.

    I now work full time in a lab at a large research institution, and have been productive in cultivating my knowledge, publishing, etc. I would like to apply for admission to medical schools in 2015. I am almost done with my first semester of re-taking Organic Chemistry I, which I have been taking in the evening. My plan is to get A’s in Organic Chemistry I and II, and to take the MCAT this summer.

    I need to take the MCAT once and nail down a high score. In order to be at my best for my job and on the MCAT, ideally, I will study over the summer. I would like to take this test on 21 July 2014, but I am worried that this might be too late to submit applications for 2015. I was wondering if you have any advice on how late in the year is too late to be sending in a primary application. In your opinion, does a later application make a bad impression?

    Thank you for your help. I have really enjoyed reading your blog.

    Sincerely,
    Annie

    Comment by Annie | 2 December, 2013 | Reply

    • To Annie:
      Don’t hold up your application waiting for an MCAT score. You can submit the rest of your application early and then take the test when you plan. Your application won’t be complete early but most schools will review the application without the MCAT and hold for MCAT scores. Since you plan on taking the MCAT in late June, your scores will likely go to the schools around mid September or so. Since your undergraduate GPA (the one that counts) is lower than the average for matriculants across the board, you need to get that application in as early as possible. This means not waiting for MCAT score to submit. You also need to apply to a broad range of schools (state, national and privates) to make sure that you have the best chance for acceptance. Your graduate work isn’t going to help or hurt you because it’s at the graduate level. Anything that you retake has to be an A without exception. If you are retaking to enhance GPA, then retake for grade. If you are retaking for knowledge, audit and don’t take the lab. Don’t retake anything that you scored a B+ or better as this comes off as anal more than enhancement. A better strategy is to take another course (biochemistry, cell biology etc.) and get an A rather than retaking classes where you received a B+ or better grade. Again, if you think you need a knowledge upgrade more than you can get from a review, then audit if original grade is B+ or better. Any retakes that are not As are liabilities that indicate potential applicant problems.

      Do not make the mistake of not doing a thorough review for the MCAT. This means purchasing some of the retired MCAT tests and taking them under actual testing conditions. Just retaking courses is not a review for the MCAT as the MCAT is a test of the application of your premed coursework and not a regurgitation (the manner in which most undergraduate course test) of the coursework. The MCAT has derailed many premed folks because they were good memorizers but poor knowledge appliers to problem-solvers. Be sure that you understand the manner in which the MCAT tests thoroughly without exception. Don’t focus on a particular score but focus on how the test is constructed and what the test requires.

      Comment by drnjbmd | 3 December, 2013 | Reply

  2. I noticed that you said that the LCME requires a medical student to complete medical school within 6 years of entry. Due to family illnesses, maternity leave, etc., my medical school career will span 7 years. The 6-year rule is listed in my school’s handbook (and we are LCME-accredited), but extending that length of study does not appear to be grounds for dismissal. It seems that it is at the school’s discretion as to whether they allow an MD candidate to complete his or her education in more than 6 years. If not, why would they let me stay? Should I be freaking out? Will I not be eligible to receive my degree or to apply to the Match? (Incidentally, do you have a source? I have not been able to find any data from the LCME about this.) Thanks for the help.

    Comment by trtops | 29 July, 2013 | Reply

    • To Trtops:
      You need to contact your school to get your questions answered. There are conditions where the 6-year rule may be waived (or didn’t apply) but you need to speak with your Dean of Student Affairs to see exactly what your status is (and is not). Good luck.

      Comment by drnjbmd | 29 July, 2013 | Reply

  3. Thanks for this! Do you think we should ever apply to a foreign med school if we’ve exhausted all options at home including applying multiple times, applying to both MD and DO programs, etc., but still want to be doctors? Like Caribbean med schools? Or if we just want to save money and have dual citizenship in Europe, since European med schools are much cheaper?

    Comment by mike | 11 July, 2013 | Reply

    • To Mike:
      Caribbean and other foreign medical schools should be a last resort if you wish to practice in this country (USA). The number of American medical graduates has substantially increased but the number of residency positions has stayed the same meaning that getting into a residency slot is going to be very difficult if you are an IMG/FMG. Many American medical graduates went unmatched in the last year because there were more applicants and fewer positions. Many programs simply will not take IMF/FMG applicants and those that do, have very high standards for entry if you are not an American medical graduate. If you don’t mind practicing in the country where you attended medical school, then going to the Caribbean or Europe is no problem (at least you are practicing medicine). If you intend on practice in this country, you have a very steep hill to climb with few guarantees even with your medical degree. A medical degree without a residency program will not lead to practice since most third-party payers will not recognize physicians who are not board certified or board eligible (have not completed a residency). Even getting an unrestricted license may be problematic in some states without residency training.

      Comment by drnjbmd | 12 July, 2013 | Reply

  4. Thank you so much for posting this. I’m going to be a senior next year, and I just took my mcat. I don’t know how well I did, but I don’t think I would get a good score. I’m kinda in the state of whether medical school is right for me or not. I’m not sure what I want to do with my life, and what if I can’t get into medical school, what else I can do. I have looked at other options like OT or PT, and I don’t feel like I want to do this. I’m doing well in my undergraduate program with a GPA of 3.7, and I’m majored in chemistry. I want to go to a grad school, but I really don’t know what are my options since I really want to do something related to the medical field.

    Comment by Tammy | 11 July, 2013 | Reply

  5. I heard that Johns Hopkins undergrad has some of the least grade inflation for any premed classes, is this true? I have a 3.3 from Hopkins and 31p mcat, i also worked for a year in a psych hospital in baltimore, do you see me as a competitive applicant

    Comment by wason | 26 August, 2012 | Reply

    • To Wason:
      Unfortunately, the name of the school does not carry much weight in terms of calculating whether or not an applicant is competitive. Often, members of the admissions committee have numbers (from year to year) broken down into science/non-science grades. Your 3.3 is low and wouldn’t compare favorably with a 3.5 the average for matriculants (3.7) for allopathic medical schools. There are many students at Hopkins who simply did better than 3.3. Couple your 3.3 uGPA which is pretty low for allopathic applicants with your 31 MCAT which is an average score = you a less than competitive applicant for allopathic schools. Working at a psychiatric hospital will not offset poor/mediocre academics. You can apply broadly, especially osteopathic schools which might be willing to place more weight on your extracurricular activities but that 3.3 (even if it’s from Hopkins) is going to be slightly below average for them. If Maryland is your state, then your state school is University of Maryland which has some very competitive applicants thus being in-state isn’t going to give you much of a boost. If you are from a state that has several state medical schools (like Ohio), you might be able to get in somewhere but 3.3 is not a particularly distinguished academic performance regardless of your undergraduate institution.

      Comment by drnjbmd | 27 August, 2012 | Reply


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