Making the decision to go to medical school

First, this piece is not a how-to guide for getting into medical school.

But I use this ploy for good, and not for evil.  Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education.  A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and publicly examine the educational arc that turns undergrads into doctors.

Dear Pal:

I am an academic scientist at a university where I often teach and advise premedical students. I can’t tell you how many kids come in to my office for advising sessions saying they want to go to medical school and then get upset that Yes, they really have to take Organic, Calc AND Biochemistry. Then it turns out that they got a D in one semester of intro Bio and Physics and are holding down a solid 2.3 GPA. WTF? I’m not going to tell them the can’t go to med school (there may be places they can get in, for all I know), but last I checked it was kinda tough to get into med school.

Should I bother with the reality check? I kinda feel like that isn’t my job.

Let’s step back and examine the mechanics of becoming a doctor.  Becoming a doctor is a hard, long, expensive road.  Most practicing physicians have had four years of undergrad, four years of medical school, and at least three years of residency (and significantly more training for subspecialists).  In the U.S. the average medical school debt burden is about 156,000 USD.   That is somewhat above the average yearly salary for a primary care physician. Paying back these loans has a non-trivial effect on quality of life and on specialty choice.  Given the hard work, the time, and the debt, no one should go into medicine unless they really believe they will enjoy it.

That’s not something that’s easy for an eighteen year old to figure out, but spending time with doctors and with patients is a good start.  Before I applied to medical school, I spent some time at a pediatric urology clinic at a major university hospital.   That experience help solidify my interest in medicine, but I’ve met others for whom these experiences have pushed them in the other direction.  But evaluating your own desire to enter a lifelong profession is always going to be an educated guess.  When you’re 19 years old, it’s impossible to know what the future may bring, but you should at least do some soul searching and gain some experiences that would help lead you to a good decision.

Once an undergrad has arrived at a (hopefully well thought out) decision to pursue medicine, they have some serious work ahead of them.  As my correspondent discovered, there are some adolescents who do not quite get the idea that prerequisites are required.  Medical schools usually publish their admission requirements online, so no one can plead ignorance.  Whether or not you agree with the standard premed coursework, it still has to be done, and done well.  The statistics on medical school admissions are clear: if you have lousy grades or lousy MCAT scores, your chances of getting into medical school are minimal.

Something noted by a number of my colleagues is that some medical students seem to approach pre-medical education as a checklist: get good grade in organic chemistry; volunteer in lab; help sick people at homeless shelter.  There’s nothing inherently wrong with this, as long as the student realizes that there is a reason for these activities beyond gaining admission to medical school.  But they must also be cognizant of the future responsibilities they are taking on.

Just as I have little sympathy for a premed student who doesn’t want to complete the required coursework, I have little sympathy for the common TA complaint that, “those pre-med gunners only care about the grade and don’t really care about redox reactions.”  It would be terrific if all pre-meds loved all science,  but sometimes it is enough understand the material enough to do well.  That is a minimum, and as an undergraduate advisor, I do think it is your responsibility to tell a student early on that, like it or not, medical school admission comes with a rigorous set of required course work, and that this course work must be done well to have any reasonable hope of being admitted to medical school.

No one likes to hear that they aren’t progressing well toward a desired goal, but if you want to pursue medicine for the right reasons, and cannot succeed in the required coursework, there are other vocations that are both interesting and altruistic.  There are also resources available at most universities to help students who aren’t succeeding.  I would rather help someone alter their dreams while they are young.  While an undergrad advisor shouldn’t tell a student they can’t be a doctor, they can show them the stats and tell them they are unlikely to get into med school.   If the student is still committed, then they need to make every effort to improve their grades to become competitive.

PalMD is an internal medicine physician who blogs at White Coat Underground.

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