Med School Confidential

by Robert H Miller

  Unfortunately, such innovation has also led to a dizzying array of options that can be bewildering to the would-be med student. Again, the AAMC Web site is helpful here, in that it can help you establish some common themes and marked differences to help you better compare and contrast among and between programs. Only you can determine what combination of pure science, integrated clinical studies, and small-group learning is best for your learning style. Think about how you learn and interact with others, and then aim for the schools whose curriculum has an almost visceral appeal.

  Reputation

  Everyone wants to go to the best med school in the country. The only problem is, no one is certain what school that is.

  What does “number 1” mean?

  Who is doing the judging?

  What criteria are they using, and do those criteria match your interests?

  The truth is there’s no truly objective ranking of schools available. The most popular ranking, clearly, is the annual U.S. News & World Report list. However, the criteria that they use may have limited relevance to the criteria that matter most to you.

  So should reputation really matter at all, then?

  The answer to that question is that it probably only matters in the extremes. If you graduate from one of the med schools that is particularly well known and respected (fairly or not), doing so will likely have a favorable impact on your residency application and future career direction. Similarly, if you graduate from a bottom-tier or offshore medical school, this may make your match and subsequent career path considerably more challenging. Outside these extremes, the individual merits of your performance, your recommendations, and your application coming out of medical school will be the metric by which you are judged. So, in general, the reputation of the school you attend will have only a moderate impact on your residency or career.

  “Doing well in medical school is vastly more important than where you go to medical school,” Adam explains. “I am currently a resident at Johns Hopkins and have had the opportunity to work with many of the current medical students here. Their performance on the wards seems to be the single most important factor in where they go for residency. My fellow residents are from medical schools all over the country, and which school they attended has not been a strong differentiator of performance.”

  In assessing the relative reputations of the various schools on your list, you should also consult your premed advisor, who will, no doubt, provide additional perspective on the med-school market and current trends and challenges. Solicit your advisor’s top ten list of schools along with his explanations for these choices, and if there’s a particular specialty that you think you might be interested in pursuing, ask your advisor and practitioners in that field for their lists of top schools in that discipline. Most schools are very strong in some areas and weak in others, so finding a school that has demonstrated excellence in the areas of your greatest interest is a good approach to take.

  Cost

  Finally, you should consider cost in your school selection criteria, though you should never let cost dissuade you from considering any given school. There are numerous mechanisms to fund your entry to even the most expensive private medical schools, and you will ultimately be able to manage whatever debt load you undertake. It is also true, however, that educational debt can be a significant burden and may have a significant impact on your life after residency. In 2006, the average debt load for graduating medical students was approximately $114,000. That isn’t chump change, and it doesn’t include other short-term debt like credit cards and car payments, which average an additional $22,000. To put these numbers in perspective, if you graduated today with that debt load and consolidated your loans to a single thirty-year amortized loan, your monthly payment would be on the order of $600 to $1,000 per month, depending on interest rates. If your debt load is $250,000 because you are also carrying undergraduate debt, your monthly payment could be twice that amount. Given that when you finally start your practice you will likely have a mortgage payment, and perhaps a family to support, the numbers add up fast.

  “Location was extremely important to me in the initial screening,” Pete explains. “Cost initially was not a strong consideration, but when the acceptances were in and the decision had to be made, it became more important. Cost is something I would stress extremely heavily to potential applicants, and it’s something that is not emphasized enough in premed discussions. In short, survey after survey shows that the amount of debt directly influences how medical students choose their specialty. An inexpensive education buys you the freedom to pursue the path you want to take.”

  So how should you use cost considerations in school selection? First, do a self-assessment of your current financial status. Do you have significant undergraduate debt that will require repayment? Do you have outstanding credit card debt? Do you own your own home or have other major investments?

  Next, consider the lifestyle choices you anticipate making postgraduation. Are you determined to live in an expensive city, to own your own boat or a second home? Are you hoping to practice rurally or in an underserved area? Are you a member of the armed forces, or interested in making a commitment for service? All these are factors that may have a significant impact on your earning potential.

  Recognize that if you’re determined to attend a school with very high tuition, you may have to make sacrifices on the other side to manage your debt load. Those sacrifices might be a leaner lifestyle for a while, a period of service in an underserved area or to the armed forces in exchange for debt relief, or a need to pursue a higher-paying specialty to facilitate your loan repayment.

  “In retrospect, I should have thought more about cost,” Ben reflects. “Almost all schools train you well or they wouldn’t be accredited. Being saddled with two hundred thousand dollars in debt, though, is another thing entirely.”

  Making your list and checking it twice

  So you’ve done your research and successfully winnowed your list of potential schools down to your top choices. For some, there may be only a handful of schools that meet your criteria (or possibly just one school if family or other obligations force you to stay in your immediate area). For others, this refined list may still be quite long. In the end there’s no magic number of schools you should apply to. While a shotgun approach of applying to every school you can find may optimize your exposure, it certainly won’t guarantee acceptance. Conversely, having your heart set on a single institution and applying solely there may prove foolhardy—unless you’re willing to wait and continue reapplying until you eventually get in. As with most things, moderation is your best bet.

  In 2005, the average med-school applicant applied to eleven schools, and the old adage from your undergrad days to apply to a three-tiered mix of schools carries over to medical school as well. Typically this would be a mix of two to three safety schools where your MCAT score and undergraduate GPA make you a promising candidate (including your in-state school), several midrange schools where your GPA and MCAT scores indicate that you should be a solid competitor, and a group of reach schools where you hope some aspect of your application will strike a chord with someone and make the stars align for you.

  Again, the specific forces driving your candidacy will shape your application list, so this is just a general rule of thumb. Your premed advisor should be able to help you tailor your application list to your specific needs. The AAMC application Web site is set up so that you pay $160 for the first school and $30 for each additional school. Be sure you apply only to schools you would actually go to if you were accepted!

  CHAPTER 7

  Finalizing Your AMCAS Application and Completing Your Secondaries

  Once more unto the breach.

  —WILLIAM SHAKESPEARE

  ONCE YOU PAY the fee correlating to your school selection, AMCAS will send your completed application dossier to each of the schools you selected. Any changes you make to the AMCAS application from this point forward will be received by
your target schools as change-updates. In other words, finding a series of errors in your original submission and sending a bunch of changes along will not reflect well on your ability to handle precision work, so make sure it is complete and perfect before you submit it.

  Shortly after you submit your AMCAS application, contact each of the schools on your final list and make sure they show your admissions file as complete. While AMCAS does a good job handling the administrative burden posed by this process, mistakes do happen. Take no chances—follow up with every school on your list.

  SECONDARY APPLICATIONS

  With your AMCAS application filed, and all schools reporting your file as complete, the waiting game truly begins. When and how will the secondaries arrive? Before you begin holding a vigil at the mailbox, remember that we’re living in the electronic era. These days, your first news will likely come by e-mail, followed by a packet in the mail. In an ideal world, medical schools would review your primary AMCAS application, weigh your credentials against your peers’, and offer secondary applications only to the students they feel are qualified for admission. One would also hope that their secondary application would expound on the primary application, giving you the opportunity to highlight your unique characteristics or comment on why you’re interested in that particular school. In such a world, by completing your secondary application and paying your second application fee, you could justifiably feel like you were in the game.

  Unfortunately, it doesn’t always work that way. Many schools see the secondary application as a financial turnstile and will send out secondaries to anyone who submits a primary application. Worse still, many of the secondaries are just reformatted versions of the information on the primary application, and some schools will still apply some objective screening criteria that they could have derived from the primary application.

  In other words, receiving a secondary application from a school does not necessarily mean that you are in the ball game. You may be looking at hours and hours to perfect a whole new redundant application, and paying another $40-$100 per application, only to be rejected outright because you don’t meet a school’s threshold screening criteria, which they could have derived from your AMCAS universal application.

  Frustrating, isn’t it?

  Unfortunately, there’s no way around this one, and no good way to say which schools employ these methods, since, understandably, med schools tend to be fairly tight-lipped about how their individual admissions systems work—particularly when the system is financially advantageous.

  There is tremendous variability in the format of secondary applications. Nonetheless, there are still a few salient points to keep in mind.

  First, these applications will likely be scrutinized even more closely than your primary application, so attention to detail remains paramount. Second, where possible, use every opportunity to expand on the content from your primary application instead of merely repeating it. You want to offer the admissions committee as much useful information about yourself as you can. In fact, you should answer every question on a secondary application completely—never leave blanks on the assumption that the admissions committee can get the information from your primary application. Never write “See Attached Resume” as an answer, as doing so is an invitation to an overworked admissions officer to move on without doing so.

  Allow a significant amount of time to complete your secondaries. Many schools place a deadline on your secondary response, often giving you as little as two weeks to return the application. When several secondaries with tight deadlines arrive at the same time, the pressure can mount. Furthermore, if you’re a senior in college at this point, this process usually heats up just as the fall semester is getting under way.

  Take your time, stay organized, and ensure quality control. Your secondaries are the key to the next stage of the process. Be sure they represent your very best work.

  With your secondaries complete, it is time to play the waiting game again. You must now sit back and hope that the various med-school admissions committees look favorably upon your hard work.

  CHAPTER 8

  How to Ace Your Med-School Interviews

  A word in earnest is as good as a speech.

  —CHARLES DICKENS

  HOPEFULLY THE LONG days of waiting with bated breath for an e-mail or the mailman have brought dividends.

  The news, of course, will not always be good. Few people will get interviews everywhere they apply, and a substantial number of students will be rejected everywhere on their first attempt. Don’t panic, and don’t feel bad if this is you. According to the AAMC, in 2004, there were 35,735 applicants, 27,189 of whom were first-time applicants (76 percent). There were 17,662 acceptance offers made, which translates into a 49 percent acceptance rate. Roughly half of all applicants got accepted nowhere, and roughly half of those went on to reapply in 2005.

  We hope you’ll land a seat at the school of your choice on your first attempt, and this chapter teaches you how to campaign in person for that offer of admission. If you’re contemplating your first interview, read ahead for advice on how to excel in this next and critical phase of your application process. If you’ve failed to secure any interviews, however, don’t despair. Recognize that you’re actually in the majority of applicants, and skip ahead to the next chapter for advice about how to proceed.

  HOW TO CHOOSE AND PRIORITIZE YOUR INTERVIEWS

  The first issue to address is how to manage multiple interviews spread all over the country. Obviously, this is a pleasant problem to have, though if you’ve applied to a range of schools with disparate geography, the financial implications of crisscrossing the country and putting yourself up in hotels for a dozen interviews is significant.

  Be very cautious, however, in rejecting any offer to interview.

  Take all the interviews you can get, and become more selective only as you develop increasing perspective about the market, your strength as a candidate, or if your desires to attend a school have diminished.

  Wherever possible, try to group your interviews by region and date so that you can minimize the number of trips you have to take. If you’ve been offered an interview at one or more med schools that you applied to in a given geographic region, call the admissions offices of the other schools you applied to in that region and try some guerilla marketing tactics. Politely and humbly explain to an admissions officer that you are going to be in the region interviewing at one or more schools, that you remain very interested in that school, and you would love the opportunity to interview on the same trip, if possible. Doing this serves to reinforce your interest in the school, forces the admissions director to review your application again, and also puts subtle pressure on the school to consider you in a more favorable light since other, potentially competitive schools in the same region thought you were qualified enough to warrant an interview.

  One caveat to this approach:

  Never, never, ever misrepresent your status at other schools. If you don’t actually have any other interviews in the region on those dates, don’t say you do. The world of med-school admissions is a small one, and admissions directors do talk, particularly on a regional level. There’s no faster way to destroy your candidacy to medical school than lying to an admissions director.

  Some schools interview a set number of candidates and will make their final acceptance decisions only at the very end of the season after all interviews are over. At these schools, the timing of your interviews is not that significant. Other schools, however, use a rolling-admissions system in which the admissions staff meets periodically to decide which of the candidates they’ve seen thus far should be offered admission. For schools that offer rolling admission, schedule your interviews as early as possible in the admissions season, when the committee has a full class to fill and has seen fewer candidates.

  PREPARING FOR YOUR INTERVIEWS

  While it may feel like you are the one on the hot seat during an interview, the truth is that the best intervi
ews are really two-way conversations. Remember that even though it’s a seller’s market, the interview is not just an opportunity for the school to evaluate you as a candidate for admission. It’s also an opportunity for you to evaluate what the school has to offer for your education. Empower yourself as a consumer to ask tough questions and discover the relative strengths and weaknesses of the programs you apply to. Naturally, your inquiries should always be respectful. Asking thoughtful, insightful, and comparative questions specific to the program, however, shows that you are a confident and educated consumer who has done your homework.

  “Be polite and courteous to everyone,” Adam counsels. “I saw a few applicants shoot themselves in the foot by being rude or short with secretaries in the admissions office. Respect your interviewers whether they are medical students or faculty—both votes are weighted equally when the committee makes its final decision.”

  Structure of the interview

  Most med-school interviews are structured similarly. You meet in the morning with the admissions director and all the other candidates interviewing that day. There is typically a short presentation by the admissions director welcoming you and giving specifics about the program. After this, you’ll go on a campus tour, usually given by a senior med student. This is a good opportunity to get a student’s perspective on the campus and student life, as well as current campus issues.