Just got my scores back, less than 3 weeks after I took it. Success!
(Note for the test makers: scoring and standard deviations aside, the computer should tell you immediately after the test if you did well enough to have essentially ‘automatically’ passed, and that your final score will be sent to you.)
Fear of malpractice lawsuits with supposedly growing payouts in a litigious society have led doctors to leave states with high malpractice premiums, lobby to enact
non-economic damage caps (“pain and suffering”), practice “defensive” medicine (order generally unnecessary tests that they would not
generally order except to prove disease X is not present, even though it is usually vanishingly rare). These are concerns because
malpractice premiums the doctors pay in many states have skyrocketed
.
There’s reason to believe, however, that perhaps there aren’t growing payments or settlements in medical malpractice. Let’s take a look at this Public Citizen report on MedMal trends :
So the payouts aren’t bigger, and there aren’t more judgments or settlements.
But doctors are instead seeing plenty of lawsuits filed. Even though 4 of 10 are dismissed because they are groundless , the accusation that a doctor performed malpractice costs more than just time and money; it takes a mental and emotional toll on the physician as well. No one likes to get sued, of course, but physicians have dedicated their lives to helping people, and have gone through enormous personal sacrifice to do so. And even if the suits are being thrown out, the media publicizes big payouts, making recall bias a problem as well. Even with all that said, only 1-in-8 damaged actually sue , if you can believe it.
Perhaps, however, doctors aren’t effectively disciplining their own. The same Public Citizen report shows only 1/3 of doctors with 10 or more malpractice payouts against them were disciplined by their State Medical Boards:
And so, as I said, doctors have lobbied for damage caps. As this GAO report suggests , it may be working to slow premium increases. This report also suggests that in many of the “problem states” with high malpractice costs, doctors are either leaving the state or leaving a particular practice because of costs, leaving both Emergency and Newborn care at risk. A rural Pennsylvania hospital no longer has an Orthopedics department because their orthopedists left. This is clearly not satisfactory for the patients this hospital serves.
Another problem–when and if a case does make it to trial, it simply turns into a he said-she said, in a Battle Royale of expert witnesses. Plaintiffs’ bring in doctors paid to argue their side of things, and defendants’ bring in doctors paid to argue their side of things.
We can take a look at other countries. But first, we’ve got to look at our whole health care system. We as physicians have to look at a system where if we make
a mistake, we’re making a mistake in a system that provides for little support for the patient to which it happened. That if you are negligent and cause a grave
disability to another person, that person is sure shit out of luck. That until they’re 65, that grave disability is not just a disability, it’s often a
major personal and financial
liability
. Because it’s now become a
pre-existing condition
. And at that point, without any guarantee that the problem or its complications–that you caused, mind you–will be paid for, of course people are going to
sue sue sue! If a 30 year-old patient loses his health insurance tomorrow, he’s got a good 35 years of extra health problems to pay for. (And mind you, the
patient knows his or her lawyers are going to take over half the settlement, anyway.)
So doctors need to take a look at our system–if only from a malpractice perspective–and see if it really makes sense for our patients. Americans sue 350% more than Canadians, and 50% more than Australians or Brits. Perhaps this health care non-system of ours is actually worse for us from a malpractice standpoint.
But patients need to pony up, too. People should be compensated for malpractice, but not bad outcomes. Americans must realize that death is part of life. That, for the most part, doctors are slowing death and prolonging life. If we weren’t here, their loved ones would die without our life- prolonging treatments that we’ve spent so long to learn. Surely this low bar should not be the standard we hold ourselves to as physicians, but there needs to be a way to quickly nip classic “adverse outcomes” lawsuits in the bud. There are certainly cases where it’s murky, but there are plenty of cases where a bad outcome or known risk is brought to court. I’m sorry, patients–I know you’ve come to expect perfection from your physicians. But we are unfortunately all too human to live up to that standard. Bad things happen. If 5% of people die from surgery X, you could be one of them. This is why sometimes doing less is more.
And this is why I support a no-fault medical malpractice system. ( This Slate article is a good start.) “No fault” is how malpractice works in a bunch of countries–and even how specific types of malpractice problems (bad birth outcomes) are handled in a few states . No-fault systems are great for problems like we face in medicine–that we try to avoid them as often as possible, but they admitedly happen. (They also take most of the money that currently goes to lawyers and gives it to patients that truly deserve it.) Quoting the Slate article:
In Sweden, when a patient suffers avoidable injury, whether through gross negligence, such as a botched surgery, or through a more understandable but avoidable mistake, such as a misdiagnosis or medication error, the patient—usually with help from the doctor’s office—fills out a form requesting compensation. That request, along with relevant doctor and hospital staff reports, gets reviewed by an adjuster who decides whether the injury might have been avoided had treatment differed. If the claim passes that hurdle, a panel of legal and medical experts considers it. If the panel decides the injury rose from avoidable error, the patient is compensated. The award varies according to the nature of injury, the degree and duration of the patient’s disability, the expenses incurred, and other factors; it may also include compensation for pain and suffering. The entire process usually takes less than six months. Patients who feel unfairly denied or undercompensated can appeal, but they cannot sue. The system is funded by premiums charged to regional organizations of medical facilities and physicians. These premiums are substantially lower and more stable than malpractice premiums in a tort system.
Such a system would generate more claims than does our present malpractice system—indeed, compensating more of the injured is part of the point. The system would save money, however, by eliminating punitive damages and legal costs. The legal and administrative costs of our present system (lawyers’ fees, court costs, paid experts) account for 60 percent of the estimated $24 billion the malpractice system consumes each year. A no-fault system would cut that to 20 percent or 30 percent, roughly doubling the money available for the injured.
Another option, which seems to be more bureaucratic (but have more precedent in the US) would be health courts , where malpractice cases would go to a specific branch of the Judicial system and cases would be heard by groups of medical experts, who could more objectively decide what is malpractice and what is bad outcome. (There are separate tax courts and patent courts for these specific types of complaints.)
EMTALA
, the law that requires ERs to evaluate and stabilize everyone who shows up, is a good law. (There went half my readers right there.) If you’re still with me:
I would argue (as would the writers of EMTALA) that we are so advanced a nation that patients should not be dying on the streets because of their inability to pay for emergency medical care. The problem with EMTALA is that it provides too much potential for abuse. This is the fundamental art of social policy — how do I put together a rule to maximize its use for its intended purposes, yet minimize the opportunities for abuse and loss of personal freedoms for whom the rule applies? (Note: unfortunately many policy makers do not seem to follow or care about this. They trust lobbyists to do this.)
If you were to look online or eavesdrop in a doctor’s lounge, likely “abuse of medical resources by certain patients” would be near the top a frequency-of-complaining list. However if you were to look at how much, in reality, these patients actually cost the system, it would be a tiny percentage of that compared to the truly sick. So it’s more a matter of wasting a doctor’s time and energy — these patients are truly draining : they frustrate physicians and nurses greatly.
The other problem is that EMTALA is an unfunded mandate. This means that hospitals are required to follow the rules of EMTALA no matter what the cost may be to the individual hospital.
Often it depends on why the patient is there — which often is near impossible to discern in the first place. Others are straightforward: hypochrondriacs? Easy.
Refer to psych. For drug seekers (note: boy would these patients be easier to spot a mile away if we had some sort of national medical record), make sure
they’re only drug-seeking, and get them out.
Others seemingly have nothing better to do. While I’d argue that perhaps job resources, education, and opportunities in the long term and for future generations might be a better solution, I’ll stick to health care for now.
If we want these patients to either stop seeking care altogether (not good to alienate people from the health care system, I’d argue, see my other posts in this series) or start seeking more appropriate care, then we’ve got to use our carrots (rewards) and our sticks (punishments) to lead the donkey.
Maybe we just need to offer better options. For some patients who simply don’t know any better, and for whom a stern lecture by a doctor isn’t going to educate them, they just need another place to go besides the Emergency Department. For these patients, we should be supporting our community health centers for after-hours clinics. They’re usually just as well-placed and located as hospitals, they provide more appropriate care settings at much lower costs, and they would also get a patient tied in for follow-up at the clinic, maybe even start seeing a physician on a regular basis. These after-hours clinics should be funded, like EMTALA (see below).
For other patients, they need a stick, as the niceities of education and better options simply don’t appeal to their finer sensibilities. Two possibilities here: perhaps it’s three strikes out at the olllld ballll game. Once a patient has been seen for non-urgent care (which would obviously need to be defined) three times, they no longer qualify for EMTALA at the hospital. If they return, they get a vital signs screening by a triage nurse, and barring no abnormal vitals or other gross, obvious issues, they are turned away. Another possibility would be charging a patient for non-urgent issues. We say, “Sure, we’re happy to evaluate you,” but if you are not even urgent (remember, you’re at an Emergency Department), you’ll be charged. (Note: this latter option I don’t support if there are no other options for these patients, which is why I think we should offer after-hours clinics.)
Finally, funding. A colleague of mine likes to say that a heavenly program can be hell if not funded appropriately, and maybe this would lead to a chain reaction of EMTALA fixes. If the federal government (read: taxpayers) had to start paying for EMTALA care (note: we already are, in the prices of higher costs to subsidize unreimbursed care), we would immediately see the true costs, and take actions to fix it. Currently, it’s all just buried in inflated prices and percentages of costs and losses in hospital account ledgers. Either way, EMTALA care needs to be funded. Some states are trying to partially fund this effort by passing certain taxes, but a national source makes more sense, since it’s a national law.
(Note: “Repeal EMTALA” enthusiasts are either kidding themselves, heartless, or living on Mars. If you believe that Emergency Departments in the United States should check for insurance in the ambulance bay or require a funds verification before they see a septic patient or one after a bad car accident, like they do in India, you might as well stop reading. We’re not going to see eye-to-eye anyway. For-profit hospitals would have no problem doing this, and it’s unethical and immoral.)
A young, healthy person very close to me called me last night with “a fever and pain on [his] right side.” I had my diagnoses 1 thru 10 (appy!) by that first sentence. He had possibly the most classic story for appendicitis I’ve heard yet in my career. Luckily he was already at the Emergency Department, waiting to be seen by the doctor and was stable and fine, except for all the pain that had migrated over the past hour to McBurney’s point . (I called him this morning, appendix now gone, and he’s already passing gas and doing great.)
But the fact that I was very close to him made the phone call a little uncomfortable to me. Sure, I have plenty of friends that call for medical advice, and almost always it’s “Boy, sounds like a virus, but I’d follow-up with your doctor,” but this time it was different. I knew that by giving him the diagnosis of appendicitis, I was putting him under the knife, and it gave me pause. It made me question myself, in a good way. “Is this really appendicitis? Is there anything else it could be that I’m missing?” This is the good side of subjective medicine–that we should try to perhaps apply this level of questioning and hypothesis to all our patients. Thinking to ourselves, “Gosh, I’d really hate to put my friend under the knife, I really want to be sure I’m right on this one,” and apply this standard to all our patients.
So I did my doubting, asked a few more questions, and felt even more convinced. He then asked me, “Well, should I demand a CT scan?” and again I thought to myself, “Boy, I’d really hate to be wrong on this and risk an unnecessary surgery, maybe he should get a CT scan anyway,” and subsequently realized the flip side of subjective medicine: practicing incorrectly because I care about a person and don’t want to put him at risk. So I thought some more, and turned my friend into any other patient, and realized I wasn’t applying the same standard — and it’s often cases like these, with celebrities, VIPs, relatives — where we apply a different standard, and they often get much worse care than if they were just a regular Joe.
The key is that fine line: treating each patient as if you know them and care about their well-being with the same regard you have for your loved ones, but not doubting yourself so much that your judgment is blurred in the process.
(Yes, duh, I obviously ceded everything to the ER doc and surgeon who evaluated him, saying I would trust their opinion over mine, but I certainly considered the situation as if my friend was in front of me. The story was so classic, the surgeon took him up around midnight, sans CT scan, and took out the big white worm. Also good to recognize that a CT is note harmless, as it exposes patients to radiation.)
So I come across this link for Stewart Uniersity: New Scotland International School of Medicine , which is apparently a “new medical school” and is somehow just down the road from Stanford. Funny, I’ve never heard of it. So I delve a little deeper, and my “sketchy”-dar (similar to gaydar) starts to go off. As I delve a bit deeper, I’m even more concerned for students and potential applicants (has scamming moved to medical schools now?). Let’s investigate the general info first:
Stewart University is an International School of Medicine. Our curriculum is the standard allopathic (MD) degree discipline. The accelerated 16 month MD degree curriculum completes the basic science courses in first four semesters.
The World Health Organization (WHO) requires recognized MD degree granting programs to be at least 30 months in length. The Stewart University MD program is 34 months in length for a student with normal degree progress.
So they’re somehow an “International Medical School,” operating in the US. While the WHO may recognize an MD program as one with 30 months of teaching, I’m pretty sure the AAMC and other licensing bodies require a 4-year medical school, no?
Next, Admissions :
2 years and ten months total program length
3 starting classes per year: January, May, September
No MCAT – NOT required for MD licensure
No Bachelor’s Degree – NOT required for MD licensure
No Minimum Undergrad Credit Hrs -NOT required for MD licensure
No AMCAS Application, Apply Directly via School Website
No Age Limit
Provisional Admittance – for those without prerequisites
Equal Admissions Process for All Applicants
Immediate Admissions Application Review
Okay, it is freaking awesome that you wouldn’t have to take the MCAT. But really–you don’t even need to go to college? No Bachelor’s Degree ?
Faculty/Administration:
Curriculum:
The Clinical phase of the curriculum is intended to be conducted at various U.S. Veteran’s Administration hospitals around the United States and Caribbean Island locations. This affords great flexibility to the student, particularly those on active duty or mobilized, to perform clinical rotations in military treatment facilities and tertiary care military hospitals around the world.
I guess this is how international medical students do it.
Accreditation:
It all leaves me pretty darn puzzled, ’cause when you Google the school’s address, you end up with A Postal Annex Store in Los Gatos, California — no medical school listing — and I’m pretty sure the Postal Annex isn’t Federal Land.
Finally, Beware any medical school catalog whose first page is entitled “California Living.”
Sure, some of these features go along with some of the features of the Caribbean Medical Schools — but an accelerated curriculum, with almost no requirements for admission, and a campus that appears to be a mailbox in a Mailboxes Etc. store? Stay away, pre-meds, stay far, far away.
(I know my tone in places is snarky or sarcastic, but in all seriousness, I think there are reasons that American medical schools require things like the MCAT, admissions essays, and letters of recommendations. Mainly those being that as an MD you will be responsible for people’s lives , and it’s not something you should be able to just “sign up and do ’cause you feel like it,” which seems like the gist of the marketing campaign of Stewart University. I’ll admit I don’t know a whole lot about the Caribbean medical schools or licensure process in the US for IMGs, but these groups at least seem more interested in putting out good doctors than just somehow skirting around the requirements to get an MD through a loophole.)
Update: I just spoke to a man who answered the phone, who was very confrontational when I asked “Where is the school located?” He started rambling about how ValueMD and StudentDoctor have been harassing and stalking people from the school. He admitted the address on the website is a PO Box, and said the school does not release the address or location of the school until an applicant has been accepted. (“Fine by me,” I said, “But it seems a little weird that a medical school wouldn’t be visitable or even map-able.”) He then noted that “members of Al Queda have been in contact” with the school, and the school had to file a “400 page document with the FBI” because of this. Yowsers.
Update 2: A spammer for Stewart University was banned from ValueMD , and a little more searching finds that Stewart University was removed from Wikipedia for possible fraud. According to this poster , none of the MDs from Stewart University were licensed in the state of California.
Update 3:
It looks like the school took over the high school in Oxnard, CA
, because let me tell you,
these photos are definitely not from beaches in Northern California
, and it was
trying to buy the high school
apparently.
Update 4:
On Stewart University’s News page
almost none of the links lead to actual stories.
The Stanford Daily has published no stories about it
,
The San Jose Mercury News has no stories on it
, nor does
The LA Times
. Hmmm.
I’m watching Baghdad Hospital: Inside the Red Zone , an HBO documentary about one of the major trauma centers in Baghdad, where they’ve gone from mainly doing appendectomies to daily shrapnel extractions and penetrating trauma explorations. Their blood bank so frequently runs low that they take a patient’s ID card, and someone must go to the blood bank in the patient’s name and donate blood to get the ID back.
Perhaps the Red Cross or hospital blood banks should use a similar tactic: there’s always a good 100 people (at least) waiting in the surgery waiting room or the ICU waiting area who are visitors or family of a patient. Why not ask them to donate blood? They’re not doing anything else, they get free cookies, and they’ll be repaying the donation someone else made to ensure that blood is available for the next person who needs it. How about it, Mr. Levy? You always seem open to trying new things.
(The film is incredibly depressing, and the images gruesome: children getting bilateral chest tubes and DPLs because they don’t have film for xrays; doctors taken hostage and killed. I can’t imagine the stress of the staff and the patients there.)
When we last spoke , we had just finished our application and were patiently waiting for…
Secondaries
Secondaries come in all shapes and sizes. Some schools have big long lengthy sections, others have a few quick questions. Be sure to save anything you submit (which
is usually online now), as other schools are likely going to ask you similar questions and you can make it work, a la
Tim Gunn
.
The key in secondaries is to give schools something new about you, or something that you just touched on but would like to develop further (often the former is easier to do based on the question). Like I said before, the faster your turnaround on the secondaries, the faster you can hear back about an interview usually. I think I gave myself maybe a week per secondary–but again, did a ton of editing in that week. Here are some examples (looking back, I’ve found typos and grammar errors that I must’ve included–ack!):
UChicago Secondary
Yale Secondary
Stanford Secondary, including drafts (final version is at the bottom)
Note, I also went back and updated my personal statement to include a couple drafts I went through with that one, too. Thought that might be helpful to see how they’ve changed.
Interviewing
Congrats! You’ve got an interview! You’re most of the way there. My feeling on interviews is this: you’re certainly a potential admit at this point.
Now you just need to prove to them that your awesomeness on paper is equal to your awesomeness in person. Smile, be social, be friendly, be polite, be humble, and be
yourself. (Some of that may be conflicting, of course.) Be someone you would want to be classmates with–because that’s how your student interviewer will
be evaluating you partially.
But also be prepared. Here’s an insanely long list of interview questions I compiled . Certainly no need to prepare yourself to that degree, but give the list to a friend, and have him or her ask you questions for half an hour. It’ll do wonders for making your first interview easier–it’s one thing to review the questions on your own and think you know the answers, but another entirely to be able to say them and explain them aloud.
Being prepared also means coming in with a list of your own questions. Show you’ve done your research. They want to know why you want to go to their school, why you’d be a good fit for their program. They already know for the most part that you want to go to A medical school. Right before the interview day, I went to the school’s website, jotted down facts about the school, things unique to the school, other things I might be interested in (the school’s free clinic opportunities, opportunity to get an MPH, etc) and brought it with me on interview day. I also made a list of questions based on those facts, and brought a copy of my personal statement and the secondaries to the school, so they’d be fresh in my mind if anyone asked about them.
Interviews are the time to toot your own horn. Now is not the time to be modest. But be humble. There’s certainly a fine line between bragging and arguing for yourself, but your goal at the end of the interview day is to make them think, “Wow, we would be silly not to accept this person!” I go into interviews with two things in mind:
1) I have an agenda, and that is to let the interviewer know certain key things about me that are impressive, unique, or important about who I am and what I will
bring (and I will make sure that I get those things across, somehow incorporating them into an answer)
2) I am there to argue my case and convince the interviewer that he or she should be fighting for me–that it would be their loss–and a huge one–not
to accept me.
Second Looks
Congrats! You got an acceptance or ten! Now it’s time to decide where to go. It’s the same thing you’ll hear anywhere–go with your gut. Go
with the feeling you get on the interview day. Do the people seem genuinely happy? Could you see yourself walking around there? Learning there? Will there be things
to do there in your free time? You can make a “pros” and “cons” list, but in the end, I think it boils down to the feel and the location.
But if you’re not sure, or if you can’t remember everything, go do a second look. Most schools offer them. I actually didn’t have a great awesome interview day at Stanford (where I currently am). I really wanted to like it, but I didn’t as much as other schools. I ran into a couple Stanford students at an AMSA convention, who basically said I’d be stupid not to go there if I got in. So I did a second look at Stanford, and I was sold. Not because of the great things the administrators said about the place, but because of the people I met as my future classmates. Second looks may try to wow you with financial aid numbers, or class skits, or parties with free alcohol, but go to them to see who your new classmates might be . That should be what sells you. They’ll be some of the most important people in your life for the next 4 years.
Final Advice
All things being equal, go to a pass/fail school. I think it eliminates a lot of competition from the get-go, and weeds out and disables any would-be gunners or
gunner-like behavior.
Good luck!
KevinMD highlights some good posts
from two of my favorite New Yorker bloggers about a new campaign encouraging people to get CT scans to catch lung cancer early, before it spreads–even though
there’s no evidence to support this. Which I totally agree with. He says:
A deplorable campaign. Currently, there is no data suggesting decreased mortality from lung cancer screening. Asking the public to “demand” a CT scan simply drives up health care costs without a demonstrable survival benefit.
I find it curious for Kevin to have taken this position, when he recently started promoting
Family Cord Blood Services
, since there’s currently no evidence that private cord blood banking will provide any benefit to children, and the
American Association of Pediatrics actually recommends against private cord blood banking
, except in the case “when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit
from cord blood transplantation.”
The AAP does recommend public cord blood banking, however–since public cord blood is available to… the public. Something I just learned that I didn’t realize–if your child ends up having a childhood blood cancer and needs a stem cell transplant, cord blood may have a higher successful transplant rate, but your own child’s blood won’t be used , because it likely already had the cancer growing in it. Someone else’s child’s cord blood will be used for the transplant.
I have no problem with Kevin’s blog advertising, and sure, Kevin, he makes it clear that it’s a “Sponsored Post.” And perhaps someday there will be a use for cord blood (I guess the 99.9% of us who don’t have our own cord blood available are just SOL). But as compared to Kevin’s other sponsors, who are selling magazines, or promoting their websites or electronic medical records, the cord blood post really makes it seem like he endorses/supports/agrees with private cord blood banking. Which is fine if he does–except the evidence isn’t there for private cord blood therapies, or lung cancer screening CTs.
(And the medical school of your choice!) I make no promises, but it worked for me, so I hereby provide my path and advice to those pre-meds out there:
Undergrad
Undergrad is the time for you to explore your interests. Okay–
to have fun
, and explore your interests. Figure out what you love. And then do that. To some it might be graphic design; for others it might be math. Or volunteering. Or lab
research. Or foreign languages. Or acting. Do. What. You. Love.
You’ll notice that I didn’t say “majoring in math,” or “majoring in Biology.” If what you love happens to be a major–great! If it doesn’t–don’t stop doing it! Figure out what it is that keeps you up at night, so excited with thoughts racing that you can’t fall asleep. Figure out what lights up that fire in your eyes: when you’re talking with friends, when is it that you get that thrill in your chest? Talking about religion? Sports? Cooking?
Undergrad should give you a depth of knowledge in one area (your major) and pique your interest in others. Medical schools are looking for the well-rounded applicant who has shown significant commitment and passion to a particular love of his or hers. Medical school is similar–you have to love learning medicine so much that you’re willing to put up with a bunch of crap for 4 years and delay gratification for many more. If you can show someone that you’re passionate and committed to something–you’re already ahead of the curve.
This all being said, of course, you also have to let medical schools know that you know you’ll like medicine. There’s nothing worse than a medical school spending their precious time and resources to figure out who they’d like to admit, and then have one of their students end up hating the practice of medicine. So find some clinical setting in which you can shadow, volunteer, or something where you get to see doctors working. I did a summer internship with a local hospital where half the time I did data entry and half the time I got to shadow doctors in different parts of the hospital.
I think one of the smartest things I did–and best for my application–was drop medicine completely from my potential career list for a time. Sophomore year sucked academically: organic chemistry and physics together for three straight quarters–and it really made me question everything. “Do I really want medicine that bad? Isn’t there something else I could do with my talents?” So I took lots of different courses, to see if I could find anything I liked more. But I always came back to medicine. I figured I could do graphic design as a hobby, program as a hobby, take foreign languages as a hobby–but never medicine as a hobby. How did this strengthen my application? I could honestly say to interviewers that I’d really challenged the idea of becoming a doctor, and that I still wanted it badly. I knew I would love medicine. (And if you find that you don’t love medicine, that’s okay. But you should really find something else to do. Better to find this out now than after you’ve taken out $50,000 a year in loans!)
Try new things in undergrad. While in some ways you want to fit in with other applicants (good scores, good grades, good letters), you want to stand out. What did every single interviewer ask me about during my interviews? Not my research, not the student groups I helped lead–it was the current events radio show I hosted with my two friends. Stand. Out. (More on this later.)
And, not totally related, but it gave me a great deal of perspective and truly changed my life: if your school offers it, do an Alternative Spring Break trip! And if your school doesn’t offer it, look into starting an Alternative Spring Break group at your school!
The MCAT
Sorry to say it, but it’s important. Because schools have thousands of applications to go through, they’ve got to use some method to reject people right
off the bat, and it’s usually some funky formula including one’s MCAT score. Doing
very
well on the MCAT will certainly help your chances at getting into your top school, but just doing
well
is important, too. In my experience, there’s some vague hazy cut-off below which you won’t get a secondary application or interview at school X, but that
cut-off is fairly low. (I wish I could talk numbers, but I don’t know any!) If you do well but not stellar, and this is just how you test, no matter what you
do–an otherwise strong application may pull you through. (And a word to you brainiacs out there–if you’re scoring 40s on your MCATs but have no
personality or can’t interview or talk to someone for 20 minutes, you in some ways have a tougher time. I’d much rather have a classmate with good MCAT
scores who I can interact with that someone with a 42 who can’t express him or herself.)
What to use to study? I took the Kaplan course, which was hella expensive. It certainly kept me on track with my studying, ’cause I didn’t want to get to class and not have reviewed anything yet, but if I could do it over again I would have just tried to buy the study books on eBay or something. I also did craaaazy amounts of practice tests, which my school had on reserve in its library. ( Go, U Northwestern! )
The Application
#1: Have your application ready by the day you’re allowed to start submitting.
Have your letters in, your transcript sent, your personal statement ready. Medical schools work on a rolling admissions basis, so the earlier you submit, the faster
you get the secondaries. The faster you submit the secondaries, the faster they can review your application and offer you an interview. And once your interview is
over, if you’ve done it early, your application will be discussed in more rounds of deciding whether to offer you a spot. (Compare that to the person who
submits in October, and your application gets two months’ more of time in committee.) For some of the faster schools (UChicago!), I had interviewed and been
accepted by early September–before I’d even received secondaries from some slower schools. (And that first acceptance is the best, ’cause you know
you get to be a doctor
somewhere
.)
The obvious: while you’re doing all this exploring and “doing what you love” stuff that I rambled on about, you’ve also got to be studying. Not just to get good MCATs, but also get good grades. This is likely something to make you learn how to find balance in your life–between your academic life and your social one (I still struggle at this, as most of us probably do).
Extracurriculars: It’s great to see someone with a ton of interests, but try to pare it down as you become an upperclassmen. Again–find what you love, and make a significant contribution to it. Take on a leadership role. Advance the field, or activity, or whatever.
Letters of Recommendation: I can’t remember the recommendations on how many science and non-science letters to get anymore, but follow them. If you fall in love with a class and a professor, and think, “Wow, I really love this topic, the professor seems great, I would really like a letter from this person,” make sure the professor gets a chance to know you. Does that mean kissing up and going to office hours for no reason? No. It means participating in class, making your voice heard, letting the professor know you’re thinking and processing the information in his or her class. When I knew I wanted to ask my Physiology professor for a letter, I made sure to start asking questions that I had during class, or going up after class to ask.
Next, ask and ye shall receive. Don’t just ask someone “for a letter of recommendation.” Ask the person, “Would you feel comfortable writing me a strong letter of recommendation?” or “Do you feel comfortable writing me an excellent letter for my medical school application?” People will tell you if they don’t know you well enough, or if they just don’t think they’d honestly be able to write you a strong one!
Finally, meet with the person if they don’t already know you extensively. A 20 minute private face-to-face, you with resume in hand, where they can get to know you and ask you some questions will make their letter much more personal, warm, and true.
The Personal Statement: The most important thing on your application. I read applications as a 2nd year at Stanford, and it was usually the Personal Statement that either impressed me or bored me the most, and weighed the heaviest on my voting. My tips:
Get the reader’s attention. In the first sentence. I do this with a lot of my non-blogging writing. Picture this scenario when you’re writing: the person reading your application is tired (true). This is either the first or last thing I’m going to do during the day. It’s late at night, I’ve just spent a long night studying, and now I’ve got 5 applications to get through. I’m in bed, with my laptop, my eyes are starting to drift as my parasympathetic (rest’n’digest) system is slowing me down. I’ve only got a reading light on, I’m so sleepy…. but I must… keep… reading… BOOM.
Hit me with your best shot by sentence one. Make me want to know more. Wake! Me! Up!
Have a theme; relate your life and your experiences back to medicine.
Next tip: Every word must matter. I went through a ton of revisions (see left) until I got it
tightened up
. I asked friends who are good writers to read it and give me their honest feedback until I got to something I liked.
Here’s my own personal statement for your viewing pleasure. ( Update: I’ve included my final draft, as well as two other drafts if anyone cares to see how the thing changed over successive drafts.)
Next time: Secondaries (again with a few samples of my own), the interview, and acceptance! Good luck to all!
So I’ve discussed being out as a blogger on residency apps , so now it’s time for the harder (but more important and wide-reaching) subject: Being Out, Coming Out–whatever you want to call it–as an LGBT person on residency applications.
I don’t really talk much about my personal life on this blog–I think mainly because where I go hiking on the weekends or who I go grab a drink with wouldn’t really interest anyone, and doesn’t have much to do with the theme of this blog: becoming a doctor, thoughts on health policy–that kind of thing. But this doesn’t get talked about a whole lot–hell, gay anything doesn’t get talked about much anywhere in the world of medicine–but it should, so here we go (sorry, it requires some history):
As a
gay man
man who happens to be gay, it hasn’t always been an easy road in medical school. Overall, I’ve been incredibly fortunate to be at a medical school in the
San Francisco Bay Area that is overwhelmingly gay-friendly–with Out gay, lesbian, and even transgendered faculty even. My classmates have truly been amazing in
their embracing of me (it probably helps that I’m kind of awesome, too). I wasn’t sure what to expect, but I’m incredibly excited for my generation
of physicians, if they’re anything like my classmates.
I decided to just be “the gay classmate” from Day One–none of that “coming out” stuff that can be awkward and uncomfortable. I’ve always preferred to just drop the hint than have to come right out and say “Oh, I’m gay.” I’d much prefer to mention my ex, and then use the pronoun he , or one of many other such schemes I have previously concocted. Easier for me that way, and I find it to be less direct and confrontational. I don’t have something to prove, or some vendetta or anything. I yam what I yam.
The residents I worked with were, for the most part, great too. I wasn’t out to most of them–rarely did it come up or have any import–but when it did everyone was very accepting (as they should be). I’m not what people might call “gay-acting” (translation: what you see in the media as gay stereotypes), but I’m always surprised when someone assumes I’m straight (’cause it’s so darn obvious to me that I’m not), which a few residents did. The one incident that sticks out in my head was a surgery resident–otherwise good guy–who called his intern who felt bad for a patient “so fucking gay,” as a put-down. Lost a lot of respect for the guy right then and there. My esprit d’escalier reminds me that I should have spoken up or said something, but I didn’t.
So for the most part, I’ve always felt like I’ve just been able to be
me
during medical school, and I decided that’s how I was going to continue to be on my residency application. Being gay is certainly part of me, but it’s not
the only part of me.
I decided to include it in my application.
I was the
LGBT-Meds president
for a year (2004-2005, baby!), so there it went on my app. (It ended up being pretty buried in my application, as achievements and extra-curriculars are listed
reverse
chronologically, and I didn’t really have anything else to say about it, so that was the only place it was on my application.)
My perspective was and continues to be this: I am going to be a great doctor. I’m smart, I work hard, I’m positive and I play well with others. If a residency program wants to drop me in their rank list because the fact that I’m gay somehow overrides all those other things? Their loss.
So applied to 13 places. And got 13 interviews.
The fact that I’m gay barely came up on the interview trail–in fact, less than the blogging did . I’m not sure if this was because people were uncomfortable (didn’t seem like it), they didn’t want to get in trouble for a rules violation (possible), or just didn’t see it on my application (also possible). A gay residency director (I think the only out one in Emergency Medicine) did talk with me about it briefly, saying it was strong of me to put it on my application. I think one resident did mention that Chicago is gay-friendly, and he has a few gay friends, which was a really nice way to both a) let me know he read my application and b) let me know that he and the program were gay-friendly.
So how did things turn out? 8/10 programs where I interviewed contacted me saying I was a great candidate–whatever that’s worth–so I’d say being gay certainly didn’t hurt my application (not trying to brag to make people feel bad, just trying to give some data to future LGBT applicants). If anything, it certainly makes me stand out as a unique candidate as well.
It’s hard to say how things would have gone had I applied in another specialty or at other programs. There’s certainly a selection bias at work here: I only really applied to major urban areas (LA, SF, Chicago, New York, Boston) for my training, which are by default more open and gay-friendly. If I was applying to more rural schools, I’ll admit I don’t know if I would have put it on my application. It also helped that I knew I had a strong application, with good board scores, evaluations, research, teaching experience, extra-curriculars, and letters of recommendation–this made it easier for me to apply to these major urban areas and still feel like I’d have a chance of matching at one of them.
I don’t know what I’d say about other specialties, really. Emergency Medicine types in my experience are usually pretty laid back, fun people who’ve seen it all, and really care more about doing a good job and being efficient than much else–so I really didn’t anticipate it being much of an issue. I have no idea about other specialties, besides that fact that I know LGBT people in many specialties–including the surgical ones–but again, they’re all in the Bay Area, too. It seemed to me like the Psychiatrists, Internists, and Pediatricians were the most gay-friendly on my rotations overall, but I’ve talked with general surgeons who have told me about their gay general surgeon friends, too. There’s a pretty outdated survey on the AMSA website about LGBT-friendliness for specialties and residency programs, if that helps anyone… I’d love to hear other people’s opinions.
I hope this helps someone!