How to Get Into Medical School

Once in a while, I interview pre-med applicants to my school. While the medical students' evaluations are probably influential as only a low-NPV serial-killer screening test, I still very much enjoy doing them. This is because, if the applicants are eventually admitted, I get profuse thank-yous and friendly hellos for the entire subsequent year. Other than this experience, I have no knowledge whatever on the inner workings of the admissions chambers, so my insights are based on some post-call Gladwellian blinks.

Please note that Numbers 1 and 4 should not actually be followed by anyone, and are akin to obtaining a Golden Ticket by serially eating thousands of candy bars, or harassing hundreds of factory employees to unwrap them. It's just not worth it.

1) Take Physics for Poets.
And Literature for Actuaries. PE for Hobbits. Enroll in the easiest courses that fulfill pre-med requirements, and for which you almost certainly can earn an A- or above. The caveat here would be that you'd have to choose a somewhat traditional-sounding major, so it cannot be Fashion Merchandising, Liberal Studies, or Communications. Slightly newer, but still well-respected (and sometimes difficult, depending on your school- be careful!) majors, such as Women's Studies, as well as many interdisciplinary majors (i.e. Latin-American Studies) are considered fine.

My reasoning here is that, when it comes to course-work, admissions committees care mostly (though not exclusively) about Overall and Science GPAs, as well as a notable absence of Cs. A B- in "Physics for Future Nobel Laureates" is worth less than an A- in your standard Calc-based Mechanics course. Don't take any high-stakes gambles.

(For those now tuning in: Do NOT actually follow this advice. Take 4 years of Russian, a Combinatorics class, and a seminar on James Joyce. Keep your life joyous and a bit irrationally exuberant.)

2) Do your Undergrad at State School.
State school makes sense in general, and especially so if you are pre-med. It's generally easier to get an A in the science classes there. I know this statement may draw some contrarian personal testimonies from people who attended The University of Somewhere. The thing is, I know that many of the kids there are just as smart as the ones in Someone University, and that the teacher quality is likely the exact same. But the same student can often be in the top 10% of his Orgo class in a public school (also improving his chances for getting an excellent recommendation), rather than in the middling middle of an equivalent Ivy course.

3)Sign up for at least one test prep program, but not for any live classes.
Study by simply doing as many sample test questions as possible, starting on day one. Then go over the explanations and the reading material for anything you get wrong. You may get many or most questions wrong in the beginning. Still, do not waste time reading through the review books before you start taking practice tests. Take your MCATs in April, not August. Try to get at least a 30, unless you funded your school's infectious diseases institute (Treating Burmese children suffering from infectious diseases is not an acceptable substitute).

4) If Short on Time, Don't Dedicate a Huge Amount of Time to Clinical Experiences
While you should have some shadowing or hospital volunteering experiences, you do not actually need much of it. An EMT who has transported five patients looks roughly the same on an application as an EMT who has worked since age 16, has delivered a hundred babies, and can already interpret EKGs. The AMCAS does ask you how many hours per week you spend on each activity, but 5 hours vs. 10 hours per week probably doesn't get noticed. If stressed and cynical, think of marginal benefits.

(Repeated disclaimer: This advice is about what gets you into medical school, not about what you should do. To become a good doctor, take advantage of every opportunity you can to gain clinical experience. Some people cut corners without any one else ever noticing, but don't allow your values and ambitions to conform to this strategy).

5)Be Specific in your Essays.
When answering questions for your secondary applications, do not write "I am passionate about..." Have a strong, unique opening, even for those one paragraph answers. When addressing why you want to attend a particular school, refer to specific professors or programs. Don't use generic phrases like "Exceptional academics," "Excellent location," or "Outstanding research." Instead, say that you've always admired the [Insert Name] Free Clinic that Dr. [Insert Name] started, and you would like to volunteer there because he sees a lot of patients with [Insert medical condition], which is a disease you may want to specialize in.

(Don't lie. No one will ever know whether or not you are truly interested in that clinic, but to maintain your dignity, try to identify specific features of a school that you do actually care about.)

I know my take on medical school admissions is a bit cynical. However, even the most caring and mission-minded committee members must focus one eye on the US News rankings. The subsequent diplopia means that the theoretically best choices for pre-meds are not necessarily those that insure a successful application. If you find yourself sacrificing too many opportunities, I'd recommend dropping pre-med, enrolling in PA school, keeping your specialty of choice, and becoming a happy, dedicated, and productive clinician.

Med Students Lobby Congress for Tuition Breaks

People, I know that we aspiring physicians are all in major debt, but some Americans can't afford the rent for their trailer homes. Let's leave the welfare-for-the-well-to-do-groveling to the AIG execs.

Pharm Free

Among medical students today, the most fashionable accessory is designed by neither Prada nor Fendi. It is that canvas tote thing, similar to the one your grandma brings to the supermarket. Except this one features duct tape plastered over some undecipherable slogan, that once said "Plavix" or "Celebrex." On the duct tape is often written "Pharm Rx." By wearing this bag, the medical student signals to the world that, despite being a future member of a stuffy aristocratic profession, the student is radical, independent, and averse to shilling for Big Pharma.

The problem is, by covering up the name of the pharmaceutical company, the future doctor does his patients and colleagues a disservice. The purpose of "Pharm Free" campaigns is to insure that the physician's recommendations are never inappropriately influenced by bribery, which could harm the unsuspecting patient. However, when a company showers a doctor with gifts, and he discloses this fact to those around him, he at least allows them to form their own opinions about the reliability of the doctor's subsequent professional recommendations. By accepting perks, but refusing to give up the names of his bank-rollers, and by concealing their names on his complementary tote bag, the doc's actions ought to be considered, in the minds of Pharm-Freers, as plain old corruption.

How Libertarian Doctors Think?

Now, I am not much of a "reductivist," in that I don't believe that people's personalities can be neatly decoded based on their political philosophies. What people feel about the proper role of government does not necessarily translate to how they may view private interactions. For example, although I am a libertarian, I am an ardent proponent of private charity and volunteerism, and I abhor the notion of "Social Darwinism." However, I do wonder whether or not libertarian doctors may tend to approach clinical situations a bit differently than do other physicians. I'll use an example from medical school.

In Los Angeles, we have tons of under-employed actors. When they aren't discussing the Stanislavsky method at Psychobabble, many come to our medical school to act as "standardized patients" or "SPs" They are given a scenario, in which they must pretend to be the dying/angry/unknowingly-HIV-infected patient, and we med student poindexters must learn how to speak with them properly. We usually have a tag-team approach, in that one student will start the "interview" until our professor calls "time-out." We then provide feedback to the student on how the interaction went, until the next student goes, taking over as the "same medical student."

One time we had an SP whose scenario is described as follows, (The patient does not really exist and is a caricature):

PAUL CASSIDY
Paul Cassidy is a computer engineer, now off work on disability, who is coming to the orthopaedic clinic today for another opinion about his chronic low back pain. He has agreed to talk to a medical student about his history before seeing the attending physician. Two years ago, he was in a car accident in which 3 lumbar vertebrae were crushed (L2, L3, and L4). He underwent spinal fusion at that time and, following a lengthy hospital stay, extensive rehabilitation. He continues to have back pain that prevents him from returning to work. He is upset that his previous orthopedist has not been able to find any additional physical complications to explain his persistent and chronic pain. (He has had x-rays and CT scan recently which show no evidence of pathology beyond his post-surgical changes.) Your task is to elicit Mr. Cassidy's concerns and history. If you have some ideas about ways he can manage his pain, you may choose to explore that with him in the later part of your interview.

"Mr. Cassidy" entered indignantly, clutching his back in pain. He was clearly frustrated by his myriad previous physicians' inability to properly help him, and insistent that the doctor find the proper pathology and treatment. He tossed out his words with a bit of bitterness, but generally remained polite. He explained how, in the past few years since the injury, he has not worked, maintained any hobbies, nor visited any friends. He has since moved back in with his mother, and basically does nothing all day. He would really like to start work again, but he is just waiting for his pain to be fixed. His only source of income is his monthly disability check.

My peers treated Mr. Cassidy with respect and empathy. They said things like "that sounds really tough," "It must be so difficult to be going through such a hard time," and "we will do everything we can to try to fix this problem." They asked him about all of his symptoms, and took a detailed history of his long ordeal. I was genuinely impressed with my fellow med students, some of whom have shockingly good interviewing skills.

When it was my turn, I similarly expressed empathy for Mr. Cassidy. I understood he was angry, and didn't take it personally. I fortunately have never experienced the inconceivable misery of chronic pain. I am aware that I likely would have behaved no more congenially, had I been the one in the patient's seat. Thus, my problem with the situation was not Mr. Cassidy's anger, but his maintenance a life of chronic anticipation. He was waiting to engage in the world again after until he was healed, and everyone presumably considered it cruel to suggest to Mr. Cassidy could possibly end up living with his pain forever.

So I finally said to Mr. Cassidy,

"Sir, we are going to pore over your charts, and try to see if there's anything that may have been overlooked. We will make it a priority to find the best analgesic for your pain. However, I do want to address something that may be a bit difficult, yet necessary, as you seem to have put your life on hold since the accident. I want you to consider the possibility that the pain may never go away, and that, no matter how hard we try, we may not make any meaningful changes to reduce your pain. Pondering that possibility, do you think that you may approach life a bit differently, that you may feel motivated to resume any of your old activities?"

Anarchy struck. The patient stood up, shouting rapidly, "You're telling me, that I'm coming here, just to hear that I'm stuck with this? That I have to live like this for the rest of my life? You call yourselves doctors, and you're saying that you can't help me?"

Mr. Cassidy wasn't the only one disappointed by my performance. During feedback, My peers said that I was too harsh, that my bluntness shattered Mr. Cassidy's hope, and only further deepened his despair.

I don't disagree. But, given another chance, I would likely re-enact the scenario in the exact same way. I felt that I owed it to Mr. Cassidy to consider the full scope of potential outcomes. I don't want him to miss out on life. Without anticipating his unfortunate reaction, I would initially be more fearful of acting dishonestly with my patient, rather than allowing for unnecessary worry.

Similarly, in our scenario with the dying patient, while I mentioned that statistics can't be predictive of any individual case, I still said that I'd look up the average prognosis for someone with his condition. For the obese patient with Type II diabetes, I didn't blame the patient, but I also didn't blame industrial food manufacturers for his plight. Ultimately, I believe that empathy must be balanced with honesty, respect for the patient's autonomy, and a realistic belief in the role of personal responsibility. And I wonder if that makes me a particularly libertarian (almost) doctor.