Chapter 1
Making the Decision
Deciding to be a doctor is probably one of the most intimidating decisions you can make. As a premed student, you'll be working for at least two years without guarantee of a spot in medical school. It means publicly stating that you want something that in 2000 only 45 percent of those applying got -- a position in medical school. After an arduous application process, that decision means committing to a labor-intensive course of study, including four years of medical school and three to twelve years of residency and fellowship.
Yet for all this, applications to med school are still quite high. There were about 37,000 applicants for the class entering medical school in the fall of 2000. And while the number of candidates has actually decreased a bit over the last year, the number of medical school positions is a mere 17,538. That means that there are twice as many applicants as there are spots in medical schools.
Getting into medical school will be one of your most difficult challenges in seeking a career in medicine, It is reasonable to assume that many of the applicants who are not admitted each year are good candidates who would make good doctors. Obviously you will need dedication and careful planning to be successful in this competitive situation.
One important element of preparing your application campaign is articulating why you want to be a doctor; it's likely that you'll have to voice your desire in your personal statement, as well as in your interview. This also involves demonstrating that you have glimpsed the reality of what it is to practice medicine, not the glamorized versions on E.R.
While some students have a clear epiphany regarding their career goal that they can movingly relate, many students have a more difficult time deciding whether to enter medicine. Some find themselves daydreaming in organic chemistry class, still trying to decide two years into the prerequisites if this is the career for them. Complicating matters is the fact that many people want to be doctors for reasons that are not purely altruistic -- for example, money, job security, or parental approval.
Are there legitimate reasons to decide to become a doctor? How can you figure out what's important to an admissions committee? How can you be honest about goals and aspirations that aren't particularly noble? It's important to address these questions as early as you can in the application process, and think through your own personal goals before you apply.
WHY GO? GOOD REASONS...
There are a number of compelling reasons to become a doctor.
An Intimate Rapport
Being a physician gives you the most privileged listening post a human being can have. A doctor gets to hear the innermost issues of a patient, and is privileged to weave those hints and facts into a diagnosis and treatment.
Unique Responsibility
Doctors are at the top of the "medical food chain." At the hospital level, physicians work on a team with nurses, therapists, and technicians. The physician's voice, however, carries the most weight. Physicians are expected to make the difficult decisions: to decide when to stop life support, to declare that the slide under the microscope shows cancerous cells, even to carry the weight of prescribing a common antibiotic that can rarely cause lethal reactions. (This responsibility can also extend outside of the professional realm. On a plane or at a cocktail party, people will come up to you as a doctor and start telling you things about their skin you never wanted to know!)
Special Authority
Many people pursue medicine because they want the knowledge of what to do in an emergency, and the ability to personally provide care for those in need. Some like the idea of being able to control things that were frightening or nebulous to them as children, while for others, the idea of being in a small town and being the one charged to take care of the whole town's health is appealing.
Other Reasons
In a recent poll, physicians reported other elements that lured them into the profession, among them:
* Continuing intellectual challenge
* Intelligent colleagues
* Joy of helping/taking care of people
* Respect of others in community
* Diversity of opportunities
* Enjoyment of working with science or contributing to research
* Job autonomy and security
* Financial reward
As you think about why you are interested in medicine, make sure that you can articulate a goal. While financial reward and job security are indeed important, numerous other careers provide these elements as well. What's important is that you can explain why medicine is your chosen profession.
REASONS TO RECONSIDER
Many people experience the desire to be a doctor well before they are in a position to draw up any conscious list of goals. Though it may seem desirable to make a commitment early in life, it's important that you reconsider decisions you may have made as a child from an adult perspective. If you're applying to med school for any of the reasons listed below, examine your motivations before you take the plunge.
Parental Approval
Saying you want to be a doctor, even as a child, evokes pleased responses from adults. If you're someone who's always wanted to be a doctor, you might be able to remember how your goal was received early in your life. Making your career decision early isn't necessarily bad, as long as you've progressed beyond the approval-seeking stage. Until you've analyzed your commitment with an adult mind, you can't really argue successfully why you believe in it. You need to have a realistic sense of the profession, and of why you want to be a doctor, to convince a committee they should let you in.
The Longest Path
Another faulty reason is "the difficulty of the path." It's sometimes the case that high achievers pursue a career in medicine simply because it is so competitive, and involves such a lengthy, arduous path. Though stick-to-it-iveness and the discipline to accomplish a difficult goal are valuable assets in life and prized by medical school admissions officers, they alone are not enough. The alchemy of desire and motivation has to precede the chemistry of mixing the right MCAT scores, letters of recommendation, and extracurriculars. Real desire should be there.
Following in Mom or Dad's Footsteps
Many medical school applicants are children of physicians. Though having a parent who practices medicine may indeed give you a sense of the field, be aware that your folks went to medical school in a different era, and attending med school and starting to practice medicine have changed significantly in recent years. Some med school admissions officers estimate that children of physicians have a higher rate of attrition from medical school than the national average of 1 to 2 percent. It isn't that they can't do the work; it's that they sometimes discover they applied for the wrong reasons. If you are a child of a physician, give some extra thought to why you want to practice medicine in today's health care climate. This climate is characterized by the following:
Greater Competition
If your mother or father is in her or his forties or fifties, it's likely that she or he attended medical school around 25-30 years ago. At that time, the odds of getting into school were a bit better than 50 percent, as compared to 40 percent now. In addition, the pool of applicants was much smaller. The MCAT your parent took was a very different test: It carried far less weight than today's test does, and test takers did not usually prepare for it as carefully. Today, some test prep professionals estimate that almost 75 percent of the people who take the MCAT take a commercial test-preparation course. Finally, back around 1970, volunteering in a health-related situation was not on the list of the AAMC's "Most Important Criteria" for admission. Today, it is one of the big five.
Changing Medical Climate
Today's medical lingo is peppered with acronyms -- HMO, DRGs, PPO, HIPC -- that were not a part of medicine a generation ago. So don't assume that because you grew up with medicine you know what it's like. Today's private practice work is often signing papers in triplicate; in a public hospital, quadruplicate. Litigation and malpractice worries abound. It is not as easy to make a lot of money in the medical profession as it used to be. Look into these issues, so you can go into practice with your eyes wide open.
THE REALITY OF MED SCHOOL
It's easy to nurture a fantasy of what med school will be like: Within days of your arrival, you'll be caring for patients, following eminent physicians, and, when you're done with a hard but reasonable day's work, you'll be leading a social life worthy of an upscale beer commercial.
Not surprisingly, few students report that their experience met their expectations. To many, med school is surprisingly reminiscent of high school, full of anxiety, pressure, and rigid scheduling.
Lingering Worries
After the exhilaration of being accepted and moving to a new place wears off, many students are left with the secret suspicion that everyone else in the orientation room had better scores and grades. The residual fear of "What if I never get accepted?" comes back in the form of "What if they find out I'm a fraud and I'm that one percent that never graduates?" No matter how often people tell you not to worry, some of that feeling remains.
Unbending Schedules
In college you could choose to skip class if you were burnt out. You probably had an hour or two of free time between class blocks. But the medical school format bears a stronger resemblance to high school, tn a typical curriculum, all 100-odd of your classmates stay in one room for a 50-minute class. When that class is over, the next professor puts her carousel of slides into the projector, and another 50-minute class on a different subject begins. Afternoon classes may be punctuated by labs. During the first year, two or three afternoons a week are typically anatomy lab, with dissection assignments that will often take you into the wee hours of the morning.
Delayed Gratification
Many students expect to jump right in and start taking care of patients. But the reality is that there's a whole world of knowledge you need before you're really able to care for people's medical needs. After years of dreaming about applying all your schooling, it's difficult to put that off for even longer.
Stress City
Part of the selection process for med school is designed to find out how you handle stress. For that reason, you may get questions in an interview such as "What's the hardest thing you've ever had to do?" or "How do you handle stress?" Med school is admittedly stressful. The toughest part seems to be the quantity of material to be dealt with. All subjects are important, and there truly is more information than you could possibly learn, Someone else has always learned more than you about something, and particularly during the first year, there are always acronyms or diseases you've never heard of. Since most medical students are accustomed to being at the top of their classes, it's hard to get used to being one of the crowd, and perhaps no longer at the top.
The students who tend to do best are those who don't underestimate the difficulty of the work, who form study groups, and who make time for regular social events. And don't forget, even the person who graduates last in the class is called "doctor,"
Decent Social Life
For many students, this is a pleasant surprise. Once most people adjust to reed school, they find they have about as much social life as they had in college. It just has to be more carefully timed. Many mothers and fathers manage to care for their families while doing well in medical school; it's just a matter of prioritizing and scheduling.
Life in medical school revolves around the testing schedule. Some schools have all tests on one day three or four times a semester. This means that the weekend after a test day is totally free. Other schools will have tests throughout the year; you'll learn to schedule weekend fun that includes a few hours away from everyone to study for your biochemistry quiz the following Monday. The changes most medical students notice in their social lives are:
* Having to say "no" to non-med school friends who want to go out
* Losing touch with some peripheral friends
* Becoming aware that their day-to-day vocabulary has become quite different from that of their nonmedical friends
* Giving in to the urge to "talk shop" while socializing
Peers and Colleagues
For some people, medical school is the first social group in which everyone wants to do basically the same things, and everyone has had to prepare academically in basically the same way. You'll find many things in common with everyone in your class. There's a flip side, though: While medical schools aim for diversity, your classmates may be a surprisingly homogeneous group. One hundred or so people is usually large enough for you to find a core group you like, but it may make for a smaller circle of friends than you're used to.
Married Life
It's no secret that med school can stress a relationship. However, plenty of couples happily survive those four years. Most medical schools, especially those affiliated with larger universities, have activities for students' spouses or partners. Married medical students are making up more of each med class. Since students begin medical school, on the average, at age 22 and graduate at 26, lots of students partner up during their medical school years. Typically, between 5-15 percent of an entering class will be married, and 40-70 percent of a graduating class will be married. Chances are if you're married or in a committed relationship, you'll be able to find other couples with similar interests from within your own class.
THE QUALITIES SCHOOLS LOOK FOR
One important consideration in your decision to become a doctor is whether you are the kind of person who is well suited to a medical career. In other words, you have to ask yourself if you will make a good doctor. This can be a difficult question to answer since there is no one model to which you can compare yourself. It takes a different set of skills to be a transplant surgeon than it does to be a psychiatrist. Each medical school will attempt to enroll a wide variety of students in the belief that this diversity will enrich the experience for all students.
While there is no one model for the ideal medical student and physician, there are a number of qualities that most medical schools find desirable in their applicants. Ask yourself how you rate in each characteristic.
Cognitive Ability
Native intelligence is essential. It takes intellectual firepower to learn and understand the body of knowledge required to be a doctor. This is why medical schools place such emphasis on your academic record.
Critical Thinking
Knowledge by itself is not enough. Doctors must be able to think critically, to synthesize information, and to solve problems. They must be able to find the answers to puzzles and to tease out a diagnosis from a set of often unclear, ambiguous, or contradictory facts or symptoms. This ability is one aspect of what has been called the art of medicine. The problem-solving nature of much of the MCAT is an indicator of the emphasis that medical schools place on this quality.
Curiosity
You need to have a sincere desire to investigate and to learn. Much of the knowledge you gain in medical school will be out of date within a few years of your graduation. You must have the desire to keep learning new things, to be a life-long learner. Do you have a sense of wonder about how the body works? About what causes disease? About how things work? Do you follow through to find answers to questions like these?
Commitment
The rewards of being a doctor are many, but in order to reap those rewards you must be committed to working harder than most people. The hours are long and so is the period of training. In fact, your medical education never ends. You need to be dedicated to spending your entire career keeping up, learning new things, staying on top. You must really want to be a doctor and be willing to make the sacrifices needed to become an excellent one. The drive should come from inside. You should feel emotionally impelled to be a doctor.
Compassion
A compassionate person is one who is conscious of others' distress and who has a sincere desire to alleviate that distress. Most people considering careers in medicine say that they want to help people. This is the heart of medicine. There is no better way to show compassion than by dedicating yourself to helping others regain or maintain their health. Ask yourself what you have done to demonstrate that you are compassionate. Medical schools will want to see some evidence that you possess this quality.
Communication Skills
A doctor must be able to communicate well. One of the most frequently heard complaints voiced by patients is that their doctors won't listen to them, or conversely, that their doctors won't talk to them. Highly developed communication skills are essential. Work at developing your communication skills by actively participating in outof-class activities that allow you to interact with others and that require you to be an effective communicator.
Cooperation
Cooperation means teamwork. Doctors must be able to work closely and cooperatively with colleagues from many specialties. Moreover, doctors do not work alone. Health care today involves a variety of professionals: nurses; therapists; technicians; and others. The effective doctor is one who recognizes the contribution each person can make to the care of the patient. Ask yourself how well you work with others. Do you insist on "doing it yourself" or are you willing to involve others?
Cultural Awareness
As a doctor you will treat patients from many cultures vastly different from your own. Their customs, beliefs, social forms, and truths may diverge greatly from the ones you were taught. You will need to be sensitive to those differences in order to effectively help those patients. This goes beyond tolerance of differences; you will need to try to understand those differences.
Character
Physicians are given a special place in society. Medicine is consistently rated as one of the most highly regarded professions in America. Doctors are granted access to their patients' most private secrets and are given powers over their patients few others are privileged to possess. With these privileges comes a high level of responsibility. As a physician you will be held to an exceptionally high standard of moral excellence and firmness. Your character must be above reproach, your values unquestioned.
YOUR PREMED ADVISER
If you're having doubts about whether reed school is for you, or wondering about your chances of getting in, the best thing to do is to talk to your premed adviser. Your premed adviser will have specific data about med school requirements, how students from your school fared in the admissions process, and where students with similar academic backgrounds and MCAT scores were accepted.
At many undergraduate institutions, the premed office handles the letters of recommendation. In some cases, they simply relay the letters to the medical schools. In other cases, the premed adviser or committee writes a letter to the admissions offices on your behalf. This letter can take the form of a "composite letter" which excerpts your recommendations; or it may simply be a cover letter that accompanies the recommendations. Either way, it is imperative that you get to know the people who are going to be writing letters on your behalf. In most such cases, the adviser(s) will require a certain number of meetings with their advisees. Take these meetings very seriously.
With the number of applications to medical school at an all-time high, premed advisers are a harried bunch these days. It's possible that if you're not a particularly strong candidate, you may find your adviser less than enthusiastic about your applying to medical school. He may have legitimate concerns about your competitiveness and may try to dissuade you from applying. Then it's up to you. You may have to go it alone without the full support of your school's premed office. Be realistic. If everyone agrees your chances are slim, have a backup plan just in case you're not admitted.
Copyright © 2002 by Kaplan, Inc.
