It will work out if you don't give up....

Lately I've been getting a lot of "panicky" emails from pre-meds. If I haven't written you back, please don't be offended... I've just been inundated with "help me!" emails as of late. And I figured I'd kind of throw my answer out for everyone to read.

So the panicky emails go something like these...

- Help! I took pre-med class X in the spring of last year but didn't pass it so I need to take it again. The question is should I take the MCAT before or after I retake the class? Because if I wait, then it might be too late to apply this year... yada yada yada....

or

-What should I do?????? I haven't heard back from any schools, should I contact the Dean? Or should I not bother them? Because I know you are supposed to assert yourself but I don't want to be annoying...

or

I got into 2 med schools and I don't know which one to go to. One is near my parents house and I can live at home for free... but the other school is way more prestigious and six times the price....

Sigh. If I could go back in time... say oh, 10 years, and tell my young semi-pre-med self just ONE thing.... it would be that NONE of this matters. Seriously. It doesn't matter if you make a phone call or send an email. It doesn't matter if you take the MCAT in April or September or even 2 years from now. It doesn't matter which school you choose.

All that matters is that you

1) try your best to make reasonable decisions that minimize your stress level and are conducive to you being happy and an overall ethical person

2) don't give up.

Really. I swear. That's it. Things will work out the way they are supposed to, when they are supposed to. And it won't be because Thank GOD you took physics before O-chem, or because you wrote a thank-you note on paper instead of sending a thank-you email. That stuff doesn't matter at all.

Getting Your MD in Italy?

Sounds pretty good to me if you are interested in going internationally. It's a 6-year program in Milan at Vita-Salute San Raffaele University. Taught in ENGLISH. Yay! No MCAT needed but you have to take an entrance exam which is only given in the USA in NYC. And it's on April 28th. So if you're interested you better get on that. Anyway, just thought it was a cool option for those of you who might be interested.

Here's the link:

Cool Med School in Italy

When Should You "Give Up" on trying to become a doctor?

Yucky question huh?

Well, contrary to popular belief, I don't think it has anything to do with taking the MCAT a certain number of times, or with how many times you've applied to med school. I personally know a physician that I used to work with that applied 12 times to medical school. Granted, that must have been at least 20 years ago... I am not even sure if you can do that now... but the point is that the time to give up has nothing to do with how many times or how long you've tried to get in.

But there is a time when you SHOULD give up. I bet you didn't think I was going to say that, did you? Well, there is. It's when you know, in your gut, that your priorities in life have changed... and pursuing doctordom is more about ego and proving you can do it than it is about actually becoming a doctor. The main thing I want to convey is that THAT IS OK! Nothing to be ashamed of. Everyone changes everyday... as do your wants and goals. I look back on lists of things I said I wanted to do in life. Many of them I've done. Many I haven't. Like "get my pilot's license". I haven't done that. But I don't consider it a failure because I no longer have any desire to do it. What-so-ever.

I think it takes true courage to be able to detect the difference between being determined and feeding your ego. I struggled with this alot because I think I was on the cusp when I applied the last time. Thankfully, I still really want to be a physician and I am loving it. But maybe 5 years from now I wouldn't have felt the same about the admissions process.

So ask yourself the tough questions. And assess your true desires. The REAL ones. Would you rather get married asap? Have a family now? Let things stay simple? Pursue a creative or entrepreneurial career? Do you REALLY want to give up the next 10 years for this? Any answer is ok... as long as it really reflects you and not your ego.

A Question From A Reader

Your blog seems to be one of the few that really highlights the positive aspects of med school and the memorable moments. At first, this didn't really bother me, but the more I thought about it, I started to remember the numerous physicians I shadowed who said similar things. It seems like there's this ongoing inside joke between physicians who try to convince pre-meds to head in a different direction.

What's your take on this? Why do a lot of physicians seem bitter of their decision? Is this something you have noticed too? Or have I just met a bunch of unhappy professionals who unfortunately chose the wrong lifestyle. I understand that medical school is difficult and can often wear a student down, but does it do this to one permanently?

Wow. Indeed this is a huge topic to cover. I'll try to answer by hitting the main points.

1. First and foremost, I think there are a lot of people in this world (doctors or not) who have poor social skills and don't know when to keep their mouth shut.... and to not give unsolicited advice. Is there a shitty side to every job on earth? Pretty much. Are there pros and cons to every decision you make? Definitely. Is it your job to be discouraging to those who want to go into the field you happen to be in? Definitely not. By doing so, you are assuming that YOUR reasons for going into medicine are the same as everyone else's reasons to going into medicine. You are also assuming that everyone else has the same criteria as to what a "good life" is, etc. Of course there is nothing wrong with giving your honest opinion... but when asked advice about your field... saying flat out "don't do it" is simply arrogant and immature. If it was THAT bad, those physicians would have likely quit long ago. Additionally, some people just enjoy being miserable... and telling others about how miserable they are.

2. I think there are a lot of older physicians who are indeed miserable. They came into medicine during a time which it was much easier to get into medical school, physicians made huge amounts of money, and never had to deal with much of the bureaucracy docs have to deal with today. They came not because of a unquenchable desire to be a physician, but rather for money, or the "good life", or the prestige, or because it was what was expected of them. As things changed, they didn't like it.... and suddenly the lack of the things mentioned above made medicine less of a draw. These are the people that say "medicine isn't what it used to be". Not true. Medicine is the same and even better. Pay, red tape, competition, etc... those are the things that have changed. All med students today know that very well... since they had to put up with it just to get into med school... so they have a different perspective.

3. Sad as it may seem... there are people who like the eliteness of medicine... and newer, younger, better physicians with new ideas and energy are indeed a threat. They compensate for the fear of the threat by discouraging others. Fortunately I think these are few and far between. Most physicians get pretty stoked at the idea of younger folks being interested in medicine.

4. Here's the one you probably don't want to hear. There is indeed an element of "Oh shit have I wasted my life on medicine?" that tends to poke its way into my consciousness every now and then. While I know that I love medicine and the rigamarole that comes with it... I have lately been having fleeting thoughts of the following...'

• Oh crap I'm 32, a 2nd year med student, and for the most part alone in a world of 10,000 other doctors
• Did I come to med school because I love medicine or because I had something to prove?
• Holy shit, I am going to be working REALLY HARD for the rest of my life. Physically hard. Long hours. Sleep deprived. Stressed. Backaches.
• Did I sacrifice having a family, etc. thinking I wanted medicine more... because now I'm not so sure...
• Can I really do this? Effing acid/base bullshit on a patient without killing them?
• Fuck, can everybody stop bitching about medicine so I can enjoy my day please?
• Wait, you mean for the next 8-20 years I'm going to be disgustingly broke and low man on the totem poll?
• Hold up. When I said I didn't mind being alone in order to be a doctor, I never said anything about being ok with being lonely. This sucks.

I mean... these things definitely hit me at least once a day. But then I have patients and procedures and classes and discussions which immediately give me a sense of clarity that I made the right decision. A sense of feeling like I'm using my talents to the best of my ability and challenging myself, and that I'll never be stuck in a different job wishing I was a doctor. Because I know that if I'd have gotten married and had children years ago at the expense of being a physician, I likely would have had just as much regret or more for NOT following through.

I can't really give a definite answer. I guess I'll have to keep you posted. I can say though, that I've had this exact discussion with physicians who absolutely love their lives in medicine and assure me that I will too. We'll see.

How To Keep On Truckin'

I've received a few emails asking how on earth I managed to keep my morale up when I failed as a pre-med. Like failing an exam, bombing an MCAT, hearing disparaging "advice", and whatnot. I guess the answer is that I didn't. I mean everytime something happened, I was distraught. And totally devastated. I started combing through my back up plans, applying to random grad school programs, looking up internships, and fantasizing about running away to the peace corps or becoming a writer or a chef or an FBI agent. It was awful. Awful because I had little perspective or knowledge that the path to becoming a physician is a long journey... marked by failures and successes. I'd see a few classmates or colleagues get right into med school with no sweat, and so I thought it wasn't meant to be for me. And so I'd head in another direction... like research, or public health, or epidemiology.... something that I THOUGHT would make me happy... as these are parallel fields to medicine.

And sure enough, these fields would keep me interested for about 10 months. Then I was bored. Soon I'd find myself back in the med school mode... tagging along with physicians, fantasizing about med school, plotting my next attempt at the MCAT or applying to med school. It was a series of try, fail, hibernate, heal, plot, try, fail, hibernate, heal, plot, try, sort of succeed (YAY!), try harder, fail, blah blah.

So I guess the answer is this.

1) Try to keep "success" in perspective. Know that when you're "up" you should enjoy it while it lasts because there will be "downs" too. And when you are "down" know that it's just temporary until the next "up".

2) After a "down"... don't be too hard on yourself, and don't make any drastic decisions that will alter your med school plans. The feeling of wanting to quit is soooo intense you can often fool yourself into thinking that you don't want to do medicine anymore.... even if you actually do. Give yourself some time to really regroup, re-evaluate, and make a better plan of attack. Immersing yourself in "parallel" fields like public health, etc. are great because they help strengthen your application while you regroup and get your ducks in a row.

3 Types Of Med Students

I wrote a guest post for Dr. D a few months back describing 3 types of med students and what the "right" reasons are for going to med school. I wanted to repost it here... bc I think it's super relevant to applying to medical school.

So before we get into what the "right reasons" are, let me clarify a couple of things. Medical school is difficult. It takes tons of time. It's stressful. It is a huge commitment. It's competitive. It is also a million other wonderful things. Everyone in medical school has essentially the same base experience.... four years of school plus residency, essentially the same course load, the same time schedule, the same amount of financial aid available for monthly living expenses, etc. Yet, you will hear every different opinion from students about their medical school experience... ranging from "it was the worst time in my life" to "this is easy cake" to "this is so much fun". In my opinion, one of the MAJOR factors that contributes to the differences in student's experiences in medical school is the vast array of reasons why they are there.

Now when I spoke before about the "right" reasons... I guess I should clarify... as who am I to say what the "right" reasons are... But let me describe a pattern I have noticed among medical student. I think there are three main groups of student attitudes about medical school. I'll describe them here.

The happiest students (those who have a balanced perspective, who do well academically, who have reasonable amounts of stress and anxiety, and those who generally "love" medical school) are those who are enjoying the journey. Meaning, they actually love medicine, love the material they are studying, love the lifestyle of continued learning and a high-paced academic environment. Of course, many have other interests and families, but to them medical school is not an obstacle in the way of those things. Med school is an awesome part of their life. Personally, I'm a second year medical student, and I love reading my huge Robbins pathology book with a cup of coffee in the early morning. I love going to lecture and participating in clinical problem solving. I feel a rush everytime I am in the hospital, I talk to my patients for too long, and my brain is always coming up with ideas for projects and research. I look forward to residency and my future career, but I am in no way miserable in school. I certainly think I fall in this category. I absolutely could NOT imagine being anything other than a physician... it took me so much work to get here that I am actually in academic bliss all the time. I know this sounds weird and a bit (ok a lot) over the top... but I know a lot of other people like this. If you ask them about medical school, they will describe it just like I have.

The second group of people are those that like medicine just fine, and it came about as a reasonable choice. They worked hard in undergrad... and are all around strong academic students. To them, medicine is more of "a good field to be in" for them instead of "the most amazing and only possible career on the planet". They are smart kids, but probably had interest in other careers as well... they could have been attorneys or engineers or business entrepreneurs or stock brokers and would have been just as happy. They are happy in medical school not because it is their #1 all time passion... but because they are very strong scholars willing to put in the work in order to be in a field like medicine. They do well academically, but are a bit blase about medicine... often eager to get home, eager to skip extra discussion about a disease or patient, and tend to be a bit disinterested and or frustrated with the rigamarole that comes with medicine. This doesn't make them less of a physician, but they do not enjoy the ride of med school as much as the above group. They are "putting up" with med school... and willing to wait to get out so they can have a family, a paycheck and a steady schedule.

The third group are the miserablites, of which there are two categories. These are the students that don't come to class because they hate medical school. They are barely hanging on by a thread academically, they are socially and academically absent, and they are caught up in the idea that that are in the wrong spot. They've figured out that medicine is a lifestyle that doesn't end after medical school... and they just come to the hard realization that the "misery" of studying, testing, stress and academic/hospital nonsense will be a theme in their lives forever. The first category of miserablites ended up in medical school because of outside pressures. Either from family or society or from within themselves, they felt pressure to do something "worthwhile", to make a choice, any choice,... and medicine seemed like it would be the answer. Their heart wasn't in it... but they either didn't have another readily identifiable passion, or they felt their other passion didn't hold enough weight. A lot of people in this category really wanted to just focus on another less traditional passion, or on family, having kids, being a parent, but got pressured into having a career first... and they are miserable because their heart isn't into med school.

The second category of miserablites came to medical school for the money or the lifestyle, and quickly figured out that those reasons are not sufficient to motivate you through the insanity of medical school. There are a million ways to be rich, that don't involve 8+ years, intense academic work, and a quarter of a million dollars in student loans. And they also figured out (news flash) that being a doctor doesn't make you rich... perhaps a bit too late. Sure you can make a life where you are comfortable financially... but 90% of doctors are not free of financial obligations. Student loans, malpractice insurance, etc. make the life less than glamorous. And frankly, though you can and will make a solid income more than the average American, the goal of being "rich" doesn't seem all that worth it two weeks before Step I when you are sleep deprived, amped up on caffeine, cramming, freaking out, and wishing you'd gotten an MBA or become a real estate agent. The miserablites are those who, as you say regard medical school as "sucking all life out of me, leaving me absolutely passionless, tired and with no ambitions". I can tell you I have NEVER even one day felt this way about medical school.

So, in essence, I think everyone applying to med school has a lot of thinking to do.

When Someone You Love Bombs the MCAT

I've seen several Google searches with the above topic directed to my blog, so I thought I would address it directly. When I tanked the MCAT, the only thing worse than tanking was seeing my parents disappointment. Not that I think they really gave a rats ass about me tanking the MCAT. It was more that they were devastated that I was devastated. So here's my what to do and what not to do list.

1. DO NOT act overly disappointed. Empathize, but if you act like this is a huge fuck-up, the test taker will only feel more like a loser.

2. DO NOT push them about "what are you going to do now?" They have just been through a HUGE amount of work that was essentially wasted (well that's how they feel in the moment anyway)... and it is wayyyy too overwhelming to think about studying and taking the test again. They will get there in their own good time.

3. DO remind them that the MCAT is a nightmare for everyone. If it was easy, everyone would be a doctor.

4. DO remind them that there are many people who take the MCAT many times and still get into great US schools. If you don't know any, you do now. See the profiles on the right.

5. DO support them in their temporary "Plan B" options (like taking a semester off, getting a Masters in pharmacology, taking a research job), but encourage them to keep trying for med school. Try to dissuade them from doing anything drastic (ie. running off to the peace corps or joining the circus). The moments after bombing the MCAT are very fragile, and it is easy to convince yourself you don't want a life of medicine... even if you really do.

6. DO NOT tell others that they took/bombed/etc. the MCAT. They will figure out a way to disclose that information on their own time in their own way.

7. DO NOT undermine the importance of the MCAT score or the difficulty of the test. Tips on how to study better or stories of how you fucked up the SAT II will not go over well.

8. DO just be a friend and invite them out to do something to get their mind off the issue will help. When I bombed the MCAT my best friend brought over a bottle of wine and we got lit.

9. As a preventive measure, DO NOT tell everyone you know that so-n-so's MCAT results are due. That's just asking for trouble if it comes back bad.

10. DO send them a link my blog. At the very least, they will feel better that they didn't eff up the MCAT as many times as I did.

Just Bombed the MCAT?

I just wrote this to a reader who "bombed the MCAT"... thought it might help some others out who might be in the same situation.

Well, my very first advice is not to panic. Yet. Everyone, and I mean EVERYONE who leaves the MCAT thinks they bombed it. I mean, your brain just went through a mental meat-grinder, right? It is the worst feeling in the world. If you left totally secure I'd be more worried. (see comments below). So I would sit tight and just wait for the results. Now if you KNOW FOR 100% SURE that you bombed (like you didn't finish the test, voided the scores, your practice scores were consistently low, or you got topics you didn't even remotely recognize), then you probably have a legitimate worry.

BUT, the good thing in medicine is that you can't get into medical school if you aren't ready. Really ready. And I promise, you'll want to be ready. When I am in my classes I am SO thankful that I had to get a good score and really learn all the material well before I started this stuff... because all the MCAT stuff (well, most of it) is your base foundation. And you don't want to start building more on top of that until that foundation is really strong.

I thought that because I did indeed put a lot of work into studying for the MCAT that I was ready, but that is not always the case. Sometimes you don't know the material as well as you think you do. Sometimes you know the material in your way, but not in the way that leads you to be successful on the exam. Unless you are a genius by birthright, the only way to be ready for the MCAT is to take FULL LENGTH practice exams until you get your target score as a practice score... for some this might be 2 tests, for others 40 tests. Until then you are spinning your wheels.

Now, I know what it is like to bomb the MCAT. I studied soft for a year and HARD for about 6 months before my first one, and I got a terrible score (you can find it on this blog :) I was devastated. Even more so my parents were devastated. I felt like an idiot, a loser, like I had no future, etc. To be expected, right? Well here's the second piece of advice I wish I knew then. Becoming a doctor has nothing to do with how smart you are, it has to do with tenacity. In medicine there is always going to be an "MCAT" situation to overcome. Whether its the application process, the board exams (you take 4 big ones in med school and residency), shelf exams, getting a residency, getting your Dean's letter, getting a fellowship, becoming chief resident, getting a directorship, making full professor, getting a big grant, etc. Its always something. And people fail. Someone has to. At the doctor level everybody is super intelligent and not used to losing... because earlier in life it was so much easier to succeed over people who weren't as capable as you are. But now, even smart people lose out. So the absolute one thing you must get used to is falling down and getting back up again.

Personally, when I bombed the MCAT I had a good backup plan. I applied to a Masters program in the health field and moved to a new city. It ended up being great, provided me some additional foundation building in the sciences, and gave me some great connections to eventually get into a great med school. Here's my issue. I am not all that smart. I mean, logically smart, yes, common sense, yes, people smart, yes. Book smart, not so much... and I'm a terrible test taker. The only reason why I'm in medical school today is because I do have the ability to work my butt off and I didn't give up. In fact when I finally got into medical school (4 MCATS later) the admissions committee basically let me in because they thought my application demonstrated "great diversity and tenacity".

Take the MCAT again if you bomb it. And enjoy the time you have before you go to medical school. Get an interesting job, study something you enjoy, travel, live in another city, or do something creative. Almost every 21 year old med student I know laments the fact that they never had another job or another life... and forever they will only be a doctor. This is a gift you just got to diversify your life before you will forever be a doctor. Start enjoying the ups and downs of the ride, because the road to being a doctor is really really bumpy.

* Oh, and 3rd advice? Stay off SDN. Especially now as you are vulnerable. Don't want to find any pre-meds throwing themselves into traffic.

Will Med School Make Me Miserable?

I answer this question on a Guest Post over at Dr. D's site. Check it out.

Stupid Premed Questions

There are some premed questions that are just plain stupid. Well, scratch that, rephrase many premed questions that are just plain stupid.

This one makes me nuts. Because it's a circular question, to which the answer is so plainly obvious that I don't understand why it generates SOOOO much talk.

Stupid question #1: Do adcoms frown on taking the MCAT more than once?

My gut response: SCREEEEECH (pterodactyl noise of irritation).

My rational (somewhat) response: Um, who cares? I mean, in every situation who cares?

If you bombed it and need to take the MCAT again, having more than one score is certainly better than having a low score.... as you won't even get considered. Better to be "frowned" upon than to have your application thrown into file 13, right? Duh.

If you got an OK score, lets say 29, and you're shooting for a better school and better score, take it! If you can't get in with a 29, you have to? Right? It's not like the school who wants a 32 would look at an application with just a 29 and say "oh GOOD, he only took the MCAT once!!!!!!!" vs seeing an application with a 29 and a 33 and saying "well, this applicant clearly sucks as he re-took the MCAT".

If you got a ROCK STAR score, why would you bother taking it again? This might be a problem better solved by counseling and a good psychiatrist. Besides, what if you got a LOWER score? Mwahahahahahahahaaaa.

If your scores EXPIRED, again, you don't really have a choice, right? Better than the app going in the trash.

If you are scheduled for the exam but not prepared, why purposely put a low score on your transcript that you will have to trump later anyways?

If you have a string of low scores... you're never going to get into med school without a good one... so what's another score??

Advice for your Med School Personal Statement

So not to toot my own horn, but toot, toot. When I want to be, (ie. not when I'm blogging or writing lame-o "fear essays") I am a very good writer. Especially when it comes to personal statements. How do I know this? For the following reasons:

1) I've been told in interviews that my PS was in the top 5% of the ones the interviewer had ever read.

2) My friends recommend me out to their friends to write/help/edit their PS's

3) Friends have reported back to me that their interviewers complimented their personal statements.

4) Essays I've written have received interviews at Harvard, Mayo, UCLA, Yale, UPenn, NYU, Mt. Sinai, etc.

So TOOT TOOT!!

Anyway, I'm done bragging but here's my advice.

1. If you know you suck at writing, or are even an average writer, seek help. Get a 2nd opinion and a 102nd opinion. Spell check. Grammar. And lose the freaking run-on sentences. Also, do a word frequency check (by eye). Did you use the same word 18 times in your essay? Did you say "I believe that" 3 times in one paragraph. Fix that. It's super annoying to readers.

2. Pick one direction, go with it. It's the worst to read a completely unorganized essay. Beginning with story 1, jumping to advice your father gave you, then describing your childhood dreams, then jumping to story 2, then describing your dog. Blah blah blah.

3. If you accomplish nothing else in your essay, demonstrate the following two things. 1) you UNWAVERING commitment to whatever you are applying for and why you want to do it, and 2) demonstrate your capabilities in the MOST HUMBLE POSSIBLE WAY. Any hint that this is anything less than your dream job is going to be a red flag. That and being an egotistical a-hole.

4. What you want to do is construct an interesting NARRATIVE that your reader will continue reading until the end. Cliche as it may seem, a story is always best because it makes your reader interested. The LAST thing you want is your Ad-com officer to be mentally exhausted and or irritated from trying to follow an illogical essay or just from TRYING to get to the end. Write a story (true or made up) in which you can weave all your cool little details into.

5. Your essay is not the time to describe every attribute about yourself in complete detail. The idea is to weave in interesting tidbits that will make your reader want to reference your application and look it over more closely. Like "Wow, how did this guy learn Farsi?"... or "Wait, this chick is 24 and she spent 3 years in Djibouti teaching... how is that possible?". If you do it correctly you will effectively coerce your reader to investigate your application more thoroughly instead of just giving it a once over.

6. Use this checklist to make sure you haven't done anything grossly offensive

• Did you come off egotistical?
• Do you put ANYONE down in your essay? Stupid professors, unsupportive counselors, etc. This is a no-no.
• Do you blame ANYONE except yourself for weak spots in your application? This is bad. For example, there is a difference between saying that your grades in college were sub-par because you were splitting energy between school and your full-time job vs. blaming your crappy grades on the fact that your parents cut you off from parental scholarship and you were forced to get a job.
• Is there ANYTHING that can be interpreted as racist, sexist, political, or religious? You should probably lose that stuff.
• Ok, here's a big one. Do you even HINT that you are interested in your chosen field because of money? Meaning you use the phrase "I really enjoy the lifestyle that medicine will afford me"? Definitely LOSE THAT. That's a BIG RED FLAG, BLACK BALL, whatever you want to call it.
• Do you mention that you are going into field X because your parents want you to? Or because your dad is also an X, and you want to be one too?
• Are you overstating your qualifications? Don't make your shadowing experience seem like you were doing lumbar punctures. Everyone on the ad-com will know you're a liar. Or at least a severe exaggerator.
• Name dropping. That's lame.

Here's some great stuff to include if you can:

• Foreign language abilities
• Clinical experiences
• Pre-med moments which made you REALLY want to be a doctor, or moments that made you really uncomfortable
• Your family status. You don't have to, but I think mentioning your kids or spouse is often indicative of your maturity and the diversity you will bring to the class
• teaching experience - adcoms love this. teachers make great learners
• international experiences
• demonstrating that you aren't a stress-basket

Ok, that's all for now. Good luck!

Top 10 Mistakes Pre-Meds Make

1. Not majoring in something you ENJOY, are GOOD AT, and you can get GOOD GRADES in.

2. Not listening to what an admissions officer tells you. Really listening. If they say, "I think you should consider the Carribean", don't waste your time applying there. If they say "I think you need 3 more points on your MCAT", don't apply to THEIR school until you have 3 more points. They aren't lying to you.

3. Asking people for letters of recommendation who suck at writing. Better to have a fabulous letter from some yahoo than 2 generic lines from a Nobel laureate.

4. Not taking full length practice MCATS. Timed. Lots of them.

5. LISTENING to pre-med advisors. Bleh.

6. Spending tons of money on high profile PBPM programs. Go to state school. It's cheap and adequate. Also, don't go to community college unless they have a VERY reputable science/pre-med department. Most admissions committees are not too keen on CC's unless they know their curriculum.

7. Focusing too much on "volunteer" work. No admissions committee gives a crap about you having a billion volunteer hours. They want to see that you are involved and committed to your community, that you are altruistic, and that you have clinical experience. If you are able to demonstrate these things in your application, racking up hundreds of hours of volunteer work is totally unnecessary.

8. Being too passive. American culture tells us that we shouldn't be pushy, that we shouldn't ask for favors, etc. That's fine if you have a stellar application with a 3.8 and a 40 on the MCAT and you've singlehandedly revamped the water system in Djibouti. For the rest of us, get assertive. Note: I am NOT advocating that you be obnoxious, pushy or annoying. But contact the Deans, make appointments, write letters, have a faculty member call on your behalf, etc. I lost out on an entire year because I didn't want to be "pushy" and the Dean simply forgot about me.

9. Stressing. About everything. But you can't avoid it. You're a pre-med.

10.Letting the MCAT and the application process affect your feelings of self-worth. I can honestly say that I do not know even one medical student that breezed through every single aspect of this process. There is a huge disconnect between a pre-meds perception of themselves and their perception of the ease to which everyone else supposedly gets into med school. And if you're going to be in the medical field, get used to going up against adversity. Because now its the MCAT and the application. But in med school you have to beat the USMLE. Then its residency application. Then competition for fellowships. Then competition for faculty, and tenure, and on and on. It will never be over. Get some perspective and enjoy the journey.

GOOD LUCK !!!!

REAL PROFILES

I've started something new. On the side bar I've started listing everyone I personally know who has journeyed to med school, law school, dental school or nursing school.... and a few details about them. Some are traditional students, some non-trads, and some are REALLY non-trads. The point is to see that there are WAYYY more who've had difficulty getting in than those who breezed in with perfect grades and scores directly out of undergrad. And some with perfect scores and grades who never got in at all. As I remember more, I'll add to the list...

PS: NONE of these are students in my med school class. They are all from my previous life.

Moments When I Almost Quit

Pre-med that is. So many emails from my readers have reminded me of these moments.. so I thought I'd write them down...

1. Freaking out before my first G-Chem exam when (Oh, WAYYY back when) I arrived and classmates were doing the classic pre-test freak out (asking questions and making me aware of the things I DIDN'T know). I got a C on my first exam. Subsequently, I failed the class because I stayed up all night studying for the final... and accidentally set my alarm wrong and slept through the exam. I was too ashamed to confess to the professor. So I took the F. I was 19 years old.

2. The pre-med counselor at my undergraduate university said it would be next to impossible for me to go to med school. I should essentially just drop the idea all together. I still remember his little pin-head. He probably wanted to go to med school, but gave up and became a pre-med counselor instead. Pin-head.

3. After finishing my first PBPM year at Harvard I had done pretty well in all my classes. But then at the very end I got a C+ in Gen Chem II. I was camping on vacation in Maine with all my friends... glad to be out for the summer. I went into town to check my grades and found out my final grade. I was literally not a happy camper for the rest of the trip. After that I decided I was going to scrap the whole med school idea, and I actually wrote an ENTIRE book about a girl who dropped out of med school. Hmmm. It was therapeutic I guess.

4. After MCAT disaster #1 I was devastated. I actually gave up on the med school idea for a while and went and got my Masters. After MCAT #2, I improved... but MCAT #3 was HUGELY emotionally disappointing.... as I actually went down 1 point. Uh. Thank god for MCAT #4.

5. The first round of rejections from med school weren't so bad because I was totally expecting it after my crappy MCAT #1. The SECOND round however, was awful. I was rejected by my current school right away. Then I had two interviews, both at state schools in my home state. In the first interview I was totally stoked. But my interviewer decided to be "brutally" honest with me because she "liked" me. And said that despite being invited for an interview that I should not expect to be accepted. I had a 28 on the MCAT... and although my application was great in many ways... she thought I needed 2 more points. And she was adamant about that. So I left, feeling horribly dejected. So dejected in fact, that I decided to skip my interview the next day at the 2nd state school... as emotionally I just didn't want to deal with that again. The interview was a couple of hours drive away... and I told my parents I was not going. They understood.

The next day my parents woke me up and asked if maybe I just wanted to get dressed for the interview... and we could drive on down to the University and see how I feel. If I wanted to go, fine. If not, we could spend the day touring around. I agreed and sloppily threw my suit on. With a too-casual shirt and a bag that didn' t match. We got there and I decided to go ahead and interview. But there was construction and I was late. And I forgot to spit out my gum. And I switched interviewers because some other kid was friends with his. And I was so so hot. It was a nightmare. But the interview started and it went rather well. I even ended up talking about my previous experience at the other school. And to my amazement the interviewer was really interested in me. And at the end he said "Well, I think you have a great shot at getting in. And I'M the chair of the admissions committee... so I can say that with authority. So consider yourself at the very least on the wait list. Possibly accepted right away" I ended up on the wait list... which missed me by about 12 people.

6. I had been working for a neuroscience professor for about 5 months. The position was extremely coveted...as all the pre-meds wanted to work for this specific professor. But she was really hard core. She expected year(s) long commitments...and most of the students had been with her forever. I was one of two undergraduate students that she allowed to work there. Unpaid and without the possibility of publication. I had a key to the labs and was assigned a project. And I worked HARD. I would come in at 2:00am and work until class started in the morning. Then I'd go to class, go home, study, sleep and start over. I did this for several months. I went to every lab meeting, prepared for journal club, cleaned the lab on my scheduled day. The whole bit. When the time came to apply to med school I asked for a letter of recommendation. And her response was "Well, if I write you a letter, I would be forced to compare you to the others in the lab. And you do the least. So I'm afraid it wouldn't look good for you". WTF???? Compare me to the others? You mean the other PhD and Masters students? Who get PAID and PUBLISHED and who aren't here at 3:00am? That sucked. A lot.

7. Um getting rejected by the Dean at my current school was crushing. The story is essentially that one dean really liked me and told me I'd be a great fit for the school. She pretty much promised me a spot. We'd been communicating pretty regularly... so I was pretty secure that I would get a spot. All of the sudden, communication stopped. And it was October and I hadn't heard anything for weeks. Since I was employed at the same school, my boss called the admissions office on my behalf and requested a review of my file. The next week I got a rejection letter. I felt so betrayed. The next summer when I approached the Dean again, she seemed shocked to see me. She explained that she had put me in for an interview the previous year... but she goes on vacation every year in October... and that's why she didn't communicate with me. When my boss called, Dean #2 must have pulled my file from the interviews, reviewed it, for whatever reason didn't like it, and rejected me. That's her story. True? Not so sure. But it made me feel better.

No Assholes Rule - BROKEN

Today at the dog park there was this guy. I knew right away, but I prayed I was wrong. Haughty. Less than mediocre looking. Cussing up a storm. Had an arrogant air about him. Throwing around his medical advice about a possibly anemic dog. Then he dropped the bomb.

Him: Well, I'm a 4th year MEDICAL STUDENT.

Me: Oh, really? How cool. You must be really smart. What are you going into?

Him: Well, I'm hoping to match here in radiology.

Me: I LOVE radiology! They get to study all those cool pictures, right? So you're at (named the local med schools)?

Him: No, I went to med school in Florida. Just moved here last week.

Me: But you don't know if you'll be here? Isn't that Match thingy in March?

Him: Well, I know EVERYBODY at (named ALL the local residency programs). I'm VERY sure I'll match here. In fact, my fiance just moved here and we bought a house, a car, and a dog (pointing to what I'm sure was a pure-bred puffy something of a dog).

Me: (Silent): Holy shit you are one egotistical maniac (Out Loud): Well GOOD for you! So you must know all the guys in Dept. X.

Him: Oh, yeah. I know them (pronouncing BOTH of their names incorrectly)

Me: (Out Loud) Good luck to you! Bye! (Silent) Arrogant prick.

Interviews - Post 2

Everyone is freaked out by the questions that you will (or will not) be asked... Fear not, the point of interviewing is just to assure the admissions committee that 1) you can string along a few words in a mildly coherent fashion and 2) that you aren't "grossly offensive" in some way undiagnosed on your paper application. 99% of interviewers feel the same way... less than 1% are actually "out to get you" (meaning they want to stump you or make you look comparatively stupid in contrast to their all-knowing godly physician-ness).

That being said, lets first discuss what you CAN do to grossly offend the 99% of interviewers:

1) BS'ing. Meaning that you've been asked a question that you don't know the answer to... and instead of owning up that you aren't actually familiar with EMTALA or the HENT receptor or the new CDC guidelines for treating HIV... you decide to BS. A lot of times you've been asked this question on the presumption that you won't know the answer... because the interviewer wants to assess how you deal with stress and how your ego works. They're hoping for a response like "No, I haven't heard about that. When did that happen?" or "I have no idea what that is. I'll have to check it out later." If you BS'd your answer, not only will your interviewer likely know you BS'd, but they'll also think you're an ego-maniac that can't admit fault. That would suck.

2)Talking shit. Hopefully, you're thinking "Isn't that obvious?"... but I've seen candidates come to interviews and complain about the poor organization of the interview day, bitch about how cold the city is, describe how boring their student host was, whatever. Bad form. Because anyone who hears you is going to think "Good god, this person bitches so much they can't even control themselves on an INTERVIEW? Yikes. This is probably how GWU ended up with a disgruntled student submitting some 500 odd complaints against them and getting put on probation. Um, NEXT" Additionally, talking shit breaks the "no assholes rule" (see Interviews - Post 1).

3)BO. Again, hopefully obvious... but for whatever reason some people can't figure it out. And BO comes in the most unexpected packages sometimes. Cute little blonde girls who wear Louis Vuitton and Christian Dior makeup. Who would have ever guessed? If you are even remotely unsure, here's my suggestion. Sit down with your best friend in the entire world (who hopefully doesn't also have BO) and say these words. "I have an important question that will affect the course of my entire life, and I need you to tell me the absolute truth no matter how much you will think it will hurt my feelings. I want to be a doctor more than I care about breathing... and if you don't tell me the truth I will never become one. Do I have BO?"

4) Being ungrateful. In any sense. Please make time to thank your interviewer for their time, thank your student host for their hospitality, and thank the secretary for making the day happen. No one owes you an interview or an acceptance. There are about 70,000 people who take the MCAT every year, 40,000 apply to med school, and about 17,000 get accepted somewhere. If you don't appear grateful, someone else will.

OK, let's move on to the questions you should be prepared for. I've seen med-school interview books with 100's of questions. If you are of normal intelligence, you don't need to "prepare" for more than about 5 standard questions. The rest can be answered by just being honest, humble, and mild-mannered. Here's the ones you should be able to answer cold.

1) Why do you want to be a doctor?

Great answers address the following:
- Why being a doctor is a different/better match for you than your other interests (note that I didn't say to slam other careers)
- The process that led you to the decision to pursue medical school (because you shouldn't have decided overnight)
- The aspects that appeal to you in medicine (like the fusion of humanity and science, or the lifelong ongoing learning)

Less than great answers go something like this:
- My dad was a doctor and I decided to become one when I was 4 (way to demonstrate that you have no free will)
- I broke my arm when I was 12 and that's when I made the decision (probably shouldn't rely on the life-long committments you made at 12)
- I want to be rich, drive a Ferrari and pick up lots of women (OK, I've never heard of an applicant say this, but I have friends who are physicians who say this is why they went to medical school... scary)
- I want to help people (duh!)

The general idea is that you want to show that you have solid reasons for becoming a physician that are unique to being a physician. For instance, if you say you want to help people... that's great.. but why not go volunteer at an nursing home and save yourself a decade of work? That is not a sufficient answer. You need to explain yourself better. When I interviewed I was asked why I didn't want to continue on as a high school science teacher. The interviewer commented that it was similar to medicine in that it helped people, had elements of science, and facilitated learning. I answered that while it did have all those things (which I appreciated about medicine), that I didn't feel that being a teacher was challenging for me. I didn't feel that I was growing as a person. In medicine I could help others while challenging myself.

2) What are your strengths and weaknesses. I hate this question. It's so dumb. As if anyone has the ability to TRULY assess their own strengths and weaknesses, and if they did... who would admit them? Is somebody really going to say "I have a stellar rack, which really helps me get attention from important people" or "I'm incredibly brilliant while the other earthlings are complete morons " or "I am secretly addicted to meth, but I still show up for work on time"

BUT, you should still have some good answers up your sleeve for when this question comes up.

For Strengths:
Pick something that the interviewer CARES about. Like I'm resourceful, I'm a mediator, I'm innovative, I'm a strong bench researcher, I speak Vietnamese, or I get along with most everyone. Pick something that will affect THEM, but doesn't sound too boring or egotistical. It's a fine balance. Don't pick something subjective like "I'm nice" or "I'm intelligent"... because frankly, you have no way to assess that yourself.

For Weaknesses:
Well after the Obama, Clinton, Edwards debate a few years ago you now really have to answer this question well. For those of you who missed it... all three were asked about their weaknesses... Clinton answered that she is too hard of a worker, Edwards said that is is too philanthropic (or something like that), and Obama said that he's completely disorganized and his desk is a disaster. Well the media jumped all over him for admitting that he was disorganized yada yada, and his response was "I must have misunderstood the question. I thought I was being asked what my weakness was... and I guess I was supposed to answer with a strength disguised as a weakness"

Point taken. Answering with a strength disguised as a weakness is well, weak. Lame. It makes you look like a pompous ass, actually. So you need to come up with a real weakness. But not too much of a real one. Don't go around admitting that you cut yourself when you stress out before exams or that you steal $100 bills from your Grandmother's secret jelly jar. You should also avoid admitting anything that will send up a red flag on your application. Don't admit weakness in regards to grades, stress, not getting along with people, not liking sick people, not being able to deal with authority, having a learning disorder, not sleeping regularly, having OCP, etc.

Pick something either 1) totally unrelated to med school 2) something that is a subjective weakness or 3) something that USED to be a weakness but you've overcome it.

Examples:
- I used to interrupt people because I get excited about what they are talking about... but I've tried to become conscious of it, and I don't do it as much anymore
- Everyone in my family plays tennis except me. I'm terrible in sports and I'd like to work on that.
- I'm really bad about keeping in touch with my old friends. I get so busy sometimes months go by before I notice.
- I eat a lot of junk food because I have a crazy schedule, and I always say I'm going to start packing healthy lunches for myself... but I never do
- I ask a lot of questions out of general curiosity which I think people can mis-interpret as me doubting the validity of what they are saying. I have really had to work on how I frame my questions.

These are truthful, but pretty benign in the grand scheme of things. You'll give off the impression that you're authentic, but smart enough not to reveal anything inappropriate.

Interviews - Post 1

So now I'm taking requests. Someone asked me to write about the interview process... and oh, boy do I have a lot to say about it. Much more than could possibly fit in one post... so maybe this will have to be the first of a few posts...

Here's My Thoughts...

1) On manners. Holy crap, I have seen some DOOZIES! For Christ's sake! Mind your manners. Do I sound like your mom? I'm guessing some applicant's mom's didn't spend much time on this topic... so lets do a quick recap. Most schools have a "no assholes" rule... and these things will definitely disqualify you.

-Elevators... these work better if you let people OUT before you try to get IN. Yes, we know your excited, but don't trample the faculty

-Cussing- So I have the mouth of a sailor under normal circumstances... but not on my interview day. Not to staff, faculty, nor to students. Don't get too comfortable. Everyone can hear you

-No complaining! For god's sake I don't care if you only eat omega-3 grass fed beef. Shut up and eat the bun and the pickle. No one wants to hear it on an interview.... not to mention you come off like a giant asshole.

-Bragging to other applicants about your Yale interview and 42 MCAT? Tacky.

-So you hate this school and the city and it's your last choice and you are hoping to GOD that you get into Mt. Sinai instead? By talking about it you are breaking the "no assholes" rule.

2) On outfits. Oh, the horror. Almost every applicant (guy or girl) is wearing a black suit and a white shirt. Every guy wears a red "power tie". Yes, I got the memo that you are supposed to dress conservative. That means take out your tongue ring, cover up your tattoos, and leave your zoot suit at home. It DOES NOT mean that you have to dress for a funeral. My friends and I talked about this before our interviews and we vowed to be conservative yet to be ourselves and stand out. And guess what? We all got complimented for dressing DIFFERENTLY. I wore a charcoal Tahari pantsuit (conservative, yes?) with a blue and purple embroidered tunic underneath. On another interview I wore the same suit with a pink silk shirt and a chunky shell necklace. My friend "T" wore a beautiful grey suit with a medium blue shirt and yellow tie. My friend "K" wore ivory dress pants with dark red patent leather heels and a beautiful sweater. Everyone looked professional and conservative, but we all stood out from the other applicants. Think about it. What would YOU want to see after interviewing 128 penguin college grads in black suits and white shirts?

While I'm on the subject, please make sure your outfit "fits". As in, your interviewer isn't staring at your pink bra through your gaping blouse buttons, and your lateral malleolus isn't visible because your pants are too short.

3) On TALKING - so we all know your going to get questions from your interviewer... but that's not what I want to talk about. I want to talk about the questions YOU are going to ask your interviewer. Because you better. You better act interested and involved and so thrilled to be there that you just can't stand it. Your goal is to make your interviewer excited about talking to you. You need them to remember you when it's time for them to write their review about you. You don't want some professor scratching his head trying to remember which penguin you were and what the hell he should write about you. I've found that the best way to be remembered is to make the interviewer feel GOOD. If they are having fun, they will remember you. I don't care if you have the most crotchety old geezer interviewing you... you can turn the situation around. Start asking them questions. About THEM! For instance, "So what brought you to this school?" or "What made you decide to go into oncology?". Best option, look around for something to comment on. Pictures of grandkids? Ask about them. A Navaho blanket on the office wall? Mention how you saw one just like it on the Antiques Road Show that appraised for $40k. Anything. Make conversation and make it authentic. Remember, everyone's favorite subject is themselves. Get them talking. They'll remember you, and that's less time that YOU will be in the hotseat answering questions about that C+ you got in O-Chem.

Let's Talk About ADCOM's

I've been getting some wonderful emails from non-trad pre-meds who are wondering HOW ON EARTH to get into med school with a (super) sketchy academic background. I should know, since I'm an expert on sketchy academics. Let's talk about what it takes to get into medical school if you have some SERIOUS academic deficiencies.

The trick is knowing how the system works.

Many pre-meds think "Well, my GPA is ridiculously low, but my MCAT is ok, and I have six years of research that should outweigh my low GPA. I mean, undergrad was so long ago. I've matured since then. Not to mention, I have tons of clinical work, and I know I interview well... so this should work!" Right? WRONG!

The truth is that ADCOMS don't review every application and they don't take into consideration the applicant's whole big picture. It's not that they don't think that your six years of research should outweigh your GPA. The problem is that your low GPA and MCAT aren't getting you to the "second round" so to speak of the application process. Your application isn't even making it someone's desk. ADCOMs get thousands upon thousands of applications. Usually there are only a handful of reviewers (who are busy physicians themselves). They can't possibly read every application.

Applications get read by one of two* ways...

.

1) By score. ALL applications are given a preliminary score. Every school's scoring system is different, but essentially it revolves around GPA and MCAT. For instance, one school I interviewed at outright told the applicants their scoring method for review. These numbers are arbitrary... just for demonstration purposes (please don't email me and ask if they are real and what school!) They take the GPA (say 3.2) and convert it to a two digit# (32). They then add that to your MCAT score (say 31). Your score would be 63. The school used a cut-off (say above a score of 60) to decide which applications to review in depth. From those reviewed in depth, a certain number will be selected for interviews. So you can see how if you are weak in your MCAT but strong in GPA (like a GPA of 3.7 and MCAT of 24) you could still get a full review. But if you are mediocre in both areas (or REALLY weak in one area), you'll never get reviewed no matter if you're an Olympian, Rhodes Scholar, Brad Pitt, etc.

2) The second way you can get a full review is by recommendation. And not just by anyone. This means that someone that the ADCOM values (not YOUR mentor, college professor or hometown doctor calling to say how great you are) has requested a full review of your application. This is usually a professor in that medical school, a donor to that medical school, a top doc in one of their affiliated hospitals, or someone else of consequence to the ADCOM. In some schools, such as mine, a med student can ask the ADCOM to review the application of a candidate they like.

*Ok, I lied. There is one more way you can get a review. That's if you yourself are high profile (ie. an Olympian, Rhodes Scholar, or Brad Pitt). I didn't make that an official category... I guess I figure the Brad Pitt's of the world should have to figure some things out on their own.

So the point of all this? If you can't get your application through the system via route #1 because your academics are too sketchy, you sure as heck better start making friends (route #2). My best advice is to find THE med school that you want to go to (this should be a reasonable school.... probably not Harvard... but hey, anything is possible)... and GO THERE. Move across the country, get your Master's degree there, do research at their teaching hospital, teach their undergrads, sweep their floors, do something (ANYTHING) that demonstrates your abilities and puts you in touch with the right people. After you've proven yourself (after about a year) you can start asking for favors and poking around looking for ways to get in.

Not only is this how I got into med school, its how MANY people get into med school.

18 Specialties For D.O.'s

Here's a list of the 18 Specialties that D.O.'s can become board certified in (not counting sub-specialties):

1. Anesthesiology

2. Emergency Medicine

3. Dermatology

4. Family

5. Internal (plus 11 sub-specialties - Cardio, Allergy, ID, GI, Oncology, etc.)

6. Neurology and Psychiatry

7.Neuromusculoskeletal

8. Nuclear Med

9. OB/GYN

10. Ophthalmology

11. Orthopedics

12.Pathology

13.Peds

14. PMnR

15. Preventative

16. Proctology

17. Radiology

18. Surgery

Not to mention, DO's can apply to allopathic residencies and then apply for board certification in those as well....

Doesn't seem so limiting now, eh?

Whoa.... psychiatrists and neurologists... relax. The AOA lists them that way. Don't shoot the messenger.

Well since we're on the subject....

I put my DO vs. MD link on the side, had a few comments, and others are posting about it again. Here's Ella's version of the straight dope.

Moment of truth: If I had to do this again. I would have gone to DO school.

GASP!

Not because I don't love my school or my program. I love where I'm at. But I could have gone to DO school years ago. I could have been a doctor by now, half way done with residency. I didn't do it out of pride. Pretty much pride only. Because I wanted to be an MD, and because I didn't want to "defend" my education to others. Which is a pretty BS reason to waste years of your life.

Additionally, I think I would have had a different peer group. More alternative routes to med school, more diverse backgrounds, and more older students. Which is something I do feel that I miss out on here.

I really don't think the education is any different. And while there is undeniable residual stigma associated with osteopathic schools... I think it's lessening. All the time I hear MDs say how cool the DO physical manipulation is. And how so-n-so is a DO and is amazingly good. And I promise... very soon osteopathic schools will have the exact same academic criteria for admission. Some of the best osteo schools are already there (like the Texas program). Others are building their reputations.

Consider it. Or don't... and spend however many extra years of your life stressing about how you can POSSIBLY become an MD.