CHAPTER 1
So You Want to Be a Physician
Many of you decided you wanted to be a physician or nurse when you were younger than five years old. This came about after witnessing a physician give comfort care to a family member, and you remembered how much he or she appreciated it and the family's frequent conversations about it. Over the years, you found that you had no one to talk to about what it takes to be a member of the medical profession. You haven't needed anything but routine care from your family physician(s) and never really got to talk to them. You formed some impressions from what you saw on TV or in the movies! Or you have talked to counselors in high school and college. We have found that many college counselors don't have very good insight or knowledge about medical and osteopathic schools and what it takes to get into them — let alone what being a physician entails. It is always helpful to talk to a physician who might agree to be your mentor.
Applicants to medical schools are finding that even if they have outstanding grades, they may not be accepted into some programs because they've done little or no volunteer work aiding the underserved. Volunteering is very important to many admissions committees. Have a separate résumé for your volunteer work going back to grade school. Describe and document what you have done with a short paragraph for each project — go by the motto: If it isn't documented, it didn't happen! This résumé is more for your records than for submission, but you may want letters from some of your volunteer-work supervisors. It also can be a good source of material for your Personal Statement, which is mostly about "Why I want to be a doctor." Mention your number of blood donations. Have you signed up to be an organ donor? Your interviewer may be a transplant physician. It is better to volunteer for a few organizations over a long period rather than for multiple ones for a few weeks at a time. This amounts to a "continuity of caring."
You don't need to go out of the country to volunteer — although a number of medical schools emphasize global medicine to their students — but it is a maturing experience. Admissions committee members don't view building hospitals or schools outside the country as rewarding as volunteering by directly helping people, e.g., visiting the homebound elderly, working in a hospice or homeless shelter, and on and on. There is no limit to the opportunities.
Process
I (author ECR) have been on the Mayo Medical School (MMS) admissions committee, and I can say that comparing our authors' admissions experiences of three to five or more decades ago to today's process is like comparing night and day. I'm sure I filled out a short application, but I don't remember being interviewed. I didn't take an MCAT. I don't recall an orientation of any kind, and there were no mentors before we started or once we were in medical school. The biggest difference is that any applicant will need to do at least some — how much likely depends on the medical school — volunteer work, even if he/she has a GPA of 4.0 and a high MCAT score. When I was on the admissions committee, the group interviewed several pre-med students who worked nearly full time to put themselves through college and minimize student loans and so didn't have time to do much volunteer work. We didn't penalize any of them for this. If this is your situation, a letter from your employer would be beneficial.
While I served on the admissions committee, we had about 4,500 applications for 50 positions in the freshman class!We could first reject about 1,000 applicants because of very low MCAT scores, incomplete applications, GPAs below our minimum expectation, visa problems, and so on. That left around 3,500 applications for review. Various members of the admissions executive committee screened these applicants to choose 300 to invite for an interview. The approximate twenty-twomember admissions committee included staff, emeriti, several medical students, and residents. Some schools accept up to 250 applicants for a position and have different admission criteria.
Every week for about four to five months, each one of our seven executive-committee members reviewed twenty-five applications (given to us at random). It would take about fifteen to twenty minutes to review a few pages of background material, four to six letters of recommendation (two to five pages each), and the applicant's Personal Statement. Then I would vote to "invite" or "reject." We were all urged to have no more than three or so "invites" out of our twenty-five because the total of 300 invitees added up quickly. Yet there were times I wanted to invite twenty of the twenty-five. These "kids," who were not much older than my grandkids, had worked so hard and exuded a passion for people, and I thought their enthusiasm was very genuine.
The whole committee met weekly to go over the "invites" and vote anonymously. The grading scale was "5" as the highest, and we could go down to "1" or "2," but almost never did. We had a lot of 3.5s to 4.9s. There could be several who had institutional actions, and a few would have misdemeanors. The applicants always had good explanations, knew they did wrong, and were very apologetic; ultimately, we didn't downgrade them for this. Applicants explained these infractions in a special area on the application. They may have gained maturity as a result of their wrongdoings or misdemeanors. It would be much more of a problem if an applicant did not list a misdemeanor and we found out — he/she would be dropped. Fortunately, this didn't happen.
We have drawn upon our experiences as past admissions committee members to create the following list of things to keep in mind when applying to medical school:
• Being a son or daughter of a physician didn't count, nor did being a legacy. We know of situations where wealthy potential donors offered to "donate" large amounts of money to the medical school — but this didn't help get their children accepted.
• Significant athletic or music skills didn't help (we had a number who were concert virtuosos). (This has changed, and today the Mayo Clinic School of Medicine values athletics, artistic endeavors, and military service in the review process.)
• We always looked for passion in the applicant. The fact we didn't sense it in an application didn't mean that it wasn't there, so we would probe an applicant a little bit along these lines during the interview. You can sense a quiet passion even if it is not obvious. Admissions committees can get a feel for this in your Letters of Reference (LOR).
• Does it help an applicant to have a Type A personality? Only — and we say only — if you also use it to maintain a balance in your life. A must.
• Do you have a purpose in life? Passion is today; purpose is your future — what you want to be and how you want to leave the world a little bit better. Physicians have a great opportunity to accomplish their goals and purpose. Incorporating your goals is something to consider in your personal letter that accompanies your application. But keep it within reason — curing cancer is noble, but it could be many decades before this happens.
• Attitude — a form of passion — is another quality that stands out. Many employers — without even knowing it — look for this in an applicant. Attitude and passion can be learned from role models. Who are your role models?
• On the flip side of having a good attitude, if your tendency is rudeness, medical schools don't want your application. You still have more growing up to do. We place a very high value on empathy, and arrogance is an absolute no-no! No medical school wants to find this out after you begin your first year.
• Some medical schools now offer half- to one-day sessions, commonly called "Med School 101," which focus on applications. These are usually held in the spring on a Saturday. Some pre-med students attend more than one of these sessions, so contact a medical school near you for a schedule. Schools often encourage students to bring their parents. Go to this early on — maybe your sophomore year — and then go back the next year to get questions answered that came up since your last visit. There also may be a finance officer there to explain scholarships, talk about incidental costs, and answer questions about student loans.
• Shadowing a physician on rounds can be enlightening and should be done maybe a half dozen times, but there isn't extra credit for doing more. It is recommended to help pre-med students get a better feel of the real world of a physician, but it has variable weight with admissions committees.
• Some applicants have worked with a researcher during off-quarters or even during a "gap" year after graduating from college. Publishing a paper with your research advisor(s) is looked on very favorably, providing you can document a significant contribution to it. Your advisor during the research can help you with this.
• Many applicants spoke two or more languages, which is nice, but of limited value regarding qualifying for admission. We suspect many schools in the United States might put some emphasis on speaking Spanish. In some major cities, a percentage of the population doesn't speak English.
• Surveys of college students disclose that one of their most important concerns is time management (this could begin in high school). To quote experts: time is everything. Managing your time could be one of the most important things you do — it is a form of continuous improvement.There will always be someone who wants your time. Begin keeping a time diary by recording everything you do in fifteen-minute periods, e.g., texting, watching TV, studying, class time, sleeping, etc., and do this for up to a week. Break the day into three blocks, such as morning, afternoon, and evening. Get academic work done during one of the blocks, and make sure you find time for extracurricular activities, such as volunteering and playing sports, and just having fun — even at work. These studies found that those who are involved in extracurricular activities are the happiest. Don't let your day become a blur of all your activities.
• Getting plenty of sleep is much more important than cramming into the night to study for a test or write a paper. Pace yourself. If you didn't learn this already, there are two things that college students want help with: time management and access to good mentors. I would add networking.
• When you are in the classroom, do not text or even look at your smartphone or tablet computer (unless you need it for the lecture). Maintain reasonable eye contact with the professor. Don't look bored. No talking or eating in class. College is serious business. And expensive!
• Ask good questions. This isn't buttering up the professor but a sign of intellectual curiosity (the professor can tell the difference). Or go up to the lecturer after the presentation or at a scheduled time. It was obvious in the Letters of Reference that professors like this, and it isn't an imposition. It's another sign that you want to learn. But don't ask inane questions just to get attention. If you are in the back half of the classroom, don't allow yourself to nod off — the professor can easily see this.
• You should have several mentors in college — a good mentor(s) can be a game changer. Talk to other students to find good mentors. But don't hesitate to change mentors if needed. Every so often, handwrite a nice thank-you note to your mentor (an email is not good enough). Ask several mentors to write reference letters for you.
• Being a teaching assistant (TA) can be rewarding to you and to your application.
• Experts will tell you to not let your parents advise on which courses to take and when. They also would advise you to not take all the heavy pre-med courses with labs in the first year. We recommend that you take a course in bioethics — this will be a good start to help you face problems you will encounter the rest of your life.
• Send in your application early — preferably in the first two weeks of June. The admissions committee secretary tells us that this is very important. Applications are reviewed in the order they are received, and they stay in this order. This doesn't mean that you will be ranked higher, but your invitation to an interview likely will occur sooner than those whose applications were received later.
• It is important to minimize or even avoid any credit card debt when applying to medical schools — even for travel and hotels. This lessens the load on your student debt.
• Some medical and osteopathic schools are requiring the completion of short-answer secondaries, which are questions about yourself, such as:
1. What particular qualities do you feel you can bring to xxxxx school?
2. Why are you applying to an osteopathic school?
3. How have you familiarized yourself with the field of medicine, especially problems with health-care delivery?
4. How would you deal with a recalcitrant patient?
5. Who in your life has influenced you the most?
These are just examples; most of them allow a limited number of words or characters.
Letters of Reference (LOR)
• Letters of Reference are extremely important, and all are read. Who should write the LOR? Anyone who knows you well, but follow the application guidelines for the school. Personal friends and family don't carry much, if any, weight.
• If you ask a professor or graduate student, including a TA who you worked closely with in a lab, to write a reference letter, it would be best that it be written toward the end of your association while you are still fresh in mind. He/she might just put it in your file until you are ready to begin your application process.
• While committee members read the multitude of LOR, a number commented on how some students quietly took on mentoring other classmates who weren't performing well. Some stuck with their "mentees" through two or three years. In some cases, the professor recognized that certain students were natural educators and asked them to help students having trouble. They commented on this in their letters.
• Educators have described a "new breed" of students — "the failing student." Their definition includes (1) sitting in the back of the room, (2) coming late, (3) missing class, and (4) being the first in the family to go to college. These students need special help, and this is where you could come in. Document what you do.
• Pre-med students sometimes wonder how to judge a medical school — they want to know if it will train them well enough to get into their preferred residency. We always say that it isn't what the school teaches but what the student puts in to getting an education and demonstrating excellent qualities and passion, which his/her dean and other letter writers point out in their LOR. Then it is up to the student to perform well in his/her interview.
Personal Letter
• This comes from the heart but shouldn't be a tearjerker! What do interviewers want to know about you that isn't in the rest of your application? Did you have an epiphany when you thought, "I am making the right decision on what I want to do with the rest of my life." Try to stick to a central theme but don't ramble. Use actual patient experiences, if applicable, and don't make anything up.
• Even if you are not applying for another year, you can begin to write your personal letter. You can revise as you go, but make this your letter, not your mother's or friend's. And no plagiarism! Some letters are computer-checked for plagiarism and, if found, will not be looked upon favorably.
• Always use spell-check and grammar check.
• How do you handle your stress? What do you like to read? Do you keep up, most likely via newspapers and weekly magazines including Time and The Economist, with the rapid changes in health-care delivery?
