The Test That Decides Your Life (But Not Really) #illumedati 4

Hey everyone, it’s Medicine Mondays again. I didn’t really have anything in particular that I wanted to write about today so this post may seem incoherent at times. Today I want to talk about The Test That Decides Your Life (But Not Really).

Stock Photo from: Pixabay

What do you mean?

Well, on The Track, there are a lot of speed bumps on the way to being a doctor. Sometimes you fall off.

Many of these speed bumps come in the form of tests. For example, the Medical College Admissions Test (MCAT) is a pretty big one. If you read the title of this post, you may have assumed that I was talking about the MCAT. It is a major speed bump on the path to becoming a doctor. When I was in college, we had professors who wouldn’t write you a letter of recommendation for medical school unless you had at least 10s in all the different subjects. Now, they’ve changed the scoring of the MCAT, so a 10 in each section is ~ 127 on the new scale.

Either way, certain professors would not recommend you for medical school unless your MCAT score was high enough. Obviously, since I went to UC Berkeley and there were a lot of pre-meds, I’m sure they were inundated with requests for letters of recommendations. For this reason, the simplest way to “weed” out students asking for a letter of recommendation was to establish a threshold.

Is this fair? No.

However, life isn’t fair.

By the way, in case you were wondering, those professors wouldn’t write me a letter of recommendation either because of my low science GPA.

So then, is the MCAT the test you speak of? The one that decides your life?

Well… It is, for some.

For those who couldn’t obtain the score needed to get them into medical school, their road ends there. However, there are plenty of people who didn’t get the score needed and still went on to medical school. However, there are those who continue to push forward afterwards. You repeat some classes, do some post-bac work, or complete a Masters degree. You study harder and retake the test to get a better score.

It’s just a test. 

Like many things, this hurdle can be overcome for many with enough effort.

I’ve said it before, but everyone has a story. 

Some of the best physicians that I have ever had the good fortune to work with didn’t get into medical school on the first try. Some of them were told to not even apply. Others were told that they would never get in.

However, when it comes down to it, it doesn’t matter how many times you had to take the MCAT or how old you were when you eventually got into medical school. At the end of the day, once you’ve made it through medical school and residency… you’re a doctor, taking care of patients.

Now, wait a second though. I don’t want people to say “Senior Resident told me I could be a doctor, all I had to do is try.”

I’m not saying that.

I am saying that for those who are serious about moving forward and understand the monumental task of getting into medical school after failing to do so, that it can be done. However, you need to do a lot of introspection to really figure out if you want to try.

For those on “the cusp”, who “just missed” the average/median needed to get into medical school, then it’s probably reasonable to reapply. However, for those who struggled to pass Organic Chemistry (like me), have difficulty with the sciences in general, and have a low MCAT score, your task becomes significantly more difficult. Not impossible, but difficult.

I see, so the MCAT decides it for some huh? But it’s not the test you’re referring to…?


As harsh as it sounds, the MCAT decides whether you will go to medical school and get an MD or DO behind your name. However, it ends there. You can go on to do any host of other things, engineer, start-up entrepreneur, computer programmer, etc. etc. If anything, after not going to medical school, you potentially have more freedom to decide your own path in life.

The test I am referring to is Step 1.

Unfortunately, this is the metric by which all medical students are judged by when it comes to applying for residency. Medical school education can vary across the nation, and when you include Caribbean Medical Schools, International Medical Graduates (IMGs), and Foreign Medical Graduates (FMGs), then you need a standard by which to judge everyone by.

Is it fair? No.

However, now with more medical schools moving toward a pass/fail curriculum or simply describing students in the “top quartile”, then it becomes difficult for residency programs to try to match the “best medical students.”

Now if you take a competitive residency like dermatology, that a Step 1 Score of 240+ has ~75% chance of matching, whereas a Step 1 Score of 260+ increases your chances to about 88%. Not having a competitive Step 1 Score makes it exceedingly difficult to match into Dermatology.

So, in that sense, Step 1 really is “The Test That Decides Your Life”. If you wanted to be a dermatologist all your life and got into medical school for the sole purpose of doing dermatology, but then get a low Step 1 Score, getting into dermatology will be difficult. You may instead do a different specialty for the next 30-40 years of your life until you retire.

You are “locked in” to your path.

Do you see what I mean by “The Test That Decides Your Life”?

However, it really doesn’t.

I’ve had friends not get into their specialty of choice on their first attempt, for whatever reason. Both of them ending up doing an internal medicine residency. However, they were both very smart individuals and good physicians. They were able to secure good letters of recommendations and then go back and do their residency of choice: dermatology for one, ophthalmology for the other. Both of these residencies are competitive.

I am not sure if it took more than one round of residency reapplication or not, but you only need to match once.

This goes back to the post I lost about “Experience Matters” which I will try to rewrite next week. After medical school is over and you’re out in the community, you will establish your own reputation and your own network. People will trust you and your abilities based on their experience with you over some score that happened a few years ago.

I’ve also had friends do a residency that they thought they wanted, only to switch out later. For example, I’ve known orthopedic residents switch into radiology, or general surgery residents switch into anesthesia. I’ve also known people finish residencies, practice a few years, and then go back and do another (completely unrelated) specialty.

Now… is it an optimal path to do a residency and then go back and do a second one?

Well, no.

However, I just remember back to my time in medical school where I had colleagues who were in their mid 50s… These guys already had whole careers and lives before going to medical school. Is a few extra years really going to make a difference as long as you are able to do what you want?

If I hadn’t matched into my specialty of choice (Radiology), I would have tried at least 2 more times to get in. In fact, I may have just finished my internal medicine residency and then reapplied.

Life is short, do what you want.


The MCAT and Step 1 both don’t decide your life.

Everyone has a story.

Can you put in the effort to get over your speed bump?

Experience Matters. (I’ll rewrite this post next week, I promise)

You only need to match once.

Life is short, do what you want.

Medicine Mondays Sensei


Agree? Disagree? Questions, Comments and Suggestions are welcome.

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4 thoughts on “The Test That Decides Your Life (But Not Really) #illumedati

  • Fred

    The other factor to think about in specialty choice, is that there is a huge intersection amongst specialties into other subspecialties. For example, sleep medicine, pain medicine, sports medicine, etc. You can do a number of any base specialties and still practice within those fields. As a medical student it is VERY hard to know what you will want to do on a day to day basis in terms of tasks. For me, I loved clinic, procedures and imaging. I ended up sacrificing clinic for a while to enter radiology where I trained in imaging and procedures galore. Then I decided I really wanted that clinic piece and went on for pain medicine fellowship. I worked for a year as a pain attending and then realized that clinic piece was not as important as I thought it originally was in the grand scheme of me enjoying life. Basically, you can enter any field and end up doing any specialty? How so? ENT… can focus on plastics or sleep medicine. Urology… can do fellowships in women’s health or pediatrics. Even family practice can subspecialize in sleep, pain, and sports… all non-primary care fields. In the example above, Derm can be a focus of primary care practices, with medspas, joining plastics practices, etc. No test will ultimately shut you out of any option in medicine.

    • Sensei Post author

      All of what you said is true. However, there are some circumstances which you can be potentially be shut out. For example, while you can still do some aspects of Dermatology in other fields, it probably would not be a good idea to do Mohs surgery. Also, while you can potentially do cosmetic surgery as a general surgeon, you can’t do general surgery as a pediatrician. So there are limitations.

      However, like you said, as long as you are flexible you can usually find what you really want to do.

      No single test will take that away from you.

      Thanks for your comment Fred.