So, in my previous post The Track, I talked about “The Track” of medicine.

I mentioned someone I knew who had “fallen off The Track” who despite his best efforts, had never really recovered. Also, if you read my prior post Caribbean Medical Schools or my About page, that I had also fallen off “The Track”.

So now let’s break down what happens when you fall off the track (at least in my opinion):

I think probably the most common bump in the road to becoming a doctor is getting into medical school.

However, that one step has multiple other problems within it. Admission Committees (adcoms) like to talk about taking well-rounded students. However, they do not mean well-rounded in the general sense, they mean well-rounded after you get X GPA and Y MCAT score. This is a fact that you must simply deal with it. Getting into medical school is first a numbers game and second an image game.

If you don’t meet the minimum criteria on the X GPA and Y MCAT scale for a particular school, your application will never even be opened. 

Let that sink in. Everything you’ve done for the prior 21+ years of your life does not matter if you do not acquire X GPA and Y MCAT. I wish this wasn’t true. However, I don’t see this happening anytime soon.

The truth of the matter is… well..  I understand.

Make no mistake, medical school is difficult. The concepts and breadth of knowledge required to pass the exams borderline on insanity. Then a 180 occurs when you begin internship/residency, where it tests your mental and physical capacity as well as your ability to think/work under high levels of stress. All the while you are trying your best to absorb the knowledge around you mostly by immersion and experience.

This is completely different from the book-learning and hand-holding that occurred during most of medical school. Then after finishing residency +/- fellowship you are a young attending and have the bare minimum of experience/knowledge necessary to see patients on your own and trade on your own name.

However, the first 5-10 years of post-residency is continually learning. Then after 10 years, you have acquired the knowledge and experience necessary to be somewhat confident. At this point you realize that a lot of things have changed since residency/fellowship and you must be self-aware enough to continue learning and stay up to date. You owe it to yourself, but more so, you owe it to your patients.

By choosing to be a physician you are signing yourself up for life-long learning during work hours…. but also outside of work hours. You must be prepared to continue to learn on your own time, over your life-time. It’s not an easy task and it is difficult to assess whether a senior in college has the determination, responsibility, and accountability to do that. No metric exists that can accurately predict whether a person will be able to be a good physician. The only thing that is available is to test a minimum ability to learn the material and grasp concepts, and the only metrics to assess that are X GPA and Y MCAT.

Letters of recommendation, shadowing a physician, or volunteering time at a hospital are all so variable, that in my opinion that they might as well not exist.

So then, you’ve fallen off the track, what is the next step?

Be honest with yourself. Why were you not accepted? Was your GPA too low or was your MCAT too low? Look at the average and median numbers for the medical school class you were hoping to get in to.

Let’s look at University of California, Irvine’s “First Year Class Profile” (2015).  In case the information changes, I’m going to copy and paste it here:

* Underrepresented in Medicine (UIM)

Ok, out of all of this information, the only thing that really matters is:

You need “around” ~ 33 on the MCAT and you need ~ 3.7 GPA.

Those are cold, hard numbers. So if we just give a rough estimation, let’s say the range is probably around 30-36 for MCAT and 3.6-3.8 for GPA. The high end may be higher, but I am just trying to approximate the 2 standard deviations from the mean.

If you don’t have at least a 30 MCAT and 3.6 GPA, it is doubtful UCI will even open your application.

So let’s say your MCAT score is <30… let’s say it’s like 28 or something.

However, your GPA is 3.7. Well, your answer to “get back on track” is simple. Don’t worry about finding research, or shadowing a physician, or volunteering at a hospital. UCI NEVER EVEN SAW whatever extra-curriculars you did. You need to have a 30+ on your next MCAT, FULL STOP. If you got a 28, getting at least a 30 is doable, and ideally getting a 33 would help your chances significantly. Your GPA is 3.7 so you obviously know how to study. So think of it like this:

For the “summer semester” after senior year, your 4 classes are:

1. MCAT
2. MCAT II
3. MCAT III
4. MCAT IV

You get up and “go to class”, whether that means the library with your MCAT study books or an actual course like Princeton Review or whatever… it doesn’t matter.

• You go to class everyday and learn everyday and try to improve everyday.
• Take a “mock MCAT” every Saturday, and try to approximate the test as best as you can.
• Review the questions and answers to the “mock MCAT” every Sunday.
• Lather, rinse, repeat. Do this for a few months until you take the MCAT again, take it, and do well.

Then you need to evaluate your score. In this situation, if your new score is a 30 (or its new equivalent, ~508), then you can probably re-apply. Anything less than that may not get you past the cold, hard numbers for UCI. However, other schools may still be an option. Newer schools may have slightly lower median/average numbers. 

A Snapshot of the New and Developing Medical Schools in the US and Canada is a good place to start.

Things are more difficult for those of you with a low GPA (in my opinion). 

If your GPA is < 3.3, but you have a decent MCAT score, 33+, you may be dismayed to not get as many interviews as you may have thought, and may not get admitted. Unfortunately, retaking the MCAT is not something that will help you much in my opinion (except in rare cases, which I will discuss later). You need to bring up your GPA and prove that you can and will survive medical school classes. There is no great way to do this, but the most common path is to go and get a Masters degree in something science related, like Biochemistry or Cell Biology or something along those lines. What you are doing is trying to prove to adcoms that “you are different” from when you were in college. This means that you must Must MUST get all As in your Masters level classes.

Trying to reverse someone’s first opinion of you (your 3.3 GPA in this case) is very difficult. 

Like I said before, you may have already been “filtered” before they even saw your MCAT scores or extra curriculars. So you need to put an * next to your GPA. You want your GPA to come up as 3.3, but then it also says “Masters Program GPA 4.0”. I’m not on an adcom, but if I saw that I would put that in the “maybe pile” and at the very least, I think it would prevent you from being filtered automatically. Then you’re in the “maybe” pile and they review your 33 MCAT and your extra-curriculars and now you probably have one more interview that you didn’t have last year.

Ok, now what if your GPA and MCAT are both low.

Let’s say your GPA is <3.0 and your MCAT is <25. This is an uphill battle. You need to sit down and really evaluate whether you want to be a physician. As I stated above, it only gets harder from here with the next 30+ years being devoted to life-long learning. You need to do some introspection.

Do you have it in you to do learn everything that is required to be a physician? Do you have it in you to continue learning day in and day out? 

Did you make a mistake? What prevented you from getting the GPA and MCAT you needed? Do you think you can fix that?

After a lot of introspection, if you can without a doubt say that you still want to be a physician, then you need to understand that it will be an uphill battle…. with 100x gravity… in snow… without shoes. And even if you do your best, you may still not make it.  You will need to prove that you are not the same person.

You need a high MCAT score, and by high I mean you need to be an outlier.  You know those people who got a 40+ on the MCAT? Yea, that needs to be you.

I’m only half-kidding. Your MCAT score needs to be high enough that the adcoms will be like “Wow!” so they can overlook your prior low GPA and MCAT scores.

With that, you also need to do a Masters and get a 4.0. You may even need TWO Masters degrees (with 4.0 in both) to prove that you are serious about studying now.

Basically, you are trying to be a non-traditional candidate with more experience and more maturity than most of the entering medical school class.

You need to prove that with numbers significantly higher than the incoming class. You need to remove all doubt.

What about Caribbean medical schools and/or foreign medical schools?

Yes, these are still an option. But if you read my post, but it will be difficult. The margin for error keeps growing smaller, you will need to prove you are 10x better than other candidates for the same position, if they even accept foreign graduates. Do not consider this route unless you have exhausted the above options. Additionally, this is not an option if you haven’t improved. If you were not able to improve your MCAT or GPA -at all- then you really should not go to a foreign school.

What can we do to change how medical school admissions works?

I don’t know. Like I said before, no such metric exists that can predict whether someone will be able to finish medical school, acquire residency, and be a good physician.

However, I really do feel that we are missing a lot of excellent candidates who are simply being filtered out.

TL;DR

Falling off “The Track” is hard.

Medical school admissions is a numbers game.

You need to get past “the filter”.

Caribbean/foreign schools should be a last resort… and only if you have shown improvement and/or more maturity.

-Sensei

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

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