Deep in the Throes of Application

I apologize for being so infrequent the last couple of months – I really do appreciate the few of you that keep checking in to see what’s going on in my quest for admission.  Also, given that I’m getting a ton of redirections from the MCAT study forum on SDN, I’d like to say hello to all those of you that have discovered me lately.  Best of luck on your exams!

My committee letter application is due in another week and a half and, while I’ve been working on these essays and the rest of the application for a while, I’m nowhere near close to the end.  This means that I need to leave perfectionism at the door and just focus on getting things done first and then reviewing them later.  I also checked out my first year college GPA…it wasn’t pretty.  My first semester right out of high school I got a 2.56 and the second semester I wound up with a 1.71.  Like a boss.  Luckily, one of my essays asks about my first year of college and what I learned, so I can totally throw myself under the bus and talk about how I’m completely different today (which is true).  Hopefully, medical schools are much more interested in my recent work than in the past.  Not sure how my total GPA is going to look at the end – I seem to remember getting a B- in senior quantum mechanics and I bombed linear algebra.

…and now I just got myself worked up into a fright about my grades and academic record, not to mention that I feel inadequate about every other aspect of my application.  Lovely.  I’ve already begun to hate application season.  And it hasn’t even started yet.

Apparently the MCAT is Important

The head of the premed committee at my institution had quite a few things to say to me earlier this week. He seemed to think that a big MCAT score on the board was something of a gamechanger and altered the way that I should look at schools. Apparently, my exam score, GPA, letters of recommendation, and research / work experience give me a very strong application and, assuming I don’t tank my interviews, he felt confident I was going to have my pick of several offers next year. When I asked about schools he was thinking would be wise to apply to, he started spouting off places like UCSF, UCSD, Stanford, Duke, Johns Hopkins, and so forth. I was really taken back because for the last two years I’ve know him, every time I walked out of his office I felt like he thought I was a joke. His inability to tell people what they want to hear is legendary. This time I went to see him, I heard phrases like “Run like the wind” quite a bit. From his perspective, I have a significant opportunity here which a lot of people don’t normally have.

A couple of weeks ago, I was talking with the physican I’ve been doing research with. We were talking about some of my goals in medicine and I told her that I really wanted to wind up at an academic institution, with a significant amount of teaching and collaboration. She asked me if I had considered the MD / PhD route. I remarked that I had considered a PhD several times since I graduated and that I had turned it down because I felt that it really narrowed ones focus and that sort of turned me off to it. In her opinion, that is a flawed understanding of the way that the dual-degrees function in medicine. In the medical field, the dual-degree functions in a somewhat different manner than it does in the hard sciences and doesn’t necessarily constrain someone to one very narrow slice of the profession. Additionally, from her perspective, dual-degrees among the faculty of most institutions is becoming more the rule rather than the exception. This of course got me thinking, because every one of my professors and classmates has asked me why I’ve not considered the dual-degree. Well, now I am.

This is all rather strange for me. Up until now I’ve been thinking of myself and my candidacy for medical school from the perspective of an underdog. I think that may be a bit of a mistake – if there is an opportunity here, I don’t want to waste it.

With that as a bit of prologue, I have a couple of questions that I’d like to crowd-source some advice on.

• Is a dual-degree (or an MD with a post-doc or fellowship) more or less the standard approach for a person with my goals?
• What are the most important aspects of a combined program to consider?
• Are there limits on what fields a person is able to pursue their PhD in?
• In general, what advice would you give to someone in my position looking at selecting schools to apply to, both for MD and MD-PhD programs?

If any of you guys have some advice, I’d love to hear it. Thanks.

So You Think Getting Into Med School is Hard?

I hate thinking about the probability of getting into medical school, particularly for the non-traditional style like myself that have been out of school for a few years and decided later in life that they wanted to pursue a life in medicine. That said, it’s pretty common to hear premeds whine about how hard it is to get into medical school. After being inundated with it for the past year or so, I decided to do some research on other professions to see just how hard others have it, relative to medical students. Here are some of my findings, in no particular order:

Special Agent for the FBI

Requirements for application to the FBI academy:

• Between ages of 23 and 37 in good physical health
• 4-year Bachelor’s degree and 3 years of work history (five different fields of interest)
• Obtain a TS/SCI, which requires completion of an SSBI and a polygraph

That’s just to qualify for the academy. In practice, most applicants have some form of law enforcement experience or extensive experience in a field which is highly desirable at the time they’re applying, like middle eastern linguistics or corporate accounting. Once you’ve been accepted, you’re sent to the FBI Academy at Quantico Marine Base for six months and then after that transferred to wherever your particular skill set is needed. I’d imagine it varies, but special agents probably have some say over where they get transferred, but at the end of the day, you’re a government asset and they can deploy you wherever they like. I should also mention that the polygraph one gets after completion of the SSBI will be one of the most stressful days of your life. I was required to have an identical kind for work and it was one of the most intense experiences of my life. I haven’t taken the MCAT yet, but I’m pretty sure that it won’t be as bad as my polygraph was. It was the suck.

Now let’s talk chances – government employment has become exceedingly coveted, since it’s largely immune to economic effects. Statistics weren’t all that available, but I’ve been able to collect the following information. In 2009, the FBI posted around 3,000 open spots, 850 of which were special agent positions. They received 250,000 applications. Let’s assume that the ratio of applicants for non-special agent positions is the same as that for special agent spots. That works out to be about 70,000 applicants for 850 spots, or an acceptance rate of around 1.2%.

Special Agent for the Bureau of Alcohol, Tobacco, and Firearms (ATF)

Requirements for application to the academy:

• Rather strict age and fitness requirements, similar to the FBI
• 4-year Bachelor’s degree, also similar to the FBI, and usually a minimum of four years of law enforcement experience
• Ability to obtain a TS/SCI, which requires completion of an SSBI and a polygraph

Becoming an ATF agent is really hard – I was only able to find limited statistics since successful ATF applicants sign an NDI concerning the hiring and training process, but according to Wikipedia, only about 5% of qualified applicants are accepted. This seems to agree pretty well with the acceptance rate I estimated for the FBI. I should mention that there is an additional constraint for virtually all applicants to federal agencies – affirmative action. Medical schools preach the virtues of diversity, but in most cases it isn’t a hard and fast rule like it is with the government. The acceptance rates for white male applicants to just about any federal office are going to be substantially less than the average. Applicants to medical school should be glad that racial quotas don’t govern admissions committees they way they govern federal hiring practices. My intent isn’t to get into a discussion of affirmative action and how or when it’s involved – I simply wanted to point out that, for federal agencies, it can be a significant hurdle for many and there’s no way to make up for it.

After acceptance, applicants spend six months in a training program and then invest another three years in a probationary role before becoming full-fledged members of the ATF community. Interestingly, the amount of time required to become an ATF agent is not that much different than a physician. An undergraduate degree, then at least 4 years of law enforcement, followed by application, training, and a 3 year probationary role that sounds a lot like residency.

So, what’s the job like for the elite 5%…? Well, you will get shot at, possibly targeted for assassination by a murderous band of outlaw bikers, have dangerous working conditions, and possibly be away from family and friends for extended periods of time. Let’s face it – anyone that has to put on body armor to go to work has it a lot worse than doctors.

Juris Doctor

I’m not going to go into this very much, since getting accepted into law school isn’t all that difficult.  An undergraduate degree, a good LSAT score, and you’re chances are pretty good.  However, that slightly belies the problem faced by those aspiring to practice law.  For the most part, it doesn’t seem to matter all that much where a person goes to medical school at.  The story for law students is quite a bit different.  A lawyer with a JD from a school like Georgetown or Yale shouldn’t have a problem finding a job after graduation.  On the other hand, a graduate of a lower tier university may very well wind up being screwed when it comes time to find a job.

I ran into a girl a couple of months ago that had graduated from a lower-ranked, private law school a couple of years ago.  She’s got about $150,000 in loans and is making about $45,000 as general council for a local newspaper.  Not exactly what she was expecting when mom and dad convinced her to go to law school.

Doctor of Veterinary Medicine
Requirements for application to veterinary school are similar to medical school, but tend to vary a bit, particularly when it comes to entrance exams. The usual coursework includes:

• English (2 semesters)
• Biology (2 semesters w/lab)
• Chemistry (2 semesters w/lab)
• Organic Chemistry – This one seems to vary the most. Some schools require a year, others only a semester but with biochemistry as well.
• Physics (2 semesters, but may or may not require the lab)
• Calculus (1 semester)
• Statistics (1 semester)
• Genetics, microbiology, and physiology are recommended by many schools.

As far as grades go, it’s the same game as medical school application where the mean GPA is about 3.5 or so. Competitive applicants usually have a GPA anywhere in the 3.0 to 4.0 range, but acceptance hinges on many factors. The real academic variability shows up in the tests required. There seem to be three primary exams which applicants may take, depending upon the schools they are applying to. Many schools require the GRE, but some have moved towards requiring the MCAT and/or the biology GRE since the VCAT has been discontinued. Since most applicants apply widely, it is not difficult to imagine some students having to take two or possibly all three of these exams. Yep. That means studying for the MCAT, the GRE, and the biology GRE all at the same time. Not cheap.

Letters of recommendation, extracurricular activities, work experience are all fairly similar to medical school, although it looks like a lack of real substantive work experience is an absolute game-ender. Altogether, it appears that, prima facie, application to veterinary school is significantly more of a hassle than application to medical school, particularly if applicants are casting a wide net (and most probably do, considering the odds).

There are 28 veterinary schools in the US, most of which are public. The VMCAS is rather tight-lipped about the application statistics, but the information they have chosen to release isn’t too encouraging. In 2010, it looks like the number of applicants was 23,422 with only 6143 matriculating. This yields an acceptance rate of around 26%, which is about half of what allopathic applicants will see. Compared to federal agencies, the odds are good, but it still sucks.

Doctor of Dental Surgery

One of my buddies that I worked with at the bike shop applied to dental school three times and was finally accepted (way to go Aaron!).  His situation sounded quite a bit like medical school.  And looking at grades and DAT scores, it appears that the story is more or less like it is for medical school applicants.  Coursework seems to be about the same anyway, along with the usual pattern for volunteer work and clinical experience.

Average GPA for dental school matriculants is about 3.5, with a DAT score of 19.3.  Relatively competitive.  I couldn’t find any statistics for applicants relative to matriculants, but the field has apparently become quite competitive.  Applications have risen something like 7-10% every year for the last ten years.  And, since the ADA has gone to great lengths to restrict the size and number of dental programs, the difficulty of getting accepted to dental school has only increased.

I’m glad that my buddy was finally able to get in.  Hopefully, I’m as lucky.

Physicians Assistant

The general impression seems to be that PA school is harder to get into than medical school.  The required coursework seems to be quite a bit worse – all the same requirements as medical school applicants, along with a full sequence of anatomy, physiology, some statistics, and a few other higher-level biology courses like biochemistry, pharmacology, and a few others.  Plus, an interesting trend seems to have emerged over the past few years – people that would have applied to nursing school are switching to PA programs because of the increased responsibility and greater compensation.  Average PA salaries are quite a bit higher than nursing students.  I looked for some PA school acceptance statistics, but I couldn’t find any.  Word on the street is that PA programs have a lower acceptance rate than medical schools do.

Astronaut
I include this topic primarily as a teaser, since this has to be the absolute hardest field to break into on earth and pretty much requires you to have spent your entire life working towards it. One mistake, and you’re toast.

Requirements depend upon whether you want to become a mission specialist, payload specialist, or a pilot, but they include:

• Bachelor’s degree in engineering, physical science, or mathematics (in practice, the requirement is a PhD in one of these fields as well, given the enormity of the applicant pool, particularly for specialists)
• 1,000 hours of pilot-in-command of jet aircraft
• Flight test experience highly desirable (given the number of military personnel applying to the program, this pretty much requires you to have come up through the Air Force or Navy, both of which are highly selective about choosing jet pilots)
• Pass NASA physical and psychological evaluations
• For specialists, industrial or academic research and development leadership positions with significant academic contributions – this isn’t the same as getting your name on a couple of papers, which a lot of premed students equate with research.

This explains why the average application age is 36 – it takes the bulk of a persons professional career to meet all of these requirements and competition is rather fierce. Plus, the training program to become an astronaut is something like 20-months and washing out is common. NASA estimates that the chances of a person becoming an astronaut are around 12 million to one, making it probably the hardest profession to get into. This totally omits the politically transient nature of your profession – you might spend your entire life working to become an astronaut, only to wind up having the program cancelled due to a shift in NASA’s mandate.

Oh. And then, on your way to work, the Russian spacecraft you’re flying in might explode.

Farming for Application Advice

Most of my classmates and friends are applying to medical school this cycle and after watching them stress out for the past six months, I realized I didn’t want that to be me this time next year.  So, to that end, I figured that I would ask the 100 or so people that visit here every day for advice on what I should be doing between now and next June.  I figure that my chances to get candid advice from intelligent people are a lot better here than somewhere like SDN.

Here is the story thus far:

My post-bacc. institution, which is closely allied with a large, well-ranked mid-western school medical school, uses the pre-med committee letter process.  An application is available in October and due by March sometime.  It requires a couple of interviews, about 15-20 short-answer, secondary-style essays, as well as 5 letters of recommendation: three from academic sources, and two non-academic.  The department also requires us to collect our academic history, grades, etc. and submit those to the committee as well.  When all is finished, we interview with one or two pre-med committee members and then the committee chair decides whether to write a letter of recommendation for us, which then gets attached to all the others and submitted to our schools of interest once we apply.

So far, I have one letter from an undergrad professor at another institution that knew me really well and another from a current professor at the university that I TA’d for last semester and has known me pretty well for about a year and a half.  I think he was also a member of the pre-med committee at some point as well, but I’ve never really asked.  My organic chemistry professor from the fall will probably be willing to write me a letter, but I’m going to wait until after the summer to ask him.  I’m going to be doing a review over the summer for some of the students that are going to be taking his class in the fall and I figure that waiting until after that’s finished would give him something specific to write about.

My non-academic letters will probably come from my manager at work, since he can speak to some rather significant things like my role in the group and the research I’ve done since hiring on with the company.  I feel like at least one of my letters should come from an MD of some sort, so hopefully over the next year or so I’ll find a way to make this happen.

Here are the salient points of my plan between now and application season during June 2012:

• Taking the year-long biochemistry section this year, followed by genetics and physiology during application year
• Plan to have at least two papers published for work-related research (non-medical) between now and next year.
• Tutoring math and science at a local high school – have been doing this for a while and really like it, so I intend to continue until I matriculate, which will hopefully be Fall 2013.
• Volunteer on the weekends in the emergency department at a large hospital downtown.  I finished an EMT course about a year ago and started volunteering there about 5 months ago.  Volunteers don’t do a lot, but we get to interact with patients and the rest of the staff there, which I really enjoy.  The more time I spent in the ED, the more interested in emergency medicine I get – if I’m accepted to medical school, it will be definitely start as my top choice of specialty until something else knocks it off.
• Summer plan is to study for the MCAT – I’m registered to take it September 10 and will start doing content review early in June, once I’ve rested for a week or two after finals.  Starting with mostly just content review and timed passages, but the last 6-8 weeks primarily timed full-length exams, reviewing the answers, and more timed practice passages.
• Once I get my MCAT score back, I’ll start researching for schools that I want to apply to – probably in October.

One gaping hole in this so far is that I don’t have a letter of recommendation from a physician, which I would really like to have.  Aside from my weekends in the hospital, I don’t have any other real opportunities to interact with doctors.  This definitely needs some attention prior to application.

So, with all that said, my questions are pretty simple:

1. Is there anything that I should be doing between now and application season?
2. Is there anything that I will need to do during application season that I can do earlier?

One last thing to mention – even though applications aren’t due until later, my goal is to be prepared to submit at the earliest possible time.  This is part of the appeal of the committee letter process; most of the essay questions they ask are present on secondary applications for a lot of schools.

So….advice?  Thoughts?  Comments?