Solving hard problems is never simple. It takes time, dedication and a willingness to take risk. Becoming a doctor is no different. Every day is problem solving—balancing highly technical and scientific information with the realities of life, and making decisions that may lead only indirectly to a solution. I’m not a doctor, but I'm the daughter of one. My best friend and roommate in college is now an Intensivist. Like everyone else, I’ve been a patient—for sore throats, annual exams, a broken arm, a torn ligament, vaccinations, childbirth and now as the parent of a toddler. Whether we respect the role of the physician or actually are one, we can all acknowledge that doctors represent the backbone of society in a number of ways. They are vital contributors at life’s turning points. We call upon when we need help. Although doctors enter their profession because they want to help others, this is all too often overlooked when we're focused on our own well-being. It's important to understand how physicians are trained and why their role isn't as glamorous as we may have been led to believe.
Getting an MD or DO to put after your name isn’t easy. It’s a highly competitive and rigorous process between studying for the MCATs, passing Step and Board exams, competing for highly sought residency positions and committing to an average of eight to 10 years of intensive training in educational, clinical and hospital settings. Physicians, no matter what their specialty, sacrifice a great deal beyond time and money to get where they are. Becoming a doctor can get in the way of relationships because transitions often require moving. It can mean broken lines of communication between family and old friends. It can result in a new circle of friends who share only the stresses and unpredictable work hours. When all is said and done, if you can survive the continual testing, training, pressures and evaluation, you’ll get to be the physician you’ve always wanted to become, but your opinion of the process and the result will undoubtedly be very different from when you started.
Throughout the past year we have been conducting focus groups comprising physicians at all stages of their career cycles. They voiced the key challenges and concerns that confront them in their profession from the moment they began to consider medicine as a career path. Challenges often seem only to escalate as their time in the medical profession progresses, as well as a perception of lack of control over outcomes, including their own. This series of posts focuses on physicians' challenges at key transition points, and on how (To) can solve them by facilitating efficient personal exploration in the limited time available to medical students and doctors.
Taking the MCAT
If you are deciding to become a physician in America today, or to pursue medical education at one of our MD- or DO-granting institutions (we add several each year), you do so by signing up for the MCAT exam. There are likely a number of things that you’ve already done—you’ve chosen the appropriate undergraduate major to prepare you for medical school, you’ve spoken with an advisor of some kind, whether formally at your college or with a friend or parent, and you’ve purchased all the required study materials in order to take the exam. It’s at that moment, when you decide you’re going to take the exam and attempt to get into medical school, that your time and financial commitment truly begins.
The MCAT is managed and overseen by the Association of American Medical Colleges (AAMC). Registration for the test costs $305 in 2016. The MCAT is required by almost all MD- and DO-granting schools (there are exceptions to this rule). In a single year, an individual can complete the exam up to three times. We found that most students will sit for the exam twice. This shouldn’t be surprising because most advanced degrees require some sort of testing and most individuals make multiple attempts hoping to achieve a better score the second time around. Average cost for multiple MCATs? $605. Average time commitment? Four hundred to 600 study hours for the exam itself. As a comparison, we examined the costs of testing for those pursuing other degrees: GMAT: $250; LSAT: $175; and GRE: $205. Why does the MCAT cost medical students so much? And why have costs associated with this required exam escalated by more than $100 in less than 10 years?
We’ve created a table above so that you can see for yourself. We realize that significant changes took place in both 2007 (transition from paper to computer record keeping) and 2015 (the exam was re-done to yield more accurate assessments of aspiring docs). However, what is the relationship between the cost to administer the exam and better school placements? Why are individual test takers responsible for these charges and costs? Do they (do you) see the benefit? Are we identifying better physicians through this process and aligning them with better program fits? The rest of this article focuses on these questions, and on the ways we can create new and effective avenues to explore personal opportunities, acknowledging that test taking and applications play a necessary but fundamentally secondary role in becoming a successful doctor.
Where to send my application
So you’ve taken the MCAT (a few times) and it cost you $500 to $700, but now you need to apply to medical school. How do you actually do that? How do you find the right school for you? How do you figure out where the schools are, what they cost, what their focus areas of concentration are, what your experiences and opportunities will be like there? You’ve been so focused on the MCAT that you have no idea where you should actually apply or attend. You probably “just start googling” as so many pre-med students have communicated to us. You look in the places that are familiar to you, and you definitely review the US News & World Report rankings for the current year as a means for getting your feet wet. Then you start reviewing acceptance rates and MCAT score requirements. In fact, you may have already done this, which is what led to round two of your MCAT exam. Then you get scared. You think about all the time and money you just spent. The thought of not getting into school is nauseating. In 2015, as reported by the AAMC, 781,602 applications where filed with MD-granting universities in the United States by only 52,550 applicants, with the average applicant applying to 15 different schools. (Yes, you read that correctly—15.) From information we have gathered, in many cases the number is actually more than 15, and more like 21. Twenty-one is an absurd number! Are there really 21 schools out there that will best meet your needs? Do you really know or are you fielding applications just because it’s easy? Perhaps you decided to apply at (1) all the places near you or in your same state, (2) all the leading programs in an area that you think sounds interesting and (3) a few outliers, just because you need a backup plan. But each school is very different—in curriculum, experiences, specializations, opportunities and (don’t forget!) location. Each choice ultimately leads to Doctor, but how you get there and where your best path begins can be quite different. Some schools offer training programs throughout the state or the country, while others require students to be in a particular location for all four school years. Consider how the schools relate to you and the types of experiences you’d like to have or expect to have. Some are focused on trauma and head injury and so are a good choice if you are interested in helping war veterans in a federal service position. Others have large community health components, while even more are rooted in research. What motivates you? What sounds interesting? What sort of exposure will you get to the various environments where you see yourself working long term? Answers to those questions can shape the type of doctor you become. Tests don't answer them, and it's not likely that as many as 21 schools could provide the right opportunities for you. Maybe the number is more like five—five of your best choices.
The costs of sending my application
Most MD-granting schools require use of the American Medical Colleges Application Services (AMCAS), also maintained and administered by the AAMC. This system does not include DO-granting schools that use their own centralized application system through the American Association of Colleges of Osteopathic Medicine (AACOMAS) and schools that do not use either AMCAS or AACOMAS. Of course, these are details that make no sense to you and are hard to understand to a certain extent, because now you’re faced with an even greater dilemma—MD or DO? Does it really matter? Hmmmm…..let’s come back to that later.
First, let’s paint a clear picture that focuses on the costs before explaining why none of these application services addresses the real challenge of making sure you find the right school, for the right degree, for the right career path, so that you can become the right type of physician you were meant to be. The first application you file through AMCAS in 2016 will cost you $160, and $38 for every application after that. Through AACOMAS, application costs are higher: $195 for the first application and $40 for every successive application. Most schools have secondary application fees ranging up to $150. To top it all off, “small” college service fees apply for transmittal of required documents such as transcripts and letters of recommendation. So, let’s do the math and draw some assumptions to determine the cost commitment for the medical student who applies an average number of times. The average cost for you to apply to medical school using AMCAS: $692.The average cost for you to apply to medical school using AACOMAS: $795. What exactly does that get you? A centralized application filed to the schools of your choice that includes your MCAT scores. Now let’s examine the cost of secondary application fees. In order to determine what they will be for the average student, we examined a number of articles that evaluated schools receiving the most applications. In early September 2016 US News & World Report published an article about this topic, found here: 10 Medical Schools With the Most Applicants. We then visited each of the schools’ websites to determine if secondary application fees are required and how much they cost. We created a table to highlight the details.
Of the top 10 schools for applications in the United States that participated in the US News & World Report survey, all used either the AMCAS or AACOMAS system and all had secondary application fees ranging from $50–$200. So, for a medical student to apply to one school, the average cost winds up being $270–$305. Not too bad, but that’s nowhere near average. Average is 15 schools, which means that the average perspective medical school student spends $2,342–$2,445 on application fees for medical school. By comparison, the average student pursuing law school spent $1,080 in 2015 on similar services (applying to an average of nine programs), and the average student pursuing an MBA applied to only five programs, spending just over $1,000. For law students and MBA students, application cost generally stops here, but for medical students, fees continue to build as a result of residency and potential fellowship applications. Before we leave the topic of costs, we should mention the cost of services that a soon-to-be medical student typically needs: an MCAT prep course ($2,300), MCAT prep books ($150) and campus visits ($6,000, which includes three interviews averaging about $2,000 per school, based on an old adage: “Interviews three, a doctor you’ll be.”) So, rounding it all out, in order to even get into medical school, you’re going to need to set aside savings to the tune of $11,500. If you’re lucky, you’ll do it for less. If you’re not lucky, you’ll do it for more, because you’ll have spent additional money applying to more schools than necessary or applying to schools twice (which many people do, meaning that $11,500 is really more like $15,000). So again, why is the medical school process so much more expensive and why is it viewed with so much apprehension by students? In part because the inclusion of “where” and “place” as a complementary tool when submitting applications is lacking.
The point of explaining all of this is to call attention to a medical school application system that doesn't provide individualized services. Getting into medical school today (or even considering it in the first place) is a linear process that requires application after test after application. While a great deal of time and money have been spent revamping and reforming testing to better assess aspiring docs, very little time has been spent helping connect individuals to the best places for their careers and interests. The med school application system burdens individuals with debt from the beginning without necessarily facilitating the best choices in the right locations—which should be the primary focus. There will most likely always be a need for some sort of centralized application service, but it’s time to get a handle on the costs and benefits of these systems and refocus attention on individuals' needs. How in the world can any school admissions team go through 15,000-plus applications per year (the average number many receive)? It can’t—it would be impossible. We need an alternative that addresses the real bottom line, which is “How do we help you, from the moment you consider becoming a doctor, to understand the costs, the opportunities and the experiences at your fingertips so that you can become the best version of yourself and the future physician you haven’t even met yet? How do we help you realize your greatest potential?”
That’s where (To) aims to help.