Proposed Federal Budget Will Negatively Impact Medical Students in Need of Loans

The average cost of medical school tuition, fees, and health insurance for the 2019-2020 academic year ranged from just under $38,000 for an in-state, public institution to $62,000 for private school or public school for non-residents, according to the Association of American Medical Colleges (AAMC). The median debt for students at graduation totaled $200,000. As such, prospective and current medical students should pay particular attention to how student loan funding and forgiveness will change as a result of the President’s recently proposed Fiscal Year 2021 budget. Below, are a few proposed budget changes that would directly impact medical students and residents.

• The capping of GradPLUS loans to $50,000 per year and no more than $100,000 in a lifetime. The AAMC says that 47 percent of medical students rely on these loans to fund their education. Capping the total amount allowed per annum and over a lifetime at these values, which are lower than the full cost of medical school, will force students to seek funding through private financing, which typically carries less favorable lending terms.

• The elimination of public service loan forgiveness programs. Currently, an AAMC survey of graduates estimates that about one-third of them are interested in pursuing public service loan forgiveness programs, which allows graduates—who work to benefit the community and make timely loan payments for ten years—to receive loan forgiveness. These programs are an important recruiting tool for many public-facing organizations, including inner-city hospitals, community health centers, and teaching hospitals, and is critical to providing healthcare services to communities in need.

• The cutting of Medicare funding for Graduate Medical Education (GME). The budget proposes funding GME solely through new grant programs from general revenues, rather than Medicare’s trust fund. However, the cuts to Medicare are so substantial that even given the new proposed funding stream, hospitals would be asked to absorb cuts of over $50 billion in funding, which could result in fewer physicians and resources at teaching hospitals.

Doctors Seek Additional Training as Technology and Big Data Converge with Patient Care

Classes in data analytics, artificial intelligence, and technology may sound like the course load of an MBA student, but a recently released report shows the immense value of this subject matter for medical students as well. The Stanford Medicine Trends in Health 2020 report entitled “The Rise of the Data Driven Physician” describes a future for physicians where data and technology are increasingly intermingled with effective patient care.

The report, which includes a survey of physicians (n=523), residents (n=133), and current medical students (n=77), analyzes how trends in medicine impact those on the front lines of patient care.  The health care sector, the report claims, is undergoing “seismic shifts, fueled by a maturing digital health market, new health laws that accelerate data sharing, and regulatory traction for artificial intelligence in medicine.”  And the report’s findings show that while there is acceptance and even enthusiasm around the benefits of data and technology among providers, there is also a real gap that exists between the training that physicians, residents, and students receive, and the demands of the evolving profession. Lloyd Minor, MD and Dean of the Stanford University School of Medicine says, “We’ve found that current and future physicians are not only open to new technologies, but are actively seeking training in subjects such as data science to enhance care for their patients. We are encouraged by these findings and the opportunity they present to improve patient outcomes. At the same time, we must be clear-eyed about the challenges that may stymie progress.”

The respondents appear keenly aware of the changes occurring within medicine and both physicians and residents say that they expect about a quarter of their current duties to be automated using technology over the next 20 years. Students predict that, on average, 30 percent of their duties will be automated. Further, just under half of the physicians surveyed (47 percent) and about three-quarters of the students surveyed (73 percent) say that they are currently seeking out training to better prepare themselves for innovations in health care. Among physicians who said they are currently attending training, the most popular subjects are genetic counseling (38 percent), artificial intelligence (34 percent), and population health management (31 percent). Students seeking additional training courses are taking advanced statistics and data science (44 percent), population health management (36 percent), and genetic counseling (30 percent) at the highest rates.

When asked about which innovations have the most potential to transform health care in the next five years, physicians as well as students and residents (grouped) were both most likely to respond with personalized medicine, followed by telemedicine. Both groups also see potential in artificial intelligence, wearable health monitoring devices, and genetic screening.

When the groups were asked about how helpful their education has been in preparing them for new technologies in healthcare, just under 20 percent of both students and residents (18 percent) and physicians (19 percent) responded “very helpful.” Current students and residents were more positive overall, with 58 percent responding that their education was “somewhat helpful.” Only 23 percent responded negatively. Among physicians, 36 percent found their education somewhat helpful, and the remaining 44 percent replied negatively.

The most notable gap, perhaps, is the one highlighted below, which showcases the difference between the perceived benefits of medical innovation for patients and how prepared the provider is in implementing that innovation. The two charts, students and residents (grouped) and physicians, show the group that agreed an innovation will be “very beneficial to future patients” compared to the group that said they feel “very prepared to use the innovation in practice.” Some of the gaps are marked. For example, over half of students and residents (55 percent) and physicians (51 percent) believe that personalized medicine will be very beneficial to future patients, yet only five percent of students and residents and 11 percent of physicians feel prepared to deliver it. Personalized medicine showed the largest gap between perceived benefit and preparedness for both groups, while virtual reality showed the smallest. Both groups feel very prepared to work with electronic health records, but there were lower levels of perceived benefit to the patient.

Gap Between Perceived Benefits to Patients and Provider Preparedness

This report demonstrates the changing nature of the medical profession, its current and continuing intersection with technology and big data, as well as the need to provide opportunities and training to medical providers so that they can use these innovations to improve patient care. Prospective and current medical students will want to carefully consider how they are using their time prior to and during medical school. It may be beneficial for them to spend time speaking with physicians and residents to gauge what technologies and research are driving change. Taking classes prior to medical school, in statistics and data modeling, as well as technology and AI may have a positive impact on their ability to bridge the gap between present demands and the traditional medical school curriculum.

Positive Learning Environments and Regular Feedback Result in Lower Levels of Depression Among Medical Residents

The impending physician shortage, coupled with the problem of physician burnout, has led to important discourse over the treatment and training of future physicians. Medical training programs are looking to improve wellbeing among medical students and residents through various avenues including reduced tuition, investments in wellbeing programs, and mental health resources. But are they doing enough? A recent op-ed published by the AAMC, by Srijan Sen, MD, PHD, suggests medical residency programs need systemic changes on top of the current efforts focused on building individuals’ resilience and wellbeing.  

Dr. Sen, along with collaborator Connie Guille, MD, analyzed data collected via the Intern Health Study to highlight the negative impacts of residency on interns’ health and propose data-based solutions for a healthier environment. The Intern Health Study, a longitudinal study that includes responses from more than 20,000 medical trainees, shows that the rate of depression increases “Five-fold within the first few months of residency” and remains higher throughout training with “about one out of four residents screening positive for depression at any given time during residency.” Dr. Sen goes on to note that beyond the questionnaire responses describing stress, there are physical indicators as well. “Telomeres, a cellular marker of aging, shorten five times as much during internship as during a typical year of life…” And, what’s more, a compromised physician is more likely to make medical errors and to provide lower-quality care to patients.

Dr. Sen references a 2019 study that reviewed over 50 internal medicine programs using residents’ feedback and information collected in national databases. The findings show variation in the depression rates between programs; more importantly, the variation showed consistency with some programs regularly registering high and others low. When Dr. Sen compared the programs, the findings showed that while the volume of hours, type of work (administrative versus patient care), and work-family conflict all impact the rates of depression, another critical component differentiating the high and low depression programs was the type of learning environment.  “A key factor among low-depression programs was residents reporting that their inpatient rotations were a positive learning experience. Another was receiving timely and appropriate feedback from faculty. Both of these factors indicate that a focus on education, and specifically directed education from faculty, makes a major difference.”

The findings are particularly pertinent given an article published last week in the NY Times by Perri Klass, MD. The article, which is in response to a recently published JAMA Pediatrics article (Walking on Eggshells With Trainees in the Clinical Learning Environment), speaks to the difficulties that many faculty members feel providing feedback to trainees. While the medical community is working hard to end the harassment and bullying of residents that typified many interns’ experiences historically, some feel the pendulum has swung too far and that they are unable to provide criticism, tough feedback, or make interns feel discomfort without retribution or poor evaluations.

Dr. Klass quotes Dr. Janet R. Serwint, professor emerita of pediatrics at Johns Hopkins, who says, “When I look back at my career and my life and how important some of that feedback was, and it was hard for the giver to give to me, I’m sure, but they did it in a respectful way… I worry that the balance is swinging in such a way that it’s all about, oh, you are wonderful.” During her time as the vice chairwoman of education and the residency program director, she said that some faculty would mention problem residents, but often they had not broached the issues directly with them. “It’s the discomfort, or the worry of retaliation and evaluation.” Furthermore, Dr. Melanie Gold, lead author of the JAMA article, goes on to say that she has also struggled with interns unwilling to experience discomfort during medical training. Her examples include a student who complained to a course director about transgender health’s inclusion in the curriculum and others who, due to religious objection, were unwilling to even observe a patient consultation. Dr. Gold went on to say that many faculty members feel ill equipped to engage in the resulting difficult conversations.

While these articles are written from differing perspectives, they describe a shared desire by residents and faculty for meaningful feedback and instruction. Given that discomfort is an inherent condition of medical training, the data would suggest that some programs are able to navigate this discomfort better than others. Dr. Sen says that “Faculty members also need to learn trainees’ specific strengths and weaknesses and then provide thoughtful, specific feedback that truly supports their learning. Programs ought to encourage faculty to invest the time necessary to support learners and reward them for doing so.”

Following this discourse is important for future medical students and interns who are applying to medical school or residency programs. Applicants can distinguish themselves by showing that they understand the role that feedback—positive and negative—plays in preparing for a medical career. Demonstrate this understanding by using interviews and essays to describe situations where negative feedback spurred improvement, learning, and connection with others despite discomfort. Just as faculty must be willing to consider how best to promote learning, trainees must demonstrate an openness to the criticism and discomfort necessary and inevitable in the preparation for a medical career.

Further, when evaluating programs, applicants should take into consideration the learning environment. Observe the interactions between faculty and interns, and question current and former program participants about how and at what frequency feedback is offered. It may also be worthwhile to engage administrators or admissions representatives on how the program structure trains and supports faculty in providing feedback, facilitating difficult conversations, and creating a positive learning environment. While more visible wellbeing investments can be compelling, it is critical to look closely at the structural elements of a program that data shows matter to the lives of residents: hours worked, tasks performed, work-life balance, and the learning environment.

Top Medical Schools Take on Student Debt in Bid to Increase Diversity and Encourage Broader Specialty Selection

Recently, Washington University in St. Louis announced that it was going to commit $100 million over the next ten years for scholarships for medical students and to “enhance and modernize the school’s medical education program.” Up to half of the program’s future students will be able to attend the school tuition-free, with many others receiving partial tuition support. The program will begin with the 2019-20 entering class.

Washington University is the latest in a string of schools working to reduce the student-debt burden associated with medical school. Last August, New York University Medical School shocked and delighted students when it announced that all current and future medical students would be attending tuition-free. Kaiser Permanente, the following February, made a similar offer for its first five graduating classes. Additional schools, including Columbia University’s Vagelos College of Physicians and Surgeons and the David Geffen School of Medicine at UCLA also have created substantial scholarship funds to ease student loan burdens.

The rising cost of medical school debt negatively impacts not only medical students but also the greater public. Students graduating from public medical school programs carry a mean debt of just under $189,000, while those graduating from private medical schools have a mean debt closer to $209,000. This debt load can impact many aspects of public health, including deterring promising students from entering medical school, encouraging those in medical school to opt for higher paying specialties post-graduation, and creating higher stress and lower wellbeing for physicians and those in training. In late April, the AAMC published updated physician shortage numbers, with the projected shortfall of primary care physicians, a lower-paying specialty, ranging between 21,100 and 55,200 by 2032.

The schools offering reduced and tuition-free opportunities for their students believe that reducing student debt will encourage a more diverse applicant pool as well as empower graduates to pursue a broader range of medical specialties. “For most medical students, debt is a significant factor in selecting a school and a career path,” said Eva Aagaard, MD, Senior Associate Dean for Education and the Carol B. and Jerome T. Loeb Professor of Medical Education at Washington University in St. Louis. “We want to help alleviate that financial burden and instead focus on training the best and brightest students to become talented and compassionate physicians and future leaders in academic medicine….This is an investment in our students and in our institution, as well as in the health of St. Louis and the greater global community.”

 While many schools have adjusted their admissions processes to attract more minority applicants, using a combination of pipeline programs, more holistic admissions standards, and a focus on diverse representation on admissions committees, the problem has thus far remained. “From 2014 to 2018, the percentage of black students enrolled in medical school rose from 6 percent to 7.12 percent, according to the AAMC. Additionally, Latino medical students increased from 5.3 percent to 6.4 percent of total enrollment while Native Americans still account for less than one-half of a percent of all medical students.”

While it is still too early to gauge success, NYU has seen promising results in its first application wave since it eliminated tuition. While overall applications to medical schools in the United States have increased by 47 percent, African American, Hispanic and American Indian applicants only increased by two percentage points. At NYU, however, almost 9,000 applications were submitted for the 102 seats in the 2019 incoming class. There was a 103 percent increase from the previous year in applicants who self-identify as disadvantaged, a 140 percent increase in black applicants and a 40 percent increase in Pell Grant recipients. Dr. Rafael Rivera, Associate Dean for Admission and Financial Aid at NYU said, “The accepted pool that we have thus far reflects increased diversity in socioeconomic status, which is an important facet of diversity in the physician workforce that hasn’t gotten the attention it deserves.”

 The other objective of tuition-free and reduced medical school programs is the freedom that it affords graduates to select less lucrative specialties or career paths. The relationship between student debt and specialty preference is well-documented. An article reviewing research on the impact of student debt on primary care physicians, included references to a 2012 study that showed students with larger amounts of student debt are “more likely to switch their preference for a primary care career to a high-income specialty career over the course of medical school” as well as a 2016 qualitative study which found that, “students described their debt as making them feel more cynical, less altruistic, and entitled to a high income.” These findings suggest that reducing the debt, through reduced tuition or increased scholarships, will positively impact graduating students’ ability to select a specialty based on preference rather than need.

 Though only time will fully show the impact of these schools’ commitments to reducing student debt on the physician workforce, there is reason for optimism about the benefits that will be seen for medical students, physicians, as well as the public.

Medical Schools Limited on Use of Race in Admissions Decisions but Still Seek to Promote Diversity

Last week, The Wall Street Journal reported that the U.S. Education Department is requiring the Texas Tech University Health Sciences Center medical school to discontinue its practice of factoring race into its admissions decisions. The medical school agreed to a deal with the Education Department in order to end the long-running federal investigation into its use of affirmative action. In 2003, after the Supreme Court ruled that race was admissible as a factor in admissions decisions in Grutter v. Bollinger, the Texas Tech University Health Sciences Center resumed use of race as a criteria in admissions decisions. In 2004, the Center for Equal Opportunity filed a complaint against the school, and the next year the Education Department began the investigation, which this agreement concludes.

Texas Tech had previously ceased using its affirmative action policy for admissions in the pharmacy school in 2008 and for undergraduate programs in 2013. However, the medical school contended that, “It must continue weighing race in its admissions process because a cohort of doctors from different backgrounds could best serve Texas’ racially and ethnically diverse communities.” However, the recently signed agreement stipulated that the school was not providing an annual review of the necessity of race-based admissions and therefore could not rule out that other factors may provide similar diversity-levels. The agreement also suggested that the medical school use other “race-neutral factors” to meet diversity aims, “such as recruiting students from low-income areas and favoring bilingual or first-generation college students.”

Earlier this week and just following news of this agreement, Kaplan Test Prep released survey results showing that 80 percent of 245 pre-med students surveyed in January 2019 say that “It’s important for the American medical profession to be more demographically representative of the general patient population.” Among the students who agreed with this statement, one commented, “While it is certainly possible to be empathetic and ‘tuned in’ to your patients despite differences in language, culture, etc., it is important for patients to feel like they can relate to and trust their clinician…If American clinicians were more demographically representative of the population as a whole, patients would likely find it easier to connect with a care provider they are most comfortable with.” Those in the 20 percent who did not agree with the statement were more likely to focus on the importance of drive and technical ability in becoming an effective doctor.

Additionally, an earlier Kaplan study with medical school admissions officers showed that many felt competent with their school’s diversity efforts. When the admissions officers were asked to grade his/her medical school on diversity, the majority gave themselves a B (35 percent) or C (34 percent), while fewer rewarded themselves with an A (18 percent) and even fewer a D or F (5 percent).

While it is clear that prospective medical students and doctors see the value in diversity in medical school admissions, the process by which the schools will implement these diversity goals is changing based on the views of the current administration. And these changes should be noted, especially by prospective medical students.

For future applicants: Overall, it is wise to seek experiences that improve your ability to work with others, particularly those unlike yourself. And throughout your application, you will want to speak to these experiences in a manner that showcases your commitment to serving a diverse population of patients, highlights areas where you will bring diversity into the program, and show how you have thrived and what you have learned in diverse environments in the past.

Medical Schools Focus on Student Wellbeing and Mental Health to Reduce Burnout

In our recent newsletter, we highlighted the topic of burnout among today’s working population. Burnout, or the experience of chronic stress which leads to physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment, remains a pressing issue within the medical student population. A literature review published in late 2018 “confirmed that suicidal ideation in medical students remains a significant concern” and cites studies showing that “medical students in their first year of studies have similar rates of psychological morbidity to the age-matched general population, but experience a worsening of their mental health as they progress through medical studies.”

Medical students and residents, who are often under intense pressure physically and emotionally, suffer from a lack of sleep, extremely long hours of work and study, as well as the emotional, life and death decision-making involved in the work. This is often compounded with a subconscious need to avoid seeking mental health professionals for fear of negative judgment from those around them or even endangering their medical licenses.

The accumulation of data on the mental health of medical students, coupled with the recent high-profile losses of medical students in New York City and California have spurred action and a recognition of the need for additional support for physicians in training. The Accreditation Council for Graduate Medical Education is promoting the importance of wellbeing, which goes beyond addressing burnout, and has compiled and posted a tools and resources page on its website: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources.

Moreover, many medical schools are showing that they too are committed to changing the culture of medical education to improve students’ wellbeing. Prospective students should pay particular attention to the following when further evaluating the schools on their list:

• Commitment to wellbeing: Many schools have codified their commitment to their students by creating wellbeing mission statements and making significant investments in wellbeing resources. At the Icahn School of Medicine in NYC, a wellbeing task force was created in 2016. In addition to creating a mission statement to focus momentum and drive steady action, the school has renovated student housing to include a wellness center.

• Accessible, confidential, and judgment-free mental health resources: This may include access to psychologists or psychiatrists, confidential check-in surveys or interviews, and/or counseling sessions during hospital rotations. At USC Keck Medical School and the University of Pittsburgh School of Medicine, mental health teams have been put in place to ensure the schools do not lose sight of the mental health and wellness needs of their students. Both are working to decrease the stigma around using mental health resources as well as increasing confidential mental health evaluations and services.

• Culture promoting a healthy academic environment: Some schools are taking tangible actions to create an academic environment that promotes rigor but not burnout and depression. Many programs also encourage collaboration, provide wellness curriculums, and promote comradery within the classes through social activities (appropriate for various personality types) and occasional days off. Examples include Duke School of Medicine’s wellness curriculum starting with a resiliency course at orientation, USC’s requirement for students to take several “mental health” days to combat burnout, and Icahn’s assessment and restructuring of grade distributions.

In September of this year, Weill Cornell is partnering with AAMC, AMSNY, and the American Foundation for Suicide Prevention to put on the National Conference on Medical Student Mental Health and Well-Being. It is billed as being the “first comprehensive, multidisciplinary forum to examine the mental health needs of medical students.” Change is underway and it is an exciting time to be considering medical school. However, prospective and current students must engage in the dialogue, stay informed, and ultimately commit to making their wellbeing and health a priority.

Want to Achieve Your Goals? First, Define Your Personal Brand.

In a Forbes article, writer Greg Llopis said that people often confuse the notion of a personal brand with having a curated social media page. In truth, however, social media is just one portion of a much larger idea. Your personal brand is how you express the compilation of experiences you’ve had, what you have to offer, and your intentions going forward. While social media accounts should align with your brand, they do not define it.

Llopis says, “Every time you are in a meeting, at a conference, networking reception or other event, you should be mindful of what others are experiencing about you and what you want others to experience about you.” This awareness of others’ experience allows you the freedom to put forward your most authentic self, rather than letting nerves or other outside influences change how you respond in a situation.

Spending time defining your personal brand will pay dividends as you move forward in your career, whether that means creating an exceptional grad school application, building a compelling resume, prepping for an interview or career-fair, or working towards the next promotion. It will not only allow you to be a proactive planner and decision maker, it will also act as a filter when you evaluate various career options.

To begin defining your personal brand, consider the following:  

1.       Your past experiences

Have you ever been so engaged in a pursuit that time seemingly disappeared? What have you found most difficult?  Which experiences stand out as those which prompted an evolution in your perspective? What are you most proud of? When have you felt most fulfilled?

2.       How you engage with others and the world

What strengths have you developed over time? What are your greatest weaknesses? How have you dealt with adversity? What feedback do you consistently receive when working with others? How do think others experience you? What five adjectives would you use to describe yourself? Do you think others would use the same five adjectives? If not, which would they use?

3.       Your future goals.

What type of work do you enjoy? What type of work do you aspire to do? What would you like your professional relationships to look like? What sort of environment do you think you would thrive in? What is your ideal work-life balance? What aspects of a position are most important to you and where are you willing to compromise? What are your short- and long-term goals?

Once you’ve refined your brand, you can start to put it into action to determine which opportunities will (and will not) be a good fit for you. Just remember to express a consistent message everywhere, including on social media. Recruiters or admissions officers should never be surprised by what they see online, rather the content should provide further depth on the person they know.

The Opioid Crisis and Medical Education: Adequately Preparing Students is an Ongoing Struggle at Most Medical Schools

There are approximately 91 people per day who die from opioid overdose. And each year, an economic burden of $78.5 billion—a result of healthcare costs, lost productivity, addiction treatment, and criminal justice fees—is associated with the opioid crisis. So why aren’t medical schools adequately preparing students to deal with addiction? A recent New York Times article quotes Dr. Timothy Brennan, the director of an addiction medicine fellowship at Mt. Sinai Health System, who compares combating the opioid crisis with the current provider work force to “trying to fight World War II with only the Coast Guard.” Further, Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, notes that while most medical schools now offer some education about opioids, the content varies widely in terms of depth. Additionally, only about 15 of 180 American medical programs teach addiction as it relates to alcohol, tobacco, and other drugs.

Earlier this week, the AAMC put out a Key Issues statement on the opioid epidemic that linked to a January 2018 survey where AAMC researchers asked Medical School deans about their current or anticipated plans for dealing with the opioid crisis. Almost all, 97 percent of respondents, noted the challenges of teaching and/or assessing students’ knowledge of prescription drug abuse. They referred most frequently to a deficiency in faculty expertise, a lack of time within a crowded curriculum, and difficulty assessing students’ mastery.

Attempting to overcome the named challenges, The University of Massachusetts, Tufts University, Harvard University, and Boston University have committed to using a set of ten competencies to drive their opioid education programs.  At Boston University, addiction education is incorporated into all four years of training and the school has partnered with Dr. Bradley M. Buchheit, an addiction medicine fellow, to train students in assessing and talking with patients about substance abuse.

Other schools are following suit. The University of Central Florida College of Medicine enhanced its curriculum to include both preclinical and clinical education on pain management, addiction risk mitigation, the use of prescription drug monitoring systems, naloxone training, and the CDC’s new voluntary guidelines for opioid prescribing. Martin Klapheke, MD, assistant dean for medical education and professor of psychiatry at UCF noted that “students are taught to fully engage patients and their families in discussing the risks and benefits of different pain therapies.”[i] At NYU, medical students have always received training in chronic pain and addiction, including a week-long pain management curriculum. And now the school is adding additional elements including a pain assessment and management training for all students going into residency programs, as well as a lecture on alternative pain management techniques.

Learn more about the battle against opioids:

• Congressional action: https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/10/04/opioid-bill-expands-treatment-options

• AAMC issue brief on academic medicine’s response to the opioid crisis: https://news.aamc.org/for-the-media/key-issues/academic-medicines-response-opioid-epidemic/

• Opioid research initiative: https://www.nih.gov/news-events/news-releases/nih-launches-heal-initiative-doubles-funding-accelerate-scientific-solutions-stem-national-opioid-epidemic

• Washington University in St. Louis Medical School hosts roundtable with HHS Leadership on opioid addiction research: https://medicine.wustl.edu/news/roundtable-on-opioids-brings-hhs-leaders-to-medical-campus/

[i] https://www.aamc.org/newsroom/newsreleases/464576/medical_schools_confront_opioid_crisis_08042016.html

As Physician Demand Will Continue to Outpace Supply, Medical School Admissions Committees are Particularly Interested in Applicants Committed to Practicing Primary Care in Underserved Locations

The AAMC recently published updated results of its physician workforce analysis, which modeled physician demand and supply to project the needs of the 2030 workforce. The analysis shows that physician demand will continue to outpace supply, which will lead to a physician shortage of between 42,600 and 121,300 full time equivalencies (FTEs) by 2030.

Within primary care, the shortage is projected to fall between 14,800 and 49,300 physicians, which incorporates various assumptions about the supply and partnership of Advanced Practice Registered Nurses and Physicians Assistants in the future, as well as the current estimated need for 13,800 physicians to reconcile the primary care shortage from currently designated shortage areas.

Projections for non-primary care specialties, including medical, surgical and other specialties, show an estimated shortage of between 33,800 and 72,700 physicians. The greatest projected gap is for surgeons, which is between 20,700 and 30,500 by 2030. While the supply of surgeons is projected to stay steady over time, the demand is expected to increase. “Other” specialties, which include emergency medicine, anesthesiology, psychiatry, radiology, and others, has a projected gap of between 18,600 and 31,800.

The main driver behind the increasing demand for physicians is the growing and aging U.S. population. Between 2016 and 2030, “the U.S. population is projected to grow about 11 percent, from about 324 million to 359 million. The population under age 18 is projected to grow by 3 percent; the population aged 65 and older is projected to grow by 50 percent; and the population aged 75 and older is projected to grow by 69 percent.”[i] Similarly, on the supply side, the aging population of physicians and their associated retirement decisions will impact the severity of the gap. “More than one-third of all currently active physicians will be 65 or older within the next decade. Physicians aged 65 and older account for 13.5 percent of the active workforce, and those between the ages of 55 and 64 make up nearly 27.2 percent of the active workforce.” [ii] Physicians’ weekly working hours are also currently trending downward across all physician age groups.

The report also modeled access to care, which is another factor that may impact demand in the future. There are currently inequities in access to care based on geographic, economic and sociodemographic factors. While projected physician shortages based on these factors was not included in the long-term projection estimates, the 2016 models show that if the country commits to improving access to care for disenfranchised groups, the demand for physicians will be drastically increased.

The AAMC is currently advocating for a multipronged approach to address the physician shortage including the improved use of technology, team-based care, and delivery innovations, as well as the increase of federal funding for additional residency positions. The AAMC is clear that the U.S. government needs to act in the short-term to expand graduate medical education to address the long-term physician demand identified in the report, as physician training is a ten-year process. Federal funding for residency positions has not been expanded since the 1997 Balanced Budget Act. While there have been two pieces of legislation recently introduced (explained below), which would provide funding for additional residency spots,[iii] neither have gained much traction since introduction.

• The Resident Physician Shortage Reduction Act of 2017 provides comprehensive reform to federal funding for graduate medical education.
• Lifts the funding cap placed on the number of residents and fellows funded by Medicare
• Adds an additional 3,000 federally-supported residency positions each year for the next five years
• The Opioid Workforce Act of 2018 specifically targets and funds residency training for areas of critical need.
• Adds an additional 1,000 federally-supported resident positions over the next five years in hospitals that have, or are establishing, programs in addiction medicine, addiction psychiatry, or pain management

Prospective and current medical students should familiarize themselves with this report, especially when considering their future fields of study.  Many medical schools are echoing the demand for students interested in primary care, as well as those committed to working in rural or otherwise underserved locations; In 2017, the AAMC reports that nearly 30% of those entering medical school plan to work in an underserved area. Additionally, these topics are likely to come up in interviews and at networking events.  

The AAMC has committed to updating the projections on an annual basis and makes the report available online.

The final report for 2018 created by IHS Markit Ltd for the AAMC is available here: https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[i] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[ii] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[iii] https://www.forbes.com/sites/brucejapsen/2018/05/17/congressional-bill-would-add-1000-doctors-to-fight-opioid-addiction/#60926102684a

Alternatives to Allopathic Medical Programs in the United States

For the 2017-2018 school year, over 51,600 students submitted an average of 16 applications each for placement into a U.S. Allopathic Medical School. With a resulting, 43 percent admittance rate and 41 percent matriculation rate, almost three out of every five applicants found themselves without a spot. While re-applicants made up just under 30 percent of the applicant pool in 2017 – 2018, and schools look favorably on re-applicants, there are some medical career alternatives worth considering.

1.       Osteopathic medicine. According to the American Association of Colleges of Osteopathic Medicine (AACOM), more than 20 percent of current medical students in the United States are training to be osteopathic physicians. These physicians or surgeons, who receive a D.O. rather than an M.D. degree, are doctors licensed to practice in the United States. While the education and certification paths are similar, differences exist in both the training curriculum and philosophy of patient care. AACOM says, “Osteopathic physicians use all of the tools and technology available to modern medicine with the added benefits of a holistic philosophy and a system of hands-on diagnosis and treatment known as osteopathic manipulative medicine. Doctors of osteopathic medicine emphasize helping each person achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention.”

Osteopathic residency is currently in a transition to a single accreditation system for those pursuing both osteopathic and allopathic degrees. By 2020, all medical internship, fellowship, and residency programs will be accredited by the Accreditation Council on Graduate Medical Education (ACGME), whereas previously the ACGME accredited allopathic programs and the American Osteopathic Association (AOA) accredited all osteopathic. The changes are very much underway, and according to National Resident Matching Program 2017 data, 3,590 D.O. candidates submitted rank order lists of programs with a match rate of 81.7 percent. Both the number of candidates and match rates were all time highs.

2.       International Medical Programs. While the U.S. is home to many excellent medical schools, there are also compelling programs in Israel and the Caribbean, which tend to be less competitive from an admissions standpoint. Caribbean schools often have the benefit of rolling admissions, and allow for students to start in January. In Israel you can attend an American Medical Program where classes are facilitated in English, though you may need to acquire some Hebrew for matriculation at The Technion and the Sackler School of Medicine at Tel Aviv University.

In 2017, according to the National Resident Matching Program, the number of U.S. citizen graduates of international medical schools who registered for the match and submitted rank order lists of programs declined. However, for the 5,069 who submitted rank order lists of programs, the match rate was the highest since 2004 at 54.8 percent. Match rates tend to be higher among those attending American medical programs in Israel, as compared to graduates of Caribbean programs.

3.       Podiatry School. Doctors of Podiatric Medicine are certified physicians or surgeons who specialize in diagnosing and treating conditions affecting the foot, ankle and related structures of the leg. These Physicians receive a DPM, rather than an MD, and undergo a similar education, residency, and certification process. 

The Bureau of Labor Statistics projects faster than average growth in the employment of podiatrists, with projected growth of 10 percent from 2016 to 2026. This is due to the aging population and the likely increase in demand for medical and surgical care of the foot and ankle, as well as for treatment of issues associated with chronic conditions, such as diabetes and obesity, that impact patients’ feet and ankles.

4.       Physician’s Assistant. A Physician’s Assistant works closely with a licensed physician or surgeon as a part of a collaborative medical team and can examine, diagnose, and treat patients under supervision. While certification requirements vary by state, most PAs graduate with a master’s degree from a Physician Assistant degree program and then need to complete a set number of clinical work hours before sitting for the National Certification exam.

The Bureau of Labor Statistics projects much faster than average growth in the employment of PAs, with projected growth of 37 percent from 2016 to 2026. This is due to the growing and aging population and a projected increase in the demand for healthcare services.

Waitlisted? Don’t Give Up Hope. Write a Letter of Intent.

News you have been waitlisted at one of your top-choice medical schools can bring a range of emotions. It’s not the desired outcome, of course, but the game isn’t over. Their admissions committee still sees you as a worthy applicant, capable of handling the rigors of the program.

The number of students who are admitted each year from the waitlist varies based on the school. Highly ranked and competitive programs will typically admit fewer from the waitlist than those further down in the rankings, as they will have a higher yield (acceptances resulting from initial admissions offers).

You can influence your chance of being selected from the waitlist of any school by continuing to showcase your interest in their program. Just as it is critical for medical schools not to overfill their incoming class, they do not want to have empty seats when the school year begins. Therefore, if you can show that you will improve their yield, a key component in medical school rankings, they will be more likely to send to you a letter of acceptance. Engagement with the program through visits and meetings with professors, admissions directors, and current students is an effective way to show interest. But don’t forget to craft a compelling letter of intent too. It should include the following:

• Meaningful updates since you’ve submitted your application. Did your research study finally get published? What have been the key takeaways in that internship you began in August?
• Reiterate your interest in the school by citing specific courses, experiential learning opportunities, professors, etc. that make sense given where you’ve been in your life and career so far and where you want to go. Why do you believe you are a good fit?  What will you bring to the incoming class? How will their program help you achieve your goals?
• Mention any experiences you’ve had on a campus visit/tour or during your interview that increased your commitment to the school.
• The Yield Protection Statement: “Medical School X is my first choice and, if admitted, I would absolutely attend.” If you can make such a statement, this will be the most impactful component of your letter.

As the waiting game continues, keep in mind that many schools do not use “rolling waitlists.” Instead, they often wait until they have received final admissions decisions from prospective students on May 15th. After this date, prospective students will only be able to hold a seat at one medical school. While prospective students can withdraw from a school if they are accepted from the waitlist into a preferred school up to the point of matriculation, students cannot hold a seat at both schools.

Good luck!        

Use Social Media to Enhance Your Graduate School Application

Last week, Kaplan Test Prep released data from their survey of over 150 business schools across the U.S. on the role of social media in the admissions process. Of the admissions officers surveyed:

• 35 percent say they have visited applicants’ social media profiles to learn more about them, up 13 percentage points from 2011
• 33 percent of those admissions officers who’ve visited applicants’ social media profiles say that they do so “often”
• Social media has helped and harmed applicants’ admission prospects in almost equal proportions (48 percent and 50 percent respectively)

See the full press release, including a video summary of the findings here: http://press.kaptest.com/press-releases/kaplan-test-prep-survey-growing-number-business-schools-turn-social-media-help-make-admissions-decisions 

Admissions officers who are reviewing students’ social media pages are looking to get to know the student and their background more fully. Prospective students can take advantage of this by ensuring that their social media profiles are up to date and supportive of the personal brand they’ve put forth in their applications. As such, we recommend that anyone applying to a graduate program, or an internship or residency, take at the least a cursory social media scan. Below, we have provided guidelines for doing so.

The Basics: If nothing else, confirm the following.

• Ensure that your social media privacy settings reflect your preferences, but keep in mind that even private information can leak or be distributed more widely.
• Review your pictures. Are there any that present you in a manner that would be embarrassing for an admissions officer to see? Be sure to go back and review even your oldest pictures. Remove those that you deem inappropriate, borderline, or simply not reflective of you.
• Ensure that your LinkedIn resume is up to date, grammatically correct, and in line with what you’ve submitted to the admissions committees. Similarly, confirm that your posts on Facebook, Twitter, and Snapchat are grammatically correct.
• Confirm that none of your content could even potentially be considered racist, sexist, or containing prejudicial language. You should consistently represent yourself as someone who will add to a diverse intellectual environment. Make it clear to your friends that you should not be tagged or otherwise included in groups that don’t share this spirit.
• Review your profiles often. Ensure that others are aware that you don’t want to be tagged in inappropriate pictures, videos, or comments.

The Upgrade: Use social media to enhance your application.

• Consider if your pictures are showcasing your hobbies and interests beyond, but including, time spent with friends. If not, add pictures that show a broader array of “you”. This might include shots from travel, volunteer work, cultural activities, time with pets, or engaging in other hobbies that show off aspects of your personality that will bring your essays and interviews to life.
• Ask co-workers from various points in your career to post recommendations on your LinkedIn account.
• Ensure that your goals are consistent between your application and social media posts. Don’t post different career goals than those that appear in your application, or actively discuss pursuing full-time careers that don’t require the graduate program to which you are applying.
• Keep your accounts up to date. Post about your current activities and events including conferences, speeches, or panels and include your reactions to the events. Share news or research articles on areas that you’re interested in. Take this opportunity to show off your writing and critical thinking skills or link to a blog containing your writing.
• Don’t hide those things which make you different. Admissions officers want a diverse graduate population, and social media is the perfect way to show off qualities and interests that set you apart from the crowd, as well as demonstrate how you currently contribute to the diversity of your community.

While, social media should continue to be a personalized and fun outlet for you, don’t forget to consider that it may also inform admissions committees or future employers about who you are, and ultimately impact their final decision. 

The Multiple Mini Interview: Preparation and Day-of Tips for Success

Each year, an increasing number of U.S. medical schools are using the Multiple Mini Interview, an interview type focused on obtaining a deeper understanding of how a student processes information under pressure and uses critical thinking skills to derive an answer. The unique format allows prospective students multiple opportunities to make a “first impression” and reduces interviewer bias because of the recurrence of opportunities for a student to think through and address various types of questions.   

Multiple Mini Interviews typically consist of between four and ten interview stations, some with rest stations included in between. At the stations, interviewees are provided with a question prompt and a couple of minutes to think through the situation, then they’re asked to respond within a five to eight-minute period. The requested response could take various forms including collaborating with other prospective students, acting out a scenario, responding to an ethical or policy scenario, writing an essay, or providing a behavioral interview response. Whatever the format, applicants’ responses must showcase critical thinking skills, strong sense of ethics, and ability to see multiple viewpoints.

Preparation for the MMI should be focused on increasing your comfort level in reading a prompt and analyzing the question quickly so that you can articulate a thorough and comprehensive response. The MMI does not aim to assess your knowledge of specific topic areas, but rather is a format designed to extract a more genuine version of you.

We recommend you consider the following as you prepare for the interview:

• Don’t forget the goal. As you practice your MMI responses, be sure that you’re integrating qualities into your answers that demonstrate intellectual curiosity, empathy, humility, professionalism, commitment to medicine and research, and tenacity. MMI questions are designed to reveal an authentic version of you, so as you prepare, make sure that you’re highlighting those qualities that will make you an excellent medical student and doctor.
• Get current. Familiarize yourself with policy and ethical issues in healthcare by reading about current events. Write down key topic areas you encounter frequently and take informed positions. Practice describing your position, out loud, with an eight-minute time limit.
• Practice your pace. If possible, participate in mock MMI interviews to get a more realistic interview experience and gather candid feedback. If you do not have someone to provide a mock interview, review sample MMI questions and record and time your responses. Critique your responses, focusing on how well you verbalized your thought process and supported your viewpoint, as well as, how adequately you made use of the time available. While this exercise may feel uncomfortable at first, it will be helpful to get used to working within the time constraints of the interview.  And viewing a recording will help you to hear/see what improvements you need to make.

On the day of the interview:

• Read each prompt carefully and think through all aspects of the response. If the question allows you to make a counter-argument, do so, and share why you opted for the conclusion you did. If it is an ethical or values-based question, be sure to point out areas of nuance.
• Make eye contact, look friendly, speak clearly and use every station as an opportunity to showcase your professionalism. If you start to stumble or get frustrated, take a deep breath or sip of water and compose yourself before continuing.
• Use your time carefully; during the two minutes of preparatory time, outline your response and the general timing you’d like to abide by to make each of your key points.
• Start fresh at each station; regardless of how well or poorly you did in the last mini interview, leave it behind and focus entirely on the prompt at hand.
• For introverts, the MMI can be particularly challenging. Be sure to give yourself some quiet time prior to the MMI to gather your energy.

Unemployed and Considering Graduate School? Ensure This Time is Meaningful and Productive

If you are currently unemployed, graduate school can appear both tempting and daunting. Tempting, in that it will offer a new path forward complete with a career center. Daunting in that it may be necessary to directly address the unemployment period within the application. While unemployment should never deter you from attending graduate school, we encourage our clients to consider carefully if graduate school is the right path for them. The money and time invested must lead to an optimal path forward to be worthwhile. Though graduate school can be tempting to alleviate the pains of unemployment, if you have never considered it prior to unemployment, it might not be the right move now.

If you’ve known awhile that eventually you would pursue a graduate program, a period of unemployment may provide a beneficial time to study for entrance exams and create compelling application materials. However, admissions committees will want to see that you are using your time wisely and productively, extending yourself beyond the work on your application materials. In order to present the employment gap as a critical time of development, consider the following:

• Volunteering at an organization where you may be able to hone your leadership skills and refine an area of expertise

  • https://www.volunteermatch.org/

  • https://giveandgetnyc.org/

  • https://www.volunteerforever.com/article_post/2017-best-volunteer-abroad-programs-organizations-projects

• Tutoring students at a local university in relevant coursework

• Taking courses at a local university or through online portals

  • https://www.edx.org/

  • https://www.coursera.org/

  • http://online.stanford.edu/

• Attending professional development conferences

  • We’ve listed a few resources and conferences that can provide great learning and networking. You can also look for conferences that have streaming capabilities to keep costs down.

    • (pre-med) https://www.amsa.org/events/, https://www.aamc.org/meetings/annual/?link=carousel&camp=LSL2017

    • (pre-law) https://shop.americanbar.org/eBus/ABAEventsCalendar.aspx

    • (business) http://techweek.com/?ticket=new-york,  http://conference.99u.com/, http://www.businessinnovationfactory.com/summit/logistics

• Doing freelance work

  • For some insight into where to get started: https://www.thebalance.com/how-to-start-freelance-writing-1360255

• Starting or writing more regularly for a blog

  • This link will take you to a site comparing various blog hosting platforms, and will give you the information you need to get started: http://www.wpbeginner.com/beginners-guide/how-to-choose-the-best-blogging-platform/

• Investing completely in a hobby or other personally fulfilling undertaking

• Writing a business plan or starting a business

On the application itself, you should not dwell on or make excuses for the employment gap.  Rather, you will want to address it briefly, explain that it is not indicative of weakness in ability or character, has not hindered your pursuit of your goals, and you did indeed spend the time productively, gaining valuable insight. You ultimately want to show the admissions committee that you will work hard throughout the graduate program, be able to secure professional placement and that, instead of slowing you down, this obstacle has given you an opportunity to adjust course, work harder, and become better.

Medical School Interviews 101

The medical school interview is a critical and exciting opportunity, as the outcome will be the most influential factor in your admission success.  It is your chance to showcase your personality, drive, and commitment to a medical career as well as those characteristics that will benefit your medical school class and future patients.

Scheduling the Interview

Most medical schools have rolling admissions, so we recommend scheduling your interview as early as possible in the interview season, which runs from the fall to the spring.  Before solidifying your travel plans, you should contact nearby schools where you have applied to let them know you have an interview in the area and when your interview is scheduled.  This serves the dual purpose of letting the other school know that you are ‘in demand’ while also showcasing a strong interest in their program.

What the Interviewers are Looking for

Most medical schools will offer prospective students one or two 30-minute interviews with faculty members or students.  The interviewers are looking to assess your interpersonal traits, your commitment to and aptitude for medicine, your potential contributions to the school and your class, discuss and resolve any red flags and finally ensure that your interview is consistent with your application.

Interview Types

The Multiple Mini Interview: While this type of interview has been used mainly in Canada, it is growing in popularity within the United States. This interview format consists of multiple “stations” through which each applicant rotates.  At each station, you are given a scenario, asked to role-play, or asked to do a team exercise.  You are provided a couple of minutes to read each exercise and prepare, then you must have a discussion with the interviewers in the room or perform the team task. 

The scenarios are designed to evaluate your values by presenting a dilemma to which you must respond.  Be sure to carefully consider the various sides of the dilemma and to address them all. Role playing exercises test your communication skills and team tasks test your communication skills and ability to work others.  Some stations may be clinically based while others are not. 

The Traditional One-on-One Interview: This interview is the most common.  Each interviewer has his/her own style of interviewing to which you should respond appropriately.  Most commonly, in an “Open File” interview, the interviewer will have access to your submission materials. However, it is important not to assume that your interviewer knows anything about you as he/she may not have had time to review your file. In a “Closed File” interview, the interviewer will have limited access to your application.  These interviews, therefore, offer a greater opportunity to drive the discussion content. 

The Group Interview: This situation involves several interviewers and interviewees.  The objective is to see how you interact with and respond to others. Be sure to listen attentively to everyone’s answers and showcase your ability to be a team player. 

The Panel Interview: Typically, the panel includes multiple interviewers with just one interviewee.

Apply Point’s Tips for Success

• Take responsibility for the interview content, by creating and driving your own agenda. 
  • Outline the key points and experiences you would like to discuss within the interview.  Take responsibility for bringing up these points, even if they are present in your application.  To do this, review all your application materials, and highlight your most relevant stories and experiences.
  • Speak about any recent accomplishments or events not included in your application.  Continue to improve your candidacy even after you’ve submitted your application.
  • Be proactive about bringing up red flags or weaknesses in your application.  Address these head-on during the interview because they will inevitably come up within the admission committee discussions.  Rather than make excuses, talk about what you’ve learned and/or how you will combat weaknesses going forward.
• Think about and practice telling your story aloud.  This will help you feel more comfortable connecting the dots between various aspects of your life when asked to elaborate. 
  • Give complete answers and use segues to transition to other related topics you want to discuss.  For example, if you are asked why you selected a particular internship, explain not only the why, but also include the when and the what.
  • Keep the conversation moving; don’t talk any longer than three to five minutes on a given topic.
• Research the school where you are interviewing as well as the interviewers.
  • Provide specific reasons why the program appeals to you and practice speaking to why you would be a great fit.
  • Be conversational and demonstrate intellectual curiosity with good questions, but don’t interview the interviewer. Be sure that your questions at the interview’s conclusion showcase your interest in the school.
• Voice your appreciation for the interview’s time and the opportunity to interview.
  • At the end of the interview, thank your interviewer, reiterate why you have a superior fit with this medical school and let him/her know that you would be honored to matriculate.
  • Send hand-written thank you notes.  The note should be short, but should include interview highlights, repeat your interest in the school, and thank the interviewer for his/her time. 

The Medical School Application’s Work and Activities Section: Key Tips to Consider Before You Begin Drafting

Crafting a compelling Work and Activities Section is an important priority for any medical school applicant. It will allow you to provide depth on your most meaningful experiences and communicate how a particular research position, teaching opportunity, or clinical exposure inspired your interest in the study of medicine. It will also give you the chance to show through anecdotes such characteristics as intellectual curiosity, adaptability, empathy, as well as your aptitude in critical and creative thinking, or your ability to thrive in a collaborative environment.   

The AMCAS application allows for a total of 15 entries, with three designated as “most meaningful.”  While all of the entries allow for a 700-character (including spaces) description of the activity, the three most meaningful entries include an additional requirement of 1,325 characters (including spaces) where you can provide further context on the perspective you gained and lessons you learned.

Key tips to consider before you begin drafting:

• Take advantage of all 15 entries, considering the various experiences you have had that influenced your decision to apply to medical school. To start, brainstorm and write them all down in chronological order, limiting yourself to college or post-graduate experiences. This section is purposely broad and can include activities from a multitude of categories (listed below). If you find that you do not have 15, carefully consider even one-day community service events that had a particular impact on you. Keep in mind that while not all experiences will be equally meaningful, several experiences are probably still worth sharing if they influenced your path in some way.

• After brainstorming all the potential activities, make note of the 15 most relevant, making sure to span a diverse array of categories. Pay particular attention, however, to clinical activities, research, and community service.

• When selecting your three most meaningful experiences, highlight first those that demonstrate a commitment to medicine and service to others. After that, consider work/activities that are unique and, therefore, will help differentiate you to the admissions committee.

• When you describe your work/activities, be sure to clearly articulate what you did and what the outcome(s) of your participation included. In your descriptions, highlight also the qualities that you used or developed through your involvement, noting your academic/intellectual growth, maturity, sound judgment, and compassion, as well as ability to interact well with others. It is also important to include, where possible, the impact of the activity on your decision to apply to medical school.

• After writing your descriptions, read them aloud, and edit. Confirm that you are within the allotted number of characters. Such a stringent character limitation emphasizes the importance of tight, clear language and perfect grammar.

The Work and Activities section gives the medical school admissions committee a summary of all those experiences that ultimately inspired your interest in and commitment to a rigorous, yet rewarding career path. Thus, it is vital to ensure each word moves your candidacy forward in a compelling way.

Set Yourself Apart with a Compelling Medical School Personal Statement

The medical school personal statement presents a critical opportunity for you to bring your voice to the admissions committee and provide them with deeper insight into how your most meaningful experiences have inspired your commitment to the study of medicine. Part memoir and part strategic communication, the brainstorming and drafting aspects of the personal statement process can be as personally fulfilling as they are productive. We can’t wait to help you get started.

Brainstorming

• Start with a white board or a blank notepad and think about your key experiences to date. Don’t limit yourself to strictly “medically related” experiences. Consider all those parts of your life that have been formative to your personality and development -- college courses, meaningful conversations with professors or mentors, sports, clubs, books or research are all great topics at this juncture. Write them down including any details that may eventually bring complexity, sophistication, and nuance to your story.

• In looking at your list, highlight your top two or three formative experiences. Keep in mind that, ideally, these experiences should be both recent and unique. You want to demonstrate maturity as you elaborate on your decision to apply to medical school. While a childhood dream is sweet, the perspective you’ve gained as an adult is far more meaningful to the admissions committee.

• Finally, write down your personal mission statement. Why are you interested in pursuing medical school? What draws you to this career? Make this as specific as possible and avoid clichés. Ask yourself, is it clear from my mission statement how medical school, rather than another graduate program is necessary for me to achieve my goal?  

Organize and write

• Think through the best structure for organizing your formative experiences and future goals and create an outline. In looking through your most formative experiences, what are the common threads? Are there qualities that clearly come across in each of the stories? How are these linked to your future as a medical school student? Once you go through this exercise, it will be easier to identify the key themes and stories you will use to ‘anchor’ the narrative. You want to be sure to keep your statement cohesive and focused throughout.

• Create the first draft by filling in your outline, which will entail showing the reader through specific anecdotes and stories why you want to go to medical school as well the skills and traits you possess that will allow you to succeed there. Remember, you want to avoid making general statements and claims about your skills and abilities. Don’t tell them, show them.

Read, revise, step-away and repeat

• Read your personal statement aloud. How does it sound? Where did you find yourself stumbling on the words? Smooth those sections out so they read clearly. Give yourself a break, and then follow this practice again. We also suggest seeking out seasoned editors who can review your work.  

• Does your statement present the best version of you? Is “your voice” present? Would a reader be able to pick up on the fact that you’re intellectually curious…a critical and creative thinker…an individual who can thrive in collaborative environments and meaningfully connect and empathize with those around you, who can think under pressure, who has an ability and eventual desire to innovate and lead in an ever-evolving field? If not, refine your personal stories to shine light on at least some of those aspects of your personality that will be relevant to medical school.

Clean up and finalize

• Do a final review of your essay for grammatical or spelling errors.

• For AMCAS submissions, you are given only 5300 characters (including spaces) to tell your story. Be aware of this restriction as you embark on the editing process.

When Deciding Where To Apply to Med School, Look Behind The Numbers

Learn Interesting Trends in the Medical Community. Consider Your Goals.

When deciding where to apply to medical school, there are numerous things to evaluate.  You will want to look at everything from admit statistics and geography to teaching style and grading systems.  But, what about your short and long term goals?  How important are they when it comes to choosing a medical school?  While it is far too early to get your heart set on a specific specialty, you may want to start thinking broadly about what you want to do long-term.  Are you set on primary care, interested in surgery, or committed to having a career in research?  Assessing your interests now is significant because, for instance, you won’t want to go to a school with a research requirement if you’re not interested in doing any. 

It is also important to dig deep and look behind the numbers schools report, so you know exactly what’s going on out there.  This is especially important when it comes to primary care.  If you’re interested in primary care, it is easy to just peruse the US News & World Report’s Primary Care Rankings and begin formulating a list of schools to which you could apply. However, the percentages of students going into primary care, that these schools report, are often aspirational to say the least.  Schools, such as the University of North Carolina, ranked 1st in the US News & World Report Primary Care Rankings, are finding that more than half of those who claim primary care actually end up specializing in something else. 

“About 10 years ago, our legislature passed a bill saying medical schools have to put 50 percent of people into primary care,” said Robert Gwyther, M.D. who advises students at UNC-Chapel Hill. “They count internal medicine and pediatrics and obstetrics as primary care, and it’s still a challenge for UNC to get the 50 percent.”

“And we know that 95 percent of the interns will end up practicing in a specialty,” he said.

Schools like UNC continue to combat primary care’s shortage of physicians, but it has proven to be a difficult task.  When Duke University School of Medicine experimented with what the school calls a “primary care leadership track,” several years ago, only three students out of Duke’s 102 graduates chose family-medicine residencies.  More recently, the Frank N. Netter MD School of Medicine at Quinnipiac University, opened with a very specific mission: mint new doctors who want to go into primary care practice.  Bruce Koeppen, Quinnipiac’s Dean, says it’s important to admit the right students to the program, so he will interview 400 applicants for 60 spots.  He will be looking more closely at women, individuals coming to medicine as a second career, those who are first in their families to go to college and students who have come from medically underserved areas, as these are the individuals more likely to go into primary care. 

Time will tell whether or not Quinnipiac will succeed.  And time will tell whether you decide to pursue primary care, a highly sought-after specialty or a career in research.  In the meantime, arm yourself with knowledge, look behind the numbers and start to formulate a vision for your future.  It will make the process of choosing where to attend medical school that much more meaningful.

Yield Protection: Know What You’re Up Against and Use It To Your Advantage

Colleges and graduate programs will do whatever it takes to protect their yield and won’t spare any expense.  Admit weekends will wine and dine prospective students with dinners at faculty clubs, organized social events and panel presentations featuring the school’s best and brightest alumni, faculty and current students.  Admissions departments will send gifts to admitted students and, in some cases, like that at a women’s college in Decatur, Georgia, school officials may even mail out a booklet containing scented pages to prospective students.  Admits of Agnes Scott College could smell pine while viewing a photograph of campus trees and a few pages later, got a whiff of freshly mowed grass while looking at an aerial shot of the Quad. 

Admissions directors and marketing managers will jump through all kinds of hoops to ensure admitted applicants matriculate as students in the next class.  But, why?  What are their incentives?  As long as programs get a full class eventually, why should it matter?  The answer is that it all comes down to rankings, as a school’s yield percentage is a significant player in the race for the top slots.     

Besides these obvious activities to woo admits, schools are also guilty of manipulating the admissions process, a practice commonly referred to as ‘yield protection.’  Some programs will waitlist average applicants so admissions directors can see who is interested enough to fight their way in.  Other programs will waitlist higher than average applicants if they believe these applicants would receive interview and admissions offers at more elite institutions.

As an applicant, instead of getting frustrated by these practices, use them to your advantage in the application process.  Whether you are applying to college, medical, law or business school, or other graduate programs within the arts and sciences, don’t forget the following tips:

Make Absolutely Sure Admissions Directors at Your Top Choices Know Their Program Is Your First Choice: Attend forums and recruiting events where you can introduce yourself to deans and admissions directors and reiterate how excited you would be if admitted to their institution. 

Put It In Writing: After events, send hand-written thank you notes to everyone you spoke with and, of course, drop in a line about your strong desire to attend if admitted.

Be Proactive: Don’t just attend scheduled events.  Arrange school visits through the admissions office and set up one-on-one appointments with various faculty members, deans, admissions directors and current students.  This not only shows your strong interest in their school, but this will also benefit you during the interview when you will be able to speak in-depth about the school’s offerings.

If You Are Waitlisted, Take Action: Visit the school if you haven’t already, send a letter with updates on your candidacy with a particular emphasis on how well you would fit in at your first choice school, send an additional recommendation letter and keep communication open.  You may think it could be annoying, but occasionally following up with admissions committees is a good way to reiterate interest and keep at the top of their minds.   

During a time of manipulative yield protection activities and marketing tactics that include scented brochures, you must arm yourself with the knowledge of this game and use it to your advantage.  In a few years, when you are studying on the quad of the reach school where you were initially waitlisted, the smell of that freshly mowed grass will be that much sweeter.

In Medical School Admissions, Assessing Your Ability To Compete In The Classroom Is Just The Beginning

Since its last major overhaul in 1992, the MCAT has included four sections meant to examine a test taker’s ability in verbal reasoning, biological sciences, physical sciences and writing.  After completing the multiple-choice questions and composing writing samples, medical school applicants hope for the best.  They know that, while this isn’t the only piece of the application puzzle, if they perform well, they are much more likely to be admitted to medical school.  They also assume that a high score means they will do well in the various classroom and clinical challenges awaiting them.  After further examination, however, medical educators and physicians have realized the current MCAT isn’t enough.   They believe that critical evaluative factors, currently left out, will be a much better predictor of a test taker’s effectiveness as a future physician.  As a result, new sections in the 2015 MCAT will stress the psychological and social dimensions of medicine as medical schools want more well-rounded applicants from a variety of backgrounds. 

And the MCAT is not all.  In an age when residency programs have been urged to pay closer attention to resident competencies in interpersonal communication and professional behavior, it is no surprise that medical school admissions committees are looking more closely at these qualities as well. “Future professionals need to have clinical skills and they need the science,” said Andy Ellner, co-director of the Harvard Center for Primary Care. “But they also need to understand organizations, how to work in teams, be leaders, manage people. They need to think about complex systems and make them work more effectively.”  

But how do you best express clinical intuition, communication skills and bedside manner in the personal statement, meaningful experiences, supplemental essays and interviews? Crucial to consider, your soft skills and how you present them could mean the difference between an acceptance letter and a denial notice.

Be Specific: Think back to some of those unforgettable moments you had in your undergraduate studies.  Why were they so memorable?  Was there a time you will always remember that put you on the path to pursue medicine?  As long as you are not applying to medical school just to please your parents, you are sure to have a compelling collection of memories you can mold into words.  Brainstorming is the first step and there are not limits at this stage.  Take the time to recall all the details.  You will soon see that the details of a situation and the descriptive insights you developed as a result is what is going to allow the admissions director to get to know the person behind file #38461.  Use colors, emotions, smells and reactions to bring the reader in, right at the moment you learned some of the most important lessons of your life.  

Failures and Weaknesses are OK to discuss: It is in times of failure you learn the most, so don’t be afraid to discuss weaknesses or failures in the application.  Admissions directors really want compelling applicants, rather than perfect ones and, most of all, they want to see that you are human and self-reflective.  The important thing to remember when handling weaknesses or failures is that it is a four-step process.  First, discuss the failure or weakness.  Second, address the result of that failure, ideally a particular scenario in which you can provide specifics.  Third, talk about steps you are taking to improve and finally, talk about the results of your improvement action plan.  What are the positives that have resulted from your ability to recognize a weakness and work towards a better solution? 

Intellectually Curious:  Most likely, at this stage of your medical education, you have not achieved grand things on the research bench or saved many lives in the developing world.  And that’s ok.  What’s important are your insights about what you observe, your intellectual curiosity and your willingness to get involved and learn as much as you possibly can, even if it means unpleasant circumstances or difficult patients. In every research endeavor or clinical experience, take notes.  What questions do you have at this moment?  Why did shadowing that particular physician have an impact on you?  What about this research process leaves you bewildered?  Why?  It will be much easier to compose entries demonstrating intellectual curiosity if you can refer back to the specifics of what you were curious about.

Go Beyond Your Research and Clinical Experiences, But Remember What They’re Looking For:  While clinical and research experiences are certainly important to discuss in your application, don’t limit yourself.  Just remember the qualities admissions directors are looking for, transferrable skill-sets that will be applicable when you are a resident and practicing physician.  For example, there are probably numerous ways to discuss your ability to emotionally connect with and influence others in your various teaching, community service and employment experiences.  Through these kinds of examples, you will also be able to show you are a well-rounded student who has been able to expand her perspective in a variety of areas.    

Social Media: You may assume your first impression to an admissions officer will be contained entirely in the memorable and polished application package you’ve been refining for months.  However, in the age of Facebook, Twitter and LinkedIn, this just isn’t the case. Therefore, it is important to be cautious, not only about the material you post online through social networking sites, but also about the information posted about you or others with the same name. A profile that lacks solid judgment may be looked down upon and create a disadvantage for you in the medical school application process. However, a well-written profile highlighting personal and professional achievements could help you stand out from the crowd.

If attending physicians are looking for more from their residents and patients are looking for more from their doctors, experts have decided that one of the first places to go, for a possible solution, is medical school admissions.  Applicants have always been more than test score and a transcript but now, more than ever, an applicant’s interpersonal ability and professionalism are moving closer to center stage.