PRE-MED HANDBOOK

VI. If You Are Not Selected

Most pre-medical advisors agree that one of the most difficult tasks connected with their job is counseling the rejected applicant. The unsuccessful applicant is usually depressed and sometimes hostile to the advisor and to the system that seems to have caused the rejection. Many rejected applicants are unable or unwilling to see themselves in true perspective, yet one of the first things rejected applicants should do is to honestly and realistically assess their position and identify the reasons for the rejections. In the vast majority of cases this is simply a matter of statistics. Their grade point averages and/or MCAT scores are typically well below the mean for accepted students. There are three courses of action open to the rejected student. These include 1) re-application, 2) matriculation at a foreign medical school, or 3) choice of an alternative career. Each of these is discussed below.

Occasionally a student with a strong academic record and competitive scores on the MCAT is rejected for admission by several medical schools, including those where he/she would enjoy preferential consideration. Does this mean that medical admissions committees are capricious and arbitrary in their selection? Certainly not. As a group, medical admissions committees take their enormous responsibility very seriously. Most committees spend hundreds of hours selecting each class. It would be difficult to find a more dedicated or intellectually honest group. However, we must recognize that admissions committees look for the person who will make the best physician. This is not always the same person who would make the best scientist and not necessarily the person who is the best student. If applicants were admitted to medical school only on the basis of GPA and MCAT scores, there would be no need for an admissions committee. The entire class could be chosen by a properly programmed computer.

Re-application
Over the past several admission cycles the number of applicants has generally increased, with a predictable increase in the credentials of accepted students. Average GPA and MCAT scores are at an all-time high and many talented students are not gaining admission. In this environment if a rejected applicant reapplies with essentially the same credentials, the chances for a favorable decision are slight.

Rejected applicants should arrange a conference with personnel in the admissions office at schools to which they have applied and/or seek advice from their pre-medical advisor. The purpose of this meeting should be to identify those areas in which their application appears to be deficient and then devise realistic ways in which deficiencies may be improved. The rejected applicant must be very realistic when evaluating the chances for significantly improving the deficiencies in their application. In some cases this may mean simply retaking the MCAT with better preparation and an improvement in the scores. In many instances the GPA must be improved. A low GPA can be improved only by taking additional classes and making better grades in them. The overall GPA may be quite competitive but grades on the required biology, chemistry, and physics may be low. This indicates a poor aptitude for science, which is a serious deficiency as viewed by most medical admissions committees. If a student continues to take science courses and continues to turn in a mediocre performance, this will not correct the deficiency. Medical admissions committees are usually much more impressed by high aptitude than by an adequate proficiency that has been painstakingly acquired over a period of several years. A person may take additional course work as a postbaccalaureate student after completion of the baccalaureate or go to graduate school. Students choosing this latter option should be aware of the fact that medical admissions committees are increasingly reluctant to accept a person who is enrolled in a graduate degree program before he/she has completed the graduate degree. Most MS programs in the sciences require a full two years for completion. This means that a person choosing to enter a Master’s degree program immediately after receiving a BS should consider re-application the second year after the baccalaureate when the MS would normally be awarded before matriculation in medical school. Completion of the MS in a basic science with a strong academic record may improve the chances of a candidate who was marginally competitive as an undergraduate. There are, of course, no guarantees that this strategy will be successful. A person enrolling in graduate school should therefore do so in a discipline which he/she would consider pursuing as an alternative career.

International Medical Schools
Large numbers of US citizens who could not gain admission to American medical schools attended international medical schools in the 1970s and early 1980s and many of these International Medical Graduates (IMGs) are now practicing in the US. There was a decrease in the number of Americans going to international medical schools in the late 1980s as the applicant pool for US students decreased, but with the increases that began in 1990, the numbers are up again. In order for international medical school graduates to be licensed in the US, they must pass the appropriate examinations and complete an approved residency in an American teaching hospital. There has been considerable discussion about decreasing the number of US residency positions to just over the number needed to accommodate US medical school graduates, which would have the effect of keeping most IMGs from practicing in the US. This possibility makes graduating from an international medical school much less attractive now than a few years ago. Persons seriously considering enrollment in an international medical school must be aware of some of the difficulties that they may face. Older copies of the MSAR contained a discussion of international medical schools as an alternative for US citizens, plus an excellent reading list, but this section was eliminated in the 1994 edition. For those students who are seriously considering this alternative, it may be wise to obtain a copy of the 1993 MSAR and read this information.

It is virtually impossible for rejected US students to be admitted to a medical school in Canada, England or Australia. If a person plans to enroll in an international medical school that is well established, it will usually be one where a language other than English is used in classes and clinics and where the student must live in a foreign culture, often in a third-world country. A number of medical schools were established in the Caribbean during the 1970s which cater primarily to Americans and in most cases the language of instruction is English. These are usually proprietary and they are in the "business" of medical education to make a profit. There have been some sudden, unannounced closing of these schools, sometimes at mid-term and no rebates were made for fees that were prepaid. Tuition for most such schools is high and in most cases clinical facilities are very primitive. They manage to make a profit on the several thousand dollars per term in tuition and fees charged which is in sharp contrast to US medical schools. Tuition and fees cover only a part of the actual costs for a medical education for accredited US medical schools. Some years ago it was estimated that it costs an average of more than $40,000 per year per medical student.

Medical school is a very taxing and stressful experience for most individuals even under the best of circumstances, but the difficulties are compounded when lectures and examinations are given in a foreign language and a person must cope with living in a foreign culture. It should not be surprising that a large number of the American students enrolled in international medical schools drop out before completion of the MD degree, often after having spent many thousands of dollars on their medical education. Many of the proprietary medical schools have virtually open admissions policies, and they will accept essentially all the applicants who can afford to pay the tuition.

Transfer to a US medical school with advanced standing is by far the preferred route for a US citizen enrolled in an international medical school. Most US students enroll in a international medical school with the expectation of transferring back to a US medical school after completing their basic medical sciences (usually after two years), but the opportunities for transfer are few. It has been estimated that less than five percent of the US citizens enrolled in international medical schools are accepted in US medical schools "with advanced standing" (transfer) and most of these have come from a very few schools that have maintained reasonable standards in both their admissions policies and in the courses offered in the basic medical sciences.

From this abbreviated discussion it may be seen that US students enrolled in an international medical school may encounter great difficulty and much uncertainty. However, with the recent large increases in the number of applicants to medical school, and the many talented students who are not accepted, there has been a recent increase in the number of US citizens matriculating at international medical schools.

Placement agencies and clearinghouses advertise in US newspapers with claims of being able to help students obtain admission to international medical schools, usually for fees of several hundred (sometimes a few thousand) dollars. Most of the information and many of the services provided are available at no cost or at a very nominal cost from pre-medical advisors, the AAMC, foreign consulates, and a number of other agencies. Students should be particularly cautious about signing contracts for such services. The AAMC warned in the 1993 MSAR "the opportunities for US citizens to obtain a quality medical education abroad are very restrictive and the possibility of being exploited by schools catering to the US student market is great."

Career Alternatives
For those not accepted, the reality of the situation may dictate that some alternative career be chosen and plans for a career as an MD be abandoned. Osteopathic medicical schools award a DO degree and practitioners have essentially the same rights as a MD, yet GPAs and MCATs of students accepted to osteopathic medical schools on average are lower than those of students accepted to traditional allopathic medical schools. A podiatric physician earns the DPM and is more restricted in practice than the MD (they treat the feet and lower legs), but this is a growing field and many students find satisfying careers in this closely-related field. Students may wish to consider other careers in the health sciences, although some of the professional schools listed below may have a bias against rejected pre-medical students if they feel that the applicant is attempting to use their profession as a stepping stone into medicine. Other closely related careers include dentistry, veterinary medicine, optometry, and pharmacy. Many former pre-medical students complete a PhD in a discipline in the basic medical sciences and enjoy a very satisfying career in teaching and research, often at a medical school. Others take graduate degrees in public health, clinical psychology, or one of the allied health sciences, such as medical technology or clinical chemistry. There are numerous career opportunities in these areas. Hospital administration should be considered by those students with good management skills and the ability to work well with people. It must be added that most of these professions are highly competitive and no assurance can be given that a student applying for graduate or professional school in these disciplines will be accepted. There are, however, many talented students with much to offer professionally who are not being accepted for admission to medical school.

Many rejected pre-medical students prefer to go into other professions which are completely unrelated to the health sciences. Unless a person can be reasonably assured of a satisfying and successful career in some other area of the health sciences, it may be a mistake to pursue a job in which the opportunity for professional advancement is limited in order to stay in a medically related profession. Students leaving the health care field frequently find very satisfying careers in such diverse fields as banking, law, sales, military service, and dozens of other businesses and professions. Whatever alternative career is chosen, it should be one that is intellectually stimulating and it should offer rewards commensurate with the talents of the student. The USC Career Center is a terrific resource for students and alumni and offers substantial information regarding career options and individual suitability. The Career Center is located on the 6th floor of the BA building and the phone number is (803) 777-7280.