3) Applying to Medical School

3.1) What is the timeline for admissions?
3.2) Where can I find a list of medical schools?
3.3) What is AMCAS/AACOMAS?
3.4) How many schools should I apply to?
3.5) Which schools should I apply to?
3.5a) What are good sources to help me choose?
3.6) How expensive is it to apply?
3.6a) Is there any way to make the application process cheaper?
3.7) Should I apply to DO schools?
3.8) What is a secondary/supplementary?
3.9) What is an MD/PhD program?
3.9a) What are the different sources of funding for MD/PhD programs?
3.10) Should I enroll in a combined BS/MD program?
3.11) What are combined MD/MPH and DO/MPH programs?
3.12) Can you tell me about combined MD/MBA programs?
3.13) Can you tell me about combined MD/JD programs?
3.14) What are PAs?
3.15) Should I consider going to a foreign school?

Subject: 3. Applying to Medical School

3.1) What is the timeline for admissions?

AMCAS (cf 3.3) begins accepting applications on June 1. After receiving your application and school transcripts, you will receive a Transmittal Notification from AMCAS, which means that schools have been sent your central application. After evaluating your application, schools can choose to have you continue the process by completing a supplementary application (cf 3.8) and after further evaluation, an interview (cf Section 4). Some schools are on a "rolling admissions" system where applicants can hear about an admissions decision fairly soon after interviewing. Other schools wait until late in the season to send decision letters. More information can be found in the MSAR (cf 1.4), the AMCAS application materials, and school admissions brochures.

3.2) Where can I find a list of medical schools?

The MSAR (cf 1.4) has a list of all of the medical schools in the US and Canada accredited by the Liaison Committee on Medical Education (LCME)  http://www.lcme.org . On the Internet, you can find this same list at  http://www.aamc.org/meded/medschls/start.htm http://www.aamc.org/meded/medschls/start.htm .

3.3) What is AMCAS/AACOMAS?

AMCAS, the American Medical College Application Service, is a centralized program which works much like the "Common Application" that you may have seen in high school (for applying to college). Run by the Association of American Medical Colleges (AAMC), it consists of a form you fill out like an application, which is sent to AMCAS, processed, and then distributed to those medical schools you wish to apply. In the past several years a computer-based version, AMCAS-E, has been developed. See the AMCAS web page at  http://www.aamc.org/students/amcas/start.htm http://www.aamc.org/students/amcas/start.htm . AACOMAS, the American Association of Colleges of Osteopathic Medicine Application Service, is a similar service for osteopathic medical programs run by the AACOM  http://www.aacom.org .

3.4) How many schools should I apply to?

Depends. If you're 4.0 and 40+ on the MCAT, then probably you could apply to only one or two and get away with it. There are stories of people who applied to 50 or 60 schools and didn't get into any. Most people apply to around 10, more if they feel their folder is a little weak, less if they think they've got a pretty solid record.
3.5) Which schools should I apply to?

Your best bet is to think about where you'd like to go to school and apply there. Remember: Wherever you go, not only will you be spending the next 4 years there, but also the odds are pretty good that you will do your residency there as well. So don't pick someplace you'd never want to live. Always apply to your state school, if you have one; most (if not all) state schools give preference to people who are state residents, and every little bit of help counts. You should have 2-3 schools that are a real stretch--places you don't think you could get in to but places you'd love to go. Try to find 1-2 places that you think you have an excellent shot at; your state school usually goes here. And in the middle, 6 (or more) places that you think you'd be competitive at. Finally, don't discount D.O. schools (cf 3.7).

3.5a) What are good sources to help me choose?

Your primary source should be your college's pre-medical advisor. Make an appointment with him/her early on--sophomore or junior year would be best. Make sure he/she pulls your transcripts, etc. before you show up. The two of you can talk about your strong and weak points, what you could do to boost your chances, and which schools you should apply to. Also keep in mind that most pre-medical advisors send a letter along with your applications, so getting to know him/her will help get a more accurate letter for your file.

The Internet is a good source. Most medical schools have web sites that give lots of information, application requirements, etc. In addition, post any questions, concerns, fears, or despairs to the misc.education.medical Usenet group. It's populated by lots of grizzled veterans who have been through this process (sometimes more than once) and can help you avoid the pitfalls.

Another essential source is the MSAR (cf 1.4).

3.6) How expensive is it to apply?

The AMCAS fee is about $45 for the first school, and $25 for each additional school. When your AMCAS is processed, most schools will request "supplementary" information, and filing this will cost an additional $60-$125. The AACOMAS fee is practically the same, and the cost for filing supplementary materials at osteopathic medical schools is also anywhere from $60 to $125. Add in costs for the MCAT, flying to schools for interviews, hotels, and other expenses, and the total application cost can rise into the thousands of dollars depending on how many schools you apply to.

3.6a) Is there any way to make the application process cheaper?

You can request from AMCAS a fee waiver, which covers the cost of AMCAS filing and supplementary filing fees for up to 10 medical schools. Fee waivers are based on financial need, and many schools will waive their supplementary application fee (cf 3.6) if you have an AMCAS fee waiver. The MCAT also offers a fee waiver program.

3.7) Should I apply to DO schools?

Osteopathic medical schools have a reputation for "looking past the numbers" in their admissions process. Consequently, the average accepted MCAT scores and GPA are a bit lower at DO schools. If you're an academically borderline candidate, but have a competitive application overall, your chances for admission might be higher at DO schools. Because most DO schools emphasize primary care medicine, they look very closely at an applicant's motivation for pursuing medicine and prior life experience. The average age of matriculation tends to be higher at DO schools than MD schools. Students who want to practice an osteopathic approach to patient care are especially sought after; this means demonstrating an interest in hands-on medicine and a commitment to a holistic understanding of patient care issues, especially time spent with a DO.

There are two important points to consider if you're thinking of applying to DO schools. First, DOs are minority physicians in the profession of medicine. If you are uncomfortable being different, think that you'll always have to prove something because you're not an MD, or are likely to become frustrated having to explain what a DO is to new patients, then DO schools might not be right for you. Second, you might have a harder time competing for some of the "brand-name" MD residencies. Many competitive MD residencies don't regard the additional training DO students receive as applicable to their particular area of medicine, and with keen competition for slots among MD applicants, they feel obliged to take their own first. There are DO specialty residencies in everything ranging from aerospace medicine to otolaryngology, but these residencies tend to be concentrated in the eastern and mid-western United States. Some students find the geographic limitations of these residencies unattractive.

In short, some students have compared the kind of medical education DO schools offer to the kind of undergraduate education that smaller liberal arts colleges offer. Both stress generalist skills and training. Like the smaller undergraduate colleges, the research programs at DO schools tend to be smaller. Consequently, the basic science faculty is usually more professionally involved in medical education than research. However, it is difficult to make accurate generalizations because there is much variety in curricular programs offered by both MD and DO schools. There are primary care oriented MD schools and research oriented DO schools. The most prudent advice is to look at the curriculum and educational focus of each medical school on a case by case basis.

3.8) What is a secondary/supplementary?

Secondary (also called supplementary) applications come in a variety of forms and typically are utilized only by schools using the AMCAS application (MD programs), or schools using the AACOMAS application (DO programs) rather than their own application. Depending on the school, they may request no more than a check and signature to complete processing of your application, or they may ask you to provide additional information such as SAT scores and respond to several essay questions.

A number of schools "screen" applicants prior to sending secondary applications. This means that based on information (essay, biographical data, MCAT scores and GPA) provided by the applicant's AMCAS or AACOMAS application, the school decides whether or not to send a secondary application to the applicant. Screening of applications at the secondary stage is not done by all schools; many schools have all applicants complete all application materials and then decide who to interview based on information contained in the primary and secondary applications.

Information on application fees and whether a school uses secondary applications may be found in the MSAR (cf. 1.4).

3.9) What is an MD/PhD program?

Students that are enrolled in combined MD/PhD programs pursue the MD and the PhD degrees concurrently. Students can select from a number of fields in which to complete the PhD. Although this field is typically a biomedical science (e.g., biochemistry, immunology), students in the past have combined their medical studies with research in engineering and the humanities. Combined programs typically require 7-9 years to complete. The first two years are typically spent on the basic science portion of the M.D. curriculum. The next three to five years are spent on full time PhD work. The final two years of the combined program are spent on the clinical portion of the MD curriculum. MD/PhD programs are eclectic by nature, however, and the course of study can be very individualized.

Combined MD/PhD programs were initiated to train a cadre of academic medical scientists who could make fundamental scientific discoveries and then translate these discoveries into tools and knowledge that could be used at the bedside. It is important to note that "doing it all", from the lab bench to the patient bedside, is extremely difficult. Both caring for patients and running a research program are full time jobs in and of themselves! Most MD/PhDs focus on either lab research or patient care to stay abreast of their fields and to remain competitive with their peers. With that caveat, however, MD/PhD training has some benefits.

Some good reasons to pursue an MD/PhD

- You want to focus on clinical research and practice, but would like rigorous research training
- You want to focus on research, but want the perspective provided by clinical training

Bad reasons to pursue an MD/PhD
- You want extra letters after your name
- You want to save money (in the long run, you probably won't!)

Ultimately, the decision to pursue an MD/PhD is a personal one. Think about the career goals you envision for yourself and whether they can be achieved with a single degree. Consider talking with MD/PhDs who have careers similar to that which you envision for yourself. Information on programs may be found at   http://www.aamc.org/research/dbr/mdphd/programs.htm .

3.9a) What are the different sources of funding for MD/PhD programs?

1. Medical Scientist Training Program (at official NIH MSTP schools)
2. Other NIH funds (e.g., Human Genome Training Grant)
3. School-Specific Funds (e.g., Franklin's scholars program at UPenn)
4. Funds from special interest groups (e.g., funds for the study of
alcoholism)
5. Howard Hughes Medical Institute Funds

3.10) Should I enroll in a combined BS/MD program?

BS/MD programs, or, more appropriately, college/MD programs, allow a high school student to apply to both college and medical school during the college application process. If accepted, the student is assured a place in a medical school class, assuming she performs at an acceptable level. While many of these programs only allow specific majors, some will allow any major, including those which award the BA.

Thirty-six of these programs currently exist all across the United States, in sixteen states and the District of Columbia. Program length generally varies from six to eight years, although the University of Wisconsin-Madison does allow extension to nine years. Admissions guidelines vary widely. Some schools specifically state entrance requirements (e.g., the University of Medicine and Dentistry at New Jersey (Newark) expects that their applicants will be in the top five to ten percent of their class with a minimum combined SAT of 1400). Most schools require program students to take the MCAT during their junior year of college. Many require particular SAT II/Achievement tests, particularly those in chemistry and mathmatics.

In essence, these programs are appropriate for the student who has already explored the field of medicine and is positive that it is appropriate for him. While admissions criteria vary widely, they all insist that the student be academically superior. As not all programs allow students to leave once they have matriculated into the program, the student must be sure that medicine is the right choice; those with any doubts are advised to consult their college or guidance counselor and consider applying to medical school "normally" in college if they then decide it is the correct choice.

For more current information about combined college/MD programs, browse the Association of American Medical Colleges' web site at   http://www.aamc.org/students/applying/programs/collegemd.htm . Students may also wish to read the AAMC's guide for high school students considering medical careers at  http://www.aamc.org/students/start.htm .

3.11) What are combined MD/MPH and DO/MPH programs?

MPH stands for Masters in Public Health. Public health is an interdisciplinary science of disease prevention. Physicians who work in public health are called preventive medicine specialists. The MPH is the professional degree for those interested in a career in public health or preventive medicine; MPH degree programs usually require approximately 50 additional semester hours of coursework in areas such as biostatistics, epidemiology, health behavior, and health economics. Many programs offer opportunities for specialization in areas such as toxicology, environmental health, epidemiology, and health administration.

It is not uncommon for medical schools to offer dual degree programs for medical students seeking public health training. This may add an additional year or two onto medical school. Usually students in dual degree program complete the first two years of medical school and then proceed to their MPH work before finishing the last two years, though some break up school between the third and fourth years. Some programs allow students to take MPH classes in addition to their medical school classes to shorten the length of the program.

For more information, see the web sites for the American College of Preventive Medicine  http://www.acpm.org  and the American Public Health Association   http://www.apha.org .

3.12) Can you tell me about combined MD/MBA programs?

Ten schools offer the combined MD/MBA program. They are: UCLA, U. of Chicago-Pritzker, U. of Illinois at Urbana-Champaign, Dartmouth, Wake Forest, Case Western, Allegheny, Jefferson, U of Pennsylvania, and Vanderbilt. This list of schools, with direct links to them, can be found at  http://www.aamc.org/students/applying/programs/mdmba.htm http://www.aamc.org/students/applying/programs/mdmba.htm . Many programs run as two years of medical school, one year of graduate (MBA) school, then a return to medical school for the final two years of medical curriculum and completion of MBA material, for a total of five years. However, there are variances in application processes and program details. For example, UCLA opens its program only to third-year UCLA medical students, who then take a year off for the MBA program and complete the MBA program during the fourth year of medical school. Application procedures vary by school, so your best bet is to contact the admissions department directly and ask for information on the program.

3.13) Can you tell me about combined MD/JD programs?

Seven schools offer the combined MD/JD program. They are: Yale, U. of Illinois at Urbana-Champaign, U. of Chicago-Pritzker, Southern Illinois U., Duke, Penn, and West Virgina U. This list of schools, with direct links to them, can be found at  http://www.aamc.org/students/applying/programs/mdjd.htm http://www.aamc.org/students/applying/programs/mdjd.htm . Program details are highly variable. One common method of integrating the two programs is to have the student complete two years of medical school, two years of law school, then complete law school during the final two years of medical school for a total of six years. Applications are generally accepted both from first-time applicants and current students from each individual program; however, as always, the best information about a particular school can be obtained by contacting the school's admissions office.

3.14) What are PAs?

Physician assistants, or PAs, provide medical care under the supervision of licensed physicians.

3.15) Should I consider going to a foreign school?

Attending a foreign medical school is a tricky situation. On the one hand, you have the opportunity of attending medical school and graduating with a M.D. degree, but on the other hand, your opportunities for practice in the U.S. are severely limited. Because of legislation, International Medical Graduates (IMGs)--students who obtain their M.D. outside the U.S.--are being scapegoated for the country's oversupply of physicians and their acceptance into U.S. residency training programs is being scaled back. This means that the IMG who does enter the US for residency training generally must score very high on the USMLE and the new Clinical Skills Assessment (CSA) examination, which is only administered to IMGs (cf 7.10, 7.11).

The education may or may not be inferior, depending on the foreign school you wish to attend, but whatever the case, attending a foreign school is going to be expensive. Student aid from the U.S. may not be so easy to come by, and you may have to spend more time in school because of the difference in curricula. Take, for example, the system of medical education in Australia versus the United States. In the US, students go through four years of undergraduate college to earn a Bachelors degree and then go on for another four years in medical school for the medical degree. In Australia, students go into a medical program as high school graduates and earn a Bachelors in Medicine and a Bachelors in Surgery in six years. This means that a US college graduate who wishes to attend medical school in Australia will have to spend an additional two years because of the medical curriculum in Australia, which translates into higher costs.

Think about your decision to apply to a foreign medical school carefully. Not all are reputable, and boasting a World Health Organization (WHO) listing is not at all impressive. Not all foreign medical schools offer a solid medical education, which of course does not preclude those that do. Speak to your premedical advisor and, if possible, any students at the schools that you consider.