Premedical students are more stressed out and burned out than ever. It’s easy to see why: pre-med courses, medical school admissions committee expectations, and application process and cost are daunting and, in their current iteration, often harmful to students and society.
I am an emergency medicine and internal medicine physician at public and private teaching hospitals and direct and teach undergraduate courses at an affiliated university. I mentor/advise pre-med (particularly underrepresented minority (URM)) students, but have heard the most-disappointing things from them, no fault of their own.
One student I’m mentoring is a Black sophomore pursuing a science degree at a good public university. His GPA is 3.97; he’s on his campus’s NAACP branch’s executive board. He’s choosing between becoming a certified registered nurse anesthetist (CRNA) vs. what he’d prefer to be: an orthopedist or cardiologist. He said he’s likely to choose CRNA because applying to medical school is a crapshoot. Students with similarly-impressive GPAs and extracurricular activities have not heard back from medical schools regarding an interview by this late (mid-March) in the application cycle. Why should he take more-difficult courses, an expensive MCAT preparation course, and the MCAT, then endure an expensive, prolonged application cycle, where his “heart and identity are on the line,” not only to be rejected but not even interviewed? Additionally, it is increasingly unaffordable to attend medical school, given the cost, duration, and lost income potential of training. In contrast, during CRNA training, he can work as an RN.
His logic is excellent. Yet, his predicament is madness. He’s the student medical schools should want and the orthopedic or cardiologist society needs.
Despite the number of available spots increasing during the past decade (more schools, larger class size), the acceptance rate has declined as the number of applicants nearly doubled (~33,000 in 2011 vs. ~63,000 in 2021). Many excellent students who would be terrific future doctors are not accepted into medical school. Schools claim to want to be at the forefront of social improvement; they’re not going to get there unless they accept more students with a diversity of interests and life experiences.
Many students interested in taking courses or performing community service or extracurricular activities for their joy and contribution do not do so; rather, they accumulate science courses and uninteresting activities to stock their résumés. One student of mine created a campus wellness group despite having little interest in the kinds of events her faculty supervisor (not me) insists upon (e.g., painting rocks for relaxation). Another student with a strong sense of social justice is researching health care disparities. She is a devout Muslim, assisting with cleaning her mosque, serving food there, and teaching kids to read the Qur’an. I suggested she seek an internship with the Council for American Islamic Relations (CAIR) in Washington, DC. She replied she wouldn’t do that because it wasn’t related to her perception of what medical schools look for: direct patient service, research experience, shadowing/volunteering.
Additionally, admissions committees seem to value students on the volume of extracurricular activities rather than depth of experience. One student’s university pre-med advising office encouraged him to add more extracurricular activities (up to 15) rather than delve in-depth into fewer.
It is now an arms race as to who can do the most activities or have the most unusual experiences and who can create new ones, such as starting a club. An example of the new standard would be creating a medical mission program in Guatemala.
As William Deresiewicz says in Excellent Sheep: The Miseducation of the American Elite and the Way to a Meaningful Life, we have undermined the purpose of undergraduate education, making hoops to jump through rather than personal growth experiences. The stiff competition for medical school spots has made it worse.
Unsurprisingly, such pressures have led to a proliferation of expensive MCAT preparation and medical school application process advising companies, which offer application strategies (e.g., MD vs. DO; gap year; how many and which schools to apply to; personal statement and secondary essay editing).
What about students (such as the one I’m mentoring) who can’t afford these services? Unsurprisingly, their odds of medical school acceptance are lower.
This is not to say medical schools shouldn’t lower their admission standards. But those standards should be a floor, not a ceiling. For example, any student with a minimum GPA of 3.5, an MCAT score of 500, one research publication, two campus or community service activities, and one shadowing or medical volunteering activity should be considered a very good applicant for any medical school. Students who, having met those minimum requirements, are interested in doing more would not have an advantage in the medical school application process but could pursue those activities in more depth or additional activities simply for the joy of the experience, camaraderie, or learning to accompany them.
Each school claims to be looking for individuals, but with similar standards, those individuals turn out to be much alike. After going through a process that selects a similar type of student through such rigorous competition, a process that does not focus on individuality, and creates an arms race, how could students feel anything other than cynical and burned out? And this is only 2023; what will it look like in 50 years? Students must have won the Nobel prize to gain acceptance into medical school.
This is not what we want in the next generation of doctors. The next generation of doctors needs to be physically and psychologically healthy, enthusiastic about medicine, and not cynical about the institutions that lead them there or that run it.
It’s heartening some medical schools recognize they can ratchet down the pressure and still maintain excellence. Top-tier schools (e.g., Harvard, Stanford) removed themselves from the U.S. News & World Report rankings. Mount Sinai’s FlexMed program doesn’t require the MCAT. These are good starts in making the rat race less ratty. Other schools should follow suit and include even-more creative ways to continue to lessen the stress while recruiting more excellent, diverse students.
The author is an anonymous physician.
