The MCAT and Medical School

Go to any university’s Natural Sciences office and you will understand, if you didn’t already, that the majority of students have selected their major, in part or in whole, based on the decision to attend or to leave the option of the MCAT and medical school available. Premeds are everywhere. All freshmen are pre-meds (I’m only half-kidding), and they come in all shapes and flavors.  Among the university community they are the most stressed and pitiful and while some may not state it outright, others base their entire academic and even personal identities upon that predilection. This should come as no surprise if you’ve spent a day on any college campus.

The Premed Student

It is no spur-of-the-moment decision to decide to become a physician or surgeon. Up to this point in their academics, most of these students’ entire lives were centered with that goal at the fore. “Premed” as a curriculum, contrary to popular belief doesn’t exist. It is not an academic major or discipline, per se even if they talk about themselves that way.

I taught at one of the top three engineering universities in the nation and was utterly shocked at the number of engineering students who were premeds. But this type of student on any campus is among the most ostensibly driven student, the most anal-retentive about their 4-year plan, the most outwardly competitive; and ask any professor, they will scratch, claw, manipulate and fight for every point or mark on even the most minor of assignments; until they do more damage than good.

I have a friend who operated with that mindset and eventually received an ‘A’ in biochemistry because the answers were expository, not multiple choice, and she presented good enough arguments for her intended answers whereas by straight numbers she deserved to get a C-. Our professor was soon retiring, recovering from a stroke, and basically relented in exasperation with her constant office visits. Sitting on the hall floor waiting at 7am daily to ask this or that.

Today, she is a practicing physician. I’m not advocating that attitude or approach, because most professors, as I myself learned, consider premeds to be the quintessential thorn in the proverbial side.

In the premed mind, priority number one is to make themselves attractive to medical school admissions committees. And that attractiveness is principally based on their grade point, particularly in what are the prerequisites for admission and science GPA (see below).

Unlike many people, to them, a bachelor’s degree is no more than the start, a means and not an end in itself. Understandably, the courses that matter most to these students are medically related ones but those aren’t necessarily the courses medical schools care about. No one cares if you know anatomy perfectly but can’t pass organic chemistry. It’s a checklist that year by year, can often be fulfilled in the natural course of completing any of several science degrees (physical or biological), but mainly chosen are biology, biochemistry and, less frequently, chemistry and engineering.

Premed Prerequisites

What are the prerequisites? They are: one semester to a year of biology and/or biochemistry (with lab), two semesters of general physics (either algebra-based or calculus-based) with lab; two semesters of general chemistry with lab; two semesters of organic chemistry with lab; and then possibly one or two other courses depending on the program. Some medical colleges expect you to be able to express yourself well in English. The new MCAT now covers topics in psychology and sociology.

To the premed student, there are even more courses, though not required, nor particularly difficult for that matter, but that is another way to signal to medical school admissions committees the true extent of the obsession to be a doctor since they could crawl. It all serves to consummate the idea to themselves of where they are determined to keep their heads in the game, and if they find they have a distaste for it, they are at some liberty to make alternative plans but that doesn’t happen, not to any significant extent. Premed-ism is a terminal disorder.

Different medical schools vary slightly in their admissions requirements, for example, a semester of biochemistry will substitute for organic chemistry 2. In fact, in some circles (led mostly by hopefuls to admission), there is considerable discussion in the media about whether an entire year of organic chemistry is necessary. Some schools may require a year of English or composition or other humanities courses. The ability to communicate is cardinal, as many English majors are admitted and well-roundedness is highly desirable. It doesn’t matter what your major is in fact as long as you do perfectly or nearly perfectly in the prerequisites. However, few if any students, plan to apply to just one medical school and satisfy its requirements alone, so they often do something akin to creating a junior medical school curriculum for themselves with the motive of undergoing the applications process at as many schools as possible, depending on their performance so far. Like most job-seeking endeavors, successful applying is a numbers game. Not only in terms of grade points, but the more schools you interface and apply to, the greater is your likelihood of acceptance somewhere. Someone I knew went to Guadalajara Medical School in Mexico (knowing about 5-10 unintelligible words of Spanish) but  transferred to a U.S. program ultimately and graduated. Now that is desperate.

The Admissions Process

Unlike high school, where the major impetus was to attend the most prestigious undergraduate institution possible, it matters far less where one goes to medical school. They are all essentially the same quality, although the models and approaches to disease differ, and all train you to pass the USMLE (US Medical Licensure Examinations)—which are the hurdles that allow you continue your medical school study. No one ever gets asked in any serious or consequential way where they went to medical school.

Of course, most will shoot for a prestige school (which may get them a better residency) and would love to attend Harvard or the Johns Hopkins, but if the only place they get admitted is in Guadalajara, Mexico, they will aprender el Espanol if that’s what it takes, damn it.

In truth, the major fallback plan or parachute (Plan B) for premeds is not necessarily foreign study, but entry to one of the osteopathic medical colleges. The point is that for such students being excluded from “the Dream” merely because of grades is not an option in their minds. An osteopathic versus an allopathic (“traditional medical”) school differs in the degree conferred at graduation. At an osteopathic school, you’re name is followed by the letters, D.O., not M.D. The point is that a doctor of osteopathy is eligible for licensure to practice medicine or surgery in the United States and elsewhere with all the same rights and hospital admitting privileges (and pay).

One does not have to base their choice of major in the physical or biological sciences and just need to do nearly perfectly in the prerequisites to be admitted—you can major in political science, art history, liberal arts but check the stats, and you’ll see that the highest percentage of admitted candidates are engineers! I taught at one of the premier engineering schools in the country (actually, in the world) and the MAJORITY were premed. Why would you attend the highest suicide rate school in the country just to have a lesser chance of doing well in the prerequisites? Well because a “C” average there is just as good as a 4.0 at other schools. A “C” in organic chemistry at Princeton, for example, is equivalent to an “A” someplace else, it’s been said.

So don’t think you have to have center your last real chance at a broad and liberal education around the same material you will learn anyway during your actual medical education. What you are learning in those undergrad courses is nothing like the mountain you will be pushing that boulder up once there. If things don’t turn out the way you dreamed, you will just have a degree and a tremendous amount of competition in the biological sciences, which isn’t very high on the list of starting median salaries…it’s actually at the bottom. The least relevant prerequisite (physics) is the highest paying bachelor’s degree by median starting salary.

The prerequisites must be completed sooner rather than later because the other main preoccupation is to perform well on the medical college admissions test in the junior or early senior year; or the MCAT and medical school admissions ordeal.

The MCAT and The Special Place of Organic Chemistry in the hearts of premeds… 

….(To Be Continued)..