Thank you! I had to work to pay for undergrad and had no time to to volunteer. One of my classmates asked each student about backgrounds and said only 3 of us were working class (in the 1970s). I'd have no hope of admission today.
The “meet these metrics and you win” model plays into the “protocol driven medicine model” we now have. It does not prioritize whole person care. We need to train doctors who are capable of thinking independently and seeing individual patients as a unique person. Thanks always for your insightful writing.
Strongly agree with this article. My entering class of 1983 included RNs, engineering grads w/a few years of work, parents, a mom who’d been on welfare (and became a splendid ObGyn), a former Navy medic, and at least one kid w/an economics degree who’d worked in a clothing store before his first year. People who’d had some experience with actual life. We were fortunate before my time, when soldiers returned from WW2 and went to medical school. Real people with REAL life experience.
Now? New physicians are striking for their monotony. It’s like the Big Room scene, from I,Robot. Well educated, but see how many can empathize with a truck driver and wife who live in a mobile home. Or a single mom who can’t undergo serial tests, because she misses work for each one. Or a veteran. Witnessing the disconnect on the inpatient OR outpatient setting is heartbreaking. Such people don’t exist in the upper middle class bedroom communities from which most med students arise.
Nice article, Adam, and I agree. What medical schools have done, unwittingly, is select for students (and later, practitioners) who are programmed to "play the game" rather than follow genuine conviction, in order to achieve short-term goal (admission, residency placement, job, salary etc.). This later follows in practice, and makes us vulnerable to administrators who exploit this goal-seeking characteristic -- defining success as a combination of meaningless metrics (wRVUs, volume, etc. etc.). Burnout ensues when the now mature physician realizes all that iterative short-term goal seeking had the long-term effect of trapping them on the low end of a bureaucratic hierarchy that views physicians as a commodity.
IMG here. I remember coming to the USA and everyone kept telling me I'd never match because I had no research experience. I was so baffled by this because research scientists and doctors were practically two different career paths with almost no overlap. Back "home" they were prepping us to be weapons grade clinicians. All I got when I got here was optimizing test scores and doing research into inane topics. I asked one of the students at the time what there research was on they literally couldn't tell me......but they had pages of the stuff. The whole thing was a joke. Im glad its behind me but man, I dont miss the grind.
Having spent more than 50% of a long academic life in admissions (to an MD-PhDprogram), I couldn’t agree more.
But don’t forget the corruptive influences of US News rankings, the often misguided advice by undergraduate career counselors—or parents who have micromanaged their kids since they were born. They have become dependent on having structure, checking boxes, and they are not encouraged to explore.
A key problem here is that young people today believe they are not allowed to fail, and we learn most from our failures—if we take the time to think about why they happened.
Another problem is that each applicant has been told (by career counselors) to send in more and more applications. The AMCAS application service makes this feasible, and the burden on medical school admissions committees is becoming unsustainable.
Probably not feasible, but if there were a limit on the number of applications an applicant could submit a year it would allow for a more holistic evaluation. Distance traveled/resilience may well be the most important measure of future success, especially for applicants from households in the lower 50% of incomes, but they are immeasurable
I will say, at least right now, being a pre-med was a lot more stressful and anxiety inducing than being an a first year medical student. In some ways, it felt like every little thing I did in undergraduate had to be perfect (i.e. test grades, "involvement," MCAT, and research). However, although I would not put myself willingly through that again, I did benefit from being forced to "widen my horizons" so to speak. Although, it did result in some sleepless nights. But, I was able to major in philosophy and focus on some other non-medical related passions as my target school highly favored in state applicants. I think this allows them to spend more time on the wholistic part of the applicant rather than solely on research and test scores because mostly instate students are accepted.
Adam. I have read some bad things about racial disparity GPA for Med school applicants, DEI importance over the smartest and brightest for acceptance. I graduated in 94, so I have no clue what is true. Can you comment, or direct us to a study that gives clarity on this issue to clear up misconceptions or promote truth. TY and interesting piece above, as always.
Thank you! I had to work to pay for undergrad and had no time to to volunteer. One of my classmates asked each student about backgrounds and said only 3 of us were working class (in the 1970s). I'd have no hope of admission today.
Frank Burns vs Hawkeye Pierce
The “meet these metrics and you win” model plays into the “protocol driven medicine model” we now have. It does not prioritize whole person care. We need to train doctors who are capable of thinking independently and seeing individual patients as a unique person. Thanks always for your insightful writing.
It's prefiltering individuals who can exist in a culture of compliance and conformity.
Strongly agree with this article. My entering class of 1983 included RNs, engineering grads w/a few years of work, parents, a mom who’d been on welfare (and became a splendid ObGyn), a former Navy medic, and at least one kid w/an economics degree who’d worked in a clothing store before his first year. People who’d had some experience with actual life. We were fortunate before my time, when soldiers returned from WW2 and went to medical school. Real people with REAL life experience.
Now? New physicians are striking for their monotony. It’s like the Big Room scene, from I,Robot. Well educated, but see how many can empathize with a truck driver and wife who live in a mobile home. Or a single mom who can’t undergo serial tests, because she misses work for each one. Or a veteran. Witnessing the disconnect on the inpatient OR outpatient setting is heartbreaking. Such people don’t exist in the upper middle class bedroom communities from which most med students arise.
I have no good answer. Only regret for the loss.
Nice article, Adam, and I agree. What medical schools have done, unwittingly, is select for students (and later, practitioners) who are programmed to "play the game" rather than follow genuine conviction, in order to achieve short-term goal (admission, residency placement, job, salary etc.). This later follows in practice, and makes us vulnerable to administrators who exploit this goal-seeking characteristic -- defining success as a combination of meaningless metrics (wRVUs, volume, etc. etc.). Burnout ensues when the now mature physician realizes all that iterative short-term goal seeking had the long-term effect of trapping them on the low end of a bureaucratic hierarchy that views physicians as a commodity.
IMG here. I remember coming to the USA and everyone kept telling me I'd never match because I had no research experience. I was so baffled by this because research scientists and doctors were practically two different career paths with almost no overlap. Back "home" they were prepping us to be weapons grade clinicians. All I got when I got here was optimizing test scores and doing research into inane topics. I asked one of the students at the time what there research was on they literally couldn't tell me......but they had pages of the stuff. The whole thing was a joke. Im glad its behind me but man, I dont miss the grind.
Thank you, Adam,
Having spent more than 50% of a long academic life in admissions (to an MD-PhDprogram), I couldn’t agree more.
But don’t forget the corruptive influences of US News rankings, the often misguided advice by undergraduate career counselors—or parents who have micromanaged their kids since they were born. They have become dependent on having structure, checking boxes, and they are not encouraged to explore.
A key problem here is that young people today believe they are not allowed to fail, and we learn most from our failures—if we take the time to think about why they happened.
Another problem is that each applicant has been told (by career counselors) to send in more and more applications. The AMCAS application service makes this feasible, and the burden on medical school admissions committees is becoming unsustainable.
Probably not feasible, but if there were a limit on the number of applications an applicant could submit a year it would allow for a more holistic evaluation. Distance traveled/resilience may well be the most important measure of future success, especially for applicants from households in the lower 50% of incomes, but they are immeasurable
I will say, at least right now, being a pre-med was a lot more stressful and anxiety inducing than being an a first year medical student. In some ways, it felt like every little thing I did in undergraduate had to be perfect (i.e. test grades, "involvement," MCAT, and research). However, although I would not put myself willingly through that again, I did benefit from being forced to "widen my horizons" so to speak. Although, it did result in some sleepless nights. But, I was able to major in philosophy and focus on some other non-medical related passions as my target school highly favored in state applicants. I think this allows them to spend more time on the wholistic part of the applicant rather than solely on research and test scores because mostly instate students are accepted.
Adam. I have read some bad things about racial disparity GPA for Med school applicants, DEI importance over the smartest and brightest for acceptance. I graduated in 94, so I have no clue what is true. Can you comment, or direct us to a study that gives clarity on this issue to clear up misconceptions or promote truth. TY and interesting piece above, as always.