Year+ in Review

A med school application cycle is longer than most people realize. Here's what's mine has been like...

January 2012

• Apply to AAMC's fee assistance program to get a discount on the MCAT and AMCAS. (TIP: If you have kids, you must do this or else you are just wasting good money.)
• Write personal statement.

February 2012

• Approach professors about potential letters of recommendation. (TIP: If they don't recognize you, go else where.)
• Revise personal statement.

March 2012

• Sign up for the MCAT (TIP: Do it earlier. I was surprised by how many dates were no longer available)
• Put on five pounds. (Hey, when you are the one studying for the MCAT at 1:00 in the morning, you'll understand.)
• Revise personal statement.

April 2012

• Freak out over MCAT
• Revise personal statement. (No, this isn't hyperbole.)

May 2012

• Take the MCAT (Holy cow! I was not prepared. Revisit my posts from mid-2012.)
• Start AMCAS application.
• Start TMDSAS application.
• Fill out letter of recommendation cover forms and forward to letter writers.
• Pretend that the MCAT couldn't have possibly gone as bad as I thought.
• Revise personal statement.

June 2012

• Get my official score. (Heartbreak and sorrow.)
• Despair for a while.
• Start AACOMAS application.
• Order transcripts (from FIVE schools--can you say "non-traditional"?) to be sent to each application service.
• Sign up for September MCAT (TIP: Only do this once if at all possible.)
• Send reminders to letter writers.
• Revise personal statement.
• Write (and revise, revise, revise) extracurricular activities sections.

July 2012

• Find a letter writer to replace one of my letter writers.
• Send more reminders to professor to submit to the other application service. (TIP: If you get all of your letters sent to Interfolio, you will avoid some of this mess.)
• Find another letter writer to tentatively replace the writer you are now stalking.
• Take four full-length, five-hour practice tests.
• Submit AMCAS.
• Submit TMDSAS.
• Submit AACOMAS.

August 2012

• Study for MCAT
• Get philosophical about where you are in life, what you've accomplished, and how you try to "live in the moment."
• Purchase "I'm a grown-up" suit. (Chocolate brown with turquoise top.)
• Preview secondary application essay prompts.

September 2012

• MCAT redoux.
• Start writing secondary applications.

October 2012

• Continue writing secondary applications.
• Get official MCAT score.
• Cry in relief.
• Get first interview invitation. Then second.
• Get first rejection.
• Get over it.

November 2012

• Buy the "right" purse. (Bright red.)
• Start interviewing.
• Freak out and apply to more schools. (TIP: Apply early so you don't do this! $170 down the drain.)

December 2012

• Keep interviewing.
• Send schools an "update." (TIP: You got to actually have something to update them with such as a new publication or a completed class.)
• Get in.
• Celebrate.
• Cancel interviews at "I'd rather go to accepted school than this one" schools.

January 2013

• Cancel another interview.
• Decline an invitation. (Oh, the table has turned and it feels so good!)
• Fail first biochemistry exam. (TIP: Don't!)

February 2013

• Start telling myself "I didn't want to there anyway" for the schools that have silently wait-listed me.
• Decline yet another invitation to interview.
• Join Facebook Group for Class of 2017 Totally Awesome University of MD Acceptance.
• Try to figure out my ambivalence over my state school (see Valentine).
• File federal tax return so that I can...
• File FAFSA. (Twice! One for me and one for Mini-Me. Looks like she'll get about a $700 Pell Grant.)

Didn't get in this time around?

Did you apply to medical school and only receive a few "unfortunately we are unable to..." letters?

It's bound to happen. There are simply too many well-qualified medical school applicants out there for everyone to find a seat. If you made it to an interview, chances are, you're well-qualified. Instead of beating yourself up or driving yourself crazy over what you should have done differently, you might want to take a Freakonomics time-out. Here's a great little (so, so sad) post to put things in perspective for you!

By the way, if you weren't a well-qualified applicant, there truly are things you can do to boost your odds of admission on your second try. Areas to review:

1. Your GPA. If your GPA is <3.5 and you are almost done with your bachelor's degree, you probably will not be able to make it move significantly. You might want to consider a master's degree program in medical sciences. Lots of schools offer these. 
2. Your MCAT score. What did you do to prep? In all honesty, do you think you can do better?
3. Your personal statement. Too many people forget that it is personal, meaning, don't just say the same thing all applicants say. (Some common cliches to avoid: I just love helping people; I find the human body fascinating; I've always wanted to do this; my science courses challenged and inspired me.)
4. The types of extracurricular activities you listed. Some schools are looking for specific activities such as research, volunteer work, and clinical experience. Find out what your schools are looking for and exceed their expectations. Volunteering in a hospital for a few four-hour shifts a month can take care of two of these requirements.
5. The way you wrote about those activities. Don't bother to list anything if all you are going to do is LIST them. As succinctly as possible, share how this experience has prepared you for a career in medicine. With 15 extracurriculars that you can write about, you certainly are not expected to give in-depth details for all of them, but don't waste this chance to convince them that you are just what they are looking for.

Falling in love

Do I fall in love too easily? Today’s visit at Texas College of Osteopathic Medicine felt like love. It felt like they loved me and, frankly, I can reciprocate. The day was sunny and bright and beautiful, and the weather was pretty good, too!

So what’s the love about? TCOM is an innovator. It was one of the first schools to develop a systems-based, integrated curriculum. It has a sim lab that served as the model for Mayo and the anatomy lab was set up by a former surgeon general (C. Everett Koop, I believe—my personal favorite SG.) There are computers at each tank and a mobile camera for all to observe particularly interesting finds on the large-screen monitors throughout the room. Students have 24-hour access to both labs.

 

The classrooms are massive. Not my favorite, but expected for such a large school with 240 students per class. There are screens in the classroom and each student has a personal mike for asking (or answering) questions. The OMM lab has five cameras on the demo table and plenty of monitors throughout.

How do they make the large classes feel not so overwhelming? Students are divided into four “colleges”—think Hogwarts School of Medicine. Each college provides students with a support network for studying and socializing. The students are further divided (not sure if this is a cross colleges or not) into work groups of 6-7 people. These are the same folks you will be doing group assignments with throughout your first two years.

 
Whatever their recipe for success is, it seems to be working. The school has one of the highest COMLEX pass rates and 90% of their students sit for USMLE Step 1 (and have a pass rate on par with any other med school in the nation).

I know that at some point in time, I would like to be involved in academic medicine. TCOM is a place where I truly would feel comfortable. It is collegial and inviting. One of my interviewers was a “second-career” DO. He was soft-spoken and very encouraging. The interview ended with him saying, “We need to find your husband a job here.”

 

My second interview was even more calming than my first. We sat down and he let me know that he read my file thoroughly. He liked what he read, and told me so. We talked a little about the journey of life. I felt like I was speaking to a kindred spirit.

And that is the greatest love. Finding kindred spirits in life is so rejuvenating. I know that TCOM would be full of them. No, not 240, but enough. Maybe I have settled into a place in my life where connecting with such spirits is easy. Maybe I’ve become better able at trusting my intuition and feeling things out. I like what I felt today. It felt like home. A strange, unfamiliar, comfortable home.

Premed Application Valentine Saga

Remember a time when you had a crush on a guy, and he didn't even give you the time of day? Maybe it was middle school or high school. I've kind of got that thing going on now. Kinda.

You see, my state school is one of those guys who thinks he's All That. God's gift to med students, if you will. Here's how our conversation has played out so far.

Me: Hey, you're kind of cute. Here's my number (application).

State School: Yeah. I know. You're not so bad yourself. (Read: fill out the secondary.)

Me: So you wanna go on a date (interview) or something?

State School: Sure. Why don't you come to my place. We can double. (He's keeping his options open.) How about lunch?

State School: By the way, don't call me. I'll call you. Maybe.

Time passes. A semester ends. Grades are posted.

Me: So, hey, what's up? I'm, you know, still here. And I haven't heard from you. And thought maybe you lost my number. Maybe you wanna go out again? (In other words, I sent an update with a list of courses I completed and my grades--4.0, of course.)

State School: Cool. ("Thank you for your update. It was added to your file.")

Me: Cool. (As in, "Where do you get off wait-listing 95% of the people you interview! Really?")

State School: <Silence>

Meanwhile, I decided to date another school. This one was out of state. Maybe he wasn't quite as cute as my state school, but he certainly wasn't as stuck up. Now I'm in some sort of New Order-esque "Bizarre Love Triangle."

Other School: Hey, Vieve, wanna go out?

Me: Whatever. I don't have anything else to do.

Other School:  Hey, Vieve, I'm really into you.

Me: Whatever.

Other School: I got you a present ("We are pleased to offer you a scholarship...")

Me: Wow. This is kinda serious.

State School: <Silence>

Other School: Wanna move in?

Here I am, crushing on this school that's student-body president while this down-to-earth, sweet-as-pie other school is looking at me with puppy dog eyes. Of course, giving in to his puppy dog eyes means that I'll be selling my house, packing up my family, and moving a thousand miles away. I find myself feeling a little resentful towards my state school. It's like he's just leading me on and toying with my heart by not giving me a "thank you for your application, but..." letter. Why? Why do you have to play hard to get? If  you are this hard to get a second date with, I'm wondering if you are really even my type. Really, what's a girl to do?

Affordable Care Act Primer for Premeds (Part 4)

I have spent more time on this four-part Primer than I originally intended. Really, I don't know how well something as massive as the Patient Protection and Affordable Care Act can be summarized  in just a few pages. Hopefully, you'll walk away feeling a little more knowledgable on the subject. Maybe you'll even learn something that might surprise your interviewer (though he/she might think you are lying--actually, the thing is so massive, they probably would believe what you are saying is true even if you were lying). 

Title V: Health Care Workforce

This is the part premeds are most concerned with, right? It’s been asserted that the Act will make things better for primary care providers and encourage more students to enter this specialty. Title V directs funds to federally-qualified health centers (FQHCs), the National Health Service Corps, and Community Health Centers. It also increases loan repayment amounts to qualified health professionals. Funds are also set aside to increase graduate nurse education training. (Leadership of nursing associations has been very successful in promoting the Doctor of Nursing Practice as the answer to our primary care shortage.)

Someone told me that more doctors will go into primary care due to the Act redistributing primary care residencies. She probably didn’t realize that primary care residencies have more unfilled positions than any other specialty. Shifting those spots to rural locations probably wouldn’t make them more attractive.

Title VI: Transparency and Program Integrity

This section of the Affordable Care Act puts safeguards in place to keep providers honest and patients safe. Gifts made to physicians and hospitals valued at more than $10 must be publically reported. Though few providers would say that they have ever been influenced by industry gifts, there have been studies to prove otherwise. Human nature makes us friendly to those who have been friendly to us.

Title VII: Improving Access to Innovative Medical Therapies

Have you heard the grievances against Monsanto? Here’s a one-sentence summary: They’ve taken something in nature, patented it, and are now licensed as gods. This section of the ACA puts a path in place for the FDA to license biological products. There are now like other medications with a 12-year exclusivity period before generics can be made. If, by some miracle, I knew that I would live to 150, patent law would be an interesting area to study. Alas, life is too short for me to learn the ends-and-outs of this regulation.

This section also gives special price-breaks for certain clinics serving low-income populations.

Title VIII: Community Living Assistance Services and Supports

This section provided a public option for long-term care insurance. It was repealed.

Title IX: Revenue Provisions

You will be delighted to learn that approximately half of the Affordable Care Act is funded. Honestly, I’m not sure what this means. Taxes and penalties enumerated in this section make the Act (more or less) 50% viable. Where the other funds will come from depends on Congress. At a med school interview, I was asked what I think are the implications of the ACA. My response was that either one of two things will happen. As the system gets stretched in a new direction, 1) we pass a breaking point which will revolutionize the way health care is done in this country with a few insurance plans being casualties of the changes or 2) the system will not stretch like we thought and we will experience a correcting recoil that puts us back to where we were five years ago. Not really that prophetic, but that’s how I see it. Either it will give us dramatic changes or it will give us nothing at all.

Title X: Strengthening Quality, Affordable Health Care for All

This section is known as “The Manager’s Amendment.” It provides guidance and regulations for inter-state health insurance exchanges. It also has a seemingly odd tidbit that reaffirms the Second Amendment. “What,” you may ask, “does the Second Amendment have to do with health care?” Some electronic health records prompt providers to ask about gun ownership to “trigger” (I couldn’t resist the pun) a conversation about gun-safety with children in the home. Wellness programs and insurance companies are forbidden from collecting this data, though providers are not prohibited from talking about safety.

Want to Learn More?

If this series of posts wasn’t enough to satisfy your curiosity, you can read more about the Patient Protection and Affordable Care Act on the following websites:
www.healthcare.gov 
www.healthreform.kff.org 
www.healthpolicyproject.org 

Affordable Care Act Primer for Premeds (Part 3)

Quality Improvement in the Affordable Care Act

The next two sections of the Act focuses on Medicare quality metrics and higher-level public health efforts. It's kind of fun to see the Federal government take an edgy, shake-things-up approach. I'm not sure, however, how well large bureaucracies can effectively function as innovators.

Title III: Improving the Quality and Efficiency of Health Care

In my opinion, this section has the potential to profoundly shift the way care is given in the US. This Title of the Affordable Care Act (ACA) established the Center for Medicare and Medicaid Innovation. Keep in mind: these are innovations, not proven solutions. Basically, the Federal government has recognized that there are big problems in our current system of reimbursements based upon procedures without any regard to outcome. CMI was put in place to discover novel approaches that are effective by increasing accountability.

Innovations that are put in place by Medicare have the potential to cause a huge rippling affect within all health systems (e.g., hospital networks, insurance plans, clinics). You see, Medicare regulations are incredibly stringent. Approved providers have quite a few hoops to jump through for any health plan, and the lower-than-average reimbursement for Medicare just adds to the sting. But there can be an upside to all that regulation.

Here’s the general idea: Health systems will implement changes designed to improve clinically-measurable outcomes such as the percentage of their patients with good blood pressure or whose cholesterol is at an acceptable level. These changes might include using case manager to follow-up with patients over the telephone or getting patients into classes designed to help them manage their chronic conditions. These systems will essentially get a “bonus” from Medicare for population-based improvements. Over time, the carrot will turn into a stick, meaning the bonus will go away and a financial penalty will be put into place. That’s a pretty strong incentive to change. It is thought that system-level changes will not only affect patients with Medicare, but will change how care is given to all patients.

This section also includes details specific to Medicare plans, such as the “donut hole.” The “donut hole” refers to a prescription drug benefit that seemed to be designed to encourage patients to limit the number of medications they took. Patients were required to pay a $300 deductible before coverage kicked in. Above that amount, prescriptions were covered until the annual amount got close to $3,000. If a patient needed more than $3,000 in prescriptions, she would be required to cover the next $3,000 out of her own pocket before “catastrophic” coverage would be in effect. Essentially, it would be possible for a patient who used $7,000 worth of prescription medications to be responsible for about $4,000. (Dollar amounts of coverage varied depending upon the year.) The ACA gradually decreases the amount of out-of-pocket expenses an individual is responsible for.

Title IV: Prevention of Chronic Disease and Improving Public Health

Lots of people believe that the ACA will increase Americans’ health status because of its focus on prevention. While the Act does require insurers to cover preventive services at 100%, there may be a bit of disappointment over the care that is classified as preventive. If your insurance already gives you a no-out-of-pocket-cost annual exam, you will probably not notice much of a change. The services that are covered at 100% are those that have received an “A” or “B” rating from the US Preventive Services Task Force.

Title IV also sets out to create an environment of health promotion through efforts such as calorie labeling at restaurants and wellness programs for older adults. Having worked in health promotion for many years, I think that these environmental approaches can help us turn the tide in the obesity epidemic. There’s more to Title IV regarding improvement in public health, but my brief primer is already too lengthy.