The Shuffle

Medical school applicants cannot hold more than one acceptance past May 15. Before that magical date, you can sit tight, waffling back and forth, filling out pro/con charts, and otherwise hem-and-ha over which school is right for you. Once accepted applicants are forced to take a stand, the flood-gates open, so to speak, and there is pretty active movement happening on waitlists throughout the country. Schools suddenly find themselves with openings and there is a rapid shuffling to fill them. My husband was hoping that tomorrow might bring an acceptance for me from my state school. Considering that I withdrew my application from them a week ago, it is highly unlikely.

So why did I do it? I'll spill the beans. Out-of-State University of Awesomeness is a Texas school. Have I already sung the praises of Texas medical schools? Let me tell you, they are fantastic! You see, Texas is pretty darn picky with their out-of-staters. State law requires that at least 90% of students are Texas residents. Some admissions offices set that number at 95%. That said, many applicants don't bother to apply to Texas since (1) the chance of getting in is so low and (2) Texas has its own application system for its eight medical schools. [FYI: Baylor is a private school, but it does receive some state funds and shows a preference for Texan applicants. Baylor uses the national AMCAS application.] Though I wasn't a fan of sending transcripts and entering data into an entirely separate and time-consuming database (TMDSAS), I was very pleased with the entire application process. My state school interviews many, many, many more people than they intend to offer positions to. Roughly one-quarter of interviewees are offered admission. Some schools offer admission to about half of their interviewees. Texas schools tend to do a more thorough screening prior to interview. That means that some schools extend acceptances to nearly three-quarters of the applicants that they interview. Got multiple Texas interviews? There is a good chance you'll get in to at least one of them.

Texas does a Match Day for med school that is similar to residency matching. As an out-of-stater, I did not go through the match process, but found it fun to follow on applicant forums. Even without applying early decision, Texas residents (as a whole) were more likely to know where they would end up significantly earlier than the typical med school applicant. Out-of-state applicants are offered admission on a rolling basis. My acceptance came three weeks after interviewing at one school.

But I really haven't gotten to my favorite part. Texas is affordable! The tuition at Texas medical schools is some of the lowest in the nation. My in-state school has a rate of $35,000 per year. Out-of-state tuition at a Texas school is lower than that. Tuition for Texas residents ranges from about $15,000 to $18,000 per year. If you are awarded a competitive scholarship as a non-resident, you may qualify for in-state tuition during your first year. Unlike many states, you can establish residency during your first year and be reclassified. (That is, if you actually meet legal residency requirements.)It's pretty amazing. I am planning on a career in family medicine. The affordable tuition in Texas really makes it possible to pursue that path without feeling over-burdened with debt.

There are other reasons why I am ready to move to Texas. Lots of them. But the freedom of moving into a new career relatively late in life without much debt is one of the greatest feelings imaginable.

The Security Myth

One of my coworkers just found out that the "guaranteed" funding for her job just got pulled. Most of the people at my office are paid through federal grant funds. I've heard it said many times, "They don't pay us enough, but at least we have job security." It's amazing to me how unhappy people are willing to be in order to feel secure. Fear traps us.

I'm not immune. I recognize the illogical appeal of this false sense of "security," yet I still crave it. If I put off applying to medical school for one more year, then I will be vested in the retirement program. Delaying my dream will give me a mere $308 per month in retirement. Logically, I know I will be much better off as a retired physician, but I'm human and that $308 is "guaranteed" if I just stick around another year. That's crazy! Why do I even think about it at all?

The desire for security is part of human nature; we seek security even if it requires us to trust in a broken system. But our work culture is changing. Job mobility today is akin to our ancestors' ability to follow the heard. You've got to be able to adapt, reinventing yourself and actively navigating your own career. Becoming a physician in my 40s is definitely a reinvention.

In many ways, physicians today are in the same boat as any hourly wage earner. There is always the possiblity of having your job replaced by lower-level (and less expensive) employees or becoming redundant in the face of a merger. Having said that, physicians are uniquely trained for change. Rotations and residency are all about overloading and adjusting, while learning as much as you can. I see limitless possibilities for me as a physician: practicing in small clinic, working as within a hospital system, developing quality improvement intiatives, teaching public health, administering evidence-based practices. Job wise, nothing is secure; but as a career, medicine offers an incredible breadth of opportunity. After all, in today's world, security is what you make it.