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AMCASRush
The supreme rush students feel to get into and to move on with their careers is one of the most common (and frustrating) themes I've encountered over my years of helping students with the MCAT, AMCAS, and medical school in general. 

As we move through this year’s applicant cycle, and as students everywhere grapple with whether or not to take the MCAT or submit their AMCAS, I thought it the perfect time to address this rush.

I'm not here to say "it’s about the journey, not the destination," to point out that a gap year can be beneficial, or to help you to decide whether you’re ready to take the MCAT, as we’ve already addressed these topics at length.

Instead, I’d like to acknowledge the many reasons students choose to rush their applications, to not put themselves in the best possible position as applicants, and the likely consequences of doing so. Let's start with one of the biggest misconceptions out there:

AMCAS Misconception: You Have Until At Least Mid-October to Apply

No you don’t (at least not if you really want to get in). If I were advising you, I’d want your application in by mid-July, and end of July at the latest. Why? Let me use my own experience as an example:

I applied late to medical school once. Sometime in October. It wasn’t my intention. I’d applied early to a school that deferred me to the regular applicant pool, meaning that on October 1st, I found out that I had 14 days to apply to every other school in which I was interested. I made that deadline, but I was not in a good position to get accepted — and didn’t, despite having multiple majors and an MCAT score and GPA in the highest percentiles. Granted, there are other reasons for this (I have to make this disclaimer, since it’s disconcerting to hear anyone with exemplary scores get rejected across the board). I had major medical issues that cast doubt on my ability to make it through the rigors of medical school, and wasn’t savvy enough as an interviewee to allay it.

All the same, I went to interview after interview where I was reminded that the process at most institutions is a “rolling” one, meaning that 60-70% of the spots were already filled, and we were competing for the remainder. I’d look around the waiting rooms at these programs and realize that unlike my competitors, I wasn’t a PhD, hadn’t cured cancer, and hadn’t started a clinic in a far-away land. Granted, this may be a hyperbolic reimagining of what went down, but I was crestfallen to realize there were certainly less qualified applicants who had been accepted before the schools even met me; that I had put myself at an unnecessary disadvantage.

Nominal requirements and deadlines for medical school admission are just that: nominal. It has been getting increasingly competitive to get into this field for over a decade now, and the belief that just doing what the AMCAS website and medical school websites say to do at a minimum is enough to get yourself accepted is naive and uninformed. Instead, you have to know what your fellow applicant is doing, as well as to be able to put yourself in the shoes of the admissions committee member who is reviewing your application. More on that below.

AMCAS Misconception: You Can Always Apply to Medical School Again

Sure, you can, but will you get in, or will you just waste your time and money? Look at this issue from the perspective of the admissions committee member who has to review your application. You’ll play you, and I’ll play the part of the admissions officer evaluating your application.

If I see that you’ve applied previously and been rejected, whereas another person with similar credentials is applying for the first time, I’d be likely to consider the two of you to be mutually exclusive, and to take your application out. “But I’m a unique individual! I’m more than my application! You need to meet me in person to see this!” you might retort. “I only failed to get in last time because I didn’t heed Birju’s advice and applied late in the cycle. Had I applied earlier, I’d have been a shoo-in!” you might add.

Sure. But as a member of an admissions committee at a prestigious medical school, I'm dealing with juggling my considerable clinical and academic duties with the admissions cycle crush. I'm finding it increasingly difficult to choose between exceptional applicants. I want to take them all and find it difficult to reject any of them, let alone to reject the majority of them. “I’m at least good enough!” the face and essay on my desk shouts at me. Yes, but so are five other nearly indistinguishable people in the same stack as you. I’m looking for any excuse to trim that pile. The less I have to think about it, the better. Getting attached to each of you only makes it feel more like I’m choosing a favorite amongst my children. And what’s this? You already applied to 12 schools and got rejected by each? Well, I’m sure my counterparts at those institutions had good reason not to accept you, and I’m justified in looking instead at your first-timer counterpart.

Does that sound harsh and impersonal? From your perspective, it certainly is. But this process is hard to understand if you can’t put yourself in the shoes of the admissions officer. We’ve all heard stories of admissions committees doing seemingly terrible things to cut down on their applicant pools, from tossing the applications into the air and eliminating anyone who falls off the table, to having a hard cutoff for MCAT scores and GPAs to be considered at all. Some of these may be apocryphal or no longer in practice, but the fact remains that applying to medical school is, for most people, a crapshoot.

You have to set yourself apart from the pack, and there are no guarantees. You might make it into your “reach” school and not even get interviewed at your “safety” school. It’s best to spread your net wide, and to put yourself in the best possible position to be considered highly, and that starts with applying as early as you possibly can.

Does this mean that it’s impossible to get in if you’ve failed to previously? No. However, if I’m the admissions officer who is looking at your applications, I’m going to ask myself a very simple question. How are you different now than you were the last time? If there’s no significant difference beyond your having done a few more classes with the same grades - or volunteered a few more hours, or continued your research, or that you simply applied earlier - you’re essentially the same applicant, and you’re likely going to get the same result.

Medical School Admissions Committee Misconception: "They’ll see that while my _____ is less than ideal, it was a tough [semester, year, etc.], so they’ll understand"

Again, it would be great if it were possible for the officer to put together a coherent timeline of your life and put everything you did in its proper context, but there just isn’t enough time. You can give context in your personal statement or during your interview. However, there’s no guarantee that consideration of your application will make it to that point. It is better to remove any potential red flags than to assume that you’ll be able to explain them away, even if it takes time to do so.

Medical School Misconception: Taking Time Off Before Medical School Will Be Disadvantageous/Financially Unwise/Intolerable

There is an impatience amongst premeds that I often find hard to understand, even though I was forced to take time off because of health issues, and became a doctor six years later than I had originally intended. Let's tackle these issues individually:

Time Off is Disadvantageous:  What used to be considered nontraditional is increasingly becoming traditional. I wouldn't be surprised to find, in the not-distant future, that going straight from high school to college to medical school will be disadvantageous in the way that attempting to do the same is for business school applicants. I had a group of nontraditional friends at med school who went so far as to say that no one should be allowed to get into medical school unless (s)he's done something else for two years.

While there's no hard-and-fast correlation between age and maturity, most of the older students in my school were better off. The feeling of many nontraditional students is that if you do anything at all between school and medical school, you'll be better off for it. You'll have a greater appreciation for the privilege this career affords, you'll be more respectful of patients and coworkers, and more tolerant of all the frustrations you'll invariably face. There's a greater chance that you'll be a well-rounded individual; someone who won't fall into the rut of study-party-study in which so many grad students find themselves. You'll be better able to manage your time well.

If you have the grades and scores to get into medical school, you'll do fine in it. Maybe you'll be a bit rusty, a bit out of practice compared to those who never stopped being students, but not only will those abilities come back, but also, you'll have all the things above that are too often overlooked in the formula for success. The outside experiences will help you put information in context, and to relate to patients and staff alike.

Time Off is a Financial Mistake:  It's hard to argue against recouping potential lost wages by getting into the workforce sooner. I hear it all the time when it comes to fellowships. I'd argue that if you're in this field, you'll live well, and you should have considerations beyond your finances — such as taking a path that leads to a fulfilling career choice. Remember: Your fellow honors students are going into fields like finance, or becoming other health care professionals — RNs, NPs, PAs, PharmDs — and making six figures or close to it before you’re even out of medical school. Finances are a consideration in your career choice, but far from the only one, and one which ends in you being very good at your job. However, this may all be beside the point when it comes to my intended audience. The point I must impress upon you is this: No one wants to "lose" time unnecessarily, but if you're choosing between waiting until you're a really solid applicant and putting yourself in a poor position to achieve your goals, all the while risking not making it into any school, you have got to choose the former.

I’m not here to poo-poo any argument you might make against waiting to take the MCAT, or to submit your AMCAS, to dismiss the postponing of your real earning (and the paying back of your student loans). I’m here to make sure that you put yourself in the best possible position to get into medical school. The right medical school for you, the first time you apply. If it takes waiting a year to apply when you’re a strong applicant, it is ABSOLUTELY worth it.

Time Off is Intolerable:  It doesn’t have to be. Don’t accept impatience about your career/life and let it push you into unwise decisions. Are your friends moving on and making money, driving nice cars, getting swanky apartments? There’s sacrifice throughout your path. Who had to keep the grades you did in college? Who was in the library with you when you were studying for the MCAT? To care for people, to have their lives in your hands, is an honor and a privilege, and society doesn’t hand out that responsibility on a whim. You have to do your penance. Don’t sabotage reaching your destination because there are bumps in the road.

Time off doesn’t have to be onerous. It’s an opportunity to get to know yourself, to stop and smell the roses, to see the world, to live life before you hunker down and work forever and ever. It’s a chance to choose what you’re doing instead of having advisers and professors making your schedule for you at every point. It’s a chance to be untethered for a bit and see where your feet lead you.

Medical School Misconception: All Medical Schools Are Created [Essentially] Equal

To argue against this is not the same as to say that “Students from the US who went to foreign medical schools are inferior and make worse doctors.” I have known far too many doctors - as fellow residents, fellow tutors, or as my own doctors - to believe that to be true.

Open doors — or at least don’t close them.
This is, as above, about putting you in the best possible position to reach your goals. If you’re thinking only about the year ahead of you, you’re looking at this all wrong. Fast forward to your years in your career. Will you be a specialist? Will you have your own practice? Will you be in academia? What will it take to get you to that position? Research? Impressive work and important contacts? A fellowship?

Now work your way backward, starting from the loftiest of your reasonable possible aspirations. To work with a mentor at a prestigious institution, you have to get into that institution or another of its caliber at the level of a fellow. To get into that fellowship, you have to perform well at a solid residency. To get into that residency, in that field, you have to do well at a good medical school. But first, you have to get into that school. If your Plan A is to get into an MD school in the States (and it should be), don’t jump to Plan B or C until/unless you have to. We’ve all heard stories of people who slacked off in college, but got their acts together in a Caribbean medical school and went on to be successful in a competitive field of medicine.

However, they’re the exception, not the rule, and they’re generally examples of people who were greatly underachieving until pulling things together abroad. For every one such success story, there are so many more who fail one or more USMLE exams multiple times, take longer than 4 years to complete medical school, struggle to get interviews for residency, and find that their status as foreign graduates unfairly holds them back even beyond that point. I personally know a number of friends and colleagues who have had these experiences, several of whom have never made it into residency.

Passing Boards and Graduating
You can absolutely get a good education anywhere, as you may have heard, but the less competitive the school, the more you will be the one making that happen. At the school I attended, and certainly at any more competitive school, just “scraping by” required you to really know your stuff, and put you in a position to pass all your boards and be a fine doctor at the residency level. Just seeing how smart your fellow students are, and how hard they’re working provides plenty of motivation to work hard too.

Getting Into Residency
I applied into psychiatry, the field I love, and one which is (most years) amongst the easiest to match into. Most US grads apply to about 12 programs and match into one of the top 3 programs on their rank list. Since I had health issues that derailed my medical school trajectory, I applied to more — 37 programs — and got something like 8 or 10 interviews. That was disheartening. It was also expensive. As a fourth year medical student, I had already spent $1700 on USMLE Step 2. Now I had to spend another $800 on applications.

I remember vividly, though, a particularly disappointing interview day at a program that put so little effort into interviewing us, and were so disrespectful and inhospitable that I knew I would rank it low. There were two other applicants there with me. One was Brazilian and the other Indian, but they had both done med school in India. They showed no indication of being treated poorly by the interviewers. They were enthusiastic, asked questions that showed how much they knew about the program and the field, and generally showed they were more into the program than the two chief residents who were introducing us to the program. I later found out that they had applied to 200+ and 300+ programs respectively, and had gotten half as many interviews as I had. They'd spent 3 to 4 times as much money as I had on applications, and would be happy just to get in somewhere.

One of my favorite attendings in all of my training, who now holds a high position in a residency program, had a similar experience. She did research at a prestigious program, made a lot of connections, and thought she'd go there for residency, but instead got into one of her last choices, a program that isn't even in the same league. But she excelled there and did her fellowship in a big name institution.

Fellowships
It doesn't make sense to me that what school you attended should matter once you've proven yourself in residency, but it does. If you're a foreign grad and want to do a fellowship that's even somewhat competitive, even in a field as relatively laid back as mine, you will likely have to be a gunner from the start, to be angling to be a chief resident just to compete against other USGs who will never have to be as single-minded or driven. Even now, with how much the gap in perception and pay between DOs and MDs has narrowed, I know a DO in an uncompetitive field who was told by a program that they have *never* interviewed a DO. With big name institutions often looking to fill their ranks at every level with people from other big name places, bad decisions early in your career can close a lot of doors for years to come.

Finances
Many a student has said that he'd rather get into a foreign medical school now than to spend more money on a masters or post-bac. That kind of short-sighted thinking can be very costly in the end. Many foreign schools appear to be preying on the desperate and the deep-pocketed. Their fees are outrageous and their quality lags far behind. Students are very likely to spend more on prep classes for the boards, to take the boards multiple times, and to spend extra years in school. A bit of impatience now is rarely worth it. It's sad to see how indebtedness affects people in this field. Many feel guilty treating themselves during medical school and residency, despite all their hard work and stress, because they're afraid to add to their mountains of debt. Many choose to pursue fields and jobs that are less fulfilling, more stressful, or for which they're less suited, because that's the only way they can see themselves paying off their debt.

Bottom Line
I'm not here to bad mouth any school or the people who've studied there. In terms of philosophy, I'd likely have felt more at home at a DO program. I don't mean to say that people who've studied at certain schools or trained at certain programs are better at their jobs. I just want you to have as many possibilities open to you at every stage as possible. Where you then choose to go is truly up to you, as opposed to mostly having the decision made for you.

Life Misconception: "If I don't become a doctor 'on time,' I'll look _______"

Insert your own word. Bad, dumb, inept, lazy. As a psychiatrist, I want to respond with, "So what?!" Even more than that, though, it's really just not true. It's so common to take time off now. It's interesting. It gives you a story to tell. To just go from school to school to training to training...? That's so commonplace, so unimaginative. If that's all you've done, when have you really lived? Do a little role play with me. I'll ask, "You're how old? Did you not go straight through?" And you say, "Nope. I took some time off." And that's that. It wasn't too bad was it?

This is a field of brilliant minds and fragile egos. Don't define yourself by some cookie-cutter trajectory others have told you is the "right" way to proceed. Don't beat yourself up for not taking the usual path to your destination, for not plowing through obstinately through any obstacle or setback. Feel entitled to take a step back, to do things right, to take care of yourself. The MCAT, the USMLEs, AMCAS, every big step on this path will take time, money, and focus. Often, life doesn't allow for those at the times you've scheduled. If that means you take a little extra time to move forward, it'll be fine, and you'll be better for it.

What do you think? Have I missed any reasons, excuses, fears? If you have a reason to rush that could apply to others in your field, tell us about it in the comments below. Maybe we'll have an answer that will help you and others too.
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Dr. Birju Patel

Dr. Birju Patel

Birju has specialized in tutoring the MCAT since 2003. He served 2 years with Princeton Review, a year with Bright Future Learning Center (NJ), 7 years with Examkrackers, and roughly 10 years as an independent private tutor, including the last 3 with MedSchool Tutors. Birju is graduating from UMDNJ-NJMS and is now in his second year of psychiatry residency at Einstein-Beth Israel Medical Center.
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