Medical School: The toughest four years of your education.
The road to becoming a physician is a long one filled with twists and turns, filled with four years of grueling curriculum. Is it worth it?
If your answer to the above, is “Yes, of course, I would do four years of hard work to become rich”, Myth # 1 – Badnews, most doctors are not rich. Yes, they have a high income, but they are not rich or wealthy. There are other ways to make a similar income without the gauntlet described below.
The Gauntlet
The competition for admission to the top colleges in the nation has become fierce over the years. For medical schools, it is on another level where families are now planning ahead starting in 8th and 9th grade. This early start ensures that students attain the best grades and maintain the highest GPA as possible, as a GPA of 3.7 has become the norm for acceptance into medical school. Maintaining this GPA in high school may seem like a breeze, but you need to carry that same focus into your undergrad studies to make sure you maintain that GPA.
With that comes the temptations of life.
For most, undergrad is a time of figuring out who you are and where you see yourself in life. If you do not truly have a passion for medicine it may escape you and the temptations of life will make it harder to attain that goal of becoming a physician. When your friends are partying, clubbing, going to the beach on the weekends, you are most likely studying to keep up with your grades and to tackle the beast ahead.
Yes, the perennial Medical College Admission Test® (MCAT®) remains the Mt. Everest for many.
Myth #2, becoming a physician is NOT only four years of school. This process starts early and sacrifices have to be made. If you were interested in football, soccer, dance, basketball, volleyball as a youth, those may have to take a backseat to make sure that you have the highest grades. You never know what world star athlete you could have been…
Imagine getting through high school and undergrad with a 4.0 GPA and the MCAT, gatekeeper to your medical school dreams, denies you entry. This is a reality for a lot of people who are not good test-takers. They may have the knowledge but anxiety, and poor test-taking skills do not allow them to perform their best in these standardized tests, which can impede their goal of getting into medical school.
Personally, as seen by my path to medicine, becoming a physician was not a goal of mine from day one, therefore the MCAT was a challenge and I did not score well which led me to alternative routes to medical school, which will be explored in another post.
Medicinae Doctor (M.D) vs Doctor of Osteopathic Medicine (D.O)
In the United States (U.S) there are two paths to becoming a physician, Allopathic (abbreviated M.D., from the Latin Medicinae Doctor) and Osteopathic (D.O., Doctor of Osteopathic Medicine) medical schools.
Currently, there are 154 M.D. programs and 36 D.O. programs in the U.S. The 4:1 ratio of MD/DO school favors the popularity of MD’s.
Both teach students the basic medical and scientific knowledge that they need in order to become a licensed physician. However, they have different philosophies and approaches to medicine.
Allopathic (MD) medical schools are what most people usually think of when they think of physicians. They teach an evidence-based scientific approach to diagnosing and treating medical conditions.
Osteopathic (DO) medical schools: some may think they teach more of a holistic approach, emphasizing the mind-body-spirit connection, as well as focusing on disease prevention and the belief that all parts of the body function together and influence each other.
Whichever path is chosen, in general, the curriculum in both programs are similar and particularly difficult. At the end of the day, both practice medicine very similarly, however, DO’s can choose to practice similarly to MD’s or they can practice medicine incorporating allopathic principles.
The MCAT was tough….yeah right…get ready for Board Exams
Licensing
In order to practice as a physician, there are several mandatory board exams that must be taken before a state will hand out those precious licenses.
The licensing exams are similar for MDs and DOs, however, some will argue that the MD’s licensing exams are more difficult. The Comprehensive Osteopathic Medical Licensing Examination (COMLEX) is the osteopathic equivalent to the United States Medical Licensing Examination (USMLE) for allopathic students. There’s a caveat that DO’s are also allowed to take the USMLE if they choose to, however, MD’s are not allowed to take the COMLEX.
Both exams are three-part series taken at different stages of the medical training journey.
I don’t need to tell you that these exams are grueling, long and expensive.
What?….I thought there was only one exam….
Myth #3 multiple exams.
8-hour exams are the norm
The first exam is usually taken at the end of the second year of medical school. USMLE Step 1 and COMLEX-USA Level 1. These exams cover foundational biomedical sciences and Osteopathic principles and practice. They both last 8 hours. COMLEX-USA Level 1 contains 400 multiple choice questions and USMLE Step 1 approximately 280 multiple choice questions, varies by exam.
Level 2 and 3 exams follow similar formats with their own nuances. However, the time frame stands.
Your exam scores can limit the specialty that you want to practice. Dreaming of becoming a neurosurgeon, but only scoring average on your board exams? your chances of getting a post-training graduate training spot in neurosurgery i.e matching (see the match) will be non-existent.
Two years of medical school….down the drain???
Students who have a difficult time with standardized exams are in for a rude awakening. Medical schools will kick you out if you do not pass the licensing exams. The first two years are dedicated to passing the level 1 exams. If you do not pass them within the attempt limits set by the school, they have the right to kick you out.
You failing the exam makes their stats look bad.
Not only do the schools have a limit on how many times you can take a board exam, but the boards also have a limit as well.
COMLEX – 4 attempts per exam
USMLE – 4 attempts per exam
This means if you fail any of the exams 4 times. Game over. Some will argue that if you are failing that many times you may not deserve to be in medicine, however looking at the gauntlet as listed above, you could theoretically be on your last board exam and fail 4 times and you would never be able to practice as a physician in the U.S. These are high stake games, with years of blood, sweat, tears, and a mountain of debt on the line.
Financial Burden
According to the AAMC, the average cost of attendance for one year at a public medical school (including tuition, fees, and health insurance) was $37,556 for in-state students and $61,858 for out-of-state students in 2019–2020. Therefore just four years of medical school will cost an in-state student $150,224 and out-of-state $247,432. This does not take into account tuition increases on a yearly basis and not accounting that medical school is usually paid for by student loans that carry interest rates. Currently, the average student loan interest is 5.8%.
Therefore by the time you are done with medical school and residency training you will most likely owe a minimum of $220,000. Unfortunately, it is becoming more common to have $300-400k in student loan debt. This may seem like monopoly money as you are in the gauntlet and do not have to make any payments, but when you have to send $5k payments to the loan servicing company, that reality will hit like a punch in the guts.
Take home points
Medical school is tough to get into, it’s difficult to get through, you will be sacrificing your 20’s and 30’s in pursuit of being a physician and it is a very expensive process. You may lose friends, become isolated, depressed, and angry at the world through the process, but there is always a light at the end of the tunnel. For those who have already gone through this gauntlet, I salute you. For those that know someone that may be interested, it’s imperative that they do it for the right reason, otherwise, they will get burned.
I would never discourage anyone from pursuing your dreams. My goal is to give you the information and let you know what to expect, and what many have gone through. This is not a decision that should be taken lightly. However, with the right passion, desire, and support, trust me you’re going to need a lot of social support; your dream of becoming a physician can come true.
