Applying to Medical School

There are two basic factors that determine admission to medical school independent of the personal qualifications of each candidate. These factors are the total number of first-year places available and the total number of applicants for admission. Presently, fewer than half of those that apply are accepted to American medical schools; about half of those that are rejected are considered qualified to attend medical school.

Starting in 1930, in the decade between the Great Depression and World War II, the number of medical schools remained substantially unchanged and the number of first-year students actually decreased slightly. In the next two decades (1940–60), nine new schools were established and, as a result, first-year enrollment increased by about 50%. In the 15-year period 1960–75, 27 new schools came into being, bringing with them nearly another 65% increase in enrollment. Over the next decade (1976–86), only seven new schools became operational. Since the mid 1980s one new school has been established. All of this points to the end of the era of medical school expansion, at least for the foreseeable future, even if a few new schools open in the coming years.

During the long period of expansion (1940–86), the total number of freshman places changed as a result of the opening of new institutions or the enlarging of class size at existing schools. The data indicates that two-thirds of the increase in enrollment was due to the latter and one-third to the former. This is understandable because new schools usually start with small enrollments and then expand.

Prospects for the Future

As noted, the era of major medical school expansion has ended. The long-term goal of the 15,000 first-year enrollments, set by medical educators to meet national health care needs, has not only been met but even surpassed. For many years, approximately 16,000 freshman medical students have enrolled each year. All indications are that the available number of freshman places has peaked, since no new schools are likely to open and significant expansion of first-year class size will not take place.

During the mid-1980s there was a continuous and marked decline in the number of medical school applicants, which reached an all-time low in 1988, with a 1.6:1 applicant/acceptee ratio. Since then, the decline has not only bottomed out, but the applicantpool consistently increased until 1996. By 1993 the number of applicants surpassed the previous peak year of 1974, and reached new heights over each of the next three years.

After seven straight years of increases, a decline in the applicant pool began in 1997 and continued to 2002. The past three years have shown a modest recovery and an upswing in applicants may possibly be in the making (see graph). Of special interest to prospective applicants, should be the (rounded-off) applicant figures for the past nine years. These can be extrapolated from the graph of applicants.

Medical School Applicants (A) and Matriculates (M) 1950–2005

Also encouraging is the fact that, in 2005, 17,000 freshmen enrolled in medical schools. This is the highest number in several decades. New medical schools are anticipated to open in Florida and Texas, which should further increase allopathic medical school enrollment.

Some educators linked the increase in the applicant pool during most of the 1990s to the prolonged economic recession in the early 1980s, when many professions no longer provided assured job opportunities. Medicine has retained its appeal as a means of providing a secure economic future; therefore, students with a variety of majors were applying to medical school. Moreover, the surge in applicants has also been fueled by women, who now make up more than 40% of all medical students, and by Asian Americans, although representation in medical school by other groups such as African-Americans and Hispanic Americans has not been growing.

In the light of the exceptional circumstances associated with the change in size of the applicant pool, it is very difficult to predict at this time what the admission prospects will be during the next decade. Clearly, a variety of conditions over the next few years will impact strongly on the issue.

There has been about a 25% decline in the applicant pool over the five years 1997–2001. As a result, by 2001 the applicant pool declined to about 35,000 or close to 12,000 below the peak year of 1996, bringing it down to the 1994 level. From the events of recent years it would appear that in 1997 we may have entered the third major decline in the applicant pool of this past half century, the others being 1959–61 and 1984–88. It is not possible to predict where and when the decline will bottom out. What is clear is that as a result of the decline over the past few years, the applicant/acceptee ratio has finally gone down well below the long-standing 3:1 ratio (the general meaning of this ratio change is discussed on page 87).

One can only speculate as to the reasons for the current decline in the applicant pool. Perhaps prospective medical students are becoming concerned about the economic and social forces that are transforming the nature of the practice of medicine. They may also be reacting to the growing chorus of discontent with their profession, reflected by some physicians, due to the negative impact of managed care and a litigious society. The existing climate has not been enhanced by reports of a prospective oversupply of physicians, which some believe may exceed 100,000. Finally, the prospects of potentially incurring a heavy debt burden during the course of one's medical education undoubtedly adds significantly to the concerns of prospective students as they contemplate a medical career.

First-Year Applicants

During the decade from 1950 to 1960, the number of applicants significantly decreased, from 22,000 to 14,000 per year, and there was a corresponding decrease in the applicant/acceptee ratio, from 3.1:1 to 1.7:1. From the early 1960s to its peak in 1974 there was a continual increase in the number of applicants, from 14,000 to 43,000 per year. Since then the number of applicants has markedly declined, to under 28,000 in 1988; consequently, the applicant/acceptee ratio again decreased from 2.8:1 to 1.7:1. From 1989 on, the applicant pool has risen sharply and steadily to peak in 1996 at 47,000. Thus, over the past half century there have been two major declines — and possibly the start of a third — as well as two major increases, dramatically reflecting the ebb and flow of the applicant pool.

From what has been noted above, it is obvious that there was a significant increase in the odds of gaining admission by those who applied during the 1975–88 period, when on average, the applicant/acceptee ratio was about 2:1, over applicants of the preceding 10 years when the ratio was closer to 3:1. In the years 1987–92, the competition turned out to be less than it had been since 1975. This was due to the significant gradual decline in the total number of applicants, which was estimated to have been about 1,000 per year. From 1989 to 1996 there was a strong and steady increase in the number of applicants, rising dramatically from 26,900 to 47,000, while the number of available places has remained about the same (approximately 16,000). As noted, since 1997 the applicant pool has declined for six successive years, lowering the applicant/acceptee ratio proportionately. The impact of this reversal is considered below.

While the current near 2:1 ratio still presents a formidable challenge, it need not be taken as reflecting any particular individual's chance for admission. Rather, it should be taken as a general reflection of the level of competition. The reason for this is that the applicant pool no longer consists almost entirely of white males as it did for well over the first half of this century. The pool now contains a very sizable female segment and a smaller minority segment, which together make up more than 50% of the freshman class each year. This situation makes it more difficult to define the exact odds for any particular individual to gain admission solely on the basis of the applicant/acceptee ratio. The problem of mathematically defining the intensity of competition is compounded by the fact that about one-fourth of the total applicant pool may be repeaters, whose chances for admission usually are significantly less than are those of new applicants. Thus, in trying to assess your own overall chances, many factors come into play. These include sex, race, residency, age, and financial status in addition to intellectual achievement and potential.

Impact of Applicant Pool Size

Over the eight-year span (1988–96), the most dramatic fluctuation in the size of the applicant pool in a half century took place, from a very depressed number (about 27,000), to a remarkable record high (about 47,000). Such an enormous change in so short a time is unlikely to recur in the foreseeable future. It does, however, serve to impressively demonstrate how the size of the applicant pool significantly influences one's chances of getting into medical school as well as a variety of factors associated with the admissions process. Even under more normal circumstances, there are cyclical phases in the size of the pool of applicants and the impact of an above or below average number of applicants (about 35,000) will also be felt, although to a lesser degree, in a variety of ways. Therefore, consideration of the multifaceted influence of the impact of the applicant pool size is very important.

During interludes when the applicant pool is very large (such as the mid-1970s and mid-1990s), competition to secure a place is naturally extremely high. Under these circumstances, the following also takes place:

1. The chances for applicants with average credentials to gain admission is markedly diminished.
2. For the more attractive applicant the number of multiple acceptances received will likely be reduced.
3. The number of schools to which an applicant should apply will probably increase; consequently, the overall cost to applicants of the entire admissions process (such as application fees and interview expenses) will be higher.
4. The response from medical schools may be slower due to the large volume of applications that need to be processed when the pool is large.
5. Less attractive financial aid packages may be offered to applicants.
6. Competition will also be intense in the selection of women and minority group applicants who make up a sizable segment of most freshman classes.
7. Marked deficiencies in an applicant's record will carry more weight than usual, to the applicant's disadvantage; therefore, chances of the applicant securing an interview, which would allow the opportunity to explain a possible weakness in that applicant's record, are unfortunately diminished.
8. Tuition will more likely remain high when the applicant pool is large.

During a period when the applicant pool is low (as in 1984–87), the reverse of the above considerations come into play, to a degree dependent on the extent of the depression in the number of applicants.

In light of these considerations, it is important for all applicants to be alert to the status of the current size and direction of movement of the applicant pool for the few years prior to the time they plan to apply. They could then anticipate the general impact that the existing applicant pool situation will have upon them.

Early Admission

Most applicants to medical school plan to have their baccalaureate degree before beginning medical study. For a typical entering class, less than 5% of the first-year students lacked their bachelor's degree. (For details, see Table 6.1, page 214.)

There is considerable variation in policy regarding the admission of students after only three years of college study. The percentage of early admissions varies between none and 25%. In any case, only the exceptional student should consider applying for early admission, since only such an applicant will have a good chance of being accepted and the best chance of successfully completing his/her study. Applying early and not being accepted, however, does not prejudice your chances for admission the following year.

If you are interested in the early admission program, compare the colleges that offer such programs, using the information included in Table 6.1.