Applying to Medical School

Meaning of Rejection

When you apply to medical school you obviously risk the possibility of rejection. While such a response is a major setback, it need not necessarily mean that the rejection terminates your career prospects. To a considerable degree, gaining admission lies outside of your powers to control, since it is in part governed by factors over which you have no control. Such factors include the total applicant pool and the ratio of men, women, and minority applicants. For a long time white males felt assured that they would stand the best chance of being accepted. With a larger applicant pool and a substantial female segment, the situation has changed considerably to a much more competitive one. The impact of an increasing number of minority applicants, especially those of Asian background, has made admission even more unpredictable. The uncertainty surrounding the admission process is further demonstrated by the fact that even superior applicants who apply to a number of schools will usually find that they are accepted by some and rejected by others.

The aforementioned considerations point to the fact that if you are rejected, this should not be automatically equated with being unqualified or unfit to become a physician. As noted in detail below, careful, thorough, and objective analysis of your specific situation is needed to judge possible reasons for your rejection and to determine the most appropriate response.

Further complicating the interpretation of the meaning of rejection is the fact that many such applicants may possess the qualities that make a good physician, such as compassion, listening skills, excellent judgment, a keen sense of observation, the ability to solve problems independently, and a desire to help others. The fact is that because of the large volume of applicants and the pressure to quantify the admissions process, great weight is placed on GPA, science cumulative average, and MCATscores. Weakness in any of these areas seriously compromises one's admission potential, even when the less quantifiable elements are present. Some applicants are able to overcome grade and test score deficiencies, but many others are not, and in spite of their potential must make alternative career plans. Some applicants may clearly not merit admission. It is the rejected borderline cases that deserve special review and analysis to determine the appropriate course of action.

Responding to Rejection

Each year many thousands of applicants to medical school are rejected for one reason or another. If you unfortunately find yourself in this category, very careful examination of your future plans is needed.

Try to determine the reasons for your rejection. Weigh the advantages and disadvantages of the various alternatives that present themselves and then select a course of action that is realistic. Almost all rejected applicants fall into one of the six categories listed below:

1. Those who plan to reapply to U.S. medical schools the following year.
2. Those who plan to apply to foreign medical schools.
3. Those who will apply to enter a different health profession.
4. Those who will apply for admission to a graduate school to enter a career in teaching and research or in the basic medical sciences.
5. Those who plan a career in science education on the high school level or lower.
6. Those who will seek a nonscience-oriented career.

Seriously consider the reasons why you might have been rejected. If your academic record has been consistently poor, your SAT I and MCAT scores were low, and there were no genuine extenuating circumstances for your unimpressive performance, then you should consider either another health profession or a nonscience career. If your academic record is good, but for obvious reasons — physical or mental health — you were considered unsuitable for a medical career, consider another health career, a career in science education, or a nonscience program.

If you were a borderline candidate and you have had a consistently fair academic record at a recognized college, satisfactory test scores, a pleasant personality, and good motivation, and were probably rejected because of a very competitive admissions situation, then you should consider attending graduate school and studying for a career in teaching or research. If your test scores were low because of some unusual circumstances, you should consider retaking the examination and reapplying.

If you think that your record, as a whole, is not exceptional but does reveal the possibility of considerable capability as reflected by occasional high performance in some key courses, high test scores, and so forth, you should seriously consider reapplying to schools the following year. You should also consider applying to foreign schools or beginning a nonscience career. The schools you select to apply to the second time should be those that offer the best possibility of accepting you.

If you believe that you were rejected because of possible late applications, delay in receiving or loss of supporting data, poor selection of schools to which you applied, too few applications submitted, poor performance at the interview, or some similar explainable factor, you should consider reapplying, and think about other options open to you. A percentage of students who reapply do succeed; therefore, you should feel encouraged to do so.

A study was made of the career choices of 98 unsuccessful applicants to an entering medical class. Of that group of 57 men and 41 women, it was discovered that 52% entered occupations outside the health care field. Forty-eight percent ultimately entered health-related occupations, of which 10 men and 2 women became physicians, 7 became dentists, and 1 became an optometrist. These data indicate that a medical career is still possible if one is rejected initially and that a career in one of the many health care professions is a realistic alternative.

A later study, consistent with the aforementioned findings, showed that unsuccessful applicants to medical school tended to reapply at least once and that 51% of those employed after being rejected initially were engaged in health-related occupations (with laboratory technology being the leading choice, especially for women). This study also noted that of the respondents who were still students, 29% of the men and 20% of the women were in health-related training. The largest group among men was in dental school and among women was in the study of microbiology or other medical sciences. Women were found to be less likely than men to enter doctoral-level health science study. Careers in the new mid-level health fields such as physician's assistant and nurse practitioner attracted a few rejected premedical students. This conclusion is strongly supported by an even more recent study of a larger sampling of unaccepted applicants to the medical school class. It was found that a majority had reapplied and that 27% had gained entrance to either a U.S. or a foreign medical school. Of those still unaccepted, about half were studying or working in health-related fields or occupations. Because the state of medical school admissions is currently somewhat more competitive than it has been in the past, reapplying to U.S. schools is clearly a less attractive option than it has been in a very long time.

In any event, you should carefully consider the risks involved with medical study overseas before applying to such schools. See Chapter 13 on Foreign Medical Study for the problems involved with transferring credits, obtaining American licenses, and other difficulties of foreign study. If you should decide to undertake an alternative health profession or graduate study, you must determine if you have sufficient motivation to do so. Without sufficient motivation, the chances for success are slim.

Coping with Rejection

A second major facet of relevance to the unsuccessful applicant is the psychological impact of falling into this category.

Occupational choice results from a combination of conscious and subconscious elements involving both rational and emotional factors. The manner in which these factors are synthesized and compromised, leading to the ultimate career choice, is unclear. Although the making of a vocational choice is, for many individuals, a long-term process spanning the college years, this is not the case for most premedical students. It has been shown that about half of these had made a definite career decision before entrance to college and that 60% never changed their vocational choice once it was made.

Thus, as a group, premedical students are likely not only to enter college with a pre-determined career goal, but also to insulate themselves from situations perceived as threats to their decision, as well as from faculty members who may challenge the wisdom of their career choice. Moreover, they surround themselves with peers who share their values and reinforce their beliefs.

Many premeds have, therefore, at an early (and perhaps premature) stage fixed their vocational goal irrevocably and insulated themselves from any possibility of change. Consequently, such individuals are potentially incapable of anticipatory coping with rejection to medical school. If this situation comes to pass, the potential exists for a crisis due to a thwarted career goal. Moreover, it is believed that, since our society equates self-worth with success, a career crisis becomes equivalent to an identity crisis, which can produce serious negative psychological manifestations. At the initial stage these may be evident as a sense of shame, inadequacy, and guilt-producing feelings of isolation. This phase may be followed by a second stage characterized by denial, resentment, and anger. This leads to placing the blame for failure to attain admission on others rather than oneself. A third stage may follow in which depressive behavior, instead of the rational self-appraisal that is called for, becomes apparent. Lethargy and fantasizing, as well as anxiety, dominate the individual's personality.

It is obvious, then, that students who fail to gain admission are confronted with a major crisis that easily lends itself to perception as having been brought about by others or by uncontrollable factors. Most individuals eventually work through the trauma of rejection successfully, begin a realistic appraisal, and successfully adjust to their new situation. Some, however, remain in one of the reactive stages noted above and may need help to cope with the stress produced by the circumstances in which they find themselves.

For those unable to handle the impact of admission failure, counseling by the premedical advisor may prove beneficial. The advisor, if necessary with the help of other relevant and qualified personnel, should initially seek to help the individual maintain his or her sense of self-worth and thus facilitate working through the crisis. The individual next should be made to realize that the failure should be perceived as another of life's problems that needs resolving and can be resolved successfully. Finally, the advisor should offer assistance in developing a strategy for meeting this problem.

There are a significant number of rejected applicants who, after careful consideration, have concluded that neither reapplying to or enrolling in a foreign medical school is a viable option. Many of these individuals, due to their background and interests, can find a rewarding career in one of the health sciences other than medicine, both allopathic and osteopathic. Listed below are the addresses of the professional organizations for the fields of dentistry (see also Chapter 17), podiatry, optometry, pharmacy, and veterinary medicine. These organizations can provide detailed literature about their respective professions.

American Association of Colleges of Podiatric Medicine

1350 Piccard Drive, Suite 322

Rockville, MD 20850

Association of Schools and Colleges of Optometry

6110 Executive Boulevard

Rockville, MD 20852

American Association of Colleges of Pharmacy

1426 Prince Street

Alexandria, VA 22314

Association of American Veterinary Medical Colleges

1101 Vermont Avenue NW, Suite 710

Washington, DC 20005

Keys to Bouncing Back

Rejection of any sort has its negative impact on an individual's personality. This is especially true when it applies to medical school admission; a serious blow to one's self-esteem and psychological composure may occur because a dream appears to have been shattered. The nature of the response to this crisis may determine whether the individual will ultimately succeed, so a critical choice must be made between passive acceptance or taking appropriate action. Obviously, the latter approach is logical and hence preferable.

In summary, you should thoroughly reevaluate your candidacy and carefully consider the following options:

1. Perform a reality check. At the outset, reassess your chances for admission. You should determine, preferably in consultation with your premedical advisor, if there is anything reasonable you can do to significantly enhance your admission potential. Determine what deficiencies exist and whether they can be remedied. A frank evaluation of the likelihood to succeed if you reapply should indicate the best course of action. The problem may not be intrinsic but merely structural; in other words, there may be no serious academic deficiencies, only a weakness in the quality of your essay or recommendations or interview performance. There may be a need for more convincing evidence of your commitment to medicine. This may have been reflected by your essay or a lack of adequate exposure to the profession. If so, an appropriate course of action should be self-evident.
2. Improve your admission potential. Merely reapplying with the same credentials will probably not improve your chances. This assumes that you applied to an adequate number of schools (see Table 4.1) and chose the right ones (see Chapter 7), as well as having handled your interviews competently. If so, determine how you can meaningfully enhance your status. You may take advanced courses in your senior year to improve your GPA, or repeat the MCAT if you are convinced that you could have done better. If you won some significant school awards or completed a special impressive project, this should be clearly stated in your new application. Obviously, the second time around, you must provide the admissions committees with a valid reason to take a fresh look at your case. Additionally, try to identify schools that you may have overlooked and would be receptive to your case with an improved application.
3. Trying again. If you decide to reapply, you should do your utmost to maximally enhance your chances. Carefully review your list of schools and select those to which you realistically stand the best chance of getting in. Consider applying to osteopathic medical schools (see Chapter 14). Intrinsic defects can be remedied by taking advanced courses or by taking the MCAT or doing research at a medical school. Such steps can make a difference and may well “push you over the bar” (see discussion on Advice to Borderline Applicants, page 102).
4. Finding success elsewhere. Should you and your advisor conclude that your rejection is irreversible, this certainly is not the end of a meaningful future career. Your skills, intellect, and desire for service can be expressed through other health care careers. Explore such viable options as dentistry (see Chapter 17), podiatry, and physician assistant. These professions are comparable in many aspects to medicine, and provide satisfaction, status, and substantial remuneration. Therefore, they have proven to be suitable careers for many whose initial option could not be realized.
5. Doing it the hard way. Should you find none of the aforementioned options appealing, and you are absolutely determined to become a physician, there is another alternative. This is to enroll in a foreign medical school (see Chapter 13). During the period of 1950 to 1970, this option usually meant going to Europe, but over the past several decades, this has involved attending an offshore medical school in the Caribbean or Mexico. You need to be extremely cautious, if proceeding along this tract, since there are potential serious obstacles along the road. These include the lack of accreditation comparable to U.S. or Canadian medical schools, the need to secure acceptable clinical clerkship experience in America, and the need to pass appropriate qualifying exams in order to obtain a residency appointment. Graduating from a foreign medical school can be done if you are highly motivated, can financially afford it, and pick the right school. Speak to individuals who currently are students at any of these institutions, and to recent graduates of these for-profit medical schools. It is essential to get the lowdown before you decide.