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From ABD to MD
January 12, 2014 7:46 AM   Subscribe

Leaving academia and going into medicine: when to jump ship?

I'm a Ph.D. student in the humanities struggling with two big epiphanies right now: I want to leave academia and I want to go into medicine (specifically primary care/family medicine -- yes, I am aware that this is on the lower end of the pay scale and requires lots of paperwork). I have lots of reasons for considering medicine, but the major ones are using my brain to actively help people every day and career stability. I have thought about going into nursing instead, but I think my personal skills (understanding how complex systems work on macro and micro scales, coming up with possible hypotheses and testing them, ability to explain complicated things to people) are more suited to being an MD and in fact would make me a good one. However, becoming an MD requires medical school. I've thought through the finances and I'm okay with the debt. My major concern is balancing doing it right vs. doing it quickly.

I need to do a post-bac program because I don't have the required science courses on my transcript. I'm pretty confident that I can get into a decent one because I have good GRE scores, a good undergrad GPA and an excellent postgrad GPA, plus I can articulate why I want to go into medicine and will have at least 6 months of hospital volunteer experience when I apply.

My uncertainty is regarding whether it's worth it to finish the dissertation. I have about two (funded) years left of research and writing and am sure that it makes sense for me to stay in the program for at least one of those to build up my volunteer experience and get my ducks in a row while still having health insurance and a paycheck. I also genuinely enjoy my dissertation topic and don't find graduate school that excruciating, and as a bonus my research is related to medicine (think history of medicine). But I'm feeling a bit impatient and nervous about "wasting" a year when I'd already be starting medical school so late.

Here's my current best case scenario plan:

-finish Ph.D. while building up volunteer experience in local hospital (2 years - age 27 and 28)
-do a 15-month post-bac with a linkage program, get accepted to linkage program or apply traditionally and endure glide year (age 29/30)
-start medical school at age 30/31
-start residency at age 34/35
-finally start practicing for real at age 37/38

On the one hand I do like the idea of finishing the dissertation while having some subsidized time to make myself a more attractive post-bac candidate. On the other, that's a whole year of my life. What do you think -- is it worth it to stay the course when the end is in sight, or should I jump ship sooner? Are there any benefits to staying that I haven't considered?
posted by oinopaponton to Education (15 answers total) 4 users marked this as a favorite
If you are currently enrolled in a PhD program, can't you take your prerequisites (i.e., the classes you would cover in your post-bac) at the university where you currently study, for free?
posted by pretentious illiterate at 7:55 AM on January 12 [3 favorites]

I would definitely try to take at least some of your required courses now, while you are funded and unstressed to determine how much you like them and how well you do in them. Bonus, you save 15 months on your time scale.
posted by bquarters at 7:57 AM on January 12

Can you take the necessary science courses while enrolled in your PhD program? And, more importantly, can you take them for free? If so, stay in the PhD program and take those courses.
posted by dfriedman at 8:28 AM on January 12

I didn't really look into taking the classes at my current university because I was under the impression that doing a postbac significantly improved chances at med school acceptances -- but if that's not true, then starting pre-med classes now is a really attractive option financially and time-wise. I don't know if I'd be able to get through the whole sequence while still making progress on the dissertation, but I could definitely do a big chunk of it.
posted by oinopaponton at 8:28 AM on January 12

Among people who set out to be MD/PhD, it is the norm for social science and humanities types to complete their PhD before starting medical school classes unless they are doing medical ethnography. Finishing your dissertation will put you in a small club of unusual candidates for medical school / residency / first job. It will definitely get your application read closely by elite places and generally in competitive specialties. For family medicine it doesn't matter, but a lot of people change their minds about specialty during training (or you may decide you want to do Family Medicine at UCSF). I'm sure you will find medicine a satisfying job, but if you want to come back to your scholarly topics after your career is established (many do; medicine is rich food for thought) it will help to have your dissertation out.

Let me recommend that you send your thoughts to the people behind the National Conference for Physician-Scholars in the Social Sciences and Humanities; there is a mailing list which has many of the people who've been through your shoes. There's also a conference with trainees and people who have made it; you have time in your plan to try and visit the one in 2015. Also look at the APSA page for which programs support humanities and social science in medicine. It might save you a substantial amount of money; some schools support or at least pay the med school tuition for their humanities-PhD trainees, but are reluctant to do so if you start making arrangements after graduating.

You may be able to optimize out some of the time in your plan; for example you may be able to take a LOA from your graduate program to do post-bac and avoid the glide year (I doubt your program is OK with you taking a bunch of premed classes while funded, but worth asking about).

Furthermore, you will find that starting med school in late 20s early 30s is not that rare. Being a grown-up has its advantages, and several excellent med schools look well upon such candidates. It's painful sometimes as a student to be mistaken for an attending, but you should focus on what will make you happy and do well for the remaining 30-40 years of your studies and career instead of what just gets you to attending the fastest.
posted by a robot made out of meat at 8:32 AM on January 12 [9 favorites]

I second robot made out of meat. That is good advice.

I do residency admissions and not med school admissions, but I don't see why a formal post bacc program would be looked on that much more favorably than doing the courses without a specific program, if that is an option.
posted by treehorn+bunny at 8:38 AM on January 12

And I'd rather be a student mistaken for being an attending than vice versa, which is what I am right now. :-)
posted by treehorn+bunny at 8:39 AM on January 12

You have a great plan. You are funded and have the flexible schedule of a grad student. Take advantage of it to take classes, get pre-med advising, and volunteer. Awesome plan. As someone who finished a Ph.D., I wish I would've switched to med school when I had the chance.
posted by htid at 8:51 AM on January 12

Oh, and I forgot that on off years (like 2014) there is a social science and humanities panel at the larger APSA conference in April in Chicago. I haven't gone in a few years, but it was well attended in the past. I would email to make sure that they are still planning on having a national rather than regional presence, and ideally talk to med schools with MD-PhD programs in your area just to get contact information for their humanities people.
posted by a robot made out of meat at 10:10 AM on January 12

Do it right, don't do it quickly. Finish your dissertation. Take your pre-requisites while you can do it in a relatively inexpensive manner. As someone who, post-med school, has around $350,000 in student loan debt, accumulating about $1200 in interest every month, I'm profoundly grateful now that I didn't have any debt before I started.

Plenty of people - most people - get into medical school without doing a post-bacc year. My medical school offered one of those high-stakes programs, and they don't take all that many people. And their program isn't really as well-looked-upon as some of the more elite programs, so the ones that don't get in at our school aren't at much of an advantage compared to any other applicant. It's a huge money-maker for the university, though, so they take just about everyone and their $40,000.

Don't let your age sway your decision. At 28 now, I'm one of the youngest people in my residency program, even as a 2nd year resident, and I often find myself wishing that I had taken some time away from school before starting medical school. We have some people in their late 30s/early 40s finishing up this year.

And yeah, don't over-commit yourself to any one speciality before you start medical school. I went in thinking that I'd go into family medicine. I ended up in internal medicine, with plans to go into geriatric oncology (fellowship applications pending)... but not before I also found out that I hated FM but loved geriatric medicine. And pediatrics. And physical medicine/rehab. And HIV medicine.
posted by honeybee413 at 10:14 AM on January 12

Doing a post-bac can significantly grease the wheels for entering certain MD programs that are known for preferring post-bacs and/or have linkage agreements (Penn is a classic example of this), but not to the extent that you should do one instead of taking your pre-reqs at the university where you are already a student. Having a PhD will distinguish you far better than being a post-bac student in the regular application pool.

If you do decide to go the post-bac route, do not underestimate the importance of volunteering and shadowing. The post-bac applicant pool is so saturated right now that the top programs are turning away traditionally qualified applicants (high GPAs, distinguished accomplishments, etc) in favor of applicants who have checked more of the boxes showing "dedication" to pursuing an MD (e.g. hospital volunteering, especially volunteering in healthcare abroad, extensive shadowing), because the single statistic that the post-bac programs distinguish themselves on is % of students who continue on to med school. If you are perceived as a flight risk, either due to a relative lack of healthcare experience or because of dropping out of a PhD program (and therefore showing a lack of follow through), you will be passed over.
posted by telegraph at 1:25 PM on January 12

Speaking as someone who's recently been accepted to her top choice med school after changing careers, doing a postbac does NOT significantly improve your chances at an acceptance! All you need to do is take the pre-requisite classes at an accredited four-year university, as I did. I took the courses at public schools in MA that are largely unknown. I was the only one from my school to apply this year. I have ten acceptances, and I'm waiting to hear back from two top-ten programs that have non-rolling admissions. Trust me when I say that the school where you complete your pre-reqs does not concern an admissions committee.

There's one big advantage on doing it quickly: In 2015, the MCAT (admissions exam) is changing. The new exam will be longer (4 sections instead of 3) and will contain new content areas: Biochemistry, psychology, and sociology. Accordingly, pre-med students will now need to take courses in these subjects. Having to take these courses could add expense and delay to to your plans, to say nothing of the increased difficulty of the exam.

However, in January 2015, there will be one final administration of the "old" version of the MCAT. If you wanted to really push yourself, and if you find a university with a course schedule that fits your needs, you could start this semester and knock out the required science courses in time to take the January 2015 MCAT. You could then apply in June 2015 for an August 2016 matriculation, and spend your glide year continuing your volunteering and physician shadowing while taking upper-level science courses to demonstrate your scientific acumen. Or even perhaps finish your dissertation? I'm not familiar with grad schools, so I don't know how feasible that would be.

Rudimentary outline here:

Spring 2014: Bio 1, Chem 1, Physics 1
Summer A 2014: Bio 2, Chem 2
Summer B 2014: Orgo 1, Physics 2
Fall 2014: Orgo 2, MCAT prep
Spring 2015: Upper-level science courses like Biochemistry and Genetics

I know, that's a much more condensed timeline than you were originally considering, but it might be worth giving some thought to.

The other consideration is that each year of your life that you delay carries a certain amount of opportunity cost, in terms of lost physician income. This is probably not a huge motivator for you, but it's a factor worthy of a spot on your pro/con list.

Medical schools love students from unusual backgrounds - Your application is going to be an attention-getter, and if you have the grades, you'll be a very successful applicant.

Let me know if you have any questions, and feel free to memail me. I love this stuff.

Oh, and for more information, you may want to check out the Nontraditional Student forum over at The Student Doctor Network (SDN).
posted by lizzicide at 1:32 PM on January 12 [1 favorite]

Thanks everyone for the useful advice -- I feel much more confident that this is possible now. I don't think there's any way for me to dodge the new MCAT because I can't take a lab class this spring due to teaching and other commitments, though I may poke around to see if there's a sociology class that fits my schedule. Assuming my funding will cover it (which I think it actually will, though I have to check), I'm leaning toward taking Chem 1&2 and/or Physics 1&2 over the summer while volunteering -- and from there on out things don't seem so overwhelming.
posted by oinopaponton at 2:11 PM on January 12 [1 favorite]

For this summer, if there's a choice to be made between physics and chem, I strongly recommend doing Chem 1&2, because they're pre-reqs for Orgo and will set you up nicely for the 2014-2015 school year. If you feel comfortable, though, do both.
posted by lizzicide at 2:14 PM on January 12

Another physician here late to the party.

There's no doubt that finishing the dissertation is going to make you a stronger candidate (esp. if you package yourself correctly) and open up more possibilities along inter/multi-disciplinary career lines once you finish medical training. But 2 years of time and lost income from the tail-end of your career is not a small opportunity cost, and adds the issue of whether those 2 years may involve a bit of floundering in your current work as your attention and motivations drift elsewhere.

I think the right answer really depends on what your ultimate career and financial goals are, how competitive you want to be as an applicant, and how strong an application you could put together without completing the dissertation. It also depends on whether there are personal/family issues that would impact the timing of things (how would any plans for kids/marriage factor into your trajectory). If you have a strong application without the dissertation, aren't necessarily interested in a top-tier med school, and just want to practice medicine in the community without utilizing your PhD for your career, you may end up padding your CV to little purpose and substantial expense. Then again, stellar performance in your pre-med courses and the MCAT aren't a guarantee, and if those don't go your way, you will wish you had the PhD completed.

Personally, if you had a year left I think it would be a no-brainer to finish up the dissertation. 2 years would be a toss up to me, depending on your situation. Just my two cents. Feel free to memail if you need any advice from an academic physician with some prior role in school/residency/fellowship admissions.
posted by drpynchon at 11:47 AM on January 22

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