we need to talk about med school
January 31, 2019 8:28 AM   Subscribe

How does a (potential) career changer know if she can hack med school?

I am an epidemiologist who loves her work, but seeks greater depth. I work with a big international organization with a lot of doctors; I work in very, very low-resource settings and I want to be the one doing patient care there. And in the US! This is a semi-annual crisis of mine and I'm wondering if I should just pull the trigger.

I have a 3.8 undergrad and a 3.9 from my MPH but no science prereqs; a post-bac would be a necessity. I'm not sure I'm smart enough for school -- I took college-level math and all the AP sciences in high school; I got straight As. But I am now aged (30, would be 32 by the time I start a postbac) and I really like to get at least 6 hours of sleep a night. That said, I just left a work assignment with 18-hour days in a very high-risk pathogen setting (yes, that one); I get really energized by my work (even though many would find it boring).

I could see myself doing an MD/PhD (I have a lot of research experience, and would want to do epidemiology). I could also see myself potentially doing nursing school -- but the clinical role of a doctor is more engaging to me. (A PA is not an option given my desire to continue with humanitarian work both within and without the US.) I would be most interested in emergency medicine, but would possibly do family medicine. I am very open to working in rural areas in the US. I have no partner and no desire for children. I am considering postbacs with linkages only.

I want to figure out if I can handle the classes and the schedule. Can you recommend the best ways to find out?

Ideas I have had:
- Taking Coursera or Khan Academy science courses, particularly bio and A&P
- Shadowing - I have shadowed the doctors in two different international health centers, though that is clearly a very different role than what doctors do in the US.
- Scribing? Though this seems to be very reserved for premed undergrads. I could take some months between assignments for my current job to do this if it is valuable.

Any miscellaneous advice on career changing into RN or MD is also very, very appreciated.
posted by quadrilaterals to Work & Money (17 answers total) 10 users marked this as a favorite
I would suggest skipping Coursera or Khan Academy as not particularly useful or relevant and instead begin taking your pre-reqs. With your background, I don't think a formal post-bacc program (like those designed for humanities undergrads) would be that useful. On of the primary purposes of those, besides the coursework, is to give you some research experience in the general area, and you've already got huge amounts of those. I would recommend applying as a post-bacc to your closest public 4 year college/university and signing up for BIO 101 or whatever the first class you need to take is. Most premeds, whether traditional or non-traditional, really find out if they can hack it when they get to organic chem. Most schools will have a premed/prehealth advisory group who can help you with course selection and all kinds of questions that you have about the process.
posted by hydropsyche at 8:37 AM on January 31, 2019 [10 favorites]

Seconding hydropsyche's recommendation of organic chemistry. When I was an undergrad, organic chem was the weed-out course for pre-meds. The thinking was that anyone who can't handle organic chemistry would probably not be able to succeed in medical school. And since you'd need to know organic for the MCAT anyway, you might as well prioritize taking the class sooner rather than later.
posted by alex1965 at 8:50 AM on January 31, 2019 [1 favorite]

Regarding the schedule: It's going to be different for every single medical school. Some places have problem-based learning curricula and the schedule is very loose. Some are very lecture-based and require attendance. Most are somewhere in between. I went to one that was lecture-based but only a few classes had mandatory attendance (and nearly all classes were recorded by that point). This was 10 years ago (holy crap) so YMMV now.

Remember that an MD/PhD is going to probably be 6-7 years, maybe longer depending on the PhD part of this. The tuition set-up varies by institution. When I started, the combined track students went for free, the whole time. By the time I finished, they had changed it to "You have to take out loans for the first two years, but if you actually matriculate into the PhD part, then we'll give you a grant to pay back the loans." If you're interested in getting a PhD to help further the science, then great - but if you're considering family or emergency medicine, you might not end up using the extra degree if you go into a rural setting (you can PM me and we can talk about why this is so, if you'd like, and where you might think about directing your specialty aspirations).

I don't have a lot of advice on getting into medical school, since I matriculated in 2007 and a lot has changed since then. I do think that shadowing is important - if you are concerned about schedule and lifestyle, you need to be able to see and talk to people about what the life is like. I thought in med school that I would never be busier than I was as a resident. And that was true until I started fellowship. And then I thought I would never be busier than I was as a fellow - now I'm in private practice and it is all about the hustle. I love my job - like, LOVE my job. But I am not a morning person, and now I'm up at 5:30 (at least) every day, in the hospital by 6:30 or 7AM, seeing patients at the main hospital until 8:30 or 9, and then clinic until about 5PM, trying to run to the smaller hospitals if I have a break between patients, or going after clinic. I'm getting home around 9 every night, still with notes to do. Not every job is like that - but a lot of jobs are like that. The clinical documentation requirements are insane.

Again, feel free to PM me directly if you have any questions.
posted by honeybee413 at 9:16 AM on January 31, 2019 [4 favorites]

I have worked in medical research for a long time with many specialist physicians. I want to encourage you to become a doctor. You are interested in it for all the right reasons. You are plenty smart enough. Physicians (as a group) are smart but not that smart. But they do work harder and longer and hold much more responsibility than most of us. That's the thing to focus on. I suspect that you can totally hack it. If you can't you will find out long before you actually are accepted into medical school, and then you'll know you're out full stop and when you're fifty you won't be thinking "what if". You sound like great doctor material to me.
posted by everythings_interrelated at 9:19 AM on January 31, 2019 [8 favorites]

If you haven't done the science pre-reqs, then yes, a postbacc will be necessary. The AAMC maintains a database although I don't know if you can search just for linkage programs. I think most have linkages now? But the specific linked schools will of course vary (usually geographically).

Regarding your timeline (MD route; add an extra 3-5 years for the PhD portion if you do that)
2021-2023: postbacc, apply to med schools, hopefully get in on the first try
2023-2027: MD
2027-2030 or 31: Residency (3 years for family medicine, 3-4 years for EM)

So you are looking at a minimum 10 year training program from here out, and starting your practice at age 40-45 or so. This is of course very do-able, people do it all the time, but make sure you run the financial numbers first. The average debt load of graduating medical students is something like $300k. You want to do everything you can to be on the lower side of that number, especially as you would have proportionally fewer working years than your 26 year old colleagues.

6-ish hours of sleep is very do-able when you're in school, provided you can study smart and manage your time well. Less so in residency, where 14-18 hour days/6 day weeks are the norm and you're on call for 28 hours, anywhere from every other day to one day in 4 or 5. (EM tends to have shorter shifts than other residents, but they still have their educational didactics, and do way more shifts than attendings.)

Shadowing is a de facto requirement at this point for medical school. Cold-calling is perfectly fine. If you're still on the fence, approach some doctors for informational coffee. People, including doctors, LOVE talking about their jobs and what they entail. Scribing is a great hands on option but most scribe programs require a long-term sustained commitment, rather than a few months. (Takes a few months to be trained!)

I'm not sure what about the PA route would prevent humanitarian work, but would an NP be a possibility? Traditionally NPs were drawn from RN/BSNs, but there are some programs that take people with a bachelor's degree in another subject. I work with lots of NPs and PAs, and clinically our jobs are indistinguishable; they see patients independently on their own schedule and don't have any more oversight than I do. The investment of time and money is way way less, and nursing in particular has a strong tradition of reaching out to underserved populations that we in the MD world are traditionally really bad at.

PM me if you have additional questions -- good luck!
posted by basalganglia at 9:43 AM on January 31, 2019 [3 favorites]

I also encourage you to do it! Your real world experience will be a huge benefit to you in handling the stress of medical school and residency. Don't do nursing or PA school if what you want is an MD. They really are different careers, not just medicine-lite.

I agree with just going straight into doing the prerequisites, although as mentioned above it might be good to look at some organic chemistry online things to prepare you. The actual knowledge of organic chemistry is going to help you very little as a doctor, so just worry about getting through the class and the MCAT.

Shadowing is very important, if only because many schools use that to weed out applicants.

I don't really see a huge long term benefit in the MD/PhD. I am an academic physician with dedicated research time and grant funding and I do not have a PhD. During my training, I really regretted not getting my PhD given my career plans but it turns out to have no impact at all. I also have many friends who did the MD/PhD and are not using the PhD at all-doing the exact same job with the exact same expectations as their MD only colleagues.

I average >6 hours of sleep/night, although it is not always consecutive when I'm on call. And I am on call a lot. But you do have options when you are selecting specialties, residency programs, and careers and some people don't take any call at all.

Feel free to PM if you have additional questions!
posted by Missense Mutation at 9:50 AM on January 31, 2019 [1 favorite]

Don't forget about osteopathic medical schools (DO is equal to MD in the US/Canada and in many, many other countries). Many of these have post-bacc programs where you're guaranteed admission - all are in basalganglia's list above. Though DO schools generally have the same admissions requirements as MD programs, anecdotally, DO schools seem to reach out to "non-traditional" students and career-changers more than MD schools.
posted by Seeking Direction at 10:55 AM on January 31, 2019 [2 favorites]

I’m an NP and would put in a plug for advanced practice nursing. As basal ganglia notes above, clinically there is much overlap between capabilities, and if you’re desiring patient care and face-to-face time, NPs get to do this in a way that doctors sometimes can’t (and we’re also from a culture that generally values working with underserved populations, addressing disparities in health, global health justice, etc.) I did a post-bac and a master’s entry program in nursing—so two years of part-time study (at night while working) and three years for the RN+NP. I think it’s a fabulous career and I’m really happy with the flexibility and work-life balance. I also know several people who do humanitarian work, research, teaching, etc. As basal ganglia also notes, the med school route would put you starting your career 10+ years from now, which may or may not be acceptable to you, but is definitely something I would consider. I would also recommend doing some shadowing rather than scribing, though it sounds as if you have loads of experience and aren’t as green as the average med school applicant. But it might be good to see how much time an average ER doc spends charting and attending to broken hips to get a picture of what your day-to-day would be.

Feel free to PM me with questions; on my phone now so apologies for a muddled and poorly formatted response!
posted by stillmoving at 10:56 AM on January 31, 2019 [1 favorite]

I don't know you, but you can handle the classes. I had taken zero science classes when I started post-bacc (took classes at night)--I was an English major. I also thought I couldn't hack it--ended up getting accepted to several American allopathic programs. As someone said above, I would just take a class at night and see how it goes. You can use Khan academy as a supplement (I used it sometimes for pre-med classes. Know you will need to bust your ass, maybe get a tutor, etc. And that's normal.

(Also, I started med school at 30. I'm 5 months away from finishing my residency. I am SO INCREDIBLY HAPPY I picked this career, though it was a decade-plus journey. + debt. And so much stress. And people tried to talk me out of it. I don't regret it for a second and think it was all worth it--it's the best decision I ever made for myself.)

PM me and I'll tell you more.
posted by namemeansgazelle at 12:14 PM on January 31, 2019 [1 favorite]

Thank you so much to everyone so far. As a note, I work outside the US, so taking classes at night is not possible.
posted by quadrilaterals at 1:00 PM on January 31, 2019

Seconding hydropsyche's recommendation to take Orgo.

I advise pre-meds in a university setting. What they need most is to grow up, and to have made the decision to serve other humans for the right reasons, not because it is the highest academic achievement level ++. Most of the med school application hoops (shadowing, scribing, service/volunteering) are to filter for that choice, basically. You are way, way past that. Seconding someone else above: please GO. We need you.

Your question was, how to figure out whether you can handle the classes and schedule. The latter your life has already answered. The former -- go ahead & take Orgo. Of the things you'll need, it's the sequence of Orgo then Biochem (so likely 2 years, unless you take one in summer somewhere) that's the biggest time-limiting factor, and you may as well get started. You'll also need Anat & Physiology, Genetics, Physics, and Sociology, to take the MCAT. My understanding is that you do not need a post-bacc; you just need to have taken the material and have a good MCAT score.

Please feel free to PM me if you think I can help.
posted by Dashy at 1:04 PM on January 31, 2019 [1 favorite]

I'm not sure how helpful this is, but as for the age thing, when I was your age I really thought about becoming a doctor and didn't in the end because I thought I was too old/it was too expensive, etc. I really regretted that decision for a long time (though I now think it may be for the best because I have terrible decision-making anxiety and I don't think that's a great quality in any physician.) The ability to pass the classes sounds like it is not going to be a problem; as several as said before, I know some people who had not taken more than high school biology who were able to get decent grades on pre-med science courses later on with a lot of hard work.

If you think you might regret not doing this (and it very much sounds like that's true), I would definitely go for it. A neighbor of ours started med school in her late twenties, then had to drop out after she had her children and her husband had health problems. She went back when she was 40, and is now a very happy, practicing doctor at 45. She is thrilled.
posted by heavenknows at 2:03 PM on January 31, 2019 [2 favorites]

Am I right to assume that you're a US citizen or permanent resident? It's really hard to go to med school in the US if you're not.
You'll also need Anat & Physiology, Genetics, Physics, and Sociology, to take the MCAT.
I'm also a pre-med advisor, and our students take an introductory Bio sequence but not necessarily Anatomy and Physiology or Genetics. (They cover some Genetics in the Bio classes.) We recommend that students take Psychology and Sociology for the MCATs, but I imagine that someone with an MPH will probably have enough exposure to that material to be fine on the MCATs with a little bit of self-study. You'd have to check individual schools, but they're not usually formal pre-reqs. Students typically take:

1 year of General Chem with labs
1 year of Bio with labs
1 year of Organic Chem with labs
1 year of Physics with labs (doesn't have to be calc-based)
1 semester of Biochemistry (doesn't need to have a lab)

You'd need to take all of that before you took the MCATs, which you should take in the late spring or very early summer before you apply. (So you're looking at more than a year between MCATs and starting medical school.) I think you should assume you'll need a minimum of three years between the time when you start taking pre-reqs and the time when you start med school.

At my institution, you would need to take the General Chem before you took Orgo, but it may be different elsewhere. Orgo has a reputation for being a weed-out class, but it actually doesn't really function that way at the institution where I work. If they've done well in the General Chemistry and Bio classes, students typically continue to do fine in Orgo.

You definitely don't need to do a formal post-bacc, and they can be expensive. I've worked with students who took classes as a non-degree student, but not through a formal program, and got in to med school. You'll probably get more guidance and hand-holding if you do the post-bacc, but I don't know if it would be enough to justify the cost.
posted by ArbitraryAndCapricious at 2:08 PM on January 31, 2019 [1 favorite]

I decided I wanted to be a doctor at 25, spent the next year working and interviewing doctors about their careers to make sure I was making the right choice, started taking pre-med classes at age 27 (the only pre-req I had from undergrad was English), was accepted to med school at 30, and started at 31. I think that so long as you talk to a bunch of physicians and get a good sense that the career is what you think it is, you should go for it.
posted by ocherdraco at 2:29 PM on January 31, 2019 [1 favorite]

And to be clear, I didn’t do a formal postbacc.
posted by ocherdraco at 2:29 PM on January 31, 2019

On whether or not you can hack the classs: you almost certainly can. My high school graduating class had 10 or 15 pre-meds in it, and 15 years later every single one of them is a practicing physician except for the one who we all thought was the “best” candidate and opted out for lifestyle reasons. Everyone else went into it with roughly the same background as you - AP Bio, Chem, and Calc - and made it through. The thing they all had in common was that they were smart enough, willing to work hard, and wanted to see it through. You sound like you would fit right in with them.
posted by asphericalcow at 4:04 PM on January 31, 2019 [1 favorite]

You have one really major good thing going for you, which is that you actually understand why you want to be a doctor. Don't underestimate how important this is.

I was a later-ish applicant to medical school (started at 28) and basically approached it as "I'll start the pre-reqs; if at any point I decide this is a bad idea, I can just stop." I kept going. I absolutely love being a doctor. I would not worry at all about being smart enough. You are plenty smart; you just have to decide if you want to deal with the grind, and it sounds like you do. (I will add that in high school I got a B in Algebra II, a C- in Precalculus, and wisely stopped at that point. I managed to get all As in my math pre-reqs for med school, demonstrating that motivation >> smarts, and have literally never used those skills again. Multiplication and fractions are about as much math as the average doc needs).

Don't bother with Coursera or Khan Academy; it will take up your time that you could be doing something else with.
I would start shadowing if you can. I don't think you need to scribe--that's a good way to get some time in a medical setting for undergrads who don't have any other exposure to what practicing medicine is actually like, but you have plenty of international experience. Although scribing may be the best way to get some time in an ED.

The MD-PhD is a good way to get school paid for but may be more time than you want to put in, especially if you want to do a longer residency or a fellowship.
posted by The Elusive Architeuthis at 8:25 PM on January 31, 2019

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