Getting straight through to med school - how likely?

Pre-Med & Medical School
45

Yes, every med school hopeful is expected to have significant close clinical exposure to patient care. At least 250 hours.

How can you possibly know that you’re temperamentally and emotionally suited to working with the sick, the critically injured, the chronically ill, the profoundly disabled, the mentally ill, the demented elderly, the dying AND their families on a daily basis unless you have spent significant time working with these types of populations?

The simple answer is: you can’t.

A clinical setting doesn’t necessarily mean a hospital. It can be a rehab hospital, a cancer center, a public health clinic, a hospice, a Planned Parenthood clinic, anywhere there is a therapeutic relationship between a patient and physician occurring.

NOTE that research subjects are NOT patients. So being involved with research project with human subjects even if the PI is a physician or the project takes place at a hospital or medical clinic is NOT clinical experience.

Should I seek if pursuing the route I specified a research component that is either involved at a hospital or has significant clinical relevancy?

MD/PhD candidates are expected to have the same clinical exposure as MD-only candidates. Physician-scientists are physicians first and scientists second. They need to demonstrate they understand the life they are signing up for.

MD applicants are expected to have ALL of the following ECs:

  1. Clinical exposure (direct patient interaction-- “close enough to smell the patient”) 250 hours in either paid or volunteer patient contact positions
  2. Non-medical community service with disadvantaged populations 250 hours. (long term participation with a single cause or organization is valued more highly than numerous short term volunteer activities)
  3. Physician shadowing --50 hours shadowing a variety of different specialties, at least some of shadowing should be with primary care physicians (family medicine, pediatrics, general internist, geriatrics)
  4. Leadership roles in your activities
  5. Lab bench or clinical research (at least a summer full time or part time a couple of semesters during the school year)

^^The above are expected for ALL MD applicants. For MD/PhD applicants, you will need all of the above PLUS

  1. Challenging upper level coursework in the subject area in which you plan to pursue your PhD studies
  2. Significant, in-depth research experience, preferably with a student driven independent project where you develop and test your own hypothesis, analyze the data and form a conclusion. The experience of writing a grant to fund your independent project is a plus, as is the experience of presenting your project before the Committee on the Use of Human Subjects. Publications deriving from your independent research are another plus.

What would a job like this look like?

It’s any job or volunteer position that brings you into direct, close contact with patients. (The key word is patients. Patients must be in a therapeutic setting under a physicians care.)

These jobs exist in many forms–a certified nursing assistant (CNA), emergency medical technician (EMT), phlebotomist, medical assistant (MA), medical scribe, patient care technician (PCT), ER tech, surgical tech, psychiatric aide. Plus many, many others.

It could be wheeling patients around a hospital to get them to tests or procedures. It could be translating for non English speaking patients in doctor’s office. It could be assisting patients with rehab activities ordered by a physician in an in-patient setting.

Hospice volunteering is highly valued by med schools.

Some of the jobs listed above do require a state certification in order to be hired/ be allowed to volunteer. (Exact requirements for certification vary by state since each state sets its own policies for licensing.)

One of my daughters volunteered as neuro-rehabilitation aide with brain injured patients. Another was a volunteer AEMT for Mountain Search & Rescue. But what type of clinical position one takes is highly individual and depends on your interest, preferences, and the access to a healthcare setting.

Can I really secure something so short a term?

It depends on what you mean by short term. Most healthcare settings require a specific minimum commitment of your time. Typically X hours weekly/monthly over a academic year. Some require a longer time commitment.

3 Likes
46

The very savvy CC med school experts (which I am not) have already weighed in… but I will add a “Layperson’s perspective” here. After watching many cycles of med school applications (both Med/PhD and just MD) and seeing the aftermath…

It’s great that OP has identified a specific area of interest. Just be aware that a successful med school applicant is someone who will become a doctor FIRST… and then- whatever the specialty, sub-specialty, area of research interest, etc. might be.

This is a slightly different take on straight up PhD program applicants- where having a very specific end game in mind is advantageous, along with a very targeted set of researchers and scholars with whom you wish to work, study under, collaborate with.

OP is going to deliver babies, insert a central line, diagnose strep, help homeless people manage their blood pressure medication, try to save heroin addicts who are in cardiac arrest, tell a family that their 58 year old mother is showing signs of early onset Alzheimer’s. That’s the foundational work (abridged for the purposes of this post) of becoming a physician in the US.

I’ve seen talented young people reeling from med school rejections when “I had it all”. And many of them did. But I suspect they came off as “orthopedic surgeon wannabees” or “curing cancer warriors” during their interviews (knowing these folks well) and no first year med student cures cancer or does knee replacement surgery.

This point was driven home for me recently- a friend who spent the first six months of Covid on a fellowship (some very esoteric and narrow subset of her field) at one of the premier teaching hospitals in NYC. She recalled the scary and inspiring speeches given almost daily by the Chief Medical Officer as well as the CEO of the hospital (remember how terrified everyone was- running out of masks, not enough medical grade gloves, is the air filtration system in the OR going to kill us?). Basic lesson- “None of you are dermatologists, oncologists, endocrinologists, cardiologists. Every single one of us is a physician, and that’s what we’re going to do. We’re going to do rounds, we’re going to diagnose and treat and heal as best we can. And when we can’t, we’re going to sit with our patients because their families can’t, and we’re going to give them the best death we can. Because that’s what we are trained to do”.

Mind you- this hospital is world renowned, attracts some of the top specialists in the world with a gazillion dollars worth of equipment and research and the bells and whistles. But with patients in tents, outside, some in a public park or convention center…suffering from a brand new and sometimes fatal disease- every doctor became a primary care physician, taking temperatures, blood pressure, monitoring vital signs.

I think it’s worth reminding the OP (and the other “I want to be a doctor” students on CC) that getting caught up in the bells and whistles early on might not be the optimal path.

5 Likes
47

I have to add one more option for the OP

@Kelvlixi_mab

You don’t need a MD or MD/PhD to do medical research. You can do it with a PhD only. There are thousands of PhDs currently doing basic lab research that will some day impact how medicine is practiced on a day-to-day level.

One of the medical research faculty D2 worked for during her AMGEN fellow summer was PhD only researcher. She was on the faculty of the med school, taught med students, residents and fellows and was involved in research using human subjects. It’s just that the human subjects weren’t HER patients. They were patients of her co-researchers who were physicians. She was able to see first hand her knowledge applied to and benefitting patients, but she did not implement that treatment protocols herself. She went on daily rounds to see patients along with the rest of the team.

She does research on optimizing treatments for gliomas so even if she were a MD/PhD neuro-oncologist she wouldn’t be implementing the treatment protocols herself since she is not a neurosurgeon nor a radiation oncologist.

Science is a team sport. There is no such thing as the lone researcher toiling alone in their lab anymore. Projects are too big to be managed & implemented by one person.

So, OP, you need to think long and hard about what path you see your future taking. There are multiple options that will get you to more or less the same place.

3 Likes
48

Since you mentioned a personally influential book, you might consider further reading.

You probably have heard of (or may have already read) Mountains Beyond Mountains (Kidder), on doctor and medical anthropologist Paul Farmer. This book connects, especially, to your interests in clinical work and disease in a socioeconomic context.

If you like anthropological, as well as philosophical, concepts and might like to explore what lies far beyond common expectation, then look into the culturally relevant books of Carlos Castaneda, such as Journey to Ixtlan.

49

I had to read this 3x before I understood what you were asking. Not trying to bash you, but I suggest that you invest time in writing a polished application. Clarity and conciseness is very important.

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