Medical A Medical School Admissions Expert’s Guide to Postbacs and Med Schools [Episode 376]

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Podcast interview with Dr. Barry Rothman.jpg
Could a postbac program boost your chances of acceptance to medical school?[Show summary]
Dr. Barry Rothman, an Accepted consultant with 19 years of experience in health professions advising, shares his expert guidance for applicants considering postbac programs and medical school.

Learn how this admissions cycle will differ from other cycles, and how you can best position yourself for success. [Show notes]
Dr. Barry Rothman is a former health professions advisor and Director of San Francisco State University’s pre-health professions certificate program, which served pre-med, pre-dental, pre-nursing, and other pre-healthcare students who were preparing themselves to apply to their graduate professional schools. Today, he helps Accepted’s clients in all aspects of the application process to graduate healthcare programs and graduate schools in the life sciences.

How did you get involved in pre-health advising at San Francisco State University? [2:22]
I was being a good tenure-track faculty member, and I was given the opportunity to be the health professions advisor because the previous one had retired. I had no idea what I was getting into. I thought, “Oh sure, it’ll be an interesting sideline.” Little did I know that I would fall in love with it. Within a few years, I would be working with many health profession students and pre-health profession students, and that they would want more service than our school was offering, especially the ones that were postbac. With their support and help and with the support and help of my dean, we created, from nothing, a postbac program that’s been highly successful the last 14 years.

Most of the applicants were premeds. Then when it was successful, I realized that it could expand into other areas. We expanded into a dental postbac program, in collaboration with UC San Francisco’s School of Dentistry. We expanded into a nursing postbac program, which was also very successful and very unusual. There are very few nursing, dedicated postbac programs.

In your opinion, who should consider a postbac program? [3:52]
There are two major types of postbacs. One is called a career changer. Some people really don’t figure out what they want to do, career-wise, until partway through, or maybe even all the way through undergraduate school. There’s a certain kind for career changers that will take them through all the medical school prerequisites and hopefully a few upper-division electives. They basically need all the coursework, or almost all the courses, that medical schools require. There’s another kind of career changer, which is somebody who actually completed their undergraduate degree, went out into the workforce, and then got the epiphany that they wanted to go into a health profession. Interestingly, many of them are children of physicians. If you’re a child of a physician or a healthcare provider, you want to make sure you’re making this choice on your own, not because mom or dad is in healthcare. Sometimes, you have to really convince yourself of that, by becoming an art history major or a political science major or a public health major, going out into the workforce, and then realizing that, “You know, inside of myself, I really do want to do this and I’ve certainly been exposed to it, but it’s not just because of mom or dad.”

I think it’s very valid. I think it’s really good to make sure it’s your decision and not just because you’re being influenced. And of course, you have a tremendous advantage because you’ve seen what the home life is of a physician or a healthcare worker, the good and the bad of it. You’ve probably worked in the office during a summer or something like that, and so you really are well-informed; you just needed to make sure it was your own decision. Those are the career changers.

Then the vast majority of people who show up for postbac programs are what we call academic enhancers. Those are people who knew for quite a while that they wanted to go through a health profession school, and they usually majored in biology; that’s the most popular major and it overlaps the most with the medical school requirements. They just didn’t perform as well as they wanted to perform. This is very common, and there’s really a huge number of academic enhancers out there. In the postbac program that I ran, a vast majority of our applications were from academic enhancers, and that’s very legitimate. Undergraduate school can be a conveyor belt of sorts, where you get on as a freshman, get off as a senior or super senior, and it takes a while to figure out what you want to do and to get it together academically.

I know when I look back to my college career, I wasn’t stellar during my freshman and sophomore years, and it took me time to mature and get used to being away from my parents. I think that’s true with a lot of students. They’re concerned about their academic record and also, many of them are concerned about having enough clinical experience. They’re also concerned about whether they know enough to take the MCAT. I think postbac programs provide a place where you can hang out with other pre-health students who are equally motivated. If the program is structured well, it’s not going to be super competitive. It will be super supportive, and it will be a chance to really get to know what you want to get into, and to enhance your academic credentials, and to mature scientifically, and just emotionally, and be ready to apply. I think that health profession schools love this. They do really well with postbacs.

I think postbacs are often exemplary members of their incoming class. They’re of course, somewhat older but more mature. Postbacs can provide some parental function within their medical school class or their health profession class, because they are older and have more life experience. They’re also very motivated. I’m teaching a class now with 10 postbacs. They’re super motivated. I can’t give them enough work. It’s very different than, say, teaching an undergraduate class, which is also extremely satisfying, but it’s just a different population with a different level of maturity.

You’ve outlined the different kinds of postbac programs. There’s also formal and informal. Do you want to touch on that? [8:52]
What I’ve been talking about so far, I would call structured postbac programs. Formal postbac programs. They have the advantage of having somebody looking over the program, and they at times have classes that are strictly for the postbacs. In our program, our classes were dedicated to the postdocs; they did not have undergrads in them. That can be a great advantage.

There can be quite a lot of advising. The medical school and health profession school application process is daunting. It is so complicated. It’s like building a nuclear sub something, there’s so many moving parts. When I look back on how much information you need to have to navigate this, it’s really quite a lot to take on. You can get a lot of really expert advising in a structured postbac program, and you can get a lot from your peers. That’s great, but they tend to be a little pricey. Our program at San Francisco State costs $600 a unit. If you take 30, 40, 50 units, you’re talking $30,000 or something. They’re pricey, and some of them have financial aid, and the ones that have graduate status have access to financial aid above and beyond your undergraduate financial aid, and so that is an advantage. Graduate loans, federal graduate loans, come out of a different pot of money than your undergraduate. If you had a lot of undergraduate loans and you used up the amount that you can get as a federal loan, going to a graduate postbac program will open up a whole new pot of money. The problem with these federal loans is that they have very high interest rates, seven and eight percent, in a time where interest rates are almost zero. That’s the disadvantage there.

The advantage of an informal program is that it’s extremely flexible. You pick the school, you pick the classes, and you just go as you need. The tuition tends to be lower, but there’s nobody to hold your hand. Many pre-health students are taking classes this way, so you can find some colleagues who are in the same boat that you are, but it’s totally unstructured. One of the things that I’ve offered to a lot of my clients is to be their advisor in an informal program, somebody to hold their hand and say, “No don’t take that class, take this class. No, don’t take a class over at that school, take it at this school.”

Whatever you do in an informal program, do not take it at a community college if you’re going to medical or dental school. They really like four-year universities. Now if you’re going to nursing school or a PA school, it’s fine to take classes in a community college. For medical and dental schools and pharmacy schools, it’s really much better to take them at a four-year university. Extension programs work too, as long as it’s associated with a four-year university. Out here in California, we have UC Berkeley extension, UCLA extension; those are both quite good extensions. Many universities have extensions; even San Francisco State has a good extension. That’s the way to go. It definitely saves money and it’s super flexible. You decide when you’re going to take a class and which school, and how many each semester or quarter, etc.

I think that you really need advising, and advising hours don’t cost that much money. If you pay $330 for an hour of advising, that would go a long way. You don’t need to have a long, endless conversation. Sometimes it’s just an email saying, “Here are the three classes I’m thinking about. Which two do you think I should take?” That’s a five-minute email.

Are there any other factors students should consider when choosing a postbac? [13:18]
I just looked on AMCAS’s website recently. They have a postbac website, by the way. It’s really worth looking at because you can filter according to many different criteria. There’s now hundreds of postbac programs. They’ve grown as an industry. There are many to choose from. I would say, most of them are competently run, but just because they are not listed on AMCAS, it doesn’t mean they’re not good. Conversely, just because they’re listed on AMCAS, doesn’t mean they’re good. You really need to look into them and see what kind of leadership there is, see what people are saying on studentdoctor.net, which is somewhat gossipy, but try to find out from word of mouth and from other people on the internet what people think about the program.

Feel free to ask the directors. Many of the directors are actually quite available and willing to talk to you. Another thing to look for is, do they have a linkage program with a health profession school, like a medical school? What’s their success rate at the school you’re preparing for? Many postbac programs have very high success rates because they’re already selecting for people who are highly motivated and think they have a chance to get in. Our success rate was 80% all around. It’s twice the national average of getting into medical school.

We are in the middle of the 2020-21 medical application cycle. MCAT has started processing applications. How do you think med schools are going to respond to the fact that many applicants couldn’t take the MCAT due to COVID-19? [15:59]
It’s really unknown. We don’t know what med schools are going to do. My best guess is, each school will have a different way to deal with this. It really raises the level of uncertainty. It could be to your advantage. Let’s say you have an okay but not stellar MCAT score. Maybe some of the schools aren’t going to even look at them. Stanford is not. If you’ve got everything locked up and you really have a great research record and you have a great clinical record, these are things that Stanford looks for. If you’re not so happy with your MCAT, apply to Stanford and see what happens.

Do they really ignore your MCAT? If you take it, it gets reported. Some schools will just ignore the MCAT, and some schools might be very forgiving of lack of certain kinds of clinical experience because of COVID-19. Some schools might be forgiving of pass/no pass versus a letter grade, if your school forces you to do it. At SF State, we did not force our students to do it. We just made it an option. Our students knew quite well it was to their advantage to get a letter grade and not a pass/no pass. I think it’s a very uncertain scenario, in terms of the application process. I think it’s worth applying. I think in some cases, your chances are better. It’s worth going for it.

WATCH: Med School Admissions, The MCAT, & COVID-19 >>

In terms of what you’re going to find as a medical student, that’s also going to be really up in the air. As our country goes through its ups and downs of spikes in COVID-19 infection and then easing up, and then spikes, all of it depends on social behavior. We need doctors. We really need doctors. No medical school is going to shut down. They need to get people in there, and they’re going to be clever about how they give them clinical experience. My guess is, they’re going to have to have some in-person clinical experience, and it’s going to have to be with some very careful personal protection, maybe very good ventilation, and positive pressure rooms, all sorts of stuff that will lower the chance of getting infected. There’s risks involved when you have contact with so many people who are ill and maybe a lot who have COVID. Your chances of getting COVID go up. Lots of healthcare professionals have gotten COVID. I guess if you’re thinking about going into med school, you should also think, “Well, am I willing to accept those risks?”

We need doctors. We really need doctors. We need healthcare professionals. We need nurses. We need PAs. We need them all, even more.

What do you recommend applicants do if they can’t do the community service or the clinical volunteer work that they had planned to do, prior to March? [21:43]
Some places are letting people work. You might be considered essential personnel if you’re a scribe or you’re helping the medical system, etc. Again, you’re having risks because you’re being exposed to the patient population. I think there will be some available positions. There’s also being clever about using the online capabilities. There are online scribing services. No personal infection risk there.

Also, think about clever things you can do that are part of helping people. There’s a lot of lonely people who are shut in, who are all by themselves during this pandemic. They need young people to talk to. Maybe you could go grocery shopping for somebody. One of my clients set up a whole website that dealt with people in her community, who were suffering from COVID, and provided services for them. I think you’re limited by your imagination. There’s a lot of clever things you can do. Schools are asking, “What did you do during the COVID pandemic?” You don’t want to say, “I got a lot of television in. Got a lot of sleep in. My Netflix, I used it well.” You don’t want to say that. You really want to think about ways you can use your time and energies and your skills to help other people. With COVID, we’re all in this together, and in many ways, it’s pulling people together who never really worked together. That’s a silver lining to this terrible cloud. I think that’s the way to go.

You mentioned that in some respects, you think the 2020-2021 application cycle is actually a good time to apply. Why do you say that? [24:01]
There’s so much uncertainty. Who knows what’s going to happen? Again, as long as you’re not risk averse, go for it. See what happens. If you have an application that maybe has some glitches in it, this may be a chance to have them overlooked. That’s why I think it’s really a good opportunity. It wouldn’t surprise me at all if applications are down.

We’ve been focusing very much on MD programs, but what about MD-PhD programs? [25:44]
The research component to the MD-PhD adds complexity to the application. MD/PhD programs really want you to be competent in research. If I were an MD/PhD program, I would not accept somebody who hasn’t proven themselves in the research world. That means working in the lab. If your lab shut down, then it’s hard to work in a lab. That can be a problem.

I think with MD/PhD applications, you really need to have good documentation of your research. Of course what really works is to have publications. By publications, I mean journal articles and peer review journals; that’s great. Book chapters, that’s great. Even a poster at a national meeting or a local meeting can help. The more you can document your research capability and the better you write it up in your MD/PhD application – which has quite a robust research essay, up to 10,000 characters – the better. You should be able to show that you know what you’re talking about, that you weren’t just a pair of hands in the lab, but that you actually brought your brain along with you and that you know what’s going on. You understand the problem, you understand why it’s important, and you can talk about it in a way that shows that you have a grasp of it. If you’re not there, then I would not apply this cycle. I would wait and try to get more experience.

We’re in the heart of secondary season. What’s your advice to applicants in terms of responding to secondary applications? [30:58]
You really have to be organized. Oh god, you have to be organized. One thing I do for my clients is, I have a spreadsheet that I created that has the 15 or 16 most common topics in secondaries. 16 rows of topics, and then columns for each school you’re applying to. In those cells, you can put the size of the essay: 500 words, 250 characters, one page, or not specified. You can track all of your different essays.

What happens is, they start to get repetitive. I guarantee you that every school will ask you about diversity. Think about how you will respond to that. There’s going to be a lot of topics that are common among the different secondaries. It would be really good to track that and try to remember, “Oh yeah, what school asked me this question? Oh, I can go to my spreadsheet and see which one. Then maybe I can use that answer for a foundation for the next answer.”

The other thing to track is the due dates. You can move the columns around so that they’re in order of due date so that you stay on track.

I recommend 40 secondaries, 40 medical MD schools. (If you’re applying DO, there are not 40 DO schools; there are maybe 15 or 20 DO schools.) I recommend that because, in some ways, it’s a numbers game. The more schools you apply to, the more of a chance you’re going to get interviews. That’s what you’re aiming for. That’s the strategy. The more interviews you get, the more chance you have of admissions.

It’s just so difficult to get into a medical school. If you think about it, most schools get 5000 applications. I can’t imagine how to handle 5000 applications. My postbac program had less than 1000 a year, and we were overwhelmed. 5000? I can’t imagine that they sit and read every one of them. Some of them are going to get filtered out, and they may lose people who are really good. Some of them they send to students, medical students, who might pick through them and find some gems. They just don’t know.

You really increase your odds of getting an interview by applying to a lot of schools. You just don’t know which school will be the magic school that says, “Oh yeah, you’re the guy that went to Amsterdam and fixed some social service. My aunt lives in Amsterdam, so I’m interested.” You just don’t know what’s going to make you attractive to that school. That’s why you just have to play the long game, so to speak, and apply to a large number of schools.

Secondaries are going to be just a huge burden with 40 schools. It’s going to take over your life. You need to have a balanced life, and you need to explain to your friends why you’re getting a little wacky during this period. You need to methodically go through it. The good thing is that because there’s a lot of overlap among those secondary questions, you can use earlier essays to help you with the later ones. We help our clients a lot with secondaries. We’re really good at it. After we’ve helped with maybe five schools or so, a lot of our clients can move on and do most of the work themselves and just ask us to proofread.

Do you recommend that clients start with a longer essay and then cut it for shorter, similar questions, or go the other way? [35:14]
I think it really depends on your style. I would do the shorter ones first, but maybe somebody else would like to do the longer ones first. The advantage of that is it’s easier to edit down than edit up. If you have a longer essay, you can cut it down for the shorter ones. The first one is the hardest. The other thing is, you can look up the secondaries from previous cycles, or some of them from this cycle, and you can get going on them before you get them.

Let’s move on to interview prep. What are some of your top tips in terms of getting ready for an interview? [36:48]
Practice, practice, practice. Few of us are born with an interview gene and are good at this. I got good at interviewing and talking because I had to teach for 30 years. Teaching is a great way to practice interviewing. For most people, you really don’t have a lot of experience with interviews. You really need to practice. That means sitting down with somebody who knows how to help you and practice first, standard interviews. Sit down, one on one or one on two, something like that, and go through many of the standard questions. Why do you want to be a physician? What are your good and bad qualities? What’s an obstacle you’ve had to overcome?

These are very standard interview questions. A lot of people really stumble over them if they haven’t thought about it. Can you imagine someone asking the question, “Why do you want to be a physician?” and someone saying, “Oh, that’s a good idea. Let me think about that”? You want to be prepared. Also, you don’t want to be over rehearsed, you don’t want to sound robotic. You have to find a way that each time you answer the question, it’s a little different. What I suggest is having a list of what I call “bullet points” in your mind that you pick from in terms of answering questions. Practice, practice, practice, and that’s just for the standard interview.

For MMIs, multiple mini interviews, you really need to practice some of the scenarios. In our postbac program when I was running it, we had a colloquium in which we practiced MMIs. I have to say, it was entertaining. We had fun doing it, and our students really gained from being asked really bizarre questions and having interesting scenarios that are similar to what happens in MMIs. You really need to spend a lot of time on this.

It’s a shame if people don’t do well after going through this very expensive process and not prepare well for interviews. A lot of people crash and burn at the interview stage. It’s not the time to be a rugged individual; it’s time to really make sure you’ve got a support system and people who are knowledgeable, who can help you with interviews. And now interviews are through MCAT’s VITA program, which I guess is like Zoom. You can practice on Zoom.

CASPers are also very popular these days. CASPer is an online MMI where you’re given scenarios and you have to type in the answers as to what you would do. Again, it’s good to do practice and not just assume, “Oh yeah, I know this stuff. No problem.”

Any last words of advice? [40:18]
Do not rush this process. Most of you are young and you have time that you can spend on it, to really get it down. Do not rush this process. That’s one big thing. The other is to lead a balanced life. You’re not going to do yourself any good if you’re just going nuts and having panic attacks in the middle of doing this. It’s much better to find ways that you can do things in a balanced way, because that’s the career you’re entering and you want to be balanced in that or it’s really going to affect your health.

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