OP, I guess I'll start by saying that there's a lot of inherent privilege in being able to apply traditionally: not only do you have to know you want to study medicine, but you have to have the information and wherewithal to be able to pursue it in an intense way from your first day in college. I had enough to apply (I'd been published, and worked in a lab for ~2 years by the time I dropped out of college due to finances). I basically had to rush to find a full time job to support myself.
While all my college friends were moving forward with their lives, I was living with my parents, grinding underpaid employment, wondering if it would all end up mattering in the end. My mental health was brought the lowest it’s ever been
I ended up taking 10+ gap years, if you can really call them that—more honestly, life just got in the way. I felt like the above, taking endless underpaid roles. I think premeds are highly susceptible to a culture where they are essentially hazed and expected to "pay their dues," under the assumption that the struggle is instructive and temporary, which disproportionately affects those seeking paid clinical employment. It didn't get better over time, and for people who get stuck in the gap for a decade like I did, it can start to lose novelty and feel merciless and cruel.
After 10 years, the people you took freshman biology with get accepted to and graduate medical school, match into residencies, and are now climbing into their final PG years. They have homes, spouses, and sometimes children. The physicians I would work with went from excited advice-offering, to neutral optimism, to superficial platitude over the years as I tried desperately to bounce off different ideas about to make it back on track with them.
As much as I am not ashamed of my journey, I wouldn't recommend it either. If I had every support I needed and all it took was personal effort to make it into medical school, it would be one of the easiest things I could have ever done in my life. It just so happens that for a lot of us, it's not about taking a gap to improve our application, it's a survival necessity.
As the economic conditions in the US become more precarious and the old guard of medicine close ranks to exclude the working and middle class, I suspect the trends we're seeing in terms of average number of gap years taken prior to application (as well as the number of hours dedicated to relevant activities documenting use of those years) will continue to grow.
Medical school will become progressively more competitive, and I suspect, more as a status symbol than an economic hedge as reimbursement declines. Paradoxically, that may fix the gap year problem, since no rational human being will forgo a more comfortable lifestyle upfront to enter into half a million in debt for compensation that will not result in a reasonable standard of living after you're done.
In other words, if you have the option—if your effort is the only thing keeping you from securing your future—you should absolutely challenge yourself to do so. Your future self will thank you. It's cute to take a gap year and "find yourself" in Barcelona, but if you're poor, a gap year becomes 5 in a blink. Once you have a car loan, a roof over your head, a warm meal most days, and start trying to establish yourself on your own, it can feel borderline impossible to come back...or tolerate the sacrifices that could offer a possibility without guarantee. Believe me, I've been there.
