How are business-oriented pre-meds getting into med school?

[RareUsername]

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Clearly there is no shortage of aesthetician practices in Beverley Hills and other affluent areas headed by "physician-business(wo)men" who barely practice and manage mostly PAs/NPs. All practices must be run like businesses to stay afloat, but you have to appreciate that these practices commercialize themselves in a way that is unlike usual private practice. Holiday promotions, BOGOs, referral bonuses, etc. You get my point.

Maybe some of these are run by late-career physicians who did plenty to repay the initial altruistic expectations of their medical training. But a basic google search shows me plenty that appear to be in their late 30s/early 40s. I imagine many went into medical school with this kind of a career in mind, which is what brings me to my question:

How are aspiring "physician-business(wo)men" getting into medical school? There is not one medical school on US soil I know of that has a mission fit with "I want to run a 5 location clinic in Hollywood with 90% of the revenue stream coming from 20 minute filler appointments". Is there some feigned altruistic promise made in their application that, at the very least, repackages this idea in a more altruistic way? Are they just very high stat applicants that can forgo altruistic promises altogether?

All in jest, but I'm also genuinely curious on how aspiring "physician-business(wo)men" are viewed in the eyes of adcoms, and how these types of successful applicants typically look.

 

[eyeeye_captain]

I mean, you’re talking about people with (in theory) the ability to sell. They sell something else in their background that resonates with an adcom. It only takes one acceptance.

I’ve trained with a few docs who do mostly cash pay/upgrade stuff, including one who markets as some kind of plastic surgeon after doing a garbage aesthetics fellowship. The mask comes off in residency. They’re usually going to be lazy, bad clinicians with professionalism issues.

To try to be fair to them, there’s a market for it, and medicine is still a job. Not everybody enjoys clinical work or getting paid like a pediatric endocrinologist. It’s not inherently evil, and the successful ones are happy to wipe away the tears they cry from lack of respect with $100 bills.

Could be worse I guess. They could’ve gone to law school to do sketchy personal injury.

 

[Mr.Smile12]

Check out dentistry or vet med. 😉

 

[Obnoxious Dad]

Clearly there is no shortage of aesthetician practices in Beverley Hills and other affluent areas headed by "physician-business(wo)men" who barely practice and manage mostly PAs/NPs. All practices must be run like businesses to stay afloat, but you have to appreciate that these practices commercialize themselves in a way that is unlike usual private practice. Holiday promotions, BOGOs, referral bonuses, etc. You get my point.

Maybe some of these are run by late-career physicians who did plenty to repay the initial altruistic expectations of their medical training. But a basic google search shows me plenty that appear to be in their late 30s/early 40s. I imagine many went into medical school with this kind of a career in mind, which is what brings me to my question:

How are aspiring "physician-business(wo)men" getting into medical school? There is not one medical school on US soil I know of that has a mission fit with "I want to run a 5 location clinic in Hollywood with 90% of the revenue stream coming from 20 minute filler appointments". Is there some feigned altruistic promise made in their application that, at the very least, repackages this idea in a more altruistic way? Are they just very high stat applicants that can forgo altruistic promises altogether?

All in jest, but I'm also genuinely curious on how aspiring "physician-business(wo)men" are viewed in the eyes of adcoms, and how these types of successful applicants typically look.

They get in by prevaricating. They tell adcoms that they want to run a pediatric clinic in Harlem or West Virginia when they actually want to peddle Botox in Scarsdale.

 

[Mr.Smile12]

They pay in cash... 🙂

 

[Hollow Knight]

People lie all the time. It's a little astonishing. Our admissions process selects for the Mother Theresa types and also for sociopaths and when I was interviewing applicants I never figured out how to distinguish between the two on the front end.

But stuff like what you're describing is why adcoms care so much about social justice/social determinants of health type stuff and volunteer work. We're trying to admit doctors who actually care about the Hippocratic Oath.........

 

[Goro]

People lie all the time. It's a little astonishing. Our admissions process selects for the Mother Theresa types and also for sociopaths and when I was interviewing applicants I never figured out how to distinguish between the two on the front end.

But stuff like what you're describing is why adcoms care so much about social justice/social determinants of health type stuff and volunteer work. We're trying to admit doctors who actually care about the Hippocratic Oath.........

One of the things I look for is that they walk the walk, and not merely talk the talk.

 

[Obnoxious Dad]

People lie all the time. It's a little astonishing. Our admissions process selects for the Mother Theresa types and also for sociopaths and when I was interviewing applicants I never figured out how to distinguish between the two on the front end.

But stuff like what you're describing is why adcoms care so much about social justice/social determinants of health type stuff and volunteer work. We're trying to admit doctors who actually care about the Hippocratic Oath.........

If you can't distinguish the sociopathic applicants from the altruistic types, maybe you stop trying and instead go after the best scientists. Anybody can gin up a bunch of clinical experiences and letters of recommendation. You just need to be a phony. Look for people who went to the toughest schools and picked the toughest majors. A willingness to work hard for four years should say more than a bunch of jive in an interview.

 

[dozitgetchahi]

Clearly there is no shortage of aesthetician practices in Beverley Hills and other affluent areas headed by "physician-business(wo)men" who barely practice and manage mostly PAs/NPs. All practices must be run like businesses to stay afloat, but you have to appreciate that these practices commercialize themselves in a way that is unlike usual private practice. Holiday promotions, BOGOs, referral bonuses, etc. You get my point.

Maybe some of these are run by late-career physicians who did plenty to repay the initial altruistic expectations of their medical training. But a basic google search shows me plenty that appear to be in their late 30s/early 40s. I imagine many went into medical school with this kind of a career in mind, which is what brings me to my question:

How are aspiring "physician-business(wo)men" getting into medical school? There is not one medical school on US soil I know of that has a mission fit with "I want to run a 5 location clinic in Hollywood with 90% of the revenue stream coming from 20 minute filler appointments". Is there some feigned altruistic promise made in their application that, at the very least, repackages this idea in a more altruistic way? Are they just very high stat applicants that can forgo altruistic promises altogether?

All in jest, but I'm also genuinely curious on how aspiring "physician-business(wo)men" are viewed in the eyes of adcoms, and how these types of successful applicants typically look.

IMO, the fact of the matter is this: much of medicine doesn’t really involve altruism. (Don’t kill the messenger.)

And this isn’t necessarily a “bad” thing. When we are in college, there is this notion presented that practicing medicine requires some sort of saint-like sacrifice, and that all physicians do (or should) spend all of their time taking care of the poorest and least able. And I don’t deny that such care is a noble pursuit.

However, this doesn’t even remotely represent the reality of practicing medicine in the US. First, putting aside these “for profit” aesthetics types (they bother me too, for what it is worth), there are lots of physicians who graduate from US medical schools who don’t even directly take care of pts. They work for insurance companies, drug companies, the FDA, the USDA, state governments, health departments, think tanks. They do research at the same tertiary care institutions whose medical schools you reference. Should all of these physicians have had their medical school applications denied?

Then, let’s take into account the significant number of physicians who DO take care of pts - but who work for the DoD. Taking care of the folks in the armed forces is necessary, and IMO also noble, but it’s definitely not the sort of Mother Theresa doctoring envisioned by the adcoms.

Then we come to the “cash pay” types of physicians. There are psychiatrists who only work with pts who pay them in cash. There are DPC and concierge primary care doctors who also work only with a cash pay clientele. Then, of course, we come to the cash pay aesthetics types - some of whom don’t really have legit training, but others of whom are fully trained dermatologists, plastic surgeons, etc who again have tailored their practices to cash pay clients. As much as some people are “offended” by these types of doctors, I’m loath to decry them as being some sort of unnecessary waste in our healthcare system. We live in a free market economy. Some of these types of physicians have tailored their practice to what works for them and their families. As long as they are providing good quality care, it is what it is. Physicians have the right to choose how they live their lives and what they want to do. (After getting to the end of this process, you may be surprised how you feel about some of these things.)

Finally, we have the bulk of the doctors in the country - the ones who work for private practices and health systems. I’m going to be blunt: I seldom encounter physicians who engage in altruistic pursuits associated with medicine. I don’t currently know many (perhaps any) doctors personally who volunteer at free clinics, or go on medical missions. Most of us are frankly working so hard that we don’t have the energy to do that. We do our jobs and then hurry home to be with our families, and maybe spend a little bit of time on hobbies or other things that might help make us happy.

 

[RareUsername]

One of the things I look for is that they walk the walk, and not merely talk the talk.

As a pre-med who is among what I suspect to be some of these types of people, they often are, on paper, walking the walk. These are the types who will amass an enormous amount of hours and kiss up to administration as to get stellar LORs. Their motives and lack of interest for patient care is only really apparent to those who they deem will not have an influence on their pre-med career.

For example, there are a couple pre-meds at my volunteering that regularly post their sign-outs as being well after they've actually left the building and administration is none the wiser.

 

[RareUsername]

If you can't distinguish the sociopathic applicants from the altruistic types, maybe you stop trying and instead go after the best scientists. Anybody can gin up a bunch of clinical experiences and letters of recommendation. You just need to be a phony. Look for people who went to the toughest schools and picked the toughest majors. A willingness to work hard for four years should say more than a bunch of jive in an interview.

I think it's unfortunate that majors are so poorly accounted for in admissions. I don't think engineering majors ought to be put on a pedestal, but I wonder if adcoms are adequately informed that certain majors (at my school, nutrition and psych) are essentially "GPA farms" filled with people who are devoid of genuine interest in the subjects at hand.

 

[RareUsername]

IMO, the fact of the matter is this: much of medicine doesn’t really involve altruism. (Don’t kill the messenger.)

And this isn’t necessarily a “bad” thing. When we are in college, there is this notion presented that practicing medicine requires some sort of saint-like sacrifice, and that all physicians do (or should) spend all of their time taking care of the poorest and least able. And I don’t deny that such care is a noble pursuit.

However, this doesn’t even remotely represent the reality of practicing medicine in the US. First, putting aside these “for profit” aesthetics types (they bother me too, for what it is worth), there are lots of physicians who graduate from US medical schools who don’t even directly take care of pts. They work for insurance companies, drug companies, the FDA, the USDA, state governments, health departments, think tanks. They do research at the same tertiary care institutions whose medical schools you reference. Should all of these physicians have had their medical school applications denied?

Then, let’s take into account the significant number of physicians who DO take care of pts - but who work for the DoD. Taking care of the folks in the armed forces is necessary, and IMO also noble, but it’s definitely not the sort of Mother Theresa doctoring envisioned by the adcoms.

Then we come to the “cash pay” types of physicians. There are psychiatrists who only work with pts who pay them in cash. There are DPC and concierge primary care doctors who also work only with a cash pay clientele. Then, of course, we come to the cash pay aesthetics types - some of whom don’t really have legit training, but others of whom are fully trained dermatologists, plastic surgeons, etc who again have tailored their practices to cash pay clients. As much as some people are “offended” by these types of doctors, I’m loath to decry them as being some sort of unnecessary waste in our healthcare system. We live in a free market economy. Some of these types of physicians have tailored their practice to what works for them and their families. As long as they are providing good quality care, it is what it is. Physicians have the right to choose how they live their lives and what they want to do. (After getting to the end of this process, you may be surprised how you feel about some of these things.)

Finally, we have the bulk of the doctors in the country - the ones who work for private practices and health systems. I’m going to be blunt: I seldom encounter physicians who engage in altruistic pursuits associated with medicine. I don’t currently know many (perhaps any) doctors personally who volunteer at free clinics, or go on medical missions. Most of us are frankly working so hard that we don’t have the energy to do that. We do our jobs and then hurry home to be with our families, and maybe spend a little bit of time on hobbies or other things that might help make us happy.

On the flip side, I get the vibe that "I want to work in the FDA" doesn't bode nearly as well as "I want to open a low-cost clinic in an underserved area" in admissions. I feel there is an implicit pressure to reframe your narrative to be as altruistic as possible. If we legally bound everyone admitted to fulfill their altruistic promises, I think we'd find that certain are just not great in certain attractively altruistic positions.

I'm entirely naive, but I feel like as a society we'd WANT the type of person who envisions themselves as working in the FDA to get into medical school (provided they are qualified elsewhere). We want passionate and motivated people in those positions. By pushing a culture of disingenuity, how can we know the true intentions of those being admitted? As to admit the FDA wannabe and not the future Beverly Hills franchised dermatology clinic owner.

 

[Goro]

As a pre-med who is among what I suspect to be some of these types of people, they often are, on paper, walking the walk. These are the types who will amass an enormous amount of hours and kiss up to administration as to get stellar LORs. Their motives and lack of interest for patient care is only really apparent to those who they deem will not have an influence on their pre-med career.

For example, there are a couple pre-meds at my volunteering that regularly post their sign-outs as being well after they've actually left the building and administration is none the wiser.

And those are the type of people that one can ask questions of their experiences and see that they're lying (most times). Also, they lack passion about the experiences.

Take comfort in the fact that the median MCAT score for text takes is 500; those people rarely get into med school.

Stop worrying about everyone else. You do you instead.

 

[dozitgetchahi]

On the flip side, I get the vibe that "I want to work in the FDA" doesn't bode nearly as well as "I want to open a low-cost clinic in an underserved area" in admissions. I feel there is an implicit pressure to reframe your narrative to be as altruistic as possible. If we legally bound everyone admitted to fulfill their altruistic promises, I think we'd find that certain are just not great in certain attractively altruistic positions.

I'm entirely naive, but I feel like as a society we'd WANT the type of person who envisions themselves as working in the FDA to get into medical school (provided they are qualified elsewhere). We want passionate and motivated people in those positions. By pushing a culture of disingenuity, how can we know the true intentions of those being admitted? As to admit the FDA wannabe and not the future Beverly Hills franchised dermatology clinic owner.

I agree.

I think the medical school admissions process is a bit warped, tbh. Note that when you apply to residency, for instance, nobody cares about whether you volunteered or did some sort of medical mission or whatever. They care about step scores, 3rd year rotation grades, sub I grade, research, and LORs. That’s it.

I’m not sure that selecting for people who are willing to do a whole bunch of volunteering etc is actually going to result in better doctors coming out the other end of medical school. Like I said, most people in medical school don’t really do this stuff, and I haven’t encountered too many doctors in real life who do either.

Also, I’d like to maybe challenge the concern about these dreaded cash pay aesthetics doctors. First, they are a small minority of doctors. Second, while I agree they don’t necessarily contribute much to proper medical care for the underserved in the country, they do fill a niche and serve a purpose. My personal physician is a cash only DPC doc. He is dedicated, caring, and good at what he does. He just serves a cash only clientele.

 

[Mr.Smile12]

I think the medical school admissions process is a bit warped, tbh. Note that when you apply to residency, for instance, nobody cares about whether you volunteered or did some sort of medical mission or whatever. They care about step scores, 3rd year rotation grades, sub I grade, research, and LORs. That’s it.

I’m not sure that selecting for people who are willing to do a whole bunch of volunteering etc is actually going to result in better doctors coming out the other end of medical school. Like I said, most people in medical school don’t really do this stuff, and I haven’t encountered too many doctors in real life who do either.

We are in the season where there are a ton of webinars advising med students going into the ERAS process (like SNMA/LMSA has a slew of Q&A's set up!). While I know the most important selection data for an interview can include STEP/USMLE, rotations and MSPE comments, research, and strategic use of signals (appropriate to the specialties), the PD's eventually do care about the human side of the people they eventually will hire for at least a year or few. The volunteering is helpful to discern why someone wants to go to a specialty or a specific program on the way to realizing their vision as a physician (in the short term). Most people in medical school who don't do all that extracurricular stuff were likely told not to do it, but their mentors may have a differing opinion.

Now, I do know a fair number of doctors who do community service in their off time. That may be a factor when choosing a hospital or healthcare system that emphasizes its role as a community partner and "encourages" its physicians to do the same.

 

[dozitgetchahi]

We are in the season where there are a ton of webinars advising med students going into the ERAS process (like SNMA/LMSA has a slew of Q&A's set up!). While I know the most important selection data for an interview can include STEP/USMLE, rotations and MSPE comments, research, and strategic use of signals (appropriate to the specialties), the PD's eventually do care about the human side of the people they eventually will hire for at least a year or few. The volunteering is helpful to discern why someone wants to go to a specialty or a specific program on the way to realizing their vision as a physician (in the short term). Most people in medical school who don't do all that extracurricular stuff were likely told not to do it, but their mentors may have a differing opinion.

Now, I do know a fair number of doctors who do community service in their off time. That may be a factor when choosing a hospital or healthcare system that emphasizes its role as a community partner and "encourages" its physicians to do the same.

I have read applications and helped with interviews for a large mid tier IM program when I was a resident, and for a highly ranked/competitive rheumatology fellowship (both my programs). I can tell you that at least at these programs, community service/volunteering (I’m not talking about shadowing in clinic or doing extra off service “rotations” in the specialty, which are a different story because they demonstrate experience and interest) did not figure into the equation.

As far as physicians doing community service, some do and some don’t. I’ve done some myself. I’ve encountered plenty of physicians who don’t.

 

[Wistfulness]

All in jest, but I'm also genuinely curious on how aspiring "physician-business(wo)men" are viewed in the eyes of adcoms, and how these types of successful applicants typically look.

I can't imagine it would look great in the eyes of adcoms, so they definitely aren't saying that even if that's their true intent. Even if it were viewed in a more positive light, the people saying "I want to do cash-only boobjobs in Palo Alto" are just as likely to have a change of heart as the people who say they want to "practice rural medicine and help the underserved" and meant it.

People lie in interviews all the time, roughly 100% of the time in my experience. Wait until the DO schools find out applicants have been lying about their interest in osteopathy during interviews this whole time.

 

[Goro]

People lie in interviews all the time, roughly 100% of the time in my experience. Wait until the DO schools find out applicants have been lying about their interest in osteopathy during interviews this whole time.

We already know that some 90% of our applicants would rather have the MD and/or aren't interested in primary care which is the mission of most DO schools.

We don't take it personally. We convert them into DOs anyway, and the majority of them fulfill our mission by going into Primary Care, and they become very good physicians, which is what we also wanted.

 

[Med Ed]

There are 1 million active physicians in the US. The fact that some minuscule percentage of them do cosmetic surgery in Beverley Hills, or run med spas or whatever, isn't much of an indictment of the admissions process.

Out of curiosity, I looked at the homepage for one of the higher profile cosmetic surgeons. One of the things he touts is his service, traveling to less developed countries to do cleft lip/palate repairs.

Cash only practices, particularly primary care ones, generally aren't doing it for the money. They are seeking the administrative simplicity and practice freedom of working outside the third party payer (insurance) system.

Admissions are competitive, and therefore an arms race, but the basic contours of how to build a competitive application are not a mystery. The process selects for people who are academically strong and generally decent human beings. The residency selection process does not need to reapply the exact same criteria. From what I can see, the large majority of graduates are out there working 50+ hours a week to see patients and deliver necessary care. So perhaps the system isn't doing too badly.

 

[Hollow Knight]

If you can't distinguish the sociopathic applicants from the altruistic types, maybe you stop trying and instead go after the best scientists. Anybody can gin up a bunch of clinical experiences and letters of recommendation. You just need to be a phony. Look for people who went to the toughest schools and picked the toughest majors. A willingness to work hard for four years should say more than a bunch of jive in an interview.

Totally get what you’re saying but I think being a doctor is fundamentally different than being a scientist. Kind of in the same way that being a lawyer is different than a poet.

I think the fuzzy-spiritual stuff matters a lot to medical care. I Just don’t know how to measure it.

Especially in the age of Up To Date and AI. Remembering lots of stuff isn’t really the game anymore.

Plus almost all the people I’ve trained with who had the backgrounds you described just wound up trying to do derm or plastics in Miami. Which is fine, but not really what our patients need. We need people who want to be family doctors and pediatricians, general surgeons, etc. everybody seems to want to be an -ologist and make 7 figures a year, and that’s not going to move the needle on our country’s health outcomes.

to your point though, maybe it’s impossible to measure what I’m trying to measure and we just need to take the e smartest people and hope they decide to do good.

 

[polymerization]

If you can't distinguish the sociopathic applicants from the altruistic types, maybe you stop trying and instead go after the best scientists. Anybody can gin up a bunch of clinical experiences and letters of recommendation. You just need to be a phony. Look for people who went to the toughest schools and picked the toughest majors. A willingness to work hard for four years should say more than a bunch of jive in an interview.

I have observed, in the last several years, that there are many pre-meds out there that secure "research" with their parents or parents' friends, who then lean back wearily on an office chair and do nothing while getting their names listed on every publication that comes out of the lab.

Similarly, I've met many a student in clinic who were the attending's kid and who would come in to "work" before any patients actually showed up. "Work" that primarily included pouring themselves coffee and reading before going to class and disappearing for the day despite being on the schedule and leaving the rest of us to accommodate double the work understaffed. Nobody bats an eye... every physician in the group lauds them for how studious they are. "Of course they should not be bothered" with clinic work. The letter of recommendation is coming anyway, and the hour count (measured with their heart) will be favorable regardless.

Obviously I can't say whether they were dishonest on their application, but I can guess by their confidence. The definition of phony... and even that would be the understatement of the century for some folks.

Let me know if you can think of some fair mode of assessment that cannot be gamed by the wealthy and well-connected. We have plenty of data that shows GPA and MCAT track household income. You can see how individual activities can be gamed, including volunteering.

Anything medical schools say they want, the wealthy will learn to game in an attempt to exploit the admissions process. I don't think the system is perfect, or that it even works particularly well, but I have spent a lot of time and effort thinking about how it could be better while still remaining fair and am coming up short.

I keep coming back here hoping someone smarter than me will usher in some new evolution of admissions that does not inevitably result in the vast majority of matriculants belonging to the top quintile of household incomes in a way nobody finds problematic or blatantly exclusionary.

 

[Obnoxious Dad]

I have observed, in the last several years, that there are many pre-meds out there that secure "research" with their parents or parents' friends, who then lean back wearily on an office chair and do nothing while getting their names listed on every publication that comes out of the lab.

Similarly, I've met many a student in clinic who were the attending's kid and who would come in to "work" before any patients actually showed up. "Work" that primarily included pouring themselves coffee and reading before going to class and disappearing for the day despite being on the schedule and leaving the rest of us to accommodate double the work understaffed. Nobody bats an eye... every physician in the group lauds them for how studious they are. "Of course they should not be bothered" with clinic work. The letter of recommendation is coming anyway, and the hour count (measured with their heart) will be favorable regardless.

Obviously I can't say whether they were dishonest on their application, but I can guess by their confidence. The definition of phony... and even that would be the understatement of the century for some folks.

Let me know if you can think of some fair mode of assessment that cannot be gamed by the wealthy and well-connected. We have plenty of data that shows GPA and MCAT track household income. You can see how individual activities can be gamed, including volunteering.

Anything medical schools say they want, the wealthy will learn to game in an attempt to exploit the admissions process. I don't think the system is perfect, or that it even works particularly well, but I have spent a lot of time and effort thinking about how it could be better while still remaining fair and am coming up short.

I keep coming back here hoping someone smarter than me will usher in some new evolution of admissions that does not inevitably result in the vast majority of matriculants belonging to the top quintile of household incomes in a way nobody finds problematic or blatantly exclusionary.

Thanks for proving my point.

It's not the role of medical school admissions offices to equalize income and wealth. All of the money, time and effort that's spent trying to sift out the people who will peddle Botox, should be spent normalizing transcripts to account for the varying rigor of colleges and majors. This is something that the AAMC should do. Grade inflation and admissions data are available. Medical schools should accept the applicants who took on challenges and did the work.

Frankly, when I see a physician, I want the best answer. I don't care about his/her motives or bedside manner. You need to find smart people who can make life and death decisions under time constraints. I went to law school with a fellow who started having low back pain and no physician, PT, chiropractor etc. could figure out the cause of his agony. He went to the barbershop to get a haircut and picked up a copy of Penthouse Magazine which featured, among other things, a story about testicular cancer. Based on that article my friend diagnosed his own testicular cancer, but it was too late. He died a year later, and his widow never had children.

In my own case I had an issue that could have killed me. I had an appointment with an NP and then I went to urgent care. No answer! I then saw a family practice doc who had the bedside manner of a transmission mechanic. He figured it out. That's what I want.

 

[Mr.Smile12]

It's not the role of medical school admissions offices to equalize income and wealth. All of the money, time and effort that's spent trying to sift out the people who will peddle Botox, should be spent normalizing transcripts to account for the varying rigor of colleges and majors. This is something that the AAMC should do. Grade inflation and admissions data are available. Medical schools should accept the applicants who took on challenges and did the work.

Well, AAMC is only beginning to influence outside of the medical school education pipeline.

Client Challenge

They aren't going to tackle equity; that's not their mission or their constituency. Ostensibly, the NMA is keeping the discussion active because of their mission and constituency.

As it stands, we have more tools with Casper/PREview to identify applicants who at least understand proper "professional"/mature behavior or decision-making. However, no one is going to use income bracket as an admissions factor; those who have more money will not stand for it. That's how we got to the current anti-DEI policies throughout all of higher education.

 

[Med Ed]

I went to law school with a fellow who started having low back pain and no physician, PT, chiropractor etc. could figure out the cause of his agony. He went to the barbershop to get a haircut and picked up a copy of Penthouse Magazine which featured, among other things, a story about testicular cancer. Based on that article my friend diagnosed his own testicular cancer, but it was too late. He died a year later, and his widow never had children.

Interesting story. Did he have a palpable testicular mass that he never mentioned or was not discovered on physical exam? Did he have an undescended testicle? Did he have any imaging studies (e.g., MRI) done on his lower back?

 

[polymerization]

Thanks for proving my point.

It's not the role of medical school admissions offices to equalize income and wealth. All of the money, time and effort that's spent trying to sift out the people who will peddle Botox, should be spent normalizing transcripts to account for the varying rigor of colleges and majors. This is something that the AAMC should do. Grade inflation and admissions data are available. Medical schools should accept the applicants who took on challenges and did the work.

Frankly, when I see a physician, I want the best answer. I don't care about his/her motives or bedside manner. You need to smart find people who can make life and death decisions under time constraints. I went to law school with a fellow who started having low back pain and no physician, PT, chiropractor etc. could figure out the cause of his agony. He went to the barbershop to get a haircut and picked up a copy of Penthouse Magazine which featured, among other things, a story about testicular cancer. Based on that article my friend diagnosed his own testicular cancer, but it was too late. He died a year later, and his widow never had children.

In my own case I had an issue that could have killed me. I had an appointment with an NP and then I went to urgent care. No answer! I then saw a family practice doc who had the bedside manner of a transmission mechanic. He figured it out. That's what I want.

They already do that. That is one part of holistic review.

There is more than one way to evaluate an applicant for a career that is about more than just passing a standardized test or getting an A in organic chemistry. I am not sure what your anecdote has to do with anything other than indicating your preference for a physician lacking bedside manner (which does not itself prove they are somehow more capable than a physician who does, and has nothing to do with the policies and protocols you are arguing against).

We live in the US, where we are protected from discrimination on the basis of a number of immutable characteristics. Even if you're not buying in to the moral argument, it is hard to reconcile the demographics against administrative fairness when the numbers look the way they do and discrimination has historically been de facto in the modern era, not de jure.

What is most ironic and paradoxical is that a lot of the anti-DEI rhetoric only points to a system of admissions that actually facilitates entry for those already structurally poised to enter (not because they are the "best," according to you, but simply because they have institutional help) and then casts moral doubt on minorities for not already being inside. Worse, even when they do overcome and show themselves to be worthy of selection by any metric you may want to prioritize, the goalposts are immediately moved to essentially chalk up to "Well, medical school admissions is too rigorous and broad! Let's get rid of anything that <my group> doesn't already have in spades," whether it creates the "best" physicians or not.

 

[Obnoxious Dad]

Interesting story. Did he have a palpable testicular mass that he never mentioned or was not discovered on physical exam? Did he have an undescended testicle? Did he have any imaging studies (e.g., MRI) done on his lower back?

I don't know how his diagnosis was confirmed.

 

[Obnoxious Dad]

They already do that. That is one part of holistic review.

There is more than one way to evaluate an applicant for a career that is about more than just passing a standardized test or getting an A in organic chemistry. I am not sure what your anecdote has to do with anything other than indicating your preference for a physician lacking bedside manner (which does not itself prove they are somehow more capable than a physician who does, and has nothing to do with the policies and protocols you are arguing against).

We live in the US, where we are protected from discrimination on the basis of a number of immutable characteristics. Even if you're not buying in to the moral argument, it is hard to reconcile the demographics against administrative fairness when the numbers look the way they do and discrimination has historically been de facto in the modern era, not de jure.

What is most ironic and paradoxical is that a lot of the anti-DEI rhetoric only points to a system of admissions that actually facilitates entry for those already structurally poised to enter (not because they are the "best," according to you, but simply because they have institutional help) and then casts moral doubt on minorities for not already being inside. Worse, even when they do overcome and show themselves to be worthy of selection by any metric you may want to prioritize, the goalposts are immediately moved to essentially chalk up to "Well, medical school admissions is too rigorous and broad! Let's get rid of anything that <my group> doesn't already have in spades," whether it creates the "best" physicians or not.

What do they do? If you are claiming that medical school admissions offices generally normalize transcripts to account for varying undergraduate rigor, I would beg to differ. Show me the data, please. I asked one admissions officer how her institution, a state flagship university medical school, normalized transcripts. She asked me how they might do that. She was clueless.

The current process doesn't level the playing field. Physicians often steer their kids away from rigorous colleges and majors because they know how the system is gamed. I encountered a pair of anesthesiologists who sent their kid out of state to a college with an average ACT score of 23 so the kid could academically curb stomp her classmates. The kid got accepted to medical school. I also know of a hospital in Michigan whose physicians routinely tell their kids that a particular rigorous private college in Michigan is off limits if the kid wants to get in the family business. How does anyone know if personal statements are ghost written?

The literature in industrial psychology and management makes the current medical school admissions process look silly. The process is unsystematic, vague, and laughably subjective. Furthermore, it rewards insincerity.

 

[polymerization]

What do they do? If you are claiming that medical school admissions offices generally normalize transcripts to account for varying undergraduate rigor, I would beg to differ. Show me the data, please. I asked one admissions officer how her institution, a state flagship university medical school, normalized transcripts. She asked me how they might do that. She was clueless.

The current process doesn't level the playing field. Physicians often steer their kids away from rigorous colleges and majors because they know how the system is gamed. I encountered a pair of anesthesiologists who sent their kid out of state to a college with an average ACT score of 23 so the kid could academically curb stomp her classmates. The kid got accepted to medical school. I also know of a hospital in Michigan whose physicians routinely tell their kids that a particular rigorous private college in Michigan is off limits if the kid wants to get in the family business. How does anyone know if personal statements are ghost written?

The literature in industrial psychology and management makes the current medical school admissions process look silly. The process is unsystematic, vague, and laughably subjective. Furthermore, it rewards insincerity.

Au contraire, if you are claiming that medical schools do not make academic comparisons across institutional pools, I would want data to suggest that, too.

You might also want to take a look at the Matthew (and related) effect(s). While I won't debate your personal experience, it is a ubiquitous stereotype that physician parents create physician children, at least at a rate so widely divergent from the general population that it is statistically significant.

Further, the physician role is not only one subject to biomedical science. You cannot assess someone for medical aptitude relevant to physician performance without actually getting a representative sample in the door, so in many ways, the professional closure across immutable characteristics is itself one of the reasons data does not exist. Folks from more humble backgrounds are just not given a fighting chance and are lost to attrition way before applying.

Personally, given the history of medical education in the US, I prefer what we have now, as challenging as it is, to the admissions process of yesteryear in which only rich White men can apply as a matter of explicit policy.

Since then, it has never been fair... but is really easy to point at some other period of time during which the argument was not on the table for historical reasons of discrimination that medicine consistently claims it has overcome. Obviously not.

I argue we are actually facing a period of regression, one that is deeply disturbing given how easily the slow instruments sloped toward fairness have been dismantled. We're going to go back 50 years, easily, and whatever is left is going to impact generations to come.

So it goes.

 

[Med Ed]

It’s truly an amazing system that manages to make everyone unhappy.

 

[Obnoxious Dad]

Au contraire, if you are claiming that medical schools do not make academic comparisons across institutional pools, I would want data to suggest that, too.

You might also want to take a look at the Matthew (and related) effect(s). While I won't debate your personal experience, it is a ubiquitous stereotype that physician parents create physician children, at least at a rate so widely divergent from the general population that it is statistically significant.

Further, the physician role is not only one subject to biomedical science. You cannot assess someone for medical aptitude relevant to physician performance without actually getting a representative sample in the door, so in many ways, the professional closure across immutable characteristics is itself one of the reasons data does not exist. Folks from more humble backgrounds are just not given a fighting chance and are lost to attrition way before applying.

Personally, given the history of medical education in the US, I prefer what we have now, as challenging as it is, to the admissions process of yesteryear in which only rich White men can apply as a matter of explicit policy.

Since then, it has never been fair... but is really easy to point at some other period of time during which the argument was not on the table for historical reasons of discrimination that medicine consistently claims it has overcome. Obviously not.

I argue we are actually facing a period of regression, one that is deeply disturbing given how easily the slow instruments sloped toward fairness have been dismantled. We're going to go back 50 years, easily, and whatever is left is going to impact generations to come.

So it goes.

Could you give us just a little more hyperbole? I graduated from high school almost 60 years ago with two guys, from very humble backgrounds, that became physicians. They had no connections. Both of them lost their fathers before age 15. They just worked like crazy and made it happen. One guy just retired at 75 as a full professor in cardiology at a top 20 med school. I have another friend, whose parents were factory workers in upstate New York, who just retired as a private practice plastic surgeon.

 

[polymerization]

Could you give us just a little more hyperbole? I graduated from high school almost 60 years ago with two guys, from very humble backgrounds, that became physicians. They had no connections. Both of them lost their fathers before age 15. They just worked like crazy and made it happen. One guy just retired at 75 as a full professor in cardiology at a top 20 med school. I have another friend, whose parents were factory workers in upstate New York, who just retired as a private practice plastic surgeon.

Easy. It's 2026. Admissions have changed a lot in the last 10 years. Needless to say it is not exactly the same game it was in the 50s.

Personally, I worked in patient-facing medicine for more than 10 years, engaged in research at NASA and published (and it was not even my only research experience) for a combined ~3-4 years, and served a term on state government writing healthcare policy. I had an A average GPA. First generation in college (really, first generation receiving any formal education at all).

I am at a T20 and people will still call me a diversity hire just because my school engaged in the same holistic review process all other schools employ and I happen to be a minority that predictably struggled. I am grateful for my past because it made me who I am, but I don't think it was necessary for me to go through what I did in order to get into medical school. There were people I met along the way that came up on the impressive experiences they needed because they received help unavailable to me.

I do not think, if we are really prioritizing the "best," that the traditional student who has just taken the classes and had some exposure to research necessarily compensates for my experiences in ~7 clinical specialties over those 10 years.

But you would probably deny that extending the preparation phase for medicine by 10 years is an ideal scenario, or at least I would hope so.

So if your point is simply that poor people can make it, the answer is yes, for now. I am an example. But look what I had to do to get there. I doubt anyone would want to match my experiences to get in, at least not willingly.

By comparison, 50 years ago, getting research at all was as close to a guarantee of admission as it gets.

 

[Goro]

It’s truly an amazing system that manages to make everyone unhappy.

That means it's working!

 

[Mr.Smile12]

I should also point out our other subforum

Med Business [ MD/MBA, DO/MBA, DDS/MBA ]

Community for students in combined MD/MBA, DO/MBA, and DDS/MBA programs. Discuss dual-degree admissions, coursework, and healthcare business careers.

forums.studentdoctor.net