What should I do?

[rdk322]

**I don't mean to come off as rude or ignorant or even start a flamed discussion, but I need some genuine input in my decision making process. I change my mind every day and it's driving me nuts!! AHH

My background:
- I'm 21 years old, a senior year in college at a top Canadian university (Canadian citizen).
- cGPA 3.92, sGPA ~3.9
- MCAT (2012: 30R: PS/VR/BS/W: 11/8/11/R & 2013: 28: PS/VR/BS: 10/7/11).
- average to decent EC's (research experience for 3 summers, 1 publication in an undergrad journal, 1 PubMed publication, 70h ward volunteering, 200h of volunteer musicians at hospitals/president of the volunteer music club, editor/president of a school science magazine (2 years), writer for school newspaper (1 year), charity fair committee member for the faculty of science (a semester), teaching assistant (2 semesters))

What I want:
- become a physician in the U.S. or Canada in an URBAN setting (Chicago, NYC area or major cities in Cali) without too much headaches with the VISA
- interests: psychiatry or pediatrics
- not too keen about working/studying at a top-tier institution although it'd be nice

What happened:
As Canadian, I applied to
- 10 US MD schools & 10 US DO schools & a few Canadian schools
- 3 interview invitations from US DO schools --> accepted at TouroNY and Marian U
- on hold for interview/rejected at 3 US MD schools
- no words from Canadian schools yet (cycle starts and ends later)

My dilemma:

Since all I want to be is a pediatrician/psychiatrist, I thought US DO would be a perfectly viable option. While I have a great respect for the osteopathic philosophy having received holistic care myself, I was uncomfortable when I went to the schools. I thought I would be able to reaffirm my desire to attend a DO school by going to the interviews. I chose my undergrad based on my gut feeling (things just clicked with me when I visited the campus), and I was hoping for this gut feeling to re-emerge, but it didn't happen at 3 DO schools I went for an interview.

As I did more research, I started to realize the reality of what Canadians must go through to complete the DO path, and it seemed like a huge uphill battle (i.e. most likely limited to ACGME residency and only at those that sponsor visa, possibility of having to return to Canada for 2 years, 2 sets of board exams, etc). I started to question whether it was all worth it for me to be a DO with my citizenship. US MD on the other hand seemed to pose less obstacles for me (obviously, Canadian MD schools will pose no obstacles, but they are equally competitive so I'm trying to broaden my options).

I'm just not sure what I should do here - try deferring DO acceptances (I doubt it'd be easy), decline acceptances, or accept. If I decline the acceptances, can I still get into another DO school? I also think I should bring up my MCAT to around 32-33 from a 28 to be competitive as an international student at US MD schools. I've already attempted to bring up my verbal (independent studying) last year, but it rather went down....

Sorry for a long message, but I can't focus on anything these days. Any input or reassurance would be much appreciated.

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[rdk322]

P.S. I'm still a full-time student, so I don't have much time. I'll be taking an online course for the MCAT and will probably plan to write it at the end of April or May. Besides the potential increase in MCAT, I don't see any aspects of my application that would be improved until the next cycle. I know that this summer is the last time I'll ever consider retaking the MCAT (I can't deal with the new one).

 

[DrMidlife]

My first worry here is your selection of US MD schools. How much research did you do on those schools?

It's typical for US premeds to apply to 25+ MD schools. Public schools are less likely to take international students than private schools, and you really have to look to see who typically takes Canadians. Some schools are so popular that your app can seriously get lost in a pile of more than 10,000 apps.

Getting waitlisted at an MD school means you aren't too far off the mark, and I'd take that as permission to keep trying for MD. I wouldn't retake the MCAT unless you have some rational basis to think you can improve your score, particularly verbal. Taking the test multiple times without showing SUBSTANTIAL improvement is bad.

I suggest finding some mentors who are Canadian students at US MD schools who can help you analyze what's happening. For instance, I have no clue how you'd pay for med school in the US. It's $250k or more.

You're WAY too particular about your preferences for practice. It's great if you're feeling motivated and ambitious, but you're expected to leave room for discovery during med school, and you're expected to know that you know nothing yet. In a med school app this tends to come across as a lack of maturity and a lack of life experience.

Best of luck to you.

 

[rdk322]

Oops, sorry. I meant I got put on hold for interview. No MD interview invitations : (

Frankly, I did not do an extensive research on my list of MD schools, but I applied to schools that were known to take Canadians.

I do agree that I may have come across as too picky/immature. I've been a city girl all my life, and I simply didn't feel at home at some schools I visited. When I looked at match list from some DO schools, a large proportion went to do residency in small towns. Maybe I do lack life experience and will like smaller cities, I don't know, but as it stands, it got me feeling uneasy.

Yes, financial burden and visa status are something I definitely should do a lot more research on.

 

[df606]

If you want to stay in the states you can apply to AOA residencies. There is no restriction on that. However if you want to come beck to Canada the residency has to be ACGME.

Visas are difficult but that would be your main concern right now. With you wanting to work in the US urban centers you will have to get a visa anyways in order to work in those places as you are not a US citizen.

 

[cabinbuilder]

Oops, sorry. I meant I got put on hold for interview. No MD interview invitations : (

Frankly, I did not do an extensive research on my list of MD schools, but I applied to schools that were known to take Canadians.

I do agree that I may have come across as too picky/immature. I've been a city girl all my life, and I simply didn't feel at home at some schools I visited. When I looked at match list from some DO schools, a large proportion went to do residency in small towns. Maybe I do lack life experience and will like smaller cities, I don't know, but as it stands, it got me feeling uneasy.

Yes, financial burden and visa status are something I definitely should do a lot more research on.

SO?? Don't apply to a small town residency.
What you have to understand is med school is med school. You will not have time to worry about how big a city you are in. If you have an acceptance, you need to be grateful and take it. Silly to defer just because you don't "feel comfortable", now that is just immature IMO. YOU cannot determine your future by a school's match list (I wish everyone would quit doing that). No one is going to tell you where you need to apply to residency - that's on you. SO if you want to do residency in NYC or Chicago then DO IT. No one is going to tell you otherwise. The location of the school HAS NO BEARING where you as the individual decide which residency program is best for YOU and YOUR goals. Medical school acceptance is like the lottery, if you have been given a winning ticket be grateful, go to school, and make the best of the opportunity.

 

[rdk322]

If you want to stay in the states you can apply to AOA residencies. There is no restriction on that. However if you want to come beck to Canada the residency has to be ACGME.

I didn't think that many AOA residencies supported visas, which meant I'd have to apply to ACGME. I'm open to staying in the States as long as I have the visa. I guess it's too early to tell.

SO?? Don't apply to a small town residency.
What you have to understand is med school is med school. You will not have time to worry about how big a city you are in. If you have an acceptance, you need to be grateful and take it. Silly to defer just because you don't "feel comfortable", now that is just immature IMO. YOU cannot determine your future by a school's match list (I will everyone would quit doing that). No one is going to tell you where you need to apply to residency - that's on you. SO if you want to do residency in NYC or Chicago then DO IT. No one is going to tell you otherwise. The location of the school HAS NO BEARING where you as the individual decide which residency program is best for YOU and YOUR goals. Medical school acceptance is like the lottery, if you have been given a winning ticket be grateful, go to school, and make the best of the opportunity.

Yes, I am grateful. It's just that the excitement died a bit when I looked at what I might face as an international DO student. I've read other posts by more experienced students/physicians, and most said the same thing as you. The reason I'm a bit concerned is because I thought the school's location had some bearing on its networks/rotation sites which may be helpful when applying for residency as opposed to having to set up elective rotations. Are they hard to set up on your own? The more I read on the reapplication forum, the clearer it is to me that I'd need a substantial improvement as a reapplicant. I'm thinking of choosing my best offer at the end of this cycle...

 

[cabinbuilder]

The reason I'm a bit concerned is because I thought the school's location had some bearing on its networks/rotation sites which may be helpful when applying for residency as opposed to having to set up elective rotations. Are they hard to set up on your own? The more I read on the reapplication forum, the clearer it is to me that I'd need a substantial improvement as a re-applicant. I'm thinking of choosing my best offer at the end of this cycle...

1. I think rotation sites are over rated. It's not that hard to set up your own elective rotations 4th year so you can rotate at your top 2-3 choices for residency.
2. The other think I think students don't realize is the importance of networking. Say you want to become an ER resident but you can't get an ER rotation where you would like to apply but you can get an FP rotation where you want to apply for ER. OKAY, so you go to the site on an FP rotation, well FP spends plenty of time in the ER and you would have opportunity to shine in the FP rotation and YOU WOULD BE NOTICED. You would also be able to meet the ER residents there and maybe the program director. Whether you work hard in FP or ER, it doesn't matter because you still WORKED HARD.

3. DO NOT become a re-applicant if you don't have to. An acceptance anywhere is a good thing and you should make the best of it because there is NO GUARANTEE that you would be accepted next year at your top choice. Anyone else would kill to have your spot.

 

[DrMidlife]

I think that med students SHOULD have substantial life experience and resourcefulness BEFORE they start med school, but that's not the norm. The norm is that med students still call their parents for money and direction, and may never have paid their own rent much less done their own laundry.

So the expected norm of having a med school make sense of rotations and residency corresponds to the normal inexperienced med student. The more resourceful and experienced you are before you start med school, the more likely you'll succeed in an environment where you have to define your own path and figure things out on your own.

For a premed who just wants to get through med school quickly and start practicing in primary care (and good lord we need a LOT MORE premeds like that), minimal planning for 3rd and 4th year doesn't have serious consequences. But for a premed who wants a lot of choices and open doors and opportunities, AND hasn't dealt with the world much yet, you'd better be in an environment where you don't have to figure out rotations and residency on your own. I sure hope inexperienced, ambitious premeds don't land at a new or poorly managed school, MD or DO. It's pretty easy to figure out whether a school is new or not, but the catch-22 here is that as an inexperienced premed, you don't know how to tell if a school is well managed or not. From what I see, the majority of SDN complaints from other premeds or med students are from those with no experience thus no sense of proportion.

One example of an environment that supports normal premeds, imho, is EVMS, where upperclassmen and alumni bend over backwards to help new students every step of the way. The school sometimes sends messages that don't match reality, but alumni and upperclassmen all over the country make sure good info is abundant and transparent. I highly recommend asking your tour guides on interviews what they know about rotations and residency and how they learned what they know.

My $.02.

 

[cabinbuilder]

I think that med students SHOULD have substantial life experience and resourcefulness BEFORE they start med school, but that's not the norm. The norm is that med students still call their parents for money and direction, and may never have paid their own rent much less done their own laundry.

So the expected norm of having a med school make sense of rotations and residency corresponds to the normal inexperienced med student. The more resourceful and experienced you are before you start med school, the more likely you'll succeed in an environment where you have to define your own path and figure things out on your own.

For a premed who just wants to get through med school quickly and start practicing in primary care (and good lord we need a LOT MORE premeds like that), minimal planning for 3rd and 4th year doesn't have serious consequences. But for a premed who wants a lot of choices and open doors and opportunities, AND hasn't dealt with the world much yet, you'd better be in an environment where you don't have to figure out rotations and residency on your own. I sure hope inexperienced, ambitious premeds don't land at a new or poorly managed school, MD or DO. It's pretty easy to figure out whether a school is new or not, but the catch-22 here is that as an inexperienced premed, you don't know how to tell if a school is well managed or not. From what I see, the majority of SDN complaints from other premeds or med students are from those with no experience thus no sense of proportion.

One example of an environment that supports normal premeds, imho, is EVMS, where upperclassmen and alumni bend over backwards to help new students every step of the way. The school sometimes sends messages that don't match reality, but alumni and upperclassmen all over the country make sure good info is abundant and transparent. I highly recommend asking your tour guides on interviews what they know about rotations and residency and how they learned what they know.

My $.02.

OP these statements are not just for you, for applicants in general.
Agreed, you should be at least 25 and lived on your own before being allowed to apply. Too much worry is spent on things that cannot be controlled, whether a location is "good enough" or "homey enough". Really? It's not like undergrad where you can pick and choose, apply and get accepted. You apply everywhere and cross your fingers, roll the dice, rub the rabbit's foot, and maybe, just maybe will get an acceptance somewhere. You go where they take you. I have students PM me because they are torn between the difference of 1 elective rotation slot!! Seriously??? Just like the folks who live and want to stay in California all the way through. Most likely isn't going to happen. You can always move back to your dream living location after residency is done. Enough already, if you are accepted. BE HAPPY and go.

 

[QofQuimica]

You want to be a doctor. You have the opportunity to be a doctor. Go to one of the med schools that accepted you and be a doctor. It's really that simple.

I agree that location is highly overrated as a method of choosing medical schools, especially for those who have limited experience with living in different places. How do you know if you'll like a particular school or location until you go there and give it a fair try?

I wasn't initially gung ho about the location of my top choice med school (where I wound up attending), but I ended up liking it a lot. To the point that I would consider going back there as faculty in the future if a suitable opportunity arose.

 

[rdk322]

Thank you for all your input. I really needed some advice from medical students/residents/attendings because I was not aware of the reality or the actual road ahead as a premed. I did not mean to imply that I am not grateful for the given opportunity. I was wondering if it would be worth it in my case to aim higher. After reading the posts, I'll hope for more interviews and choose the school that's best fit for me to start school next year.

 

[Escape_Goat]

Aim higher?

 

[OldMemphis]

You got in. Go. This isn't brain science. Unless you are reconsidering the career. Then don't go.

 

[IlDestriero]

1. I think rotation sites are over rated. It's not that hard to set up your own elective rotations 4th year so you can rotate at your top 2-3 choices for residency.
2. The other think I think students don't realize is the importance of networking. Say you want to become an ER resident but you can't get an ER rotation where you would like to apply but you can get an FP rotation where you want to apply for ER. OKAY, so you go to the site on an FP rotation, well FP spends plenty of time in the ER and you would have opportunity to shine in the FP rotation and YOU WOULD BE NOTICED. You would also be able to meet the ER residents there and maybe the program director. Whether you work hard in FP or ER, it doesn't matter because you still WORKED HARD.

3. DO NOT become a re-applicant if you don't have to. An acceptance anywhere is a good thing and you should make the best of it because there is NO GUARANTEE that you would be accepted next year at your top choice. Anyone else would kill to have your spot.

1. Yes it matters. The quality of your clinical rotations absolutely affects your education. Setting up rotations at places that have no current agreement with your school is a huge pain and takes months of work far in advance. I tried to do this from a well known school, and they wanted me to come. It's not a trivial matter and it relies on many others to move things along in a timely manner.

2. Nonsense. If you are auditioning for a residency spot you need to be on the service working with the people you want to impress. As an anesthesiologist, the only way I'd notice a surgical resident or medical student at all would be if they were so completely incompetent they were causing frequent significant problems, and I'm 5 feet away from them for hours at a time, on and off for months. Rotating on FP or whatever is great, if you want to match there for FP. You're not getting a LOR from the local EM physician for your great job admitting GOMERs to the FP service.

3. Absolutely don't reapply. Your poor repeat MCAT is killing you. You would need to have a stellar score to change that fact. It seems unlikely unless you really didn't study before and can devote significant time now to proper prep. You didn't list your schools, but you seem to have researched which ones were Canada friendly, so that's probably not the problem either.

Just embrace your success. If you shoot for the stars and only make the moon, you're doing fine. If you score multiple acceptances, look at reputation, rotations, and quality of life in the area. Go take another look. You may change your mind, but peds and psych are not very competitive, so if you work hard and kill the USMLE, you'll be fine.

 

[cabinbuilder]

1. Yes it matters. The quality of your clinical rotations absolutely affects your education. Setting up rotations at places that have no current agreement with your school is a huge pain and takes months of work far in advance. I tried to do this from a well known school, and they wanted me to come. It's not a trivial matter and it relies on many others to move things along in a timely manner.

2. Nonsense. If you are auditioning for a residency spot you need to be on the service working with the people you want to impress. As an anesthesiologist, the only way I'd notice a surgical resident or medical student at all would be if they were so completely incompetent they were causing frequent significant problems, and I'm 5 feet away from them for hours at a time, on and off for months. Rotating on FP or whatever is great, if you want to match there for FP. You're not getting a LOR from the local EM physician for your great job admitting GOMERs to the FP service.

Sorry, this was not my experience. I set up most of my rotations in medical school so I could be seen where I wanted to be seen. To each his own. Yes, of course try to get a rotation on the service for the residency you want to apply for. I was just trying to point out that you can't always get the rotation you want but sometimes an alternate rotation at the same site can be beneficial as a last resort.