Why the emphasis on volunteering?

[deleted87051]

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I (generally) agree that if you can afford to apply to med school there's a great degree of privilege, although that isn't to say someone can't have faced some form of adversity or challenges. My concern is that adcoms see volunteer service as a proxy for empathy and caring, which is incredibly naive. There are plenty of pre-meds who commit hundreds of hours of service in service to their own ends, not because they genuinely care about disadvantaged populations/people. Those same people, years down the road and wielding some actual influence, will never advocate for the changing of oppressive systems and structures that adversely affect health outcomes (particularly at the level of their own community,) because it's "uncomfortable".

I beg to differ. Look in the resident forums. They do want to bring down oppressive systems and structures. It’s just that the physicians classify themselves as the victimized oppressed group and patients, insurance companies, hospital administrators, “old farts”, and private equity overlords are the oppressors. When doctors do advocate, they mostly advocate for better pay, for themselves. This selection process has been around awhile and it has produced the intended results😉

And most doctors don’t want to work with disadvantaged populations because the payor mix is bad. Why help poor people when rich people also need help and it pays 2x? Unlike med school admissions theatrics, when looking for attending jobs, they ask sensible questions like “What’s the pay? What’s the schedule? How much call do I have to take?”

Based on med school applications, we should have millions of Paul Farmers moving their families to Haiti and Liberia in order to serve the poor but there was only one. Instead the current system selects for doctors who are obsessed with homes in “good” (white) school districts, TV sports, microbreweries and avocado toast/mimosa brunches.

 

[Mr.Smile12]

... My concern is that adcoms see volunteer service as a proxy for empathy and caring, which is incredibly naive. There are plenty of pre-meds who commit hundreds of hours of service in service to their own ends, not because they genuinely care about disadvantaged populations/people. Those same people, years down the road and wielding some actual influence, will never advocate for the changing of oppressive systems and structures that adversely affect health outcomes (particularly at the level of their own community,) because it's "uncomfortable".

Your point is acknowledged since no one in current power (went to medical school say 20 to 30 years ago) has removed many of the structural barriers in health education, and we've been training doctors for decades (just counting post-WW2). We can go on about how some of the lack of progress is due to the community of physicians in the first place. Regardless this is still an expectation and I know most applicants get their volunteering and service in before they start school.

 

[TragicalDrFaust]

In this situation, I believe it's best to meet people where they are. We're all coming from different backgrounds where some things may be more or less accessible. Keep a dialog open with students seeking advice about what works for them in their situation and see if you can use those suggestions to help other students in similar situations.

For example say you grew up with access to a car and you're advising someone who doesn't have access to a car or reliable transportation. Brainstorm with them about how they've seen other people in their situation handle it. Online opportunities? Bartering babysitting to use a neighbor's car? Finding a program provides lower cost bus passes? Maybe connecting them with a mentor who overcame similar obstacles.

 

[Neuroscifan]

You keep saying willingly. That would be the case if volunteering wasn’t mandatory.


Why do so few physicians continue to volunteer after they are fully trained and can make a larger impact? If you make volunteering mandatory for premeds, they do it because it’s mandatory. It doesn’t select for anything but people who are willing to jump through hoops to achieve their end goal.

“situations that force them to grow in perspective and experience. Then they are forced to think about how those experiences have impacted them in the primary application. They then demonstrate their level of growth and real commitment to service of others in the interview.”

 

[Goro]

You keep saying willingly. That would be the case if volunteering wasn’t mandatory.


Why do so few physicians continue to volunteer after they are fully trained and can make a larger impact? If you make volunteering mandatory for premeds, they do it because it’s mandatory. It doesn’t select for anything but people who are willing to jump through hoops to achieve their end goal.

We already know that:
1) they work in a service profession
2) they know what they've gotten into
3) they're willing to spend decades being around sick and injured people and their families.

Meaning they've already walked the walk.

 

[deleted87051]

Your point is acknowledged since no one in current power (went to medical school say 20 to 30 years ago) has removed many of the structural barriers in health education, and we've been training doctors for decades (just counting post-WW2). We can go on about how some of the lack of progress is due to the community of physicians in the first place. Regardless this is still an expectation and I know most applicants get their volunteering and service in before they start school.

The irony is that mandatory volunteering for premeds is a structural barrier in health education. Because med school admissions has become so competitive (because money and job security), these geniuses have decided to add more structural barriers. If you’re rich, well connected, and without financial worries, it’s easy to find great volunteer opportunities to buff the application. If you’re poor, have clueless parents, and no transportation, it’s much harder.

 

[deleted87051]

We already know that:
1) they work in a service profession
2) they know what they've gotten into
3) they're willing to spend decades being around sick and injured people and their families.

Meaning they've already walked the walk.

Doctors have done this for generations before volunteerism became a fad in med school admissions.

 

[Mr.Smile12]

The irony is that mandatory volunteering for premeds is a structural barrier in health education. Because med school admissions has become so competitive (because money and job security), these geniuses have decided to add more structural barriers. If you’re rich without financial worries, it’s easy to volunteer.

I can't argue though I will point out this is also expected in other health professional careers to some extent among those paths that begin after earning a bachelor's degree. Physician assistant programs may not require so much volunteering but they do generally require a lot of clinical exposure. Dentistry also expects volunteering/community service. I am interested in the possibility that if admissions were much less competitive that volunteering would not be seen as a requirement. (Looking at podiatry on this...).

On the other hand, leadership has always been expected of physicians as well as a positive regard within the community, usually because of service orientation.

 

[Goro]

Doctors have done this for generations before volunteerism became a fad in med school admissions.

True, but the world has moved on beyond stats.

 

[deleted87051]

True, but the world has moved on beyond stats.

The funny thing is that the old guys who volunteer and donate tons of money to our outreach organization went to med school when admissions was based on stats. We have trouble recruiting younger doctors because…excuses. I don’t think you’re getting what you think you’re getting. It would be interesting to measure and compare outcomes.

 

[LizzyM]

The funny thing is that the old guys who volunteer and donate tons of money to our outreach organization went to med school when admissions was based on stats. We have trouble recruiting younger doctors because…excuses. I don’t think you’re getting what you think you’re getting. It would be interesting to measure and compare outcomes.

This is not unique to medicine. I've been involved in a volunteer organization for about 15 years. It is very difficult to engage people with young children. They tend to prioritize their nuclear family, as well they should. It is only after the children has flown the nest, or can be left without a babysitter, that it becomes more feasible to dedicate one's time to volunteerism. On the flip side, it is possible to recruit the assistance of very young people who have not yet settled down. So, it does not surprise me volunteer hours are on a U curve with service early in life and at older ages.

 

[Proudfather94]

While I was a TA last semester, I sent out an email to the class after a particularly difficult exam with a really low average that told a little about my origin story and the difficulties I had during freshman year. That email led to me being a kind of sounding board for tons of young college kids, many of whom will be applying to medical school. While I don’t necessarily mind the emails, I sometimes just don’t know what to tell them. One of the emails I recently got made me feel kind of bad about the advice I gave, which was essentially just “suck it up.”

The issue was with volunteering hours and this student’s difficulty getting to them. The problem is that he doesn’t have a car and his parents are controlling his budget to the point that he doesn’t even have enough money to get a bus pass. I told him that he should try getting a job as a scribe, there are always posting for them at our school, and then he will have a little bit of income coming in so he can afford to get around, plus he’ll have the added benefit of some clinical experience. He said that his parents won’t let him do that because they are (I think really he is) afraid it will interfere with his studies. That’s when I basically said suck it up and get it done. Find a way. And that’s just not very good advice.

In the past, I’ve always compared them to what I have going on now, with kids, a wife, a mortgage, 20 credits a semester, etc. and I was still able to fit around 500 hours of volunteering in. But I never compared them to my situation when I was their age. Afterwards, I thought about it more, and I compared it to my situation when I was first an undergrad, and I realized how truly horrible that advice was. The worst part is, this wasn’t the first person I gave this bad advice to. Our situations were a bit different, but the end results were very similar. In my place, I ended up having a sudden need for income during my freshman year that made it so I had to work more than full time while attending school. I barely held it together then, but if I would’ve tried to add a large amount of volunteering into the mix, I just wouldn’t have been able to do it.

So what should I say to students who, for one reason or another, can’t get the required volunteer hours? This particular student called it a “classist policy that caters to rich kids” and he’s not exactly wrong. So what are the middle class kids, the ones who won’t qualify for any economic hardship status, but also can’t afford a car to get around, supposed to do?

I got a couple things I want to mention. First off if this students parents are this toxic or broke they need to take out loans to make this happen. Unless your school is in a major city with great public transportation they need a car. Teenagers have been expected to have cars for over half a century (drive ins and other stuff aimed at teenagers like arcades) so it's reasonable to expect someone to have one by the time they are in their early 20s in this day and age.

Lastly they can make it work if they refuse to get a car. Do a can drive on campus and have ask someone with a car to help you deliver it. Surely a social science major that wants to help the community wouldn't mind a short drive to deliver food to help the poor? If that doesn't work have a premed with a car help you and you can split the hours.

 

[PhD_to_DO]

While I was a TA last semester, I sent out an email to the class after a particularly difficult exam with a really low average that told a little about my origin story and the difficulties I had during freshman year. That email led to me being a kind of sounding board for tons of young college kids, many of whom will be applying to medical school. While I don’t necessarily mind the emails, I sometimes just don’t know what to tell them. One of the emails I recently got made me feel kind of bad about the advice I gave, which was essentially just “suck it up.”

The issue was with volunteering hours and this student’s difficulty getting to them. The problem is that he doesn’t have a car and his parents are controlling his budget to the point that he doesn’t even have enough money to get a bus pass. I told him that he should try getting a job as a scribe, there are always posting for them at our school, and then he will have a little bit of income coming in so he can afford to get around, plus he’ll have the added benefit of some clinical experience. He said that his parents won’t let him do that because they are (I think really he is) afraid it will interfere with his studies. That’s when I basically said suck it up and get it done. Find a way. And that’s just not very good advice.

In the past, I’ve always compared them to what I have going on now, with kids, a wife, a mortgage, 20 credits a semester, etc. and I was still able to fit around 500 hours of volunteering in. But I never compared them to my situation when I was their age. Afterwards, I thought about it more, and I compared it to my situation when I was first an undergrad, and I realized how truly horrible that advice was. The worst part is, this wasn’t the first person I gave this bad advice to. Our situations were a bit different, but the end results were very similar. In my place, I ended up having a sudden need for income during my freshman year that made it so I had to work more than full time while attending school. I barely held it together then, but if I would’ve tried to add a large amount of volunteering into the mix, I just wouldn’t have been able to do it.

So what should I say to students who, for one reason or another, can’t get the required volunteer hours? This particular student called it a “classist policy that caters to rich kids” and he’s not exactly wrong. So what are the middle class kids, the ones who won’t qualify for any economic hardship status, but also can’t afford a car to get around, supposed to do?

It can be tough to volunteer while being a full time student and trying to figure out rent, groceries, and other life necessities. That said, volunteerism is an expectation and knowing this, I took a couple of gap years to serve as an AmeriCorps VISTA after finishing undergrad. The cool thing is that AmeriCorps, the CCC, and VISTA all partner with local universities now and students can now volunteer with them, get paid AND get health insurance, and fulfill an expectation for their eventual medical school application. Tell the student to check with AmeriCorps to see if there are any part time options with them.

 

[bigdawg45]

I’ll add my 2 cents. I worked a full-time job, while raising a toddler, and giving my fiancé the attention she needed. I volunteered, not with as many hours as some may have gotten, but I chose very meaningful activities to spend my extra time. I did research, didn’t publish, but did enough to be able to write and talk about it. I had a point in time where a had two jobs, one being a scribe so I could get my clinical hours in. I worked out of complete necessity. Bills had to be paid, food had to be put on the table, and rent was due every month. I did everything a successful premed does all while going to my daughters tee ball games, ice skating lessons and whatever else she was into. I worked 40 hours + per week by working 12+ hour overnight shifts on the weekends. I hardly slept most weekends and had to work at least one night during the week. My sleep schedule was always messed up. I did this for my entire undergrad and my grades never wavered. I was often tired, but I wanted to get into medical school so bad that I just did what was necessary, no excuses. I come from a very low SES background.

As has already been stated, if there’s a will, there’s a way. It’s not necessarily fair that some students have to overcome so much to get into medical school while others just have to worry about being a good premed. But, that’s just what it is. You’re either gonna do what it takes or you’re not.

 

[dnyal]

Let’s be realistic and honest to ourselves. I find this whole volunteering here in American medical schools (maybe Canadians, too?) to be moot. If it is a requisite, everyone will do it because it is required. Do you really think medical schools “weed out” all the applicants who did it because they felt obliged to? That’s definitely not happening. Lots of medical students stop volunteering as soon as they get an acceptance.

Of course, many will tell you about all the benefits of volunteering and how you’re going into a a job that helps people and growth and whatnot. Let me give you my perspective, which might be unique here. I went to medical school overseas. Unlike in North America, in the vast majority of countries in the world (including Europe), medicine is an undergraduate bachelor’s degree (usually six years long). You go into it straight from high school. I’m familiar with the system in Latin America (where I’m from) and Spain. There’s no volunteering requirement there whatsoever. Especially in Spain, public universities are entirely meritocratic based on a national admission’s test and your grades. When I was a medical student, we had a visiting medical student from the Charité Universitätsmedizin in Berlin. I asked about her school and how she got into it. Volunteering never came up, although she had vocational training in health care during high school (vocational training is a big thing in Germany), and she said that helped. I personally never volunteered beyond the compulsory 80 hours required for high school graduation in my home country. It was a nice experience, but that was it. Everyone else had those hours, too, and it wasn’t a requirement for any of the schools I applied to, anyway.

Now, are American doctors better with people because they volunteered? Did volunteering allow schools to choose better doctors? In my experience, no. My spouse and I have a few medical conditions, so we go to our PCP and also see specialists throughout the year. I’ve lived in big cities and rural areas. In our experience, doctors here don’t treat us better than any of the doctors we’ve seen in other counties, and we’ve had our share of a-hole doctors both here and overseas. Tbh, I’ve encountered more a-holes here, but that could be just a statically insignificant deviation. I actually prefer to be seen by NPs or PAs because I learnt medicine in a system where clinical practice prevails above all else. Doctors here have never performed a physical examination on me that’s left me satisfied, whereas NPs have. It was also a common complaint among my former patients who lived here in the U.S.: doctors here never “touched“ them, as in properly examined them. I know an US can tell you a lot more than palpation in many cases, but again, I was taught imaging and other aids were used to confirm your findings, not find things for you. My spouse is American and says Americans don’t like to be “touched,” so doctors avoid it. I told him I once had a full blown gringo come to me when I was practicing medicine overseas, and he left delighted, not only by my English, but also my comprehensive physical examination. I’m not trying to deride the medical practice here in America, as I find medicine here quite advanced (the health case system here is trash, though). So, take what I just said as you will. Oh, I almost forgot to mention I often had arguments over the phone because insurance companies would deny prior authorizations to my former patients (overseas). I wanted them to get the medication they needed, and we doctors had to do all the paperwork ourselves; we didn’t have those “fancy” assistants that abound in American medical offices. Twice I’ve tried to get doctors here to do PAs for my family in two different offices: total and complete nightmares. We’re still waiting for one right now after a month. They just couldn’t be bothered any less.

In conclusion, I’m trying to say that volunteering, from what I see, does not make better doctors. At least, in my family’s experience and my own. I think it is important, but it definitely is a burden on low-income students. A person not getting into medical school because they didn’t volunteer is unheard of in most of the world. The extreme volunteering emphasis is an entirely North American phenomenon, maybe because Puritan heritage? Idk. Since most doctors here come from well-to-do backgrounds and socialize in certain academic circles, they probably have this theoretical notion of what volunteering is and should do and thus enforce it strictly. These are people who can’t relate to what it truly means being a working poor, and they can’t possibly conceive how someone could have such difficulty fulfilling the volunteering requirement. To them, they’re just coming up with excuses. Like a doctor (former friend) of mine who told me a few years ago that we (my family) were having trouble making ends meet because we needed to “budget better.” When you’re a working poor trying to do the whole medical school thing again, there’s no budgeting strategy that could extend a household income of 200% the poverty line enough to afford moving to an expensive metro area two hours away so one can finish a bachelor’s. I think that’s is a kind of commitment and sacrifice that medical schools should find as worthy as any length of volunteering.

 

[LizzyM]

Let’s be realistic and honest to ourselves. I find this whole volunteering here in American medical schools (maybe Canadians, too?) to be ...

Med schools can make all kinds of seemingly unrealistic requirements for admission because there are more than twice as many applicants overall as there are seats, applicants apply to 15+ schools, and each school has 10-20 applicants (or more) for each seat. So schools can ask for the moon and get it. Does it make better doctors? That's debatable but the point is, when you are sitting with 5,000 applications for 100 seats, you need to find some way to winnow the stack of applications to a manageable subset for interview and then for admission offers.

 

[Psychiatrist wannabe]

I actually agree with your original post. The requirement is one of many barriers to economic diversity in medicine. Your concerns were on point. Most people aren’t ready to see that in a different light just yet. It’s refreshing to see the question posed.

 

[Mr.Smile12]

I have done analysis on application pools to see if there is a relationship between SES and volunteering hours, and at least with the pool I analyzed, there was no statistically significant difference. Now this is a biased pool because the pool captured those individuals who felt they were ready to apply, but while I agree there are significant challenges for anyone who is disadvantaged, when it finally comes to applying to professional schools and getting into a position to be accepted, there was no difference in volunteering hours observed. Same thing with clinical experience hours. So while I agree that we should keep this in mind with holistic review on an individual basis, when looking at the aggregate pool, you would need more solid evidence that SES and volunteering really are barriers working against admission to health professions programs.

What would you suggest that we do to help those who can't volunteer so they can get "enough" experience to get them to an offer? If adcom expectations don't budge, how should we offer opportunities for SES students to volunteer?

Does volunteering necessarily make better doctors? I guess it depends on what you mean by "better." With the AAMC competencies statements, it is clear that service orientation is a high priority for desired attributes of future physicians as a whole. We have every right to be skeptical or roll our eyes, but these are the ideals set for all applicants... and no one is forcing anyone to be a physician.

 

[Leon'sMom]

Ideally, every college should have a competent pre-health advisor. One who sets the bar very high for what the UG should accomplish before applying. They should clearly articulate goals for academic course load, GPA, ECs, work, volunteerism, exta-curricular reading, etc. If they lay out a winning strategy for the student, and the student rises to the call, they will increase their chances. If a student attends a college with a weak pre-health advisor, I'd suggest that they reach out to another college with a history of high acceptance rates to med school. The student may be limited in which college they can attend due to finances/location, but that doesn't mean that they can't reach out to another for friendly advice.

Ideally, every college should have an active pre-health society where students can gain advice from other students ahead in the process. Learn from others' mistakes and get helpful tips on things like volunteerism from those who have already walked the walked. Some societies have a Volunteerism subcommittee that can provide you with a list of campus and regional opportunities. If your college does not have one, find another college that does and reach out to them for friendly advice.

Ideally, every college should have a Community Engagement Office which provides lists of volunteer opportunities and sometimes provides transportation to off campus locations.

When all else fails, make your own opportunities. If your campus doesn't have a food kitchen on it or near it, ask administration if you can start one. Advertise to students, especially before and after breaks and end of semesters, to drop off non-perishable food items. If it doesn't already exist, ask to spearhead a campus-wide collection of toiletries that can be donated to homeless shelters (some will accept partial full size shampoos). If it doesn't already exist, ask to run an end of the year collection of unwanted furniture (many students would rather donate than transport) and then arrange for a pick up by local Good Will or like. If your school has a peer tutoring program join it; if not, advertise that you are willing to tutor your fellow students in a subject for no-cost.

Be creative.

 

[NOLZAOINK]

I think you can also tell the college student directly about your concern of coming off as someone with achieved status, the caveats behind your relatively few lines of advice (although reasoned through). It's like teaching. If you explain to them other things besides the final point, show your true emotions reciprocally and considerations, they can get it, not just for this situation but also for others.

 

[sydd]

...this entire thread is toxic

 

[i-doctor]

Ideally, every college should have a competent pre-health advisor. One who sets the bar very high for what the UG should accomplish before applying. They should clearly articulate goals for academic course load, GPA, ECs, work, volunteerism, exta-curricular reading, etc. If they lay out a winning strategy for the student, and the student rises to the call, they will increase their chances. If a student attends a college with a weak pre-health advisor, I'd suggest that they reach out to another college with a history of high acceptance rates to med school. The student may be limited in which college they can attend due to finances/location, but that doesn't mean that they can't reach out to another for friendly advice.

Ideally, every college should have an active pre-health society where students can gain advice from other students ahead in the process. Learn from others' mistakes and get helpful tips on things like volunteerism from those who have already walked the walked. Some societies have a Volunteerism subcommittee that can provide you with a list of campus and regional opportunities. If your college does not have one, find another college that does and reach out to them for friendly advice.

Ideally, every college should have a Community Engagement Office which provides lists of volunteer opportunities and sometimes provides transportation to off campus locations.

When all else fails, make your own opportunities. If your campus doesn't have a food kitchen on it or near it, ask administration if you can start one. Advertise to students, especially before and after breaks and end of semesters, to drop off non-perishable food items. If it doesn't already exist, ask to spearhead a campus-wide collection of toiletries that can be donated to homeless shelters (some will accept partial full size shampoos). If it doesn't already exist, ask to run an end of the year collection of unwanted furniture (many students would rather donate than transport) and then arrange for a pick up by local Good Will or like. If your school has a peer tutoring program join it; if not, advertise that you are willing to tutor your fellow students in a subject for no-cost.

Be creative.

Nice in theory, but then if/when every college does it, it just moves the goalposts ever higher and worsens the arms race. It’s already a version of the Hunger Games as it stands now. (And then getting into, say, Derm is like Hunger Games part 2, where all the past winners/superstars compete with each other).

Probably better to go the opposite direction:
Create a metric—such as exam— where the top 10% or 20% automatically get accepted to Med school. The middle 40-50% will enter a lottery for the rest of the positions . If failed applicants want to re-apply, they can take the exam again +/- lottery again. As many times as they want. In order to get the Med Schools on board, maybe they’d each be allowed a few slots to fill in their own (usually legacy/donor admissions) while the rest will be filled from the system outlined above.

 

[Radishguy]

I have done analysis on application pools to see if there is a relationship between SES and volunteering hours, and at least with the pool I analyzed, there was no statistically significant difference. Now this is a biased pool because the pool captured those individuals who felt they were ready to apply, but while I agree there are significant challenges for anyone who is disadvantaged, when it finally comes to applying to professional schools and getting into a position to be accepted, there was no difference in volunteering hours observed. Same thing with clinical experience hours. So while I agree that we should keep this in mind with holistic review on an individual basis, when looking at the aggregate pool, you would need more solid evidence that SES and volunteering really are barriers working against admission to health professions programs.

What would you suggest that we do to help those who can't volunteer so they can get "enough" experience to get them to an offer? If adcom expectations don't budge, how should we offer opportunities for SES students to volunteer?

Does volunteering necessarily make better doctors? I guess it depends on what you mean by "better." With the AAMC competencies statements, it is clear that service orientation is a high priority for desired attributes of future physicians as a whole. We have every right to be skeptical or roll our eyes, but these are the ideals set for all applicants... and no one is forcing anyone to be a physician.

I’ve been thinking about this a lot since posting, and the solution I’ve come up with is to have a universal premedical undergraduate program, with extremely specific requirements, and have that degree or certificate be a requisite for applying. Mind you, it isn’t perfect and it probably isn’t practical, but it is definitely possible and definitely would produce a more equitable and fair environment. In addition, it has the added benefit of producing more competent medical students.

Now, before you say, we already have a prerequisite… not really. There are essentially 8 universal prerequisite classes, which is less than most PA schools or nursing schools. So why would MD require less premedical education than PAs or RNs? Instead, add anatomy, physiology, biochem, micro, nutrition, psych, sociology, etc., until you have enough for a premedical degree that covers the prerequisites for all of the health-related schools. Next, replace the volunteering sort-of-requirement with a substantial, university-arranged internship/externship actual-requirement, and then work with the undergraduate universities to make those happen. By making this a for-credit-class that moves an applicant toward a degree, it removes a lot of the inequality in finding experiences and spending time in those experiences, while enhancing the positive aspects of these experiences.

Having it as a class has some added benefits. First, since it is a class and not volunteering, the things the student can do in the activity will be more broad than what they can do if they were a volunteer. A student can generally wipe a nursing home resident’s butt, volunteers generally can’t. This means that the types of experience prior to medical school will be pretty much equal for all candidates, and the “trying the suit on” need that Goro mentioned will really be a known quantity as opposed to just going by whatever a LoR says. Second, it can be made to be very difficult. Why is that a benefit? Because as has been pointed out so often in this post, there are more candidates than seats. Having a requirement like this, and having it be grueling, means that you are not only getting the kids who are smart enough to pass the classes, but also the determination to get through the difficult internship. Third, it can be more of a benefit to society. Instead of having 20 kids lining up to clean the same exam room, you could have the schools spread those students out more efficiently to more locations doing more work.

The internship portion isn’t the only part that makes it more equitable. By having this as a degree, it allows universities to have MCAT prep courses as built in for-credit classes. Which means students on scholarships, work study, etc. will be able to use that money, and again their class time instead of time they need to spend working, to prepare for the exam.

As to your original point, I think you are right about it being biased. How many low income applicants see the quasi-requirement and never apply because they know they can’t meet it?

 

[Lawpy]

Yes medical admissions suffers from deep problems of forming classes comprising largely of students from upper class/wealthy backgrounds on top of suffering from deep nepotism by willingly and easingly welcoming kids of doctors/medical professors (especially if they’re med school alumni)

But slamming volunteering is a very wrong move. Volunteering can be gamed yes, but volunteering IS THE ONE GOOD THING in the entire premed journey without a question. Service to community is important. Helping the underserved is important. Developing a sense and appreciation for different cultures and communities is important. But at the most fundamental level, recognizing and enhancing your altruism for other individuals is so paramount that it’s completely necessary for anyone considering the medical profession

In fact, I will argue that people from low SES backgrounds who grew up in poverty are those who will just as easily benefit and enjoy volunteering because of how relatable their experiences are and how they’ll feel that it’s truly their mission to give back to their community. It’s those people and people from middle class backgrounds trying to make ends meet who I wish to make up much of med school classes, not the super wealthy and elite.

If you want to blame the disparities in the admissions process, you should condemn idiotic things like Casper existing and the drive to have bizarrely strong research/wet lab experiences and asking about travel/leisure/X factor experiences that are practically inaccessible to low/middle SES students. You should condemn the absurdly high costs of MCAT preparation/exam, secondary application costs, interview travel costs and the absurd financial aid determination processes at many med schools.

But volunteering SHOULD NOT be blamed and in fact should be continued to be required.

 

[Radishguy]

Yes medical admissions suffers from deep problems of forming classes comprising largely of students from upper class/wealthy backgrounds on top of suffering from deep nepotism by willingly and easingly welcoming kids of doctors/medical professors (especially if they’re med school alumni)

But slamming volunteering is a very wrong move. Volunteering can be gamed yes, but volunteering IS THE ONE GOOD THING in the entire premed journey without a question. Service to community is important. Helping the underserved is important. Developing a sense and appreciation for different cultures and communities is important. But at the most fundamental level, recognizing and enhancing your altruism for other individuals is so paramount that it’s completely necessary for anyone considering the medical profession

In fact, I will argue that people from low SES backgrounds who grew up in poverty are those who will just as easily benefit and enjoy volunteering because of how relatable their experiences are and how they’ll feel that it’s truly their mission to give back to their community. It’s those people and people from middle class backgrounds trying to make ends meet who I wish to make up much of med school classes, not the super wealthy and elite.

If you want to blame the disparities in the admissions process, you should condemn idiotic things like Casper existing and the drive to have bizarrely strong research/wet lab experiences and asking about travel/leisure/X factor experiences that are practically inaccessible to low/middle SES students. You should condemn the absurdly high costs of MCAT preparation/exam, secondary application costs, interview travel costs and the absurd financial aid determination processes at many med schools.

But volunteering SHOULD NOT be blamed and in fact should be continued to be required.

I’m not saying volunteering is a bad thing. I think it is great. I genuinely enjoy the volunteering I do. I’m saying that having volunteering as an unofficial prerequisite isn’t a great thing because volunteering is such a great thing. The problem is that since volunteering is such a great thing, you can’t really talk bad about it by bringing up unfortunate truths like the fact that volunteering is significantly easier for a wealthy kid than a poor kid. That makes the whole requirement kind of insidious. It is something that could significantly impact a lower economic class’s likelihood of applying as compared to a higher class, but at the same time, it’s volunteering, you can’t say anything bad about it.

 

[jhmmd]

I’ve been thinking about this a lot since posting, and the solution I’ve come up with is to have a universal premedical undergraduate program, with extremely specific requirements, and have that degree or certificate be a requisite for applying. Mind you, it isn’t perfect and it probably isn’t practical, but it is definitely possible and definitely would produce a more equitable and fair environment. In addition, it has the added benefit of producing more competent medical students.

Now, before you say, we already have a prerequisite… not really. There are essentially 8 universal prerequisite classes, which is less than most PA schools or nursing schools. So why would MD require less premedical education than PAs or RNs? Instead, add anatomy, physiology, biochem, micro, nutrition, psych, sociology, etc., until you have enough for a premedical degree that covers the prerequisites for all of the health-related schools. Next, replace the volunteering sort-of-requirement with a substantial, university-arranged internship/externship actual-requirement, and then work with the undergraduate universities to make those happen. By making this a for-credit-class that moves an applicant toward a degree, it removes a lot of the inequality in finding experiences and spending time in those experiences, while enhancing the positive aspects of these experiences.

Having it as a class has some added benefits. First, since it is a class and not volunteering, the things the student can do in the activity will be more broad than what they can do if they were a volunteer. A student can generally wipe a nursing home resident’s butt, volunteers generally can’t. This means that the types of experience prior to medical school will be pretty much equal for all candidates, and the “trying the suit on” need that Goro mentioned will really be a known quantity as opposed to just going by whatever a LoR says. Second, it can be made to be very difficult. Why is that a benefit? Because as has been pointed out so often in this post, there are more candidates than seats. Having a requirement like this, and having it be grueling, means that you are not only getting the kids who are smart enough to pass the classes, but also the determination to get through the difficult internship. Third, it can be more of a benefit to society. Instead of having 20 kids lining up to clean the same exam room, you could have the schools spread those students out more efficiently to more locations doing more work.

The internship portion isn’t the only part that makes it more equitable. By having this as a degree, it allows universities to have MCAT prep courses as built in for-credit classes. Which means students on scholarships, work study, etc. will be able to use that money, and again their class time instead of time they need to spend working, to prepare for the exam.

As to your original point, I think you are right about it being biased. How many low income applicants see the quasi-requirement and never apply because they know they can’t meet it?

But why would you want to do this anyway?
A. Write about it in your PS. 😉

 

[Proudfather94]

I actually agree with your original post. The requirement is one of many barriers to economic diversity in medicine. Your concerns were on point. Most people aren’t ready to see that in a different light just yet. It’s refreshing to see the question posed.

The burden that volunteering places on one can be mitigated if they do a few hours a week over a longer period of time. 8 hours a month which is just 2 hours a week would give one 96 hours a year. 3 years of this would give 288 hours which is enough to apply. I'm sure people can give up 2 hours a week. If you do what I did and wait until the last minute to get those hours you will need to spend more time volunteering but that's the price I paid for not planning.

 

[Jetcat]

I’ve been thinking about this a lot since posting, and the solution I’ve come up with is to have a universal premedical undergraduate program, with extremely specific requirements, and have that degree or certificate be a requisite for applying. Mind you, it isn’t perfect and it probably isn’t practical, but it is definitely possible and definitely would produce a more equitable and fair environment. In addition, it has the added benefit of producing more competent medical students.

Now, before you say, we already have a prerequisite… not really. There are essentially 8 universal prerequisite classes, which is less than most PA schools or nursing schools. So why would MD require less premedical education than PAs or RNs? Instead, add anatomy, physiology, biochem, micro, nutrition, psych, sociology, etc., until you have enough for a premedical degree that covers the prerequisites for all of the health-related schools. Next, replace the volunteering sort-of-requirement with a substantial, university-arranged internship/externship actual-requirement, and then work with the undergraduate universities to make those happen. By making this a for-credit-class that moves an applicant toward a degree, it removes a lot of the inequality in finding experiences and spending time in those experiences, while enhancing the positive aspects of these experiences.

Having it as a class has some added benefits. First, since it is a class and not volunteering, the things the student can do in the activity will be more broad than what they can do if they were a volunteer. A student can generally wipe a nursing home resident’s butt, volunteers generally can’t. This means that the types of experience prior to medical school will be pretty much equal for all candidates, and the “trying the suit on” need that Goro mentioned will really be a known quantity as opposed to just going by whatever a LoR says. Second, it can be made to be very difficult. Why is that a benefit? Because as has been pointed out so often in this post, there are more candidates than seats. Having a requirement like this, and having it be grueling, means that you are not only getting the kids who are smart enough to pass the classes, but also the determination to get through the difficult internship. Third, it can be more of a benefit to society. Instead of having 20 kids lining up to clean the same exam room, you could have the schools spread those students out more efficiently to more locations doing more work.

The internship portion isn’t the only part that makes it more equitable. By having this as a degree, it allows universities to have MCAT prep courses as built in for-credit classes. Which means students on scholarships, work study, etc. will be able to use that money, and again their class time instead of time they need to spend working, to prepare for the exam.

As to your original point, I think you are right about it being biased. How many low income applicants see the quasi-requirement and never apply because they know they can’t meet it?

It really seems like your plan would make students pay to do unpaid work that would normally be a job.

 

[Means]

I would venture to say that 99.9% of applicants, regardless of SES, can find the time and opportunity to volunteer in their community in some capacity. If they can't, then they are seriously mismanaging their time or quite frankly just not trying hard enough.

 

[i-doctor]

It really seems like your plan would make students pay to do unpaid work that would normally be a job.

Yes, free labor which will lend itself to abuse just like the “almost” free labor of medical residents.

 

[Radishguy]

It really seems like your plan would make students pay to do unpaid work that would normally be a job.

Right, because there are no other situations where you pay a tuition in order to go to a school and then go to, I don’t know say a hospital, and you do things that simulate work, and might actually produce a limited service, and don’t get paid for it, but you do learn and it does contribute to your degree. It’s almost like a clerkship in medical school, but no…

 

[Jetcat]

Right, because there are no other situations where you pay a tuition in order to go to a school and then go to, I don’t know say a hospital, and you do things that simulate work, and might actually produce a limited service, and don’t get paid for it, but you do learn and it does contribute to your degree. It’s almost like a clerkship in medical school, but no…

I mean if you want to view it that way you can, but your line of thinking there brushes up against some of the many other problems with your plan.

Agree to disagree I guess

 

[LizzyM]

The problem becomes one of having enough "experience" slots for all of the people who want to be "pre-med" (or pre-whatever). And enough supervisors to supervise these graded, for-credit experiences. And the tuition dollars that go to creating memorandums of agreement with the sites and the insurance policies that indemnify the university if something goes wrong at a site. If you want to create a system that is more expensive and less inclusive, have at it. I have my doubts that it would solve the problems inherent in the pre-med pipeline.

 

[99cutter]

Some of the ADCOM/physican responses in this thread are very worrying.

 

[Proudfather94]

Some of the ADCOM/physican responses in this thread are very worrying.

Can you elaborate why?

 

[99cutter]

Can you elaborate why?

Other people have put it more eloquently than me; my personal opinion is that some of the ADCOMs/physicians in this thread are completely out of touch with reality.

 

[Proudfather94]

Other people have put it more eloquently than me; my personal opinion is that some of the ADCOMs/physicians in this thread are completely out of touch with reality.

I'm sorry but you need to be more specific with what you're saying. If you're talking about the volunteering requirement I disagree. If you volunteer 2 hours a week for 3 years during undergrad you will have enough hours to apply. If you are taking an exam that week just make the hours up during break. If you stretch it out it's pretty easy to do.

 

[i-doctor]

I think I am one of the out-of-touch physicians they are referring to. I advocated dropping the whole requirement entirely, and rely on test scores and a lottery system

 

[Proudfather94]

I think I am one of the out-of-touch physicians they are referring to. I advocated dropping the whole requirement entirely, and rely on test scores and a lottery system

I don't really agree with that. While luck does play a role in terms of one's lifes circumstances I don't think we should make the application process depend on luck even more. If you get unlucky in some regards like got the crappy prof and couldn't volunteer or got a bad grade you can just take a gap year and fix your application.

Volunteering shows that you care about helping others and I would bet a ton of selfish people change their mind about applying because they would look at it as a waste of their time.

 

[Princeton Medical Student]

Honestly the amount of out of touch physicians/med students/premeds I have seen and spoken to who come from families making 150k+ (cant wait for someone to tell me that thats not a lot) to practicing medicine with zero life experiences is already a lot. There are a lot of injustices in the process but volunteering a few hrs a week is within reach for most people.

My hot take? Add an LCME requirement that requires the average parental income of any particular class (averaged over some years) to be under 150k.

 

[Proudfather94]

Honestly the amount of out of touch physicians/med students/premeds I have seen and spoken to who come from families making 150k+ (cant wait for someone to tell me that thats not a lot) to practicing medicine with zero life experiences is already a lot. There are a lot of injustices in the process but volunteering a few hrs a week is within reach for most people.

My hot take? Add an LCME requirement that requires the average parental income of any particular class (averaged over some years) to be under 150k.

Wouldn't that punish kids whose parents are physicians through no fault of their own? I would agree with a system that's more forgiving of those from poor backgrounds or circumstances I believe that would be more fair.

Say you need a 3.7 and a 512 to be competitive at a school but your family income is under 100k and you had to work through college. Schools should lower that standard for the student to be on equal footing with their peer such as a 3.5 and a 508 being equal to one with better resources having a 3.7 and a 512.

 

[Princeton Medical Student]

Wouldn't that punish kids whose parents are physicians through no fault of their own? I would agree with a system that's more forgiving of those from poor backgrounds or circumstances I believe that would be more fair.

Say you need a 3.7 and a 512 to be competitive at a school but your family income is under 100k and you had to work through college. Schools should lower that standard for the student to be on equal footing with their peer such as a 3.5 and a 508 being equal to one with better resources having a 3.7 and a 512.

Ultimately that is what that would do. Schools would still take people with physician parents but they would be competing against other similarly incomed individuals. Ultimately it wouldn’t punish them, but would require them to compete harder on more equal footing with their like-incomed peers.

 

[Goro]

I think I am one of the out-of-touch physicians they are referring to. I advocated dropping the whole requirement entirely, and rely on test scores and a lottery system

And how does one distinguish amongst the ocean of high stat candidates? Especially the ones who have no idea what Medicine is like, or what a doctor's day is actually like, or how different doctors approach the practice of Medicine, or the candidates who suddenly discover upon matriculating that "this isn't really what I wanted to do and Gawd., those patients are so icky!" or the lab rats who have no desire to actually touch a patient but just want to do research (and would be far better off with a PhD)?

 

[Mr.Smile12]

I’ve been thinking about this a lot since posting, and the solution I’ve come up with is to have a universal premedical undergraduate program, with extremely specific requirements, and have that degree or certificate be a requisite for applying. Mind you, it isn’t perfect and it probably isn’t practical, but it is definitely possible and definitely would produce a more equitable and fair environment. In addition, it has the added benefit of producing more competent medical students.

Now, before you say, we already have a prerequisite… not really. There are essentially 8 universal prerequisite classes, which is less than most PA schools or nursing schools. So why would MD require less premedical education than PAs or RNs? Instead, add anatomy, physiology, biochem, micro, nutrition, psych, sociology, etc., until you have enough for a premedical degree that covers the prerequisites for all of the health-related schools. Next, replace the volunteering sort-of-requirement with a substantial, university-arranged internship/externship actual-requirement, and then work with the undergraduate universities to make those happen. By making this a for-credit-class that moves an applicant toward a degree, it removes a lot of the inequality in finding experiences and spending time in those experiences, while enhancing the positive aspects of these experiences.

Having it as a class has some added benefits. First, since it is a class and not volunteering, the things the student can do in the activity will be more broad than what they can do if they were a volunteer. A student can generally wipe a nursing home resident’s butt, volunteers generally can’t. This means that the types of experience prior to medical school will be pretty much equal for all candidates, and the “trying the suit on” need that Goro mentioned will really be a known quantity as opposed to just going by whatever a LoR says. Second, it can be made to be very difficult. Why is that a benefit? Because as has been pointed out so often in this post, there are more candidates than seats. Having a requirement like this, and having it be grueling, means that you are not only getting the kids who are smart enough to pass the classes, but also the determination to get through the difficult internship. Third, it can be more of a benefit to society. Instead of having 20 kids lining up to clean the same exam room, you could have the schools spread those students out more efficiently to more locations doing more work.

The internship portion isn’t the only part that makes it more equitable. By having this as a degree, it allows universities to have MCAT prep courses as built in for-credit classes. Which means students on scholarships, work study, etc. will be able to use that money, and again their class time instead of time they need to spend working, to prepare for the exam.

As to your original point, I think you are right about it being biased. How many low income applicants see the quasi-requirement and never apply because they know they can’t meet it?

For a few decades this has been the argument regarding forming "premed majors" or not. There are some schools that have done so as "health science" majors but the idealists in higher ed can't possibly think about developing specific curricula for specific careers. (I'll stop here before I start sounding super ridiculous.)

Many schools have prehealth classes already set for students and have set up arrangements for shadowing or clinical observation with local hospitals or healthcare providers, for a one-credit class.

Basically, I just want to say this already exists at some schools.

 

[Mr.Smile12]

Honestly the amount of out of touch physicians/med students/premeds I have seen and spoken to who come from families making 150k+ (cant wait for someone to tell me that thats not a lot) to practicing medicine with zero life experiences is already a lot. There are a lot of injustices in the process but volunteering a few hrs a week is within reach for most people.

My hot take? Add an LCME requirement that requires the average parental income of any particular class (averaged over some years) to be under 150k.

Interesting... I'd probably go with some requirement that actually requires a certain proportion of graduates either come from or go to residency in a medically underserved area. Not sure how we can do this, but some financial incentives from HRSA or Dept of Ed may need to be thought up. Heaven forbid the USNWR develops a criterion for it. (More relevant: median student debt should be under 200K... 🙂 .)

About that admissions lottery @i-doctor :

McMaster -- the innovators of the MMI and similar situational judgment exams -- beat you to it.

Accepting randomness in medical school admissions: The case for a lottery - PubMed

McMaster University's medical school, faced with the need to socially distance during the COVID-19 pandemic, recently replaced their structured admission interview process with a partial lottery. At first, it may seem that leaving medical school admissions partly to chance could erode autonomy...

pubmed.ncbi.nlm.nih.gov

Posting for posting's sake... 🙂 Lottery docs? Randomize medical school admissions for fairness

 

[deleted87051]

Ideally, every college should have a competent pre-health advisor. One who sets the bar very high for what the UG should accomplish before applying. They should clearly articulate goals for academic course load, GPA, ECs, work, volunteerism, exta-curricular reading, etc. If they lay out a winning strategy for the student, and the student rises to the call, they will increase their chances. If a student attends a college with a weak pre-health advisor, I'd suggest that they reach out to another college with a history of high acceptance rates to med school. The student may be limited in which college they can attend due to finances/location, but that doesn't mean that they can't reach out to another for friendly advice.

Ideally, every college should have an active pre-health society where students can gain advice from other students ahead in the process. Learn from others' mistakes and get helpful tips on things like volunteerism from those who have already walked the walked. Some societies have a Volunteerism subcommittee that can provide you with a list of campus and regional opportunities. If your college does not have one, find another college that does and reach out to them for friendly advice.

Ideally, every college should have a Community Engagement Office which provides lists of volunteer opportunities

Those are a lot of “shoulds”. Not all colleges do. The colleges filled with rich kids do have prehealth societies, excellent prehealth advising, and well connected volunteer offices. If you can’t afford one of those schools, you’re SOL. More structural barriers for the have nots.

When we review CVs from doctors who went to medical schools abroad like Iran, Syria, India, Korea,etc…they list qualifications like scored #234 out of 70000 on the national medical school entrance exam. Their engagement and service to the community is indistinguishable from US Grads. Sometimes I think we should just go back to a system like that.

 

[deleted87051]

Ultimately that is what that would do. Schools would still take people with physician parents but they would be competing against other similarly incomed individuals. Ultimately it wouldn’t punish them, but would require them to compete harder on more equal footing with their like-incomed peers.

We’ve had more than a handful of physician kids and Rotarian kids volunteer for our medical missions because they are well connected. It would be nice if one of them continued to volunteer after they got into medical school, or even better, after they complete their training. We do have several former patients who are very dedicated, having volunteered for 15-20 years, and that is very heartwarming. It would be equally heartwarming if some college kid who volunteered with us would come back as a plastic surgeon or an ophthalmologist or an anesthesiologist but it hasn’t happened yet and that is kind of disappointing.

 

[Proudfather94]

For a few decades this has been the argument regarding forming "premed majors" or not. There are some schools that have done so as "health science" majors but the idealists in higher ed can't possibly think about developing specific curricula for specific careers. (I'll stop here before I start sounding super ridiculous.)

Many schools have prehealth classes already set for students and have set up arrangements for shadowing or clinical observation with local hospitals or healthcare providers, for a one-credit class.

Basically, I just want to say this already exists at some schools.

My school had something like that but they kept it hush hush for some reason. My advisor never talked about it and none of the premeds did when I went to school there either. When I was applying and working at the uni hospital another employee who was premed brought it up. It would have been an easier way to get shadowing and the help with my application would have probably kept me from having to reapply. Like most things with my school I think it was purposely something they wanted people to find out through the grapevine as a "who you know" thing because the uni never talked about this class.

 

[Radishguy]

My school had something like that but they kept it hush hush for some reason. My advisor never talked about it and none of the premeds did when I went to school there either. When I was applying and working at the uni hospital another employee who was premed brought it up. It would have been an easier way to get shadowing and the help with my application would have probably kept me from having to reapply. Like most things with my school I think it was purposely something they wanted people to find out through the grapevine as a "who you know" thing because the uni never talked about this class.

That’s an area where having a specific health sciences degree would really come in handy for all those people who aren’t in the know because it would be listed in the school’s academic catalog. And then all the aspects of the program would be at everyone’s disposal. My school doesn’t have any specific degree, they have some prehealth adjacent degrees, but nothing specific. They do have a prehealth committee, though, which does at least send out emails about volunteering and employment opportunities in the area. However, I would not have known about the prehealth committee other than when I looked into med school applications, I saw that some schools accept a committee letter, so called my school and asked if they had one. My degree at the time was biomedical engineering, you’d think that I would be on some sort of a mailing list that let you know about these things, but no. The majority of the student who email me or come to my office don’t know about it either, and they are generally biology or neuroscience majors.

So again, it becomes an equity issue. The students who have parents who went through the process are given yet another huge advantage. People can say that there is this policy and that policy that dampens that advantage during the application process, but it does nothing for all the students who never make it to the application because they weren’t given the advantages of all those student who knew the right people.

 

[doomer_md]

My hot take: there should me a more emphasis on volunteering for lower income applicants. Being low SES doesn’t make a person automatically more altruistic, in fact I would argue the opposite. They are more likely to feel wronged by society, and have a “screw you, I got mine” mentality and be more financially motivated than people who were born into money.