Friday, March 26, 2010

Subject: How to pursue pre-med studies

NOTE: This is a very long question, and subsequently a long answer. I decided not to edit down the question, as all of the parts seem to be equally important to the questioner.

I have a B. Mus. in classical music performance from Oberlin. When I was wrapping up my degree, my desire to learn more about the human body trumped all my plans -- grad school, a performance career. For the past three years I have been employed in healthcare, first in a nursing home as a caregiver, and then as an EKG tech at my local hospital. I needed to spend this time working in the field to confirm my desire to become a physician and to develop accurate perceptions about healthcare.
My son is only eighteen months old, but I feel like I can't put off post-bac studies any longer. It makes me miserable to continue to put my education on hold, and it's becoming increasingly difficult to be enthusiastic about a job where I'm completely underutilized. I just accepted a new job working overnights in the ICU so that I can take classes during the day. My husband is a nurse and we work opposite schedules.
Meanwhile, I have been accepted to several programs as a transfer student to obtain a second bachelor's degree (in biology) and two post-baccalaureate pre-medical programs. Although I would love to attend one of the post-bac programs, they are all through private institutions and I'm just not sure if we can afford it or even secure adequate loans. Some of the B.S. programs are through state schools, and very, very affordable ($3000/year after grants), but not many of my credits from Oberlin will transfer and it would probably take 3-4 years to complete the degree.
Should I just take courses a la carte? It seems like a more direct route in some ways. I could afford to do this at a state school, but I hate that I wouldn't have an advisor, that I wouldn't have the opportunity to be involved with research, that it would be difficult to get to know my professors and that it would be hard to build the rapport that I would later need for recommendations. Some of the physicians I work with are willing to write recommendations, but I feel like I will still need someone to comment on my academic ability.
Should I try to complete a masters program instead? Could I tack on pre-med courses while completing an MPH? Are there other graduate programs that I should consider? I didn't apply to any graduate programs, but in retrospect, I sort of wish I had.
Did any of you work full-time overnights while being a full-time student? How did you do it? Did you ever sleep? If so, when? Were you scary or silly? I'm feeling desperate and crazed and I would be so grateful for some outside perspectives. -E.G.
(E.G. is a 24 year-old EKG technician living in Upstate NY.)

I’ll attempt to answer this as best I can, E.G. It sounds as though you’re already quite accomplished, and I understand your frustrations with feeling as though your life is “on hold” – but there are many things that you may not be aware of as you look toward your goal of becoming a physician. First, there’s no rule that says you need to have majored in the sciences to become a doctor, so looking at obtaining a second bachelor’s degree in biology may be overkill. What you do need to look at are the classes that you’ll need to succeed at the MCAT, as well as the pre-requisites for medical school. As such, the “a la carte” approach might be the most reasonable path to pursue. I wouldn’t be afraid of not being a full-time student in that scenario, and I wouldn’t worry about not having an advisor – I think that most professors would be willing to work with someone in your position in such a capacity. Even though you wouldn’t be a full-time student, you’ll still get to know your professors. In fact, you’ll likely have the same professor for several of your courses, and they’ll be able to easily comment on your academic abilities when needed. And why are you even considering an MPH? Is it something you think you’ll ultimately use? If not, at this stage of the game, it’s likely to be more of a burden than a benefit.

Now, let’s consider how realistic it will be to work full-time nights and attempt to be a student during the day. Something’s going to give, and it’s likely to be your sanity. For most of us, balancing a full-time job and a family is a stretch; adding a full load of college classes seems to be a recipe for disaster. Sleep deprivation will impair your memory, impact your grades, and potentially injure some of your relationships. To address the specific question you asked, most of us become very scary when we’re chronically sleep deprived.

I haven’t even begun to discuss the economic impact that this will have on you and your family. There’s no getting around it - medical school is expensive. It will be very difficult to work through your first few years due to the course load, so to be practical, you’ll want to have as little debt as possible prior to entering med school.

Lastly, your son is only eighteen months old. While it seems like he’ll be tiny forever, wait another three seconds and see how old he’s suddenly become. Don’t miss out on your time with him in your desire to finish your schooling. What about other children? Two kids are exponentially more difficult than one, especially if you’re working – let alone going to school.

Ultimately, although it seems that you must complete everything now, in reality you’ve got lots of time. You’re way off the path of being a traditional student at this point, so revel in your non-traditional status. Enjoy your job – use it to hone your bedside manner with the patients you see on a daily basis. Share your ambitions with the physicians you work with – you may find that they go out of their way to share some interesting findings with you. Do the best you can in the classes you take, even if it’s only one per term – professors are much more likely to write letters for students who have genuinely enjoyed and subsequently succeeded in their classes. And realize that there’s no reason to be desperate and crazed now – save those emotions for later (like when you’re post-call, your husband is out of town and your son won’t stop barfing….).

I hope this helps –


  1. I second everything that Artemis said.

    When I did my post-bac, I was working full time at a University, which enabled me to get 50% off the tuition. Some places will give you 100% off the tuition. I also took the classes a la carte, and was able to finish all of them in 2+ years by taking some over the summer. State school is a completely reasonable alternative as well.

    Second, Artemis is right. 24 is NOT OLD. I know it seems like you've figured out what you want, and could go to med school RIGHT NOW, but if you take an extra year or two to do the pre-reqs in a way that preserves your sanity and allows you to get all As, you will be better off.

    Third, Oberlin is an outstanding institution, and I am sure they have a pre-med advisor who can help with these things. You just need to figure out who to call. Most of them will work with you from a distance. That being said, my advisor wasn't terribly helpful, so you may just need them for when you actually apply (they will put together a "packet" about you to send to the schools and advocate on your behalf -- you will want to take advantage of that).

    Good luck! It may take a few years, but you will be able to do this if you want it.

  2. I decided after getting a liberal arts college degree to go to med school as well - and spent a little over a year taking "a la carte" pre-med courses at a local university (I did not have a husband and children, so I stacked the courses high - I did have a night job and a day research job, though, both of which I was phasing out of). I hadn't taken science classes since high school, but found out what professors had the best reputation (i.e. toughest) - so that if I did well I could ask them for recommendations to the local medical school. I ended up acing the classes and developing good relationships with the professors - even though I was a "non-traditional" student. This was a much more cost-saving, direct route for my goals.

    And here I am. Wow.

    Good luck! I think Artemis' answer is amazing. And Old MD Girl's advice above.

  3. Hi Artemis,

    Thanks so much for your input.

    I have been reluctant to consider taking courses part-time, mostly because of what I was told from an admissions counselor during a medical school visit. She discouraged me from taking courses part-time, because she said that it would insinuate I couldn't handle a full course load. (This seems a little ridiculous to me, considering how much of a balancing act even that would be).

    Then I realized that there was no way that I could afford to attend most of the institutions that are close to me without applying to a program (and as a result, receiving financial aid).

    Realistically, I think the only affordable way to do this is to attend a state school...and probably to the only way to avoid total exhaustion is to just take the courses that I need to take. I've observed some of these core classes at different institutions, and many of them have 300+ students in them. Having come from a college where my biggest class had maybe 40 students in it, it seems really daunting to get to know faculty in that kind of an environment. I guess that's part of why I feel so needy re: having an advisor, being part of a program, etc.

    As for going back to school right away, yes, I definitely feel a sense of urgency. I don't plan on having more children, and it is often hard to enjoy time with my son because I am so dissatisfied with my life. I don't think I have ever been more unhappy than I am now. I think most people would be unhappy, too, if they had spent the last three years working menial jobs while waiting to continue their education. Even though I would spend more time sleep-deprived and away from home, I think it would be healthier for me and my family to do this now.

  4. ED -- I heard a lot of the same things that your advisor told you about not "being able to handle" the rigors of med school. She is completely wrong. It did not come up during my interviews once.

    Get all As. Take an honors science class (or 2) if you need to prove to yourself that you can handle it. Nail the MCATS. With your prior experiences in health care, you are going to look to admissions committees like you are going into this with your eyes wide open.

    As for approaching your professors for letters, one of the things I have learned through this process is that writing letters is part of the job. Plus, you will be an older student, getting high scores on most of the tests. Believe me. They will know who you are. Approach them after class with a couple of questions from lecture to break the ice. You'll see, it will all be ok.

    Also, if you can get letters from people who really know you (people you work with maybe?) that can be a big help too.

  5. Old MD Girl,

    Smart move taking your classes while working at a college/university! I looked into this when I first moved back to the area. The caveat with my local university is that you have to work there full-time for a year before your qualify for those benefits, and then I think the limit is 1 class/semester.

    In the end, I decided to stay at the hospital. My hospital actually reimburses $1000/year for continuing education (for anyone on staff), and will give a larger scholarship if you sign a loyalty agreement to work there for each year they subsidize your education.

    I did contact the pre-med advisor at Oberlin when I was finishing up my degree. She wasn't particularly helpful. I am pretty sure that she was not a professor and it was a purely administrative position. Is that the norm?

    I think Oberlin also has some kind of pre-medical faculty committee: a group of professors who will write some kind of generic recommendation. Is this who I will need to get in touch with? Will it still be useful when I'm approaching them five years after I graduated? I'm a little confused about this recommendation stuff. Should I try to get this recommendation from Oberlin or the school where I would be finishing all my coursework, or both?

  6. EG - I agree with old MDGirl's comments regarding the part-time vs full-time load; I think that anyone who knows you even a little will be able to recognize everything you're doing, and will not dismiss your part-time course work while employed in a full-time position.

    It sounds like you've been running up against some advisors who aren't familiar with non-traditional students. I'd look into the counseling department at the state university where you'll be taking classes - they'll likely be able to help from this point on. You might want to start with the admissions department - ask about which professors have the reputation of mentoring pre-med students, and then contact one (or more) of those to set up a meeting to describe your situation. I have a feeling that you'll find someone to give you the direction you need during this time. I don't think the pre-med group at Oberlin will be of any benefit to you so many years after graduation - most of them probably didn't know you while you were there, and the generic letter you'd receive isn't going to make you stand out in any way. It would be better to contact your music professors for a more personalized letter detailing your work ethic that was exhibited during your time at Oberlin.

    I'm currently in the position of being asked to write many letters of recommendation for the residents and students who rotate through my office; I know what I look for when I've been approached about a letter, and the differences in the letters I generate when I know someone versus when I can barely recall who she was.

    Feel free to send me an email if you have further questions about this: thoughts_of_artemis AT yahoo dot com


  7. Are you set on being a doc? PAs and NPs have meaningful impacts on people and the training is significantly shorter. Moreover, some nurses are actually making better salaries than MDs with significantly fewer years of training (CRNAs make more than prime care docs).

    If you are really that unhappy in your current jobs and are certain you want to be a doctor and not a NP or PA, then I'd consider taking out loans and enrolling in the post-bac program.

    You need to pull strait A's either way and rock the MCAT and having a year dedicated to classes, MCAT and application may be easier than piecing things together over the next few years. Depending on your situation, you make actually rack up more debt working lowpaying jobs and taking expensive classes over a few years than just biting the bullet and getting started with training.

    On the other hand, I might not take a post-bac program unless you know you could rock it because taking on that much debt and not being able to repay it could be an issue...many, many people don't get into med school or take years trying.

    Sorry this is so jumbled, post call and tired.

  8. EG -- As someone who took 7 years off, I didn't find the advice I received from the pre-med advisors terribly helpful. They were the administrator types that you describe. That's pretty much the norm.


    There is that group letter you mentioned. That was the big thing they did for me. I think your state school will be helpful, but as an Oberlin alum, you should be able to avail yourself of their letter as well. I'd look into both options, at any rate, (state school and Oberlin) for your pre-med advising. It definitely couldn't hurt.

    Remember, as a music major who took time off and worked in alternative health care career, you should really stand out (in a good way) to med schools. Just make sure you do as well as you can in your courses and MCAT.

    I can't really opine vis a vis what the smartest move is financially since I am an MD-PhD and am funded. I do know that med school will take every dime you have for tuition. All those savings you have built for your family will end up being subtracted from whatever financial aid package you get. At least that is what it seemed like to me when I was considering the MD-only programs. Keep that in the back of your mind.

  9. I had a similar debate about a la carte versus formal program. I am taking my classes at a state school and having a great experience. While there are a lot of people in my classes, not a ton of them are in office hours every week - so I am having no trouble getting to know my professors. I even have a part-time job doing research in a lab and I turned down a position in another research group offered by my biology prof. I am full-time, but a friend is doing something similar part time and has had the same opportunities (research and an advisor.)

    Not all state schools are the same. One way to get an indication of whether the support will be there for you ... call up the pre-health advising office and see if they will speak to you as a non-student. My school did, and so did the University of Utah when I considered moving there. (There's something to be said for the West. Lower populations and somewhat healthier state budgets.)

    Not to sound so sage since I'm only four years your senior ... but two other morsels of advice. Have some faith in yourself. I would say $30,000 is too much to pay for less bureaucracy. Find a reasonable, less expensive route and if you sometimes have to bug an administrator to get into the classes you need, or make some other kind of end runs, you will be more than up to the challenge.

    One final word of caution. I understand the frustration of dead end jobs - I've been there. But a job alone will not make you "happy." Nor am I convinced you are miserable now simply because you are not yet on this path. So be sure to admit to yourself everything that is motivating you and acknowledge those things that won't be satisfied by getting onto this path, alone. I went through that process ... I'm still going through it on the basis of other's advice - and it's been worthwhile. And best of luck.

  10. EG - Go ahead and go to the state school and take classes al la carte. Most schools will have a pre-med advisor, or even a pre-health committee. Find out who that is and utilize them.

    I know a class of 400 students seems large but you can get to know professors. Sit in the front, ask questions, and visit their office hours as much as you can, even if you don't have questions, and discuss the materials in the course you find interesting.

    As for working, I know you want the financial benefit for your family. But full time at nights might be a bit much. I am currently a pre-med student and have an 8 month old daughter. I'm taking 12 credits, the minimum to be considered full-time, and I work two part-time jobs. Sort of. The one job I work from home, whenever I want as long as I get the job done by the deadline. The second is being a TA, so it's more like studying than working.

    I'm home by 3 almost every day, and can spend some time with my daughter, and then I'll study or work during naps or after her bedtime. This has been a good balance for me, but barely, I do lose a lot of sleep. So from my perspective I think you could continue to work, but only full-time.

    If your worried about the financial impact not working will have on your family look into your state school, most universities will have scholarships available for non-traditional or re-entry students.

  11. i left classical music and did a post-bacc program at Columbia. it was expensive and I took out loans to pay for it. Loans are available for this sort of education and its not the worst idea to consider them especially if it will improve your sanity. However, my caution to the loan question is that you should take them out with eyes wide open. If it is your heart's desire to be a primary care physician in an academic practice, the loans from post-bac and from medical school will make such a dream unreasonable (this goes to my soap box about how you can only fix the primary care crunch if you make it affordable for doctors to consider it - a.k.a they cannot graduate with 200,000+ dollars and afford to be in the lower paying specialties, but I digress).

    While the structure of a post-bacc program was good for me as I had not had *any* previous work in health care and needed to be around people making a similar life change, I know plenty of people who went the "a la carte" route and did just fine. A resident in my class was in that situation.

    Finally, I agree with the comments that you need to find a way to enjoy the journey. I left music because I wasn't enjoying the journey. I wasn't going to be happy or feel successful unless I had a career like Yo-yo Ma or Joshua bell. I have LOVED the journey of medicine. Its too long a road to feel like "i'll be happy when...".

  12. A couple extra notes.

    My pre-med advisor was a chemical engineer w/ almost no concept of what medical school involves, so I don't think having a pre-med advisor is all that.

    2. I agree w/ the idea of loans. But my husband managed to get a ton of smaller scholarships. We went to a state school and he went w/ the idea that no scholarship was too small. He managed to get thru 4yrs of med school w/ less than 40K in debt due to all the scholarship he applied for and managed to get.

    3. If you are willing to live in a smaller town in your state of choice, some hospitals have programs in which they will help offset the cost of med school as well as a stipend if you are willing to return to the town and work there for some amt of time. There is also the National Health Service Corp which also offsets the costs of med school in exchange for working in areas of need (which can be urban or rural).

    4. Definitely strongly consider state schools (unless you're planning on going into a high-research competitive field). I went to a state school b/c of the costs and once I got into residency, felt there was no difference in my education vs. my colleagues except for the name on our diploma (which meant very little post-residency).

    5. Good luck!!


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