There are two types of "medical doctors."
The practice of medicine is devoted to the diagnosis and treatment of disease and trauma. Entry into medical practice may be gained: (1) through admission to an allopathic medical school from which the graduate earns an M.D. degree or (2) through admission to an osteopathic medical school from which the graduate earns the D.O. degree. Although there are differences in education and practice emphases, both types of physicians are licensed health care professionals in all 50 states. Allopathic physicians are recognized by most foreign countries, whereas osteopathic physicians continue to gain recognition outside of the United States. Either one of these two routes to become a physician requires a minimum total of about 11 years of formal undergraduate, medical school, post graduate (residency) education and training. Physicians represent two types of "doctor" that possess the M.D. or D.O. degree. Differences among these and various kinds of doctors should be understood by the student planning a career in the health professions.
Because of population demographics, an increasing shortage of physicians will develop over the next decade and beyond. According to the AACOM, osteopathic medical schools graduated a little over 3000 physicians in 2005 and will continue to expand that number to about 5000 by 2015. This will be done by increasing class sizes and adding new osteopathic medical schools. Osteopathic physicians represent 6% of the physician workforce in the U.S., but graduate 10% of the total physicians. Three new osteopathic schools will receive provisional accreditation in 2006 and several more are planned for 2007 and 2008. According to the AAMC, allopathic medical schools are seeking to increase the number of graduates by 30% by 2015. Allopathic physicians represent 94% of the physician pool. This will be done mainly by increasing class sizes and possibly adding several medical schools or branch campuses.
Did you know? The average U.S. applicant to an allopathic medical school applies to 11-12 schools, whereas the average U.S. applicant to an osteopathic medical school submits applications to 6 schools.
Considering a career in medicine and the medical school admission process require serious analysis, research, and planning.
The decision to be a premedical student is one that is much more serious than deciding which movie you are going to watch tonight. One must first make the decision to explore the profession by learning and observing as much as possible about the day-to-day activities of practicing physicians. Ask several of these medical practitioners about the positive and negative aspects of their work. Gather all knowledge about the profession from hard copy sources and reliable sites on the Web. During this process, often taking many months, one's consideration of medicine as a career will strengthen or wane. Comparisons of your personal needs with what a career has to offer must be made in an honest and intelligent way. Get help and advice from others, but no one other than yourself can make your decision as to what is best for you -- do not expect anyone to tell you what you should do. This will be your life, not theirs. This process of career selection must be self-initiated and an "on going" activity with each aspect of a career consideration being evaluated as positive, neutral, or negative. Somewhere in the process you will know if your chosen career is for you. You will need to reach this stage at some point early in the application phase.
Once a career goal starts to become solidified, the process of learning how to achieve that goal must be researched. The student must construct a working "timeline" of steps and events that will be occurring in the future. This knowledge of the application process is as important as your knowledge of the profession itself. Whereas medical practitioners are experts in the profession, your premedical advisor is the expert in helping you prepare for the admission process. The overall pathway to a career in medicine is a sequence of educational experiences requiring personal decisions and evaluations of performance by others before proceeding to the next step in the process. With medicine and many other career choices, it is a hard fact that your goal to become a physician may not be reached because of your own shortcomings or because of the decisions of others who evaluate your performance at each step of the process. To practice medicine you must be admitted to medical school by an medical school admission's committee. Premedical advisors cannot predict that you will never get into medical school, but they certainly can lay out probabilities of how an admission's committee will act on your application based on their experiences.
Medicine requires a lengthy and rigorous educational path in which the student must demonstrate a high level of performance to have a chance to continue with the next step. Because of this requirement, estimates indicate that the number of freshmen premedical students at all colleges and universities dwindles to less than a quarter of the original number by the end of the junior year. The remaining number is usually increased somewhat by students who "discover" medicine as a career early in their college years. In most cases, the college experience opens up new career possibilities for premeds that they have not thought about before. Others who still have medicine as a career goal may realize that they do not have the dedication, abilities, resources, and qualities to be a competitive applicant or a successful practitioner.
As an initial step in exploring medicine and the process required to achieve this career goal, invest in the most recent preparation guide, "Medical School Admission Requirements: United States and Canada, 2005-2006". New editions come out usually in May of each year. This is known as the "AAMC MSAR Guide". The current cost is about $25, plus $7 shipping, and can be ordered from the Association of American Medical Colleges (AAMC) web site. Older copies may be borrowed from your premed advisor, but it is a good investment to have your own copy. Yearly updates are available in late spring to college juniors for the year of admission for which juniors will be applying. Because changes in admission policies do occur from year to year, college juniors should purchase their own most recent copy as they begin the application process in the spring of their junior year.
In constructing your "career timeline", it is suggested that you refer to the "Timeline for Application/Admission" that is printed on the inside front pages of the MSAR Guide. Timeline activities for being a premedical students specifically at Missouri State University are also found in the List of Premedical Advisement Sheets on the website of the Biomedical Sciences Department.
Admission to medical school is competitive.
Admission to medical schools for the MD or DO remains highly competitive with more students applying than can be admitted. Competitive admission requirements and the long period of educational preparation that are required to become a physician demand that students not only meet the minimum requirements, but present themselves as competitive applicants. Do not fall into the "trap of the minimums". Virtually, no one with the minimum posted requirements gets into medical school. A decision to apply to medical school requires a strong personal commitment to the ideals of professionalism and a large investment of effort, time, and financial resources. Admission becomes possible only when a student possesses high intellectual abilities and demonstrates a consistent record of academic excellence. Allopathic and osteopathic schools have different preferences for certain important personal qualities and experiences in considerations for admission. Students who have not demonstrated these qualities or experiences are usually not accepted regardless of top academic records. Individual schools may also differ in cost, curricular approaches, attribute preferences, and educational mission. Accepting only the top applicants from a field of otherwise qualified students ensures greater integrity and prestige for the profession as a whole. Medical schools recognize the differences in the opportunities that some groups of applicants may have had. All medical schools actively encourage applications from qualified minority students from under-represented populations (URMs) in American society and in medical practice.
Competence and qualities important in medical school admission.
Personal qualities sought by medical schools in applicants are within a minimum of five domains of personal characteristics. These include altruism, compassion, communication skills (including attention to non-verbal and other paralinguistic cues), empathy, and integrity. By selecting applicants who have demonstrated these qualities, medical professional, educational, and licensing groups hope to improve the expectations of students, residents, and practicing physicians in regard to the status of the social contracts between society and the medical profession. Students demonstrate these qualities by presenting a record of meaningful community service and leadership. When performing community service, some pre-meds make the mistake of accumulating hours and experiences. More importantly, the student should introspectively evaluate each experience as to how it has promoted the development of their own personal qualities and an understanding of self. Experiences in these activities must demonstrate that the applicant is service- and people-oriented and that the student is in the process of developing an understanding of the sensitivities of the doctor/patient relationship.
Medical- and hospital-related experiences also must demonstrate that the student has the knowledge and experience to make an informed decision of becoming a physician. Other factors taken into consideration include "evaluative type" letters of recommendation, personality, motivation, interview impressions, and difficulty of undergraduate course work. Generally, these qualities are accessed after the student has passed through an initial screening that considers the overall, science, and non-science grade point averages (GPAs) and the Medical College Admission Test (MCAT) scores.
The MCAT is developed by the Association of Medical Colleges (AAMC) in cooperation with its member medical schools. After summer 2006 the MCAT will no longer be available in the paper and pencil formal. In the transition to the computer-based MCAT it is important to register for a particular site as early as possible. It is recommended that students take the test about 13-15 months before they intend to enter medical school. This is generally in the second semester of the student's junior year or early summer between the junior year and senior year. The test takes about a half day to complete. For suggested MCAT preparation materials, see Heading XVI on the suggested reading list for premedical students and Suggestions for Preparing for the MCAT.
The minimum prerequisite science coursework taken at community colleges or advanced placement credits may not be acceptable to many medical schools. Most medical schools place a heavy emphasis on the student's personal statement. When there is any doubt in an otherwise strong application, the medical school interview may become very important in reaching a final decision about an applicant. Because of this stringent admission process, all premedical students are urged to plan for an alternate career option, commonly called "plan B", while pursuing their undergraduate degree.
Basically, medical school consists of two years of biomedical/medical sciences coursework and two years of clinical rotations (clerkships) before graduation.
Various learning modalities are used to greater or lesser extent at medical schools in the United States. These include: lecture, problem-based learning (PBL), evidence-based medicine, case-based problem solving, computer-guided self-study, self-assessment, clinical correlation, laboratories, small-group discussions, student presentations, and group projects.
The first year of medical school usually includes biomedical science courses stressing human biology, such as biochemistry, cell and molecular biology, human genetics, cell physiology, gross human anatomy, histology (microscopic anatomy), human physiology, and neuroscience. Depending on the school and the modalities of instruction and learning, these experiences may be integrated to various degrees and include analytical and problem-solving components. There is more to know than can be obtained in a four year medical school education. A primary emphasis in physician training is to teach physicians how to find relevant information for proper diagnosis and treatment and how to utilize the best research-based information in decision making.
The second year of medical school usually includes courses in microbiology, immunology, infectious diseases, pharmacology, pathology, and pathophysiology. Again, depending on the school and the modalities of instruction and learning, these experiences may be integrated to various degrees and include analytical and problem solving-components.
Some clinical exposure occurs during the first two years, but the amount differs from school to school. After the second year, the student begins to take the "board" exams. If enrolled in an allopathic school, this will be the United States Medical Licensing Examination (USMLE), Part I. If enrolled in an osteopathic school this will be the Comprehensive Osteopathic Licensure Examination (COMLEX-USA), Level 1. Students in osteopathic schools are also eligible to take the USMLE if they intend to pursue allopathic postgraduate training.
The third year begins mandatory clinical rotations (clerkships) through the primary areas of medicine. Each clerkship experience lasts 8 or 4 weeks depending on the area. Third year clinical rotations at most schools include areas entitled: internal medicine, family medicine, neurology, obstetrics and gynecology, pediatrics, psychiatry, surgery, among others. In most cases, the school will tend to begin to inculcate the school's philosophy and attitudes about patient care during these clerkships.
The fourth year usually continues several mandatory clerkships, required courses, and elective clerkship rotations. Mandatory rotations may include areas such as neurology, advanced surgery, primary care, emergency medicine, among others depending on the school. Before graduation the student must pass the USMLE, Step II, before graduation. If in an osteopathic school the student takes the COMLEX, Part II at the end of the clinical clerkship years prior to graduation.
Students at international, off-shore, or foreign medical schools need to be aware of limited clinical rotation opportunities (clerkships) in various clinical areas at most of these schools. To ensure opportunities for its students, several off-shore medical schools now have formal agreements with U.S. teaching hospitals to provide such clerkship opportunities. Also, it is important to the student to have such clerkship experiences in the United States, especially in their areas of specialty interest, because references from clerkship supervisors are often important in helping secure residency positions in the United States after graduation from these off-shore schools.
Physicians are required to complete a residency as a part of their medical education.
Upon completion of medical school and the award of the M.D. or D.O. degree, physicians are required to complete several years of clinical training in residence in one or more specialty areas of medicine before being licensed to practice. Residency programs are associated with "teaching hospitals" that usually have a close relationship to a medical school. Through agreements with medical schools, residencies may also be found in non-teaching hospitals, such as at Cox Hospital or St. John's Medical Center here in Springfield, Missouri. Most residency programs are selective and have limited openings. Securing some types of residencies are difficult and particular residency sites may be highly competitive. During the senior year, medical school students and residency programs rank their mutual preferences for each other and are matched during 'Match Day' in March of each year.
Shifts in the numbers of residency programs across the United States indicate more opportunities in the so-called Primary Care specialties, most often considered to be Family Practice, General Internal Medicine, General Pediatrics, and Obstetrics/Gynecology. Fewer opportunities are becoming available in the more highly specialized practice areas of medicine, such as the surgery specialties and about 25 others. Primary care is the point at which patients enter the health treatment system. Primary care physicians diagnose and treat over 80% of the problems that present themselves, oversee the activities of any specialists involved in their patient's care, and provide the continuity of patient care.
It is not uncommon for premedical students to become interested in medicine through a particular interest in a physician specialty or subspecialty. Medical school education exposes future physicians to the broad range of medical practice areas that results in a "generalist" graduate. After medical school, post-graduate internships, fellowships and residency programs prepare physicians to become primary care physicians or physician specialists. Just as medical schools are competitive, so are opportunities for acceptance into residency programs. Part of the preparation of a physician in medical schools involves "clerkship rotations" through different physician specialty areas. During rotations, the student learns about the nature of daily work and responsibilities, the length of workdays, the salary, and the length of residency programs for these medical specialties. There are many considerations facing a physician in the fourth year of medical school as to a choice of residency and their selection and acceptance into a residency program. By this time in their medical education, it is most common for physicians to change preferences for a particular specialty held previously. Therefore, as a pre-medical student, it may be considered naive to be adamant about wanting to go into some specialized area of medicine before medical school. Nothing prevents the pre-med from having such personal goals, but most pre-med advisors recommend that the student's stated immediate public goal be one of gaining admission to medical school to become a good physician first, not that of becoming a specific medical specialty practitioner later. Applicants do have an opportunity to state their aspirations on the AMCAS Practice Vision Statement, but most medical schools don't place a strong weight on that AMCAS item and point out that it is too early to make that judgment. Often medical schools will better receive that type of information in the secondary application and interview. Making a decision about the kind and site of residency is usually a major dilemma for most senior students in medical school.
Allopathic residents take step III of the USMLE prior to the end of the internship year and osteopathic residents take Part III of the COMLEX similarly. To become Board Certified in a particular specialty after residency training, physicians take certification examinations from the specialty board that oversees that specialty. Continuing medical education programs (CME) requirements are determined by each state's licensure board.
Academic preparation for the premedical student at Missouri State University.
"Do not expect others to do for you what must be accomplished by you yourself." Colleges and universities don't get students into medical school -- the applicant does that. Advisors don't get students into medical school -- the applicant does that. The burden rests with the student, not with anyone else. The school and advisors can assist, but the student is the one who must accomplish and perform. With a strong curriculum and good advisement, a school's success in preparing students for the health professions rests only on how well the students have done their part in preparation for admission and career success using the educational resources that are available. This is the message premedical advisors would like to convey to students and their parents when they ask about a school's acceptance rates. Student advisees who have, or develop, the attributes to make good physicians and who perform very well academically get into medical school, regardless of where they attended college.
Being a "pre-med" at any college or university represents your "professional intention" and is not the same as your "academic major". Most pre-meds choose academic majors in one of the sciences, but a science major is not a prerequisite to admission into medical school as long as the medical school core requirements have been met. Some pre-meds in non-science areas can often achieve the minimum requirements using a science minor and electives to meet the science requirement. The most important consideration in the choice of an academic major for the pre-med should be a major that the student is interested in and passionate about, not what the student thinks might be the best ticket into medical school. Although only a handful of philosophy majors who have met the minimum science requirements apply to medical school each year, they have the highest percentage of acceptance among applicants! These philosophy majors have a higher percentage of acceptances because they are great students, with great credentials, and have the qualities for becoming great physicians, not because they were philosophy majors!
Premedical advisors are found in most science departments and several of these routinely accept pre-med students from majors outside their departmental affiliation. The Missouri State University Premedical Committee consists of premedical advisors from representative science and non-science departments and are appointed by the President of the University. The Premedical Committee assists students in the more formal aspects of the medical school admission process particularly during the latter part of the junior year and early part of the senior year. Information, schedules, and calendars from the Missouri State University Premedical Committee are posted on the premedical bulletin boards in Temple Hall and the Professional Building. Calendars and notices are found on the Missouri State University Premedical Society web site. Students are encouraged to pick up and complete application packets for a Premedical Committee letter in the spring of their junior year (but no later than the beginning of the fall semester of their senior year). After evaluation, interview, and assessment of an applicant, the committee submits a letter containing the committee evaluation and recommendation that is required or preferred by many medical schools. Applicants who choose not the go though the Premedical Committee, or do not meet the criteria of determining eligibility for a committee interview, may ask individuals including two science faculty to write supporting letters directly to the medical schools to which they are applying. The premedical advisors strongly recommend that students go through the Missouri State University Premedical Committee whenever possible.
Premedical students are also urged to participate in the student organization for premedical students, Missouri State University Premedical Society. Activity and involvement in this student organization helps support your interest in medicine in the eyes of medical school admission committees. This organization provides additional opportunities and programs that premedical students cannot afford to pass up.
There is no better asset to the premedical student than the premedical advisor. Often, but not always, this individual will also serve as your academic advisor. Since there is no ideal premedical applicant, your premedical advisor will guide you through the program of preparation, particularly during the first two to three years of your college experience as a "pre-medical student". The goal of the advisor is to advise and prepare potential medical school applicants to be knowledgeable and prepared for the challenges of competitive selection. Students need to recognize the importance of the help that a pre-med advisor can offer, particularly in preparing for the non-academic selection factors in medical school applications. It remains a hard fact for pre-med advisors across the country that students who are well suited for medicine often make serious errors that shut the door to, or delay, medical school admission. "Horror stories" in which the help and advisement of a student's premedical advisor was not utilized always make for interesting discussions when premedical advisors get together at advisor meetings.
Superior academic achievement and high selectivity of applicants with desired attributes and experiences ensure that medical schools obtain applicants able to complete a rigorous medical school program. Curricular options for several science majors and suggested ways of meeting basic medical school requirements and recommended course work are outlined in the Premedical Student Handbook, Missouri State University. A paper copy of this premedical student guide is available from your premedical advisor.
Choosing an academic major as a premedical student.
It is common for premedical students to confuse a premedical curriculum from an academic major. Physicians come from a variety of academic backgrounds and the premedical curriculum accommodates a variety of academic majors as long as the student also fulfills the admission requirements for the medical schools to which he or she plans to apply. Non-science majors should use their elective courses to complete the medical school admission requirements. At Missouri State University there are a number of science majors and minors that are appropriate for premeds depending on their academic interests. A secondary consideration ought to be how well the selected major prepares you for an alternate career if opportunities in medicine are not available. Premedical students need to be aware of the importance of considering an academic major in an area that is of interest to them. Statistics indicate that an overall majority of premedical students entering as freshmen will choose to pursue a different career option by the time they are seniors. It is important that premedical majors in the sciences elect additional courses in the liberal arts. Academic majors such as "biology", "cell and molecular biology", and "chemistry" attract a large number of premedical students. The vast majority of freshmen premedical students who encounter the difficulty of science courses or who lose interest in medicine still find career options in other health professions or the sciences.
To explore the advantages and opportunities of the premedical major in cell and molecular biology (CMB), please visit this link. The overriding advantage of this major in the Biomedical Sciences Department is that all required coursework and most of the highly recommended elective courses for premeds is built into the cell and molecular biology comprehensive major. Also, check student testimonials from former CMB majors who have completed medical school or are completing their medical education in both allopathic and osteopathic medical schools.
Nontraditional premedical students might want to check out the National Society for Nontraditional Premedical and Medical Students .
Resources and checklists for premedical students.
Need help with various aspects of the application process, such as preparing for interview, writing personal statements, finding lists of recommended books, or sources to prepare for the MCAT? Check out the advisement tips and guides found in the
Are you "on schedule" with the timeline activities expected of applicants to medical school? Premedical students should refer to the appropriate timeline checklist as they proceed through their premedical curriculum.
Premedical Timeline Checklist for Freshmen Students
Premedical Timeline Checklist for Sophomore Students
Premedical Timeline Checklist for Junior Students
Premedical Timeline Checklist for Senior Students
A post-baccalaureate program may be needed for applicants from non-science areas or for those who need to improve their academic credentials.
Postbaccalaureate means "after the bachelor's degree". The phrase "postbac programs" refers to programs geared for the college graduate who wants to apply to medical/vet/dental school. They are offered by undergraduate institutions, graduate schools, and medical schools (Lang, 2001). A significant portion of applications to medical school do come from applicants who already have bachelors or other degrees. Some may have initially chosen other careers and then decided to apply to medical school. If these graduates were not science majors, they must complete the required coursework as a postbac student in a regular college or through the more formal postbaccalaureate premedical programs found at a number of colleges and universities. These programs range from formal one- and two-year programs for full-time students to more informal part-time programs that may not be labeled as postbac programs.
Formal postbac programs differ in emphasis. If you are looking into these programs make sure you know what the purpose of the program is. Some specialize in preparing applicants who are changing careers (i.e. career changer programs). Others emphasize enhancing the prior academic performance of applicants who failed to gain entry (i.e. enhancement programs). Still others are particularly designed for underrepresented minority students (i.e. minority enhancement programs). In addition to the traditional master's degrees in the biomedical sciences, there are several "Special Master's" programs offering MS degrees in the medical sciences. These usually include a combination of medical school courses and graduate science courses offered by medical schools. Advanced standing or transfer credit to medical school is usually not earned (Baffi-Dugan, 2001).
Primary websites for premedical students.
- Information on the 125 allopathic medical schools in the US: http://www.aamc.org/students/start.htm
- American Medical College Application Service (AMCAS) for applications to allopathic medical schools.
- Information on the 19 osteopathic medical schools in the US: http://www.aacom.org
- American Association of Colleges of Osteopathic Medicine Application Services for applications to osteopathic medical schools
For more information
Contact one of the following Premedical Advisors:
Dr. Colette Witkowski* (417) 836-8961, Prof. Bldg, Room 404
Dr. Scott Zimmerman* (417) 836-6123, Prof. Bldg, Room 338
Dr. Richard Garrad* (417) 836-5372, Prof. Bldg, Room 345
* indicates current member of the Premedical Committee
Department of Biomedical Sciences
Missouri State University
Springfield, Missouri 65897